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