• The development of social and interpersonal skills and communication skills such as listening and debating. These skills have been recognised as important learning outcomes to be addressed in an educational programme.

• The ability of a student to work as a member of a team and to recognise the roles of other team members. Students are encouraged in small group work to behave in a professional manner and to respect the views of others in the group. Doctors need to work effectively as team members and the skills that enable them to do so should not be taken for granted.

• The ability for students to engage in problem solving, critical thinking, the analysis of a complex issue and refining their understanding.

• The fostering of skills required by students to cope with uncertainty. This reflects medical practice where issues are frequently complex and uncertainty not uncommon.

• Innovative thinking, creativity and the development of new ideas.

• Deep learning with a more complete understanding of the subject rather than superficial learning where there is an emphasis on memorisation.

• Students reflecting on their own abilities and attitudes and exploring further the concept of professionalism in medical practice. Members of the group may find preconceived beliefs challenged.

• Students’ ability to take responsibility for their own learning.

• Small group learning embraces the FAIR principles of effective learning as described in Chapter 2. In particular it encourages active rather than passive learning and provides learners with immediate feedback with regard to their understanding and attitude to a subject.

• Students find working in properly organised small groups engaging and motivating and are encouraged to continue further with the learning process. The approach does place demands on the students but they find the less formal atmosphere of group work more relaxed and conducive to learning. The experience may even be enjoyable.

• Small group work draws and builds on the expertise and talents of the members of the group. The less effective and efficient learners may learn from others in the group and improve their learning skills. Studies have shown that where a number of groups are addressing a problem, the results from the ‘poorest’ group are invariably better than the results from the best individual student working alone.

• Teachers accustomed to lecturing may be less experienced in the role of facilitator in the small group setting. As a result, small group work deteriorates into mini lectures.

• Small group teaching is considerably more difficult to manage than a lecture as more attention needs to be paid to individual students’ behaviour, personalities and difficulties. Diversity in a group promotes varied and interesting opinions, but it also has the potential to create conflict and may interfere with the proper functioning of the group.

• Scheduling the necessary number of rooms for small group teaching may present a logistical problem. If a class of 180 students has small group activities scheduled at the same time with nine students in a group, 20 small group rooms need to be made available. This is not a problem in team-based learning as the small group activities take place in a lecture theatre or large demonstration room.

• Excessive demands may be placed on teachers’ time requiring a higher than normal teacher–student ratio. This can be less of a problem if there is a greater emphasis placed on student-directed groups, or if one teacher, as in the team-based learning approach, manages a number of small groups.

• Students too often are not briefed before a small group session as to the benefits to be gained and the expected learning outcomes. This can result in them being less favourably disposed to the teaching method. They may not value what they learn in the small group work and may consider it to be a less effective use of their time when compared to attending a lecture or reading a textbook.

• Brainstorming. This is a creative thinking exercise in which group members generate as many ideas as possible without criticising or questioning their validity until time or ideas are exhausted. The ideas are then discussed. This approach is especially valuable to encourage creativity and generate new ideas.

• Snowballing. Learners work initially in pairs to discuss the issue or task. They then join with another pair to compare and contrast their results. The group of four learners then combines with another group of four and the exercise is repeated. The deliberations are finally discussed in a plenary session. Snowballing particularly encourages clarification of ideas and values in a non-threatening situation. A variation of snowballing is the jigsaw group. With this technique, after a topic is discussed, the groups reform into new groups, with each new group containing one member of the old group.

• Role-playing. Students enact a scenario assuming in turn the role of the doctor, nurse or patient. Role-playing is particularly valuable in exploring communication issues and attitudes. The sessions may be videotaped and this can be helpful to students who can view and analyse their own performance and learn from it.

• Journal club. This approach is frequently used in postgraduate education. Participants are asked to present and comment on recent papers in the medical literature. The group then discusses the comments.

• Tutorial/seminar. Tutorials are particularly helpful to enable students to critically probe subject matter in more detail. This helps them to clarify and expand on their understanding. Triggers such as clinical photographs, a videotape clip or a short student presentation may be used as a springboard for the tutorial. In a tutorial, the group can discuss material that has been covered in a lecture or in a directed self-learning exercise. The tutorial may be focused on aspects of the subject where students have encountered difficulties.

• Problem-based learning. Small group work plays a key role in PBL as discussed in Chapter 14. Group discussions are directed around a problem presented to the group. The students’ learning needs relating to the problem are identified.

• Clinical teaching. Teaching is conducted with a small number of students around patients in the ward or outpatient department. Clinical skills centres also provide the setting for clinical teaching with small groups using simulated patients and models. Clinical teaching is discussed in more detail in Chapter 24.

• chair person – eliciting information and opinions from the group and managing the group process

• consultant – providing information or specialist knowledge in an area

• observer – commenting on the group discussion at appropriate places

• Devil’s advocate – confronting and challenging the group

• counsellor – releasing tensions in the group where members feel threatened or where some students dominate the discussions.

1. Are you making sufficient use of small group methods in your teaching programme?

2. If you are using or considering using small group teaching, look again at the learning outcomes you expect your learners to achieve. How do these compare with the suggested outcomes for small group work described above?

3. Which small group methods would be appropriate in your own context and what is your role in the group?

4. Would attending a staff development programme on small group teaching be helpful to you?