The small group in problem-based learning: more than a cognitive ‘learning’ experience for first-year medical students in a diverse population

Figures & data

Table

Practice points

• The small-group tutorial in problem-based learning provides a conducive, collaborative learning environment.

• The small-group tutorial, in addition, facilitates student adaptation to a new and unfamiliar academic environment.

• Amongst culturally and educationally diverse student populations, the small-group tutorial fosters integration and socialization.

• The interaction of students in small groups promotes considerable individual personal development.

Table 1.  Students (males vs. females; matriculants vs. mature) responding to a query (Did the small-group sessions impact on you personally or on your behaviour?) in the introductory theme (Nutrition) of the first year of a problem-based learning curriculum

Respondents	% Respondents
All survey respondents (n = 178)	Yes (n = 166; 93.3%)	No (n = 10; 5.6%)	No response (n = 2; 1.1%)
Females (n = 113): 63.5%	94.7 (n = 107)	4.4 (n = 5)	0.9 (n = 1)
Males (n = 65): 36.5%	90.8 (n = 59)	7.7 (n = 5)	1.5 (n = 1)
Matriculants (n = 101): 56.7% (i.e. matriculated in 2003)	95.0 (n = 96) 67 females:29 males	3.4 (n = 4) 4 females	1.1 (n = 1) 1 female
Mature (n = 77): 43.3% (i.e. matriculated in 1984–2002)	90.9 (n = 70) 40 females:30 males	8.0 (n = 6) 1 female:5 males	1.1 (n = 1) 1 male

Note: No statistical differences were recorded between males and females and between matriculant and mature respondents.

Table 2.  Development students indicated they had undergone as a result of the group work in the Nutrition theme

Domain of development	% respondents (n = 178)	% Females (n = 113)	% Males (n = 65)	Fisher's exact p value	% Matriculants (n = 101)	% Mature (n = 77)	Fisher's exact p value
Social domain
• Made friends	38.8	39.8	36.9	0.751	33.7	45.5	0.0023
• Cooperative (sharing, etc.)	27.0	26.5	26.5	0.863	28.7	24.7	0.604
• Interactive	16.3	19.5	10.8	0.146	19.8	10.4	0.10
• Meeting different people	9.0	12.4	3.1	0.054	8.9	9.1	1.0
• Improved communication skills	5.6	5.3	6.2	1.0	6.7	1.1	0.178
• Exposed to different views	3.9	6.3	1.5	0.425	5.9	1.3	0.142
• Social skills developed	1.7	0	4.6	0.047	2.0	1.3	1.0
• Great facilitator	0.6	0.9	0	1.0	1.0	0	0.433
Affective domain
• Became more confident	12.9	12.4	13.8	0.819	10.9	15.6	0.375
• Developed tolerance	10.1	10.6	9.2	1.0	10.9	8.0	0.610
• Learnt to respect/more  open to other views	6.7	8.8	3.1	0.215	11.9	0	0.0013
• Learnt to speak my mind	5.1	7.1	1.5	0.158	3.3	6.8	0.503
• Learnt to listen to others	2.8	3.5	1.5	0.654	4.4	1.1	0.654
• Became more patient	2.2	2.7	1.5	1.0	4.4	0	0.135
• More disciplined	1.1	0.9	1.5	1.0	2.0	0	0.506
• Friendlier	0.6	0.9	0	1.0	1.0	0	1.0
• More considerate	0.6	0	1.5	0.365	1.0	0	1.0
*Self-evaluation	10.1	11.5	7.7	0.606	13.9	5.2	0.078
Cognitive domain
• Better understanding	15.0	9.7	9.2	1.0	9.9	7.8	0.793
• Learning took place	15.0	8.0	12.3	0.428	9.9	9.1	1.0
• Filling in gaps	5.1	5.3	4.6	1.0	7.9	1.3	0.080
• Broader view	2.2	2.7	1.5	1.0	3.0	1.3	0.635
• New ways of learning	2.2	2.7	1.5	1.0	3.0	1.3	0.635
• Clearing up misconceptions	1.7	1.8	1.5	1.0	3.0	0	0.260
• New ways of thinking	1.7	1.8	1.5	1.0	3.0	0	0.260
• Worked harder	1.7	1.8	1.5	1.0	3.0	0	0.260
*Self-assessment	9.0	11.5	4.6	0.174	8.9	9.1	1.0

Notes: Students’ comments were categorized into three domains. Bold p values indicate statistical significance. Underlined p values almost reached significance.

*These were categories largely assigned by the authors in response to student comments. Self-assessment refers to personal traits (e.g. become more of a leader) while self-evaluation refers to the learning context (e.g. identified my shortcomings).

Table 3.  Students’ comments pertaining to some of their experiences in the small-group tutorial during the Nutrition theme

Cognitive domain
A conducive and cooperative learning environment:
• Working as a group … stimulated my thought processes to a higher plane
• Working as a group helped me to understand the content better
• I wouldn’t have coped if I was working alone. Working in a group clarified the confusion I had during SDL
• My group mates were encouraging, nice and cooperative. They would sometimes give tips of how to read and understand something and be able to ‘narrate’ to others
• It's more stimulating, arousing your conscious (in terms of working), thus preventing intimidation/guilt of parasitism
• I learnt a lot of things during feedback sessions and got to acquire a lot of skills and grew as a person
The value of group work in learning:
• I actually learnt a lot, one being that one cannot know it all but need each other's input
• It made me realize that you can learn from other people
• I found I was able to contribute more in a small group (rather than a large group resource session)
• Made friends and felt very useful in my contribution
Affective domain
Personal development:
• I am a real introvert and the fact that we all had to input in our feedback session really got me talking and I actually realized that I am quite friendly
• I used to be a shy person who didn’t really talk, but now I’m getting used to it
• I used to be alone and I had a big problem with my English, even now I’m struggling but it is becoming better
• You get to know and understand different individuals and you are able to tolerate them as well
• I am more patient, interactive and friendlier
• It made me more of a leader than follower
• I realized that I have a wicked sense of humour
Social domain
Diversity and the small-group tutorial—making friends:
• I had an opportunity to befriend many of the classmates who I wouldn’t normally and I made lots of friends
• I made friends. I think the first theme will always be special to everyone because we all came into the group a little uncertain and left a little more confident
• You get to know people you would otherwise never talk to, and that sense of camaraderie never leaves, even in the next theme
Diversity and the small-group tutorial—broadening one's views:
• It allows me to listen to others and accept their opinions and respect them
• I’ve learnt to appreciate other people's views more openly
• I got the satisfaction of having people listen to all my views and opinions
• The varying and diverse views and opinions gave me a broader understanding of various issues
• By so many people airing their views, we were able to look at the situation from a wider view

Table 4.  Reasons offered by seven of the 10 students who did not find the small-group tutorials beneficial (seven mature:three matriculants; five females:five males)

Relating to the individual:
• I am used to group study (n = 2)
• I prefer learning on my own than checking with others later (n = 1)
• I didn’t talk much so didn’t make enough friends (n = 1)
Relating to group processes:
• I made enemies in terms of arguments about some things (n = 1)
• Made me feel uncomfortable and angry at the same time because I feel like I was contributing more to the group and the others were just keeping ideas to themselves (n = 1)
• People in the group remained quiet and did not want to fully examine the ideas (n = 1)

Table 5.  Student comments pertaining to the social aspects of the curriculum, mostly with reference to group work extracted from their ‘most rewarding experience’

Most rewarding experience	% respondents (n = 178)
• Congenial group atmosphere	7.9 (n = 14)
• Cooperative learning environment	3.9 (n = 7)
• Making friends	3.9 (n = 7)
• Meeting different people	2.2 (n = 4)
• Underwent personal development  (e.g. more tolerant)	1.7 (n = 3)
• Exposure to different views	0.5 (n = 1)

Note: Thirty students (16.9%) identified one or more social aspects (21 matriculants:9 mature students; 22 females:8 males) of the theme as their most rewarding experience.

Table

Please spend a few minutes reflecting on your experiences in the Nutrition theme. We need to know how you feel, how you coped and how the theme impacted on you. Please tick (✓) the appropriate box. We thank you in advance for your cooperation
Gender: Female _ Male _	Date of birth: ______
Year matriculated: __	School matriculated: ____
Previous tertiary studies: YES _ NO _	If YES, give details: ____
1. Were you able to cope with the content of the Nutrition theme? YES _ NO _
If NO, explain
2. Were you able to find suitable resource material to answer your learning goals? YES _ NO_
If NO, explain
3. Were you able to manage your time and activities during this theme? YES _ NO _
If NO, explain
4. Were you able to cope with the self-directed learning expected in PBL in the Nutrition theme? YES _ NO _
If NO, explain
5. Did working in a group impact on you as an individual or on your behaviour? (e.g. more tolerant, made friends, etc.) YES _ NO _ If YES or NO, explain______
6. Did the Nutrition theme impact on your awareness of your personal dietary intake? YES _ NO _
If YES, explain
7. Did the Nutrition theme result in any lifestyle changes for you? YES _ NO _
If YES, explain
8. Did the Nutrition theme result in you advising anyone about their dietary habits or their lifestyle? YES _ NO _
If YES, explain
9. What was your most rewarding experience during this theme? Explain_____
10. What was your least rewarding experience? Explain
11. During the theme, you worked out some statistics for yourself. Please indicate if you cannot remember.
Can you remember a. Your body mass?_kg □ Cannot recall
b. BMI? _ □ Cannot recall
c.% body fat? _ □ Cannot recall
d. Total daily kilojoule intake? _ □ Cannot recall