89 Medical student engagement in small-group active learning Students reported that interventions from all three dimensions of engagement would help. Tutors could stimulate them through their behavior (e.g., remind them of the rules or read a case out loud), their cognitions (e.g., ask them a question), or their emotions (e.g., have them reflect on their personal stance towards a patient). However, students reported that, in their eyes, tutors sometimes had difficulty distinguishing engagement from disengagement. Student behavior, looking outwardly the same for tutors, could have different intentions. One student gave an example of this difficulty, when his behavior of grabbing and using his smartphone was misinterpreted by the tutor: Student: I am only on my phone when I am looking up something. But I have heard from [tutor] that I grab my phone too often. But sometimes they [peers] say something during the meeting and I just want to look it up. Because they look like they are searching on their laptop, but they are just sending messages through WhatsApp, while I am looking up what we are talking about […]. Interviewer: So what you’re saying is that a tutor cannot distinguish between reasons why you grab your phone? Student: Yes, exactly. (Student 4) Therefore, although behavior is observable, it can be difficult for tutors to accurately assess the intention behind the behavior. That makes it difficult to assess if the behavior fits engagement or disengagement, and if an intervention is required. For the student above, the intervention of the tutor (give feedback on phone use) actually led to emotional disengagement within the student (negative emotions, being misunderstood), cognitive disengagement (reducing his intentions and effort for learning from the meetings), and behavioral disengagement (not looking up information anymore). The same difficulty of accurately assessing intention was observed for cognitive engagement: Interviewer: At a certain point I heard the tutor asking if you wanted a break. Student: Yes. Sometimes we have a small break in between, especially after a very long assignment. Then everybody agrees to take a break. But usually everybody is like “let’s get this done as quick as possible.” So we don’t really take breaks. Interviewer: So at a certain moment some sort of exhaustion arises, and you need a break. Even if you want to give your best and engage, you cannot do so for two hours non-stop? Student: True. But the thing is, a group meeting officially lasts two hours, but we don’t actually need two hours. And we have a couple of people in our group who are like “okay let’s rush through this” […] And the idea is that ‘if we are done early, we can leave early’. (Student 6) This quote shows that students keep working on the assignments, not for the sake of learning, but for the sake of ending class early. While it might appear students are cognitively engaged, they actually are disengaged. Students’ intentions here are again important. 4
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