Fellowship of Physicians examinations of the Colleges of Medicine of

South Africa.

Note1. This AMEE Guide was published as van Tartwijk J, Driessen

E W. 2009. Portfolios for assessment and learning: AMEE Guide

no 45. Med Teach 31:790–801.

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Davis HM, Friedman Ben David M, Harden RM, Howie P, Ker J, McGhee C,

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Effective small group learning: GuideSupplement 48.1 – Viewpoint1

DEAN PARMELEE

Wright State University, USA

The AMEE Guide in Medical Education: Effective small group

learning by Edmunds and Brown (2010) immediately begs the

question ‘‘why use small group learning?’’ In medical educa-

tion, the predominant driver for how students should learn has

always been the ‘‘content’’ to be mastered. Therefore, lectures

prevail because they seem to ‘‘cover content’’ so efficiently, i.e.

almost no limit to the number of students in the room, one

faculty person, pack in 8 h/day and a lot is ‘‘covered.’’ Study

after study have demonstrated that students learn what they

need to know in spite of this approach, and small group

learning has evolved to provide meaningful learning

opportunities through discussion, collective problem-solving,

peer-peer teaching, and closer over-sight and guidance with

an instructor.

But, the KEY word in the title is Effective. If you ask

students coming out of secondary education or even higher

education settings how they have experienced ‘‘small group

learning,’’ they will respond: ‘‘Mostly a waste of time.’’ ‘‘It all

depends on who the faculty person is.’’ ‘‘If we had to do a

project, I ended up doing most of the work.’’ ‘‘Just tell me what

I need to know, don’t bother me with all the discussion stuff.’’

The authors of the Guide aptly highlight many components

Correspondence: D. Parmelee, Boonshoft School of Medicine, Wright State University, Academic Affairs, PO Box 927, Dayton, OH 45401-0927,

USA. Tel: 937 775 3803; fax: 937 775 2842; email: dean.parmelee@wright.edu

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needed on the part of the faculty member and the students for

effective small group learning.

I believe that there are two types of small group learning

that work really well for students in health professions

education:

(1) The ‘‘Discovery’’ model, whereby groups of 5–7

students, facilitated by one faculty member, meeting

regularly for many sessions to discover more about

their own values, how they will personally manage the

many challenges of making life and death decisions,

and how they might rely upon one another in the

community of clinicians. Generally, the only assess-

ment of the student’s learning is through some sort of

reflective writing or facilitator evaluation of participa-

tion. This model works well for exploring ethical

decision-making, complex patient care encounters,

and ‘‘professional formation’’ (Rabow et al. 2010).

Often, however, the key to the success of this model

is faculty who can truly facilitate the discussions and

serve as enduring role models for professional

behaviors.

(2) The ‘‘Accountability’’ model, whereby groups of 5–7

students in either a ‘‘traditional’’ problem-based learn-

ing (PBL) curriculum or a team-based learningTM (TBL)

curriculum wherein content must be mastered, it must

be applied to authentic problems, and the group or

team process is integral to all students learning

effectively through their collective identification of

what is important and solving commonly encountered

clinical problems. There are several critical differences

between the two strategies, e.g. PBL requires a

facilitator for each group and TBLTM needs but one

content expert for the whole class. Academic outcomes

with either approach are at least as good, if not better

than standard lecture fare curricula (Koles et al. 2010),

and assigning tasks to small groups within very large

classes has been shown to lead to better learning

outcomes than lectures, even given by a very

experienced lecturer (Deslauriers et al. 2011).

Since the readership of this journal is largely health

professions faculty who want to enhance the learning of

their future practitioners, I consider it important to consider: if

health profession students learn what they need to know

through effective small group strategies, then they are more

likely to be able to work well with others in the health care

teams of the future. The days of the solo practitioner are mostly

a memory, and patient care outcomes are now highly

dependent upon a team of professionals working

collaboratively.

Future research on small group learning is needed, as the

authors’ note, to determine more about group dynamics and

the ways in which instructors can promote deeper critical

thinking, decision-making that is ethical and evidence based,

and complete difficult intellectual tasks in the small group

setting – analogous to how they are likely to be challenged in

the workplace. Sweet and Michaelsen (2007), reviewing the

group dynamics literature, highlight how the interactions of

small group members change predictably over time, and our

instructional strategies are likely to influence these changes.

Also, knowing that there is emerging evidence for ‘‘collective

intelligence’’ in a small group (Wooley et al. 2010), and how it

is influenced more by factors other than the average or

maximum individual intelligence in a small group, compels us

to design strategies that capitalize upon these factors to give

our students the richest experiences possible.

As of now, PBL and TBL are the two small group learning

strategies that hold the greatest promise to transform health

profession education. As a TBL proponent, and not at all an

opponent of PBL, those of us using, improving, and

researching its ‘‘best practice,’’ are determined to (1) head-

to-head compare long-term academic outcomes with tradi-

tional lecture strategies; we know that students learn the

material better with TBL for course exams, but we do not

know whether or not they can transfer what they have learned

to novel problems at a later date; (2) apply the emerging

evidence for collective intelligence to guide team creation and

the design of application exercises to capitalize upon strengths

of social sensitivity within the team; (3) discover whether or

not the social skills that we feel are developed by a TBL

curriculum have endurance and make students more effective

team members in the workplace. In particular, does ‘‘dis-

tributed leadership,’’ a characteristic of all members of a highly

productive team, become a new or improved behavioral

characteristic of a member when she is in a new small group

setting in which decisions must be made?

In conclusion, and returning to the foundational question

‘‘Why use small group learning?’’ Here are some questions we

should ask faculty about their teaching and if they answer

‘‘yes,’’ then they have answered the question for themselves:

. Do you want students to come prepared for class?

. Do you think students can learn from one another, often

more than from you?

. Do you feel that the best use of your classroom time is to get

students engaged in problem-solving?

. Do you like a noisy classroom in which the students are

tackling your assignments together?

Declaration of interest: The author reports no conflicts of

interest. The author alone is responsible for the content and

writing of this article.

Notes on contributor

DEAN PARMELEE, MD, is associate dean for Academic Affairs at Wright

State University Boonshoft School of Medicine. He was the inaugural

president of the TBL Collaborative and is a consultant for health professions

curricula design and active learning in the US and internationally.

Note

1. This AMEE guide was published as: Edmunds, S. and Brown,

G. 2010. Effective small group learning: AMEE Guide no 48.

Med Teach 32: 715–726.

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Koles PG, Stolfi A, Borges NJ, Nelson S, Parmelee DX. 2010. The impact of

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Rabow MW, Remen RN, Parmelee DX, Inui TS. 2010. Professional

formation: Extending medicine’s lineage of service into the next

century. Acad. Med. 85:310–317.

Sweet M, Michaelsen LK. 2007. How group dynamics research can inform

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