Small-group teaching

Chapter 9


Small-group teaching



Medical educators can use a number of instructional situations for teaching learners (see Chapters 8–17). Small groups represent a teaching situation or environment of growing importance in healthcare education.


Recent studies are beginning to unravel the reasons why small groups have a positive effect on learning performance (van Blankenstein et al 2011). These studies cite both socio-behavioural and cognitive benefits. Socio-behavioural benefits include promoting learner motivation, social cohesion and authenticity. Cognitive benefits include facilitating elaboration and reflection or recourse to prior knowledge and experiences. Additionally, emotional engagement theories stress that instructional authenticity enables the learner to more meaningfully engage with the material to enhance learning; small-group teaching enables the potential for more authentic instruction than that provided in the large-group setting.


The reader is encouraged to review the benefits of small-group teaching to maximize potential learning. Furthermore, recent work has shown that learning situations can be complementary: for example, combining small-group teaching with lectures (Chapter 8) can facilitate the potential benefits of instruction with each format.



What is a small group?


Small groups are instructional settings that better optimize the instructor-to-learner ratio. Small-group sessions often complement large-group (i.e. lecture-based) courses: lectures are the ‘prototype’ for large-group teaching. Typically, when small groups are used to complement large-group teaching, a primary purpose of the small-group sessions is to further explore the key concepts in the lectures and readings with a practical emphasis to help students with complicated material pertaining to the subject being presented and discussions that are difficult to conduct in a larger group setting. Additionally, small groups can also help educators integrate material from multiple courses, such as a clinical reasoning small group on chest pain that could integrate anatomy, physiology and pathology concepts into the session.


The size of the small group can vary greatly in healthcare education. Prior studies suggest that groups of five to eight learners are optimal. However, the number of students in a group should not conform to any set rule.



image “The number of students in a small group should not conform to any set rule.”


Indeed, the experienced small-group teacher may be able to effectively facilitate a much larger number of students than a less experienced instructor. The goal with determining small-group size should focus on effectiveness that will be dependent upon goals and objectives for the session and learner experience/expertise with the content being discussed (i.e. difficulty of the content). For example, if the group is too small or the material is very straightforward to learn, exchange of ideas can be limited so a balance should be struck in determining the number of students in a small group. The challenge for the healthcare educator is to construct a small-group size that will best facilitate exchange of ideas and concepts for the content being discussed, given the learning goals and objectives for the session.


Newble and Cannon (2001) discuss three signature characteristics of small-group teaching: active participation, purposeful activity, and face-to-face contact. We believe that consistently achieving these three characteristics is essential for small-group teaching effectiveness.



image Three signature characteristics of small-group teaching are active participation, purposeful activity, and face-to-face contact.


According to these authors, if the small group lacks any of these components, the teaching activity will likely be suboptimal. For example, active participation and purposeful activity are needed for the cognitive benefits of elaboration and reflection. Elaboration and reflection accompanied with face-to-face contact are needed to optimize motivation and emotional engagement with the content. Indeed, the size of the group is less important than fulfilling these three characteristics. For example, effective team-based learning (Chapter 21) allows for larger groups through the formation of smaller subgroups within the teaching setting and can capitalize on these three signature characteristics within each subgroup. Indeed, one of the most often cited reasons for combining lectures with small groups is that it is extremely difficult, if not impossible, to have active participation and purposeful activity in the typical large-group lecture setting.



When to use small groups?


The reason(s) for choosing to incorporate small-group teaching into a curriculum should be primarily guided by learning goals and objectives. A secondary reason is the difficulty of the content being presented (which is dependent upon the expertise of the learner with the content). As stated above, if the content presented in the small-group session is too straightforward, the three signature characteristics discussed above are unlikely to be met. Further, since small groups are one of the most resource-intensive teaching formats, the reason(s) for using this format should be carefully considered, weighing the pros and cons of this format with alternatives.


There are many advantages to teaching in small groups, and we have introduced some of the theoretical benefits of this teaching format at the outset of this chapter. Additional benefits include the fact that small-group instructors can become more familiar with learners’ knowledge, skills and experiences with the content being discussed than in larger group teaching settings. Instruction can therefore be more customized or tailored to the learners’ needs in small groups. This benefit may be particularly important with complicated material, where learners may have a variety of differences in knowledge, skills and experiences and difficulty with integrating the material to be learned. Also, in small groups, the teacher has more opportunity for individualized feedback, which has been shown to be important, especially for learning complex information. Further, peer evaluation and self-reflection can add to teacher-directed feedback to enhance the experience for learners. Additionally, learners have the opportunity to get to know their classmates and may be more comfortable asking questions during a small-group session than in larger group settings; again, this benefit may be particularly relevant when the content to be learned is difficult for learners (due to their relative expertise with the content).


Another potential benefit of small-group teaching is that learners can become familiar with adult learning principles, which are something they will be encouraged to apply for the rest of their professional lives. For example, learners are encouraged to take responsibility for their own learning (self-directed learning or self-regulation, e.g. adequate preparation for the small group, asking questions during the session, follow-up readings after the small-group session has concluded), and learners are encouraged to use problem solving and reflection skills. In a similar vein, small-group learners have the opportunity to develop important interpersonal and communication skills that they will use in their future practice. Small-group teaching also offers the opportunity for teachers to model professionalism, respect for different opinions and time management. Finally, small-group teaching promotes engagement between the teacher, learner and content, enabling the instructor to reinforce concepts that move beyond recalling content and asking trainees to apply this content in a more meaningful manner than in larger group settings. Therefore, small-group sessions should challenge the learner to apply what is learned in larger settings and/or from textbook readings.


These advantages come at the cost of needing additional faculty for instructional purposes, so medical schools in the United States and elsewhere typically include other teaching formats, such as lectures and seminars, to introduce content and use small-group teaching to reinforce key learning concepts. Finally, recent work from the cognitive load literature suggests that using small-group sessions for straightforward content can actually increase extraneous (not useful for learning) cognitive load in learners and potentially impair learning; therefore, careful construction of goals and objectives for the small-group session will help maximize chances of success.



image Careful construction of goals and objectives for the small-group session will help maximize chances of success.


Two additional questions that are relevant to determining when to use small-group teaching are what format of small-group teaching and what type of instructional methods.



What format of small-group teaching?


A number of small-group teaching formats exist. Formats of small-group teaching include problem-based learning (PBL), case-based learning (CBL) and team-based learning (TBL). This content is beyond the scope of this chapter. The reader is encouraged to review this content in other chapters of this book. A notable distinction between PBL, CBL and TBL is the role of the instructor. In PBL, the instructor is a facilitator; being a subject matter expert on the content is not required. In CBL, the instructor is a facilitator but also typically provides summative comments at the end of the session, sharing their subject matter expertise. In TBL, the instructor typically provides both facilitation and subject matter expertise, the latter often provided through both summative comments and/or pre- and post-session quizzes.

Related posts:

  1. Clinical skills centre teaching
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  3. Instructional design
  4. Basic sciences and curriculum outcomes

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Dec 9, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Small-group teaching

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