Small Group Teaching

MAJ Keith Salzman, MC, USA

(edited for web page by CDR DL Hufford, MC, USN, 03 JUL 99)

Faculty Development Fellowship

Madigan Army Medical Center

Objectives:

• Review advantages and disadvantages of small group discussion
• Describe the major steps in leading a discussion
• Review the characteristics of effective questioning

Introduction:

• Students must master and enormous body of knowledge, however, the cognitive knowledge is only one part of medical education; they must also learn-
• Motor skills necessary to perform procedures
• Affective knowledge-behaviors, attitudes and values that foster professionalism
• One of the most effective settings for promoting this learning is the small group
• Small group discussions are excellent vehicles for
• Developing speaking skills
• Promoting responsibility for learning
• Stimulating thought and understanding

Advantages of Small Group Discussions:

• Instructors can discern how much material is being retained and provide immediate feedback to the students
• Instructors can promote the higher order cognitive skills-application, analysis, synthesis, and evaluation
• Excellent setting for teaching values and ethical standards which develop over time in discussions over complicated moral issues with peers and instructors
• Generate active participation and increase students’ and residents’ motivation to learn

Disadvantages of Small Group discussions:

• Time consuming
• Not well suited for covering large amounts of material
• Can be problematic for introverted students
• Less control by instructor

Major Steps in Leading a Group Discussion

A. Preparation

• Discussions take more preparation than a lecture
• Identify goals and objectives for the discussion
• Ensure everyone in the group comes with a similar level of prior learning, then try to anticipate the wide range of material that may arise

A. Getting Started

• Give the group a sense of direction
• Introduce the topic a lay out the objectives and agenda
• Move quickly to establish a climate of mutual respect for everyone’s ideas
• Let the students know that participation is expected

C. Managing the Group Process (A subtle skill that takes time to learn)

• Main role is facilitation-not a lecturer or expert
• Keep the group on track, clarify issues, mediate disputes and summarize key points

D. Bring the Discussion to Closure

• Allow time at the end of the discussion to summarize key points
• Ensure that students leave with a clear understanding of the most important ideas

Facilitative Behaviors in Leading a Group Discussion:

1. Be patient-conversations take time to develop

• Use silence as a time of reflection to deepen the level of discussion
• Avoid dominating the discussion

1. Control the flow of discussion to keep the group on track, but don’t be afraid of letting the conversation follow a natural course-being too rigid can stifle participation.
2. Recognize all contributions made by participants

• If someone is not participating-draw them into the conversation
• Don’t let one or two individuals dominate the discussion

1. Avoid premature agreement-a common problem is for 2-3 vocal participants to quickly come to an agreement and want to move on-other, less vocal members of the group may have different ideas to contribute
2. Challenge assumptions and conclusions, but don’t belittle them

The Art of Asking Questions: (This skill is essential to running small group discussions)

1. Type of questions

1. Convergent questions-ask students to summarize and pull their knowledge together-i.e. "What are the major organisms that cause pneumonia in AIDS patients?"
2. Divergent questions-promote further discussion to broaden the perspective-i.e. "Does a physician have the right to refuse treatment of an AIDS patient?"

1. Levels of questions

1. Knowledge-test what a student knows-i.e. "What are the different types of insulin available for diabetic patients?"
2. Application-ask the students to apply their knowledge to a situation-i.e. "A diabetic patient has resistance to a certain form of insulin, what would you do?"
3. Problem Solving-ask students to work through a complicated scenario-i.e. "You have just admitted a diabetic patient in DKA with a fever, what would you do? Please justify your answer."

1. Types of probing questions

1. Prompting-used to stimulate discussion
2. Justification-asks a student to bolster or defend his or her ideas
3. Clarification-gets a student to think his or her answer through more carefully or better explain a good idea that may not be clearly stated
4. Extension-asks the student to take his or her thinking a step further
5. Redirection-asks the student to apply his or her thinking to a different but related topic

1. Dynamics of questioning

1. Ask one question at a time and state it clearly
2. Ask the question, then call on a student if necessary
3. Allow time for students to formulate their responses

4. Don’t always look at the person speaking, otherwise students will see the discussion as a series of conversations with you, not the group as a whole

Summary

• Small group discussions promote learning
• Steps in leading an effective presentation:
• Preparation · Managing the group process
• Getting the discussion started · Concluding the discussion
• There is an art to asking questions that will facilitate participation

Group Discussion:

• Review the various small group teaching sessions used in your program
• Practice leading a small group discussion using the techniques described in this session

Annotated References:

Freightner JW: Solving problems: how does the family physician do it? Can Fam Phy 1977;23:457. A look at clinical problem solving thought processes by family physicians

Foster PJ: Clinical discussions groups’ verbal participation and outcomes. J Med Ed 1981; pg 56. A study to determine the relationship between participation in group discussions and outcomes. Many relationships were found between discussions and outcomes

Hyman RT: Questioning in the college classroom. Kansas State University 1982; pg 129-32. A brief paper that lays out the purposes for questions and the tactics/strategy for asking and answering questions

Olmstead JA: Methods of call group discussion. Theory and Practice 1979; pg 99-107. Presents concise descriptions of small group discussion types

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