What is small group teaching?
Small
group teaching is defined by group size, usually
6 to 10 participants,
and a focus on active learning
and communication between
members of the group.22 These sessions can occur in a conference room, an administrative or clinical office,
or even at the bedside of a patient. You will need to assure
that the room is large enough for everyone to be able to sit and make
eye contact. Tutorials, seminars, and attending
rounds are the traditional modes of small group instruction in the clerkships. Small
groups can be effective in accomplishing many tasks:
ƒ Introduction of new material/concepts (basic science and/or clinical)
ƒ Review of material
ƒ Application
of material
ƒ Journal club discussion of article(s)
ƒ Case-based formats
for review, introduction, integration, or application of material
ƒ Patient-centered discussions (e.g., bedside
teaching; ambulatory teaching)
ƒ Team projects
As Steinert
has written, “small group teaching offers students an opportunity to discuss
and refine their understanding of
complex issues, to problem solve and apply their knowledge to new situations, and to reflect on their attitudes
and feelings.”23 This method also provides an opportunity for integration of domains such as professionalism, humanism, communication skills, and self-directed learning into the formal
curriculum of the clinical years. Finally, small group teaching
allows for much closer contact with faculty than the traditional lecture
approach.
Categories of small group teaching
The main categories of small
group teaching methods that will be presented in this section are focused discussion, problem-based learning, student-led seminars, and
role-play.22
Focused Discussions
In
focused discussions, a faculty member will present a case or a problem and then lead a discussion
with the rest of the group. Cases should be relevant to the learners, address defined
learning objectives, and
contain teaching points that can be applied
to other situations.24 Cases can be prepared in advance by the faculty member to “capture real
life situations in which a professional (representing the students who are training to adopt similar
professions) confronts a dilemma
common to the discipline.”
25 Cases
can also be prepared by students,
based on a memorable or relevant clerkship
experience. The discussion is usually
led by the faculty member,
but can be assigned to the student. One can also consider using video clips, handouts, or study guides to stimulate
discussion, reflection, and learning
in the small group setting.23
Strengths and Weaknesses:
The strengths
of focused discussions are that they are
case-based, relate to potential
clinical experiences, and encourage the learner to actively apply knowledge.
Additionally, the team approach to solving the case helps develop communications skill for use on the ward and other clinical settings.
The limitations of focused discussions
are that prepared cases may not be directly relevant to the learners’ own
experiences on the clerkship.
Problem-Based Learning (PBL)
This technique is similar to
the focused, case-based discussions, but encourages
increased learner independence. PBL traditionally has been used for teaching
in the first 2 years of medical school,
but can also be an effective teaching
strategy in the clerkship years. As part of a small group (ideally 4-6 members), students
are first presented with a clinical
problem that unfolds over 2 to 3
sessions with progressive disclosure of historical information, physical exam, laboratory data, etc. Students
define the facts, develop hypotheses based on these facts, and then develop their own learning objectives and plan for solving the clinical problem.
At the beginning of each
session, students self assign their roles in the session, as Leader (moderator), Reader, Scribe, or Participant. These roles will rotate with subsequent sessions,
ensuring maximum active participation from all members
in the group. Learning objectives are researched between sessions by students
and presented back to the group for discussion. This type of small group
fosters self-directed learning
and teamwork among participants. The faculty
member’s role in PBL is
to facilitate this process, rather than to direct and lead it. For more
information about problem-based learning, the brief
overview by Wood should help.26
Strengths and Weaknesses:
Because PBL is cased-based, students are more focused on the clinical usefulness of the information they look up and
report to the group. Students
also learn to work more independently, and there is a greater
focus on self-directed learning. Teamwork is encouraged. PBL takes more in-class time than other methods. Faculty
have less control over the
learning environment than in focused
discussions because they function as facilitators of the process and not discussion leaders.
Student-led Seminars
In these seminars,
the student is charged with presenting a topic to the rest of the group.
The nature of the topics is usually
negotiated within the small group. A topic may be chosen to complement a
previous discussion or clinical experience, or a new topic may be presented.
The presentation is usually followed by a focused
discussion. Expectations for length of presentation, use of handouts,
or audio-visual material
should be clearly stated in advance.
Strengths and Weaknesses:
A major benefit of student-led seminars
is that the topic discussed is
relevant to the learning needs of the small group and is taught at the level of the learners. This strategy
also provides an opportunity for students to teach
each other. One weakness of this
teaching method is that student–led seminars rely on the student
teacher’s knowledge
of the topic and
application of effective teaching methodology. Thus, discussions may not
be well presented or facilitated, and there is a danger that the clinical
relevance and applicability will not be clear.
Role-Play
Role-play is an excellent technique for building clinical skills in the safety of the small group setting. It is particularly effective
for practicing communication skills.
Role-plays can be based on previously scripted written scenarios
or on a real case that may have
been presented to the group. Clear instructions must to be given regarding the nature of the roles, timing, and specific objectives. The role-play may be enacted in groups of
two, with one student
playing the “physician” and another playing
the “patient.” Role- play can also take place in groups of three, with an observer added to the group. The observer should be given a checklist to facilitate observation
and feedback. The role- play should always be followed by a debriefing and an opportunity for self-assessment
and feedback.
The student in the role-play, the physician, should first be given the opportunity to self-assess by being asked “what went well” and “what would you have liked to have done differently?” Opportunities for a “re-play” may be given if desired. Ideally, students
should switch roles so that each one has the opportunity to
practice each role. An alternative is to have a role-play demonstration, also
known as a fish bowl, with the rest of
the group observing and participating in the feedback
session.
Strengths and Weaknesses:
The role-play method
allows learners to practice clinical
skills, particularly communication skills,
in a safe environment without the expense of paying for a Standardized Patient.
The faculty member can
directly observe the skills of multiple
students during a single session.
By playing the role of the patient,
the student can get a better understanding of the patient’s
point of view. The biggest limitation
of role-play is the almost universal hesitance of students (and sometimes faculty) to role-play.
Brief Description
|
Student
Preparation
|
Faculty
Participation
|
|
Focused
Discussions
|
Faculty-moderated discussion of a case
|
Students
should read on topic area in advance
|
Faculty member
guides the discussion based on defined learning
objectives
|
Problem Based
Learning
|
Student-driven,
problem-centered case discussions
that unfold
over two- three sessions
|
Students
identify learning issues during the case session which they research between meetings
|
Faculty member
facilitates the student’s discussion of the cases and
student-identified learning issues
|
Student-led
Seminars
|
Topic-centered discussions led by students
|
One student (the “teacher”) prepares a presentation
on a topic relevant to a
case
|
Faculty member should be prepared to assist
the “student teacher”
|
Role-play
|
Students are assigned roles based on written
scenario to simulate real interaction in a
classroom setting
|
Preparation
generally unnecessary
|
Faculty member demonstrates technique and serves as observer to
assess skills and to provide
feedback
|
Categories of Small Group Teaching
Using Small Groups Effectively
For small group
instruction to be effective, the instructor should keep in mind five principles of adult learning
theory.27 Adults learn best
when:
• Instruction
is relevant
• Instruction is conducted in a safe learning environment that encourages a processing and verbalization of thought
• Instruction draws from the learner’s experiences
• Instruction
is problem-centered
• The adult learner
is provided with feedback
Encouraging Participation
One of the biggest concerns of
any small group facilitator is getting all the group members
to participate. Jaques describes a number of techniques for breaking down a
group of learners into smaller units,
thereby increasing student
participation and decreasing the involvement
of the faculty member: 28
• “Group Round” - Participants
are given a brief period of time to say something
and then move to the next member of
the group (for example, an icebreaker in which
students are asked to state their name and its meaning).
• “Buzz Groups” -
Students pair up with a neighbor to discuss their own answers to a particular question
for a set period of time.
Then the larger group reconvenes and discusses the answers.
• “Snowball or Pyramid
Groups” - Participants are initially asked to carry on a
discussion with their neighbor (buzz group) and then sequentially neighboring
groups are paired to form groups of four, then
eight. A representative from this group then
presents the group’s findings back to
the larger classroom group.
• “Fishbowl Groups” -
The group is divided in two, where there is an inner, discussion or role-play group, and an outer observational group. After a period of observation and a debrief
session, the roles may be switched.
• “Crossover Groups” -
Students are divided into subgroups
for the initial discussion. The subgroups
are then divided
and participants are split into new
subgroups to maximize the amount
of information crossover.
• “Circular Questioning” - Each member
of the group asks a question to another group
member, who briefly
answers the question. Then the next person in the circle asks a question.
The exercise is complete when everyone has asked a question. The facilitator can
wrap up the session by summarizing questions asked and responses.
• “Horseshoe Groups” - Small groups are arranged around tables and each table is arranged in horseshoe fashion around
the lecturer. This allows the facilitator to move between lecturing
and interactive small group activity.
Tweet to @dennydixie
