The Effect of Faculty Presence on Small-group Learning and Group Dynamics in a Family Medicine Clerkship Miriam Hoffman, MD; Joanne Wilkinson, MD; John Wiecha, MD, MPH; Jin Xu, BS Department of Family Medicine Boston University School of Medicine

Outline Background Background Brief literature review Brief literature review FM Core Curriculum, Rationale FM Core Curriculum, Rationale Methods Methods Results Results Future directions Future directions

Small Group Learning Is it better? Is it better? Why? How do we know? Why? How do we know? What type of small group learning? What type of small group learning?

Literature Review PBL; Preclinical years PBL; Preclinical years Questionnaires, focus groups Questionnaires, focus groups Have assessed: Have assessed: Group learning process Group learning process Preference Preference Evaluation/assessment of the group experience Evaluation/assessment of the group experience Learning outcomes Learning outcomes

Literature Review Outcomes Outcomes Peer-led discussions similar to teacher-led (performance, highly rated) Peer-led discussions similar to teacher-led (performance, highly rated) Role of the faculty Role of the faculty Active faculty -> better satisfaction and board scores, perception by students of teacher’s importance Active faculty -> better satisfaction and board scores, perception by students of teacher’s importance What makes a good group from process/dynamics standpoint? -> Faculty member ranked lowest (Willis) What makes a good group from process/dynamics standpoint? -> Faculty member ranked lowest (Willis)

Role of the faculty – group dynamics and group learning process Teachers were responsible for 93% of the interactions which resulted in a teacher-dominated discussion (Jaarsma 2009). Teachers were responsible for 93% of the interactions which resulted in a teacher-dominated discussion (Jaarsma 2009). Student-led groups took short cuts through the cases. This may undermine the development of complex problem-solving skills (Steele). Student-led groups took short cuts through the cases. This may undermine the development of complex problem-solving skills (Steele). Students may be relying on the teacher to provide the right answer, rather than participating in the group process and interaction (Jaarsma 2008). Students may be relying on the teacher to provide the right answer, rather than participating in the group process and interaction (Jaarsma 2008).

Preference Both students and faculty prefer PBL or small group based learning (even in less clinically oriented courses). Both students and faculty prefer PBL or small group based learning (even in less clinically oriented courses). Faculty perceptions  concern about amount of faculty time (Mayo). Faculty perceptions  concern about amount of faculty time (Mayo).

BUSM Family Medicine Clerkship 6 week third year clerkship 6 week third year clerkship Clinical placements throughout New England Clinical placements throughout New England Core curriculum Core curriculum Online Clerkship Online Clerkship

Core curriculum 4 didactic days at BUSM 4 didactic days at BUSM Small Groups, SP’s, Geriatrics, Grand Rounds Small Groups, SP’s, Geriatrics, Grand Rounds McQ and Rivera families McQ and Rivera families Small group, SP’s, online video, final OSCE Small group, SP’s, online video, final OSCE Small groups Small groups Paper cases Paper cases Student-run discussion Student-run discussion Faculty facilitator Faculty facilitator

Differing dynamics and discussion levels between groups Point in the year; outliers within the group Point in the year; outliers within the group Prior rotations Prior rotations Personality types Personality types Student interest and buy-in Student interest and buy-in Nature and content of a particular case Nature and content of a particular case Faculty member Faculty member

Our Instrument Most items derived from 2 validated tools, including the GCQ-S Most items derived from 2 validated tools, including the GCQ-S Assessed: Assessed: Group learning process Group learning process Group dynamics Group dynamics Role of the faculty Role of the faculty Student preference Student preference Participation Participation

Implementation students per block students per block Divided into 2-3 small groups with 1 faculty/group Divided into 2-3 small groups with 1 faculty/group 2 surveys completed per session (intervention and control) 2 surveys completed per session (intervention and control) Scripted instructions, standardized timing Scripted instructions, standardized timing Cases rotated Cases rotated Paired t-tests Paired t-tests

Results – Group dynamics and Group Learning Process Group dynamics and group learning process were significantly better, with more student discussion and participation, during cases in which the faculty member was absent. Group dynamics and group learning process were significantly better, with more student discussion and participation, during cases in which the faculty member was absent.

The group and its members…. Faculty Present (n=114 Faculty Absent (n=114) p …helped each other to express their ideas and feelings …utilized the knowledge of students in the group <0.01 …the members challenged each other in their efforts to sort things out …utilized the knowledge of the facilitator <.001 …depended upon the faculty leader for direction <.001 The group discussion was chaotic and disorganized

Results – Participation and Preference Better self-reported participation after “out” cases. Better self-reported participation after “out” cases. Students felt fairly neutral with respect to preference for faculty presence/absence. Students felt fairly neutral with respect to preference for faculty presence/absence. But after “in” cases – students felt more strongly that they prefer having faculty present. But after “in” cases – students felt more strongly that they prefer having faculty present.

Faculty present (n=114) Faculty absent (n=114) p Rate your participation level I felt comfortable speaking during the student discussion I prefer to have faculty present during the entire discussion of this case <0.001 * Items are on a 5 point likert scale: 1 = minimal / strongly disagree; 5 = most possible / strongly agree

Results – Preference and Case Content/Success Indicators of student preference and student perception of success of the case show that students feel more dependant on the faculty member after an “in” case. Indicators of student preference and student perception of success of the case show that students feel more dependant on the faculty member after an “in” case. However, after “out” cases, they felt that the faculty member was not essential to the success of the case, and after “in” cases, they felt only minimally that the faculty member was essential. However, after “out” cases, they felt that the faculty member was not essential to the success of the case, and after “in” cases, they felt only minimally that the faculty member was essential. They felt they got the same amount out of the case after both “in” and “out” cases. They felt they got the same amount out of the case after both “in” and “out” cases.

The group and its members…. Faculty present (n=114) Faculty absent (n=114) p Arrived at a reasonable management plan for this case The faculty member was essential to the success of this case discussion <.001 I feel I got the most I could out of the discussion of this case Considered psychosocial issues in the management of this case

Summary of Findings Better group dynamics, group learning process, and participation with faculty absent. Better group dynamics, group learning process, and participation with faculty absent. Students feel somewhat dependant on faculty, more so when the faculty is present. Students feel somewhat dependant on faculty, more so when the faculty is present. But students do report similar case success after both “in” and “out” cases. But students do report similar case success after both “in” and “out” cases.

Future Let them fly! Let them fly! Learning outcomes Learning outcomes Depth of discussion Depth of discussion Change teaching modalities Change teaching modalities Redistribute faculty time Redistribute faculty time Training and evaluation of team-working abilities Training and evaluation of team-working abilities

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