How to Increase Small Group Learning Participation

(By Dr. Doug Mann, PhD, Department of Social Medicine, OUCOM, 10/2003)

INSTRUCTIONS FOR STUDENTS:

DON’Ts

Don’t hesitate to speak up because you think others in the group know more than you do. There are many, many ways to make useful contributions to the discussion (see DO;s list below). Everyone can contribute.

Don’t be afraid to make a mistake in discussion. If you have a reason for your idea, it’s worth expressing. Even if your idea turns out to be wrong, if it’s thoughtful and relevant to the case, it will advance the discussion.

Don’t assume that everyone else already knows the information that you want to contribute to the discussion. Bringing things up can reveal whether there’s a consensus, and whether there are related unanswered questions.

DO’s

Consider all the ways that you can contribute to the discussion. It’s not a race to see who can state the correct diagnosis first. A thorough differential is important. There’s plenty to talk about in relating the patient’s signs and symptoms to each possible diagnosis in terms of pertinent positives and negatives. Diagnoses can be ruled in or out. Tests should be justified in relation to diagnoses, and then test results need to be interpreted. Underlying basic science explanations are needed. Sharing good sources of information is always appreciated. Occasional summaries of what the group understands about a case-related topic may be needed, to check for consensus and for unanswered questions. Drawings may be needed – visuals are very powerful learning devises. Teaching is sometimes the best learning activity. Reviews of difficult topics can be offered. The prognosis, treatment plan, and patient education issues offer many opportunities to contribute. Learning issues need to be generated and prioritized. The group process, the cases, and the block learning activities can always be refined and improved upon.

Make some notes to prepare your questions and contributions for each group session. What specific questions do you want to ask, and what information do you want to share? Make a list of topics, and check them off as you go.

Be assertive about getting your ideas and questions into the discussion. Think before you speak, and then get the floor and state your idea/s. Don’t let the discussion move ahead until you are sure that everyone heard what you had to say. This is important to keep the group moving ahead together, without bypassing important ideas, only to “discover” the idea again much later, or to miss it entirely.

Become the best listener you know. Probably the quintessential skill of the best physicians is an ability to listen with the intent to understand rather than listening for your perspective to solve.

Give the basis for each question that you ask. This shows that it’s a thoughtful question related to the case, and they you’ve prepared for the group session. For example, you could ask “I understand how A causes C, but can anyone explain how B causes C?” Or, “Topic A is important for the case for this reason, and I understand the topic in general, but not this specific detail.” Or “I reviewed the topic in books A and B, but I still couldn’t find a clear answer to X.”

Follow up other group member’s statements in a constructive way. If you don’t understand what someone said, ask for a clarification. Chances are that others will also benefit from the clarification. If you think someone is wrong, ask for an explanation of their reasoning, or explain how you reached a different conclusion.