69 Changes in student appreciation of small-group active learning over the course of three years. Strategies aimed to supporting student development would therefore benefit from a program level approach in which faculty collaboratively designs and implements interventions. Strengths and limitations The main strength of our study lies in its design. By inviting students to repeat the study procedure three years after their original contribution, we could examine in-depth how and why student appreciation for small-group active learning changed over time. Although repeated Q-studies have been published, by far most are cross-sectional in design (40,43). The absence of a protocol or accepted guidelines to follow was a challenge, but it offered us the chance to develop an analytical approach. Moreover, as Q-methodology is a way to do person-centered analysis (instead of variable-centered), being able to study students over time, allows for the design of tailor-made educational interventions for students at different stages of their study program (39). Q-methodology can also help decrease the research-practice gap in education by making research findings more recognizable and actionable (39,46,47). The current manuscript, along with the previously published paper with first-year students, provides an example of how research findings can be described in a recognizable way and used to improve educational practice. There are limitations to the study. First, twenty of the original 52 students (38.5%) participated in this follow-up study. Although Q-studies have been published with fewer participants, this number is rather low. Q-methodology does not rely on large numbers, but enough participants need to be recruited to establish the existence of viewpoints (38). Therefore, strategic approaches to recruitment are advocated in order to ensure a heterogeneous sample with diverse viewpoints. In this study, the twenty participants represented all four original factors and were varied in demographic characteristics (like age and gender), demonstrating its heterogeneity. However, it remains uncertain if additional participants would have influenced the findings. Second, related to the number of participants, all Q-methodological studies are limited in their generalizability (38). This is also true for this follow-up study. Although our attrition rate (61%) is not higher than in other studies with a longitudinal design (48), we are cautious in drawing generalized conclusions, or writing implications for all medical or higher education studies. However, because of our extensive description of the local context and the grounding of our study in the educational concepts of active learning, approaches to learning, and epistemic beliefs, we believe our findings transfer to other (comparable) contexts (49). Third, we chose an online approach in this follow-up study because of the COVID-19 pandemic, compared to a face-to-face approach in the original study. Online Q-studies have been performed pre-COVID-19 and are described as cost-effective, allowing wider recruitment, and convenient for both researchers and participants (41). However, there are 3
RkJQdWJsaXNoZXIy MTk4NDMw