85 Medical student engagement in small-group active learning Table 4.1. Coding template for analysis (continued) Components of engagement Explanation Illustrative quote Other school activities Everything to do with (potentially conflicting) other school activities, e.g., other classes, exams “I didn’t have a lot of energy, because we just had a break for a couple of hours after an exam. And I studied hard in the morning, and afterwards didn’t really feel like doing anything. And that also didn’t make me have a lot of energy for a brainstorm.” Prior knowledge Everything to do with the prior knowledge and experiences of students “Well, I notice that, for example with the topic of antibiotics, we just had a lecture about that, and I knew a lot about it. And then I want to engage more because I am like ‘okay, I know something about it’.” Tutor Everything to do with the tutor, e.g., their behavior, their content expertise “Having or not having a tutor with a medical background has a big influence on discussions. Because last period we had a tutor with a research background and the topic was medical research, and he had a lot of input, and you are discussing longer, and more focus is being put on the process towards the answer. And that is why last period, those study group meetings were so unbelievably good.” We reached theoretical sufficiency after including two study groups and conducting fifteen interviews: data from the last interviews did not require modifications of the identified categories (46,47). Furthermore, all authors agreed the sample was adequate and appropriate, and the data were rich enough to answer the research questions (46). Ethical aspects The Ethical Review Board of the Netherlands Association for Medical Education approved the study (dossier number 2019.2.7). 4
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