Wrap Up Ideas

Wrap-up

According to the PBLP process outlined in the program documents, the wrap-up is an essential part of group work. Wrap-up is designed to be a time for the group to evaluate their efforts and make recommendations on how to improve their performance. Observations revealed that this debriefing process was usually led by the facilitators and was weak at providing the kind of feedback necessary for growth in group functioning.

Studying the group session process revealed several problems concerning wrap-up. In almost every session it was observed that a "how'd we do" question got an "Okay" answer, and not much more. Looking specifically at wrap-up allows for a discussion of strategies to make wrap-up "work."

A good start might be to orientate thoroughly the group on wrap-up expectations and timing. Many underlying concerns never surfaced at wrap-up because there wasn't sufficient time. Also, expectations have not been developed based on an insistence and example of nonattribution required for this type of activity.

Specific open ended questions are best for eliciting the kind of feedback that allows members to think about and then speak out on their group process. Some understanding of question dynamics can go a long way in promoting good feedback. Questions that can be answered with a "yes," "no," or "okay" are not the type of questions that will provide anything substantial to the improvement of the group process.

Thinking about wrap-up generates several other ideas to make it function as it is intended:

1. Have students and facilitators note their comments and concerns throughout the session for wrap-up. (This is a good suggestion for facilitators even it isn't used for wrap-up.)

2. Make session feedback a part of the students’ independent study and start the session with feedback from the previous session.

3. Ask the students to keep a journal about ideas concerning how the group is functioning and periodically discuss their entries at wrap-up or privately.

These ideas, or variations of them, can at least be tried, in order to see if they make a difference to the wrap-up process.

One strategy shared by a student is to have a time of encouragement. Encouraging feedback is just as important, probably more so, than problem feedback. The major point, however, is that feedback must be specific to be meaningful, and that rarely occurred during the last minute rush to check the wrap-up block within our group.

Wrap-up has the potential for real meaningfulness if carefully attended to. Facilitators need to model good feedback and solicit it from the group. The wrap-up is an important part of the PBLP group session process but its potential can only be realized through purposeful, proactive efforts.

Davis, S. 1994, “Problem Based Learning in Medical Education: A Qualitative Study of Curriculum Design and Students’ Experience in an Experimental Program,” pgs 237-239.

Dr. Doug Mann idea for your consideration and use;

The students seem to enjoy this exercise at the end of the discussion of each case. I make a point of telling the case presenter that I'm NOT evaluating them based on their ability to answer the patient questions, AND they can stop and consult with their peers. It's low risk, good learning.

CPC I Winter quarter 2005 CBL patient questions: EXAMPLE

1. CARDIOVASCULAR BLOCK

Jan. 3-7, James Ayers questions

- Dr. Albrecht, am I having a stroke or a heart attack?

- So, Dr. Albrecht, my heart has an electrical block and some premature beats. Is this something I could die from?

- What made me pass out? Would you explain it to me?

- What can I do to make it less likely that I'll pass out again?

- My heart still feels like it isn't beating right. When will it feel normal again?

- Is it OK for me to drive? Can I travel?

- So I'm not going to die today or tomorrow, anyway. Do I need to be careful with exercise? I like ballroom dancing -- Mrs. Ayers is better than I am -- and walking. What can I do safely?

- I give lectures in medieval history. Should I be doing something different when I teach? Sitting down or walking around more?

- If I have to go off my blood pressure medicine, what's going to happen to my blood pressure? How can we keep it from getting too high? Seems like I'm caught between treating the blood pressure problem versus the heart problem. Makes me feel like I'm getting old.

- Am I really going to need a pacemaker? Putting one in is a risky surgery, isn't it?

The idea is to simulate the questions a patient will actually ask let them practices trying to deal with patient education, safety, EBM, ethics, and other topics for patient well being. This tactic can be easily adapted to any case.

- If wrap up is weak, ask participants to answer the following questions (post them or provide them on handout for focus):

o How well do I think I performed on this case?

o How well do I think the group performed on this case?

o What could I/we have done better?

o What did I particularly like about this case? Dislike? Why?

1) Wrap-up – how to make it useful

a) Watch people’s body language for cues when doing wrap-up.

b) Create a different open-ended question for each session to encourage wrap-up. Give them the question at the beginning of the session so they can watch for discussion points.

c) The question was raised about dealing with student’s emotional responses. This was suggested as a possible wrap-up question.

d) Taking notes during the session help with wrap up.