Inductive teaching method–an alternate method for small group learning

Abstract

Background: Different forms of small group interactive teaching have found an increasing role in medical education in the recent past.

Objectives: This study aimed to evaluate the efficacy of topic-based small group tutorials and compare between two such tutorials, the directed tutorial where the tutor takes the initiative and the inductive tutorial which places the initiative on the student.

Methods: Final-year medical students were exposed to alternate sessions of directed and inductive teaching during their rotation in paediatric surgery. For inductive teaching, the topic was announced and the students took turns in asking questions and answering them, the tutor stepping in only when required. The tutor both initiated and guided the discussion in the directed method. Students assessed the tutorials and compared the two learning methods evaluating eight different parameters using a Likert scale. Statistical significance was tested using the Wilcoxon signed ranks test.

Results: Feedback was available from 49 out of 52 students. The tutorials were ranked highly for all parameters studied. The inductive method was better for comfort, interest, memory, inspiration to read more, comprehension and for correlation with previous knowledge (P < 0.05). The directed method was superior for the content covered in a given time (P < 0.001).

Conclusions: The topic-based tutorials were effective. The inductive method by adding a reflective component, appeared to facilitate deep learning. Further research will determine its suitability for formal introduction into the curriculum.

Introduction

Small group interactive teaching has found an increasing role in medical education in the recent past (Vernon & Blake 1993; Jaques 2003; McParland et al. 2004; Landry et al. 2007; Srinivasan et al. 2007). Some studies have found small group tutorials which have mainly been studied in the context of problem-based learning (PBL), to be superior to traditional lectures for deep learning, creating favourable student attitudes and performance in clinical examinations (Vernon & Blake 1993; Albanese 2000; McParland et al. 2004). Concerns with various lacunae in PBL however, have led many academicians to resurrect the case-based method wherein an expert directs the small group to learn in a guided fashion (Shanley 2007; Srinivasan et al. 2007; Tarnvik 2007). While this can overcome the problems with the open enquiry method of PBL, concerns with a lack of defined syllabus and knowledge gaps still remain (Hsu & Ong 2001; Maudsley et al. 2007). We have traditionally used the topic-based tutorials for students rotating to our department. In addition, we developed and introduced the inductive method of teaching to combine the advantages of reflective learning with guided enquiry in a small group teaching scenario. Our study sought to evaluate topic-based small group learning methods. We also describe the structure of the inductive method, an alternate way of small group learning and compare it with a more directed approach to small group learning, the crucial difference between the two methods being in handing over the initiative from the tutor to the students.

Table

Practice points
•Topic-based small group tutorials combine the effectiveness of small group learning with ensuring coverage of a pre-defined syllabus.
•The inductive teaching method, an alternate method of topic-based small group tutorial promotes asking of relevant questions, drawing of information from memory to answer them and reasoning by a process of induction through causal cognition, under guidance from an expert.
•Students rated the topic-based small group tutorials highly for all the parameters studied. The inductive method in addition suggested an increase in deep learning, though it required more time compared to the directed topic–based small group tutorial.

The inductive method was developed on the premise that additional stimulation of student initiative would further enhance the learning experience. The basis for the inductive method is the intuitive theory. This involves a system of related concepts, together with a set of causal laws, structural constraints or explanatory principles that guide inductive inference in a particular domain (Tenenbaum et al. 2006). This process which is intrinsic to human learning is applied to medical learning in the inductive method. In most traditional small group methods, the learning process is directed by the teacher. Students may then follow or build on this initiative.

The inductive method, however, requires the students to take the initiative, ask all the questions and also develop the answers for a given topic. The teacher continues to participate as a facilitator, stepping in to answer when doubts or factual information cannot be correctly resolved by the students.

Methods

Study design

This study sought to investigate the effectiveness of topic-based small group tutorials and compare inductive teaching with directed teaching in the setting of paediatric surgical tutorials. The study was conducted during the academic year of 2007. The study was approved by the Human Research Ethics Committee of the University of Sydney (Ref No 07-2007/10170). Informed consent was obtained from the participating students.

Participants

The first two authors, both with more than 10 years experience in teaching medical students, undertook all the teaching sessions. All student participants were final year graduate medical students assigned by the Clinical School to these two authors, in groups of 6–8, for their paediatric surgical tutorials. A total of 52 students participated in these tutorials.

Description of tutorials

The content for the five 1-hour tutorials and the audiovisual aids provided were standardized for the two tutors. The tutorials were held at weekly intervals. After the initial introductory tutorial where the inductive method was revealed and a working relationship established between the students and their tutor, the inductive and directed methods were alternately employed over the next four sessions. Each group of students received two sessions of inductive and two sessions of directed tutorials. The two tutors taught different groups of students and used both methods to prevent tutor preference from becoming a source of bias during evaluation. For the inductive tutorials, a topic (e.g. intussusception) was presented, and a given time (approximately 15 minutes) allocated for discussion. Any student could ask a question about the topic and the other students in the group would be required to answer it, the teacher stepping in if the explanation was either not forthcoming or incorrect. All students were then given the opportunity to ask and explain, the teacher ensuring that there was no confusion, disparity in involvement or diversion from the topic. In the directed method, the tutor directed the content of discussion for the given topic. At the end of the time allotted for each topic, a series of picture slides were shown summarizing the topic and reinforcing what was discussed for either method. The methodology of the tutorials incorporated most of the recommendations for small group teaching outlined by Jaques and the flexible questioning employed for the inductive method was a modification of the circular questioning outlined therein (Jaques 2003).

Evaluation

A participation information sheet was provided to students which defined the inductive and directed methods of small group learning, provided assurance of anonymity, data protection, responses to the study being de-linked from academic progress and time taken to complete the questionnaire (<10 minutes). At the end of the final tutorial, the students were requested to fill out a questionnaire evaluating the tutorials and comparing between the two methods using a five-point Likert scale. The implied consent in returning the questionnaire was mentioned in the body of the questionnaire. A series of eight statements investigated parameters including interest, memory, correlation with previous knowledge, number of topics covered, comfort, inspiration to read, confidence generated and comprehension of content. ‘Strongly agree’ was coded 5 and ‘Strongly disagree’ was 1. Additional free-text comments were invited from student participants in relation to their perception of the strengths and weaknesses of the tutorials together with suggestions for improvement. As students received additional paediatric surgical input in the form of lectures and teaching during clinical attachments, assessment using examinations was not done.

Statistics

Excel spreadsheets (Microsoft Windows XP) were used to chart the ordinal data and SPSS v15.0 for Windows was used to test for statistical significance using the Wilcoxon signed ranks test with a p value of <0.05 considered significant.

Results

Feedback was available from 49 out of 52 students (94% response rate). The overall responses showed a median score of four for all the parameters evaluated. The inductive method appeared to be better for generating interest (p < 0.001), remembering facts (p < 0.001), providing inspiration to read more (p < 0.001), comprehension (p = 0.03), student comfort (p = 0.006) and for correlation with previous knowledge (p < 0.001) (Table 1). There was no statistical difference between the two methods for confidence generated. The directed method enabled a greater content coverage in a given time (p < 0.001).

Table 1.  Overall evaluation of the topic-based small group tutorials and comparison between the directed and the inductive methods using a five-point Likert scale where ‘strongly agree’ was 5 and ‘strongly disagree’ was 1. (n = 49)

		Comparative responses (teaching method)
		Directed		Inductive
Parameters evaluated in the questionnaire	Overall median response	Median	Range	Median	Range	p-value
Generated interest in the topic	4	4	3–5	5	3–5	<0.001
Facts covered (content)	4	4	2–5	4	2–5	<0.001*
Facts retained (memory)	4	4	2–5	5	3–5	<0.001
A conducive environment for learning was produced (comfort)	4	4	3–5	5	2–5	0.006
Generated confidence in my medical knowledge	4	4	2–5	4	2–5	0.237
Helped me to understand the topics (comprehension)	4	4	2–5	5	2–5	0.034
Inspired me to read more (inspiration)	4	4	2–5	5	2–5	<0.001
Was able to better correlate with what I already knew (correlation)	4	4	2–5	4.5	2–5	<0.001

Notes: Wilcoxon signed ranks test; p < 0.05 significant.

*In favour of directed tutorial; others in favour of inductive method.

Among the written comments, the most common strengths of the inductive tutorial mentioned were the interest (45%) and positive interactions (42%) generated. As one student stated, The inductive tutorials made us think what we need to know, kept us involved and maintained our concentration. It forced us to logically think about information and inference process. The most common weakness mentioned was the limited knowledge about some of the topics hindering the discussion (65%). This was aptly summed up by one student, If you do not know anything about the topic, conversation ends early. The directed tutorials were popular for the structured information given to the students (47%). A student stated, … (directed tutorials) enabled content to be covered comprehensively and logically in a given time … without going off in a tangent. The major weakness of the directed tutorial was the passivity involved (34%). One of the comments read, … could not engage more actively in the learning process … less easier to maintain concentration & focus.

The most common suggestion given was to indicate before hand the topics to be discussed for an inductive tutorial (60%).

Discussion

Basis for study

The last two decades have seen an increasing move away from didactic teaching in medical education to a greater proportion of small group learning (Albanese 2000; Vernon & Blake 1993). In addition to PBL, guided methods of small group learning have been described and espoused by some educational centres (Shanley 2007; Srinivasan et al. 2007; Tarnvik 2007). The small group methods of learning facilitate self-directed and deep learning, clinical reasoning skills and help in social and personal development (Vernon & Blake 1993; Albanese 2000; McParland et al. 2004; McLean et al. 2006; Tarnvik 2007). The guided case methods additionally fill knowledge gaps as self directed learning is guided by an expert (Shanley 2007; Srinivasan et al. 2007; Tarnvik 2007). These methods are all case/problem based, however, and still suffer from the disadvantage of lacking a defined syllabus (Maudsley et al. 2007). The topic-based tutorials ensure that a predefined syllabus is covered. Whereas in PBL or case methods, reasoning and self learning is incorporated into the analysis of the situation vignette, the inductive method promotes reasoning by a process of induction through causal cognition.

Illustration of the inductive method

The advantages of inductive method can be understood in several ways. It does not require prior preparation for the tutorial. Students however expressed a desire to voluntarily prepare for the tutorials in our study. The facilitator is always an expert in this method so that the discussion can be meaningfully directed and gaps can be filled. For example, when ‘intussusception’ is presented as a topic for discussion, a typical pattern of questions asked by the students is something like What is it?, What age-group is it common in?, Are there pre-disposing factors for it?, What are the clinical manifestations?, What complications can it cause?, How do you diagnose it?, What are the treatment options?, What is the long term prognosis?. At times the questions may be haphazard or incomplete. Students may not also know all the answers to the questions they raise and the tutor then steps in to fill the gaps in knowledge. Nevertheless, students gain the opportunity to ask questions about the given topic within the frame of the inductive tutorial in a given time. This enables them to prioritize the information which they need to know, thereby aiding their clinical reasoning skills. Answering questions prompts them to draw upon the information already possessed and verbalize it. Very often, even when the answers to the questions are not known, students can, through a process of causal cognition arrive at the required information. Causal cognition is at the heart of inductive learning. When students know one aspect of a disease condition, they can, through an inductive process build knowledge of the clinical presentation, the complications and the possible treatment. This is aided by the fact that being final-year medical students, they have a working knowledge of disease pathogenesis, clinical manifestations and treatment concepts in general. It is not difficult for a final-year student to ‘induce’ that mechanical obstruction and bowel ischaemia follow a telescoping of one part of the bowel into another in intussusception and that vomiting and bloody stools are the respective sequelae of mechanical obstruction and bowel ischaemia. That dehydration follows and fluid resuscitation is required is easily understood by the student. The logic of non-operative reduction of intussusception failing which surgery is performed is again induced by the student. The process of asking relevant questions, drawing of information from memory to answer them and making inferences based on what is already known under guidance from an expert in a given time makes the inductive tutorial effective, more so for final-year students who have a baseline knowledge to which further information can be added. It remains to be seen how well this method can be adapted to students early in their course.

Interpretation of findings

The overall high scores in the assessment of the topic-based small group tutorials indicate the necessity of refocussing on the topic-based methods in the current post PBL scenario (Tarnvik 2007). The inductive method retains the reflective element introduced by the PBL, though in a topic-based scenario. Comparison between the inductive and the directed methods indicates the superiority of the former for deep learning but it falls short in terms of time constraints. The potential superiority of the inductive method in generating interest, aiding memory, comprehension and correlation leading to deep learning can be understood as sequelae of learning through induction. The inspiration to read more can be understood by the sense of inadequacy created when the situation demanded the asking or answering of questions about a topic of which little was known. Failure to find any difference in the confidence generated may possibly be explained by the positive trend when students were able to build up a discussion being offset by the negative trend when they were not able to do so. At times the students found the line of discussion during the inductive method confusing because it was initiated by students with a limited knowledge of the subject. It was far more orderly when the tutor guided the discussion. This may explain the less obvious difference in the comprehension component. Student comfort increased during the inductive sessions probably because the students felt the freedom to discuss and learn with their peers. The limitation of the inductive method was the decreased number of topics covered in a given time as compared to the traditional method. The evaluation in this study was based on student opinion and not on formal examination of the students. Further research with randomized groups receiving either directed or inductive teaching with examination to test knowledge base may provide a more formal evaluation of the inductive method of learning.

Conclusions

Our study suggests that the topic-based small group tutorials can be effective. The inductive method, in addition gives a reflective flavour to these tutorials, promoting deep learning and hence would warrant consideration as an enhanced teaching methodology.

Acknowledgements

We acknowledge the support by the participating students, Cornelis Biesheuvel, Hospital Statistician, The Children's Hospital at Westmead (CHW).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Notes on contributors

Vinci S. Jones

VINCI S JONES, MBBS, MS, MCh, is a Fellow in transplant and general paediatric surgery at CHW and is also a lecturer of the University of Sydney.

Andrew J.A. Holland

ANDREW GA HOLLAND, BSc (Hons), MBBS, FRCS, FRACS, PhD, Grad Cert Ed Studies (Higher Ed), is an Associate Professor of Paediatric Surgery at CHW and is also the Director of the Burns Institute at CHW.

Wendy Oldmeadow

WENDY OLDMEADOW, MEd, is a Lecturer in Education at the Clinical School at CHW.