93 Medical student engagement in small-group active learning Future research Tutors might want to learn how to best initiate a spiral of engagement. Within engagement it is possible to identify qualitative differences (37). Emotional engagement, for example, can range from simple liking to deeply valuing a topic. Cognitive engagement likewise can range from simply remembering to creating new knowledge. It is likely that higher qualities within each dimension have a better chance of initiating a spiral. Secondly, students have suggested that teachers play an important role in stimulating, maintaining, and regulating engagement. However, students also reported responding well to prompts from peers. If peer prompts have a greater chance of initiating a positive spiral, this could influence how teachers design their small-group learning activities. A study in which students are asked about their responsibilities regarding their engagement might include questions about the design of learning activities. CONCLUSION This study illuminates the dynamic process of student engagement and explains the difficulty of recognizing and influencing this process in practice. Teachers can use the insights and suggestions gained from this study to optimize the engagement in their classrooms. With higher engagement, small-group active learning will be a more pleasurable and instructive form of education for both teachers and students. Acknowledgments We thank our colleagues of the Research in Education Team, Stéphanie van den Burgt and Bart van Elswijk, for their help with the data collection. 4
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