Why Consider Using Small Group Instruction

By Carol Thrush

There are a wide variety of small group instructional methods that are increasingly being used by health educators throughout the world.  Some of these methods have been referred to as team learning, problem-based learning (PBL), collaborative learning, and cooperative learning, just to name a few.  There are a number of reasons why health professions educators might want to consider using small group instruction approaches.

A quick review of the literature on small group instruction suggests that small group teaching skills are essential for modern day health professions educators.  According to a review by Lusardi et al.(2002), students who participate in small group instruction, particularly those involved in PBL methods, are more likely to engage in scholarly activities (e.g., use more textbooks, journal articles, and informal discussion with faculty and classmates) and are more likely to study in a way that promotes deeper understanding of the material. Research has shown that the benefits of small group instruction methods may even include better pass rates on board exams, better problem solving skills, better self- and peer-evaluation skills, better communication and listening skills, and better collaborative skills.  Perhaps most importantly, because the small group learning environment gives students opportunities to build and develop their interpersonal skills, these students tend to have improved abilities to address the social and emotional issues of patients effectively (Blue, Stratton & Donnelly, 1998; Peters et al., 2000; Moore, Block, Briggs-Style & Mitchell, 1994; and Levine et al., 2004).

Part of the rationale for using small group instructional methods in the health professions is based on the reality that for health care professionals to be able to function successfully in the complex and dynamic health care environment, it is important that as students they develop not only competencies required of their profession (knowledge, skills, and attitudes), but also process-oriented capabilities that help them to function in various contexts, continue their learning, and adapt to change over time (Fraser & Greenhalgh, 2001).  Several small group instruction techniques have been heralded as methods to help achieve these goals.

Methods such as PBL may be uniquely suited to help learners become more effective in delivering team approaches to patient care and more skilled in ongoing self-directed learning activities, such as the ability to access and use evidence-based information. The importance of acquiring these skills has been noted by a number of national associations, accrediting bodies, and others concerned with the quality of health professions education.

As noted by previous investigators, the lack of rigorous, controlled educational research on this topic makes it difficult to sort through and understand how contextual factors and variations in implementing and carrying out small group instruction methods might affect the results of research. Overall, however, the available evidence suggests that small group instruction approaches are at least as effective as traditional lecture-based curriculum in preparing students for clinical practice and appear to provide students with a more enjoyable and richer learning experience.

Of course, there may also be some disadvantages and challenges in using small group teaching methods.  For example, small group methods that are highly structured such as PBL have been criticized for being too time-intensive and costly. When students are expected to work together and learn in teams, as in team learning, there are often concerns from both instructors and learners about how to best assess and “grade” each individual. 

In addition, another disadvantage is that instructors and students involved in small group instruction methods may have a hard time adjusting to new roles in the educational process.  Educators who use small group teaching methods should be comfortable with their group process skills and with allowing the learners to become more involved in the educational process.  Learners, on the other hand, may experience difficulties in assuming a more active responsibility for participating in the learning process with others. 

In short, small group instruction methods and techniques have demonstrated effectiveness across a variety of outcome domains and although there are often significant challenges in using such methods, these concerns may be offset by the unique advantages of group/peer interaction and student enthusiasm and motivation. 

References

Lusardi, M.M., Levangie, P.K., & Fein, B.D.(2002). A problem-based learning approach to facilitate evidence-based practice in entry-level health professional education. JPO,14(2): 40-50.

Blue, A.V., Stratton, T.D., & Donnelly, M.B. (1998). Students’ communication apprehension and its effects on PBL performance. Medical Teacher,20:217-221.

Peters, A.S., Greenberger-Rosovsky, R., Crowder, C., Block, S.D., & Moore, G.T. (200). Long term outcomes of the New Pathway program at Harvard Medical School: A randomized controlled clinical trial. Academic Medicine, 75:470-479.

Moore, G.T., Block, S.D., Briggs-Style, C., & Mitchell R. (1994) The influence of the New Pathway curriculum on Harvard medical students. Academic Medicine, 69:983-989.

Levine, R.E., O'Boyle, M., Haidet, P., Lynn, D.J., Stone, M.M., Wolf, D.V.,  & Paniagua, F.A. (2004). Transforming a clinical clerkship with team learning. Teaching and Learning in Medicine, 16(3): 270-5.

Fraser, S.W. & Greenhalgh, T. (2001).Coping with complexity: Educating for capability. BMJ, 323:799-803.