8 Chapter 1 Medical education is increasingly making use of active learning, recognizing its potential to enhance student learning (1–3). However, its implementation can be optimized. Faculty and students continue to struggle with integrating active learning into their teaching and learning practices, resulting in reduced effectiveness (4–6). Student engagement has been identified as a major contributor to active learning effectiveness, yet it has also been described as a complex process that can be difficult to influence (1,7,8). The aim of this thesis is to contribute to the implementation of active learning by advancing understanding of the student engagement process and the role that teachers can play in optimizing it. To illustrate the potential and process of student engagement in active learning, I have titled this thesis ‘from small spark to great fire’. It refers to the saying (from unknown origins and phrased in various ways): ‘Education is not the filling of a bucket, but the lighting of a fire’. This saying captures how I approach my work. I strive to inspire and motivate the teachers and students I work with to develop their competencies: to light their fire. The title also holds promise. That great fires follow from small sparks, or in other words, optimal student engagement in the active learning process. Through the research conducted in this thesis, we will see whether that promise holds. Lastly, the saying is consistent with a constructivist view of learning, which I will elaborate on later in this introductory chapter. To outline the following parts of this general introduction, I will first describe how this PhD started. Then, I will introduce the research topic and describe its implementation in medical education, followed by a description of this thesis’s overarching aim and central research question. Next, I will contextualize the research and describe the methodological approach applied in the investigation of the topic. After that, I will provide some reflective thoughts about our approach. To conclude the chapter, I will provide an overview of the subsequent chapters. Starting this PhD After completing my studies in 2010, I began my career as a small-group teacher at a medical school. My role was to support medical students in developing their non-technical skills, such as communication, collaboration, and professionalism. All classes I taught incorporated at least some elements of active learning. I was both fascinated and frustrated by the differences I experienced between student groups. While some groups engaged easily with the content and with each other, others remained disengaged despite my best efforts. This discrepancy was particularly puzzling to me, as many factors were constant across those groups: they had the same teacher (me), employing the same teaching methods, in the same course, in groups with comparable student demographics and of equal sizes. This made me curious: what was causing these differences? Moving ahead to the year 2018. I had taken the next step in my career by joining the Vrije Universiteit Amsterdam as a faculty developer. Here, I fully embraced the concept of active learning as an essential teaching and learning strategy in any study program. During
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