Learning in small groups

An extended summary of AMEE Medical Education Guide No 8 by Joy Crosby

    This guide explores the arguments that support the movement towards small group learning, the many benefits from small group activities and the different types of small group methods. Students working in small groups interact in a variety of ways and the teacher has an important role to play. Barriers, more often perceived than real, may impede the adoption of small group teaching. Practical guidance is offered on why to adopt small group work and how to do it effectively. The teacher is provided with a framework for what to consider before, during and after the small group activity.

    What is small group learning?

    Small group learning is the learning that takes place when students work together usually in groups of 10 or less. Some groups may work effectively with a larger number of participants. What matters is that the group shows three characteristics.

    1. Active participation: A key feature of small group work is that interaction should take place among all present.
    2. A specific task: There should be a clearly defined task and objectives, and they should be understood by all members of the group.
    3. Reflection: In small group learning, it is important to learn from an experience and to modify behaviour accordingly. Deep learning is a key feature of small group work: reflection is a key feature of deep learning.

    Why is learning in small groups important?

    • Small group work is important in medical education. It is an effective method of learning.
    • It provides students with experience of working in a group, it helps them to acquire group skills. These include the ability to communicate effectively, the prioritising of tasks, the management of time and the exercise of interpersonal skills.

    The benefits of small group learning

    Small group teaching has many advantages to offer the learner:

    • Self direction and active learning: Small group work encourages students to self-direct their own learning. It encourages reflection upon and control of learning activities and development of self-regulatory skills conducive to lifelong learning.
    • Self-motivation: Small group work, by encouraging the students’ involvement in the learning process, leads to increased motivation and more efficient learning.
    • Exploration of issues: Small group work allows students to test their thinking, to explore issues together and to test out hypotheses in a way that is not possible in, for example, a lecture.
    • Deep learning: Small group work encourages deep learning and higher-order activities - eg, analysis, evaluation and synthesis.
    • An adult style of learning: Acceptance of personal responsibility for their own progress and direction of learning is important in professional education. This is encouraged by small group teaching methods.
    • Transferable skills: Transferable skills, such as leadership, teamwork, organisation, prioritisation, encouragement to others, problem solving, and time management skills are encouraged through group work.

    Perceived problems of learning in small groups

    The introduction of small group work into a curriculum is frequently resisted. Various arguments are used.

    • “Students do not like small group work”: Initial dissatisfaction with small group work may be expected and is natural. Barriers may be:
      • Perceptual - The student may not perceive the value of small group work.
      • Cultural - Students may be used to being told what to learn and how to learn it.
      • Emotional-motivational - In small group teaching, the student takes responsibility for his or her own learning.
      • Intellectual - Students may not appreciate that learning is ongoing. Previously, emphasis may have been placed on passing tests of superficial knowledge rather than on deep learning.
      • Environmental - The student’s environment may discourage the adoption of some ways of learning.
    • “Staff do not know how to teach in small groups”: Teachers may lack the skills necessary for running small group sessions. This may be seen as more of a problem by course or curriculum organisers than by teachers themselves. A staff development programme, however, is important.
    • “We do not have enough teachers for small group work”: Staff shortage may be a real issue - or may be a misconception. The small group method adopted and the timetabling both have a significant impact. Identify all the staff who could be available for small group teaching.
    • “There are too few rooms”: Space is frequently a contentious issue. Creativity is usually the best solution. Do not be afraid to experiment - students are resilient.
    • “It is a waste of time - students do not learn anything”: It may take longer to cover a topic in small group work than in lectures. However, what really matters is if, and what, students learn and not just what is taught.

    Some small group methods

    A variety of methods can be used with small groups and these include:

    • The Tutorial: Tutorials let teachers check the progress of, encourage and guide students. The group discusses material already covered or previously assigned. For tutorials to work, students must take responsibility for preparing material. Tutorials let students critically probe the subject matter. They allow students to clarify and expand on material.
    • The Seminar: The teacher negotiates with students a piece of work for the students to present. All students prepare the material, then it is presented to the group by one or more students and feedback is given. The seminar promotes research ability, presentation skills and critical discussion.
    • Snowballing: The teacher assigns to pairs of students prepared stimulus material on a topic or issue. The pairs discuss a topic or issue and each pair then joins with another pair. The process is continued until the whole group meets together. Snowballing allows clarification of ideas and values. It is especially useful for students and the teacher to determine the level of the students’ development and understanding.
    • Free-discussion group: The teacher introduces stimulus material which the group discusses. The teacher facilitates the discussion, which should range freely within the topic area and then summarises the discussion. The free-discussion group is intended to foster interaction and exploration of values and feelings.
    • Problem-based learning: Problem-based learning follows a simple cycle, the role of the teacher varying with each stage of this cycle or seminar. The teacher is responsible for generating a problem and making it available to the students. The students establish the learning needs raised by the problem. The students then undertake self-directed study and a critique of the learning needs. In follow-up sessions the group meets to discuss the material studied and to summarise and integrate the learning. Finally the group, facilitated by the teacher, meets to draw generalisation and conclusions.
    • Brainstorming: Brainstorming has a three-step sequence (1) the group generates ideas on a topic usually selected by the teacher; (2) the group then clarifies the ideas and categorises them, (3) finally the students evaluate the ideas and summarise their conclusions. Brainstorming may form the first stage of a problem-based learning session, when the learning issues are identified.
    • Role play: In role play the students take on various roles and enact a scenario usually chosen by the teacher. The teacher negotiates or selects which student plays which role. Role playing is particularly valuable in exploring communication issues and attitudes.
    • Games and simulations: The teacher introduces a game to the students, explaining the rules. The game is designed to simulate reality and encourages the effective transfer of procedural skills. After the game, a debriefing session clarifies what has been achieved. Computer-based simultations are increasingly available.
    • Clinical teaching: Teaching of students in small groups in the clinical setting remains the cornerstone of medical teaching. It is frequently conducted around patients’ bedsides or in the ambulatory setting. Clinical skills centres are growing in popularity: these reproduce the clinical environment through the use of simulated patients and models.

    Implementing effective small group work:

    The following checklists have been generated for running small group work.

    Prior to the small group activity:

    1. Consider the objectives of the session: Consider carefully the objectives of the session or course you are running and whether other teaching methods, eg lectures, independent learning, may be more appropriate.
    2. Determine your available physical resources: Accommodation availability may be a limiting factor. Small groups require suitable accommodation, which allows chairs to be set out in a circle to maximise interaction among the students, and space for appropriate audio-visual materials.
    3. Determine the manpower availability: Small group teaching requires the participation of a larger number of teaching staff. Consider carefully how many teachers are available and their expertise as small group facilitators.
    • Does a facilitator have to be an expert? For small groups to function most effectively, the facilitator should have expertise in the content area and in small group facilitation.
    • Can different facilitators be used with the one group? Continuity of the facilitator is desirable. The facilitator can be considered as a member of the group and changing the composition of the group may disrupt the group dynamics.
    • Can a teacher facilitate several groups? A floating facilitator can be assigned responsibility for maintaining the task and function of more than one group. Success varies, frequently depending on the dynamics of the groups and the skill of the facilitator.
    • Can a student facilitate his or her own group? A student can successfully facilitate a peer group. This depends on the group’s dynamics, on the student’s ability and on the briefing given to the student.
    • Determine the group membership: Groups may be self selected, strategically determined, randomised, or selected alphabetically. It may be appropriate to change the membership of a group after a designated period of time, eg semester or year. Groups will work less productively if constantly changed, as they are less likely to reach a productive stage.
    • Ensure that the staff is prepared for the session: Staff must be given detailed briefings for the small group work. They should have prior opportunities to see small group work in action and to attend staff development sessions.
    • Select the most appropriate small group method: The educational objectives should determine the choice of small group method.
    • Develop stimulus material: Stimulus material might include problem-based scenarios, video clips, a set of questions, key articles for exploration, a real or simulated patient. The stimulus material required will be determined by the small group method adopted.
    • Inform students about the role of the small group work: Students should be informed why small group work is being adopted and how it relates to other activities and to the learning outcomes for the course.

    During the Small Group Activity:

    1. Allow adequate introductions - use ice-breakers if necessary: Ice-breakers are a brief activity that relaxes and introduces the members of the group. Establish ground rules to help students to feel secure in the educational climate.
    2. Ensure that the students understand what to do, why they are doing it and how they should achieve it.
    3. Facilitate learning: The facilitator’s objective is to help the student become more self-reliant and independent by establishing a climate that is open, trustful and supportive. An educational facilitator’s role has two distinct areas: maintaining the functioning of the group and ensuring the task is completed. Facilitators must understand the changing dynamics of a group through four stages: forming, storming, norming, and performing.
    4. Debrief the group on the activity: Debriefing summarises or clarifies what has been learnt and may take as long as the activity itself. During debriefing, constructive feedback may be given.

    After the Small Group Activity:

    1. Evaluate the success of the session: There are two aspects - achievement and quality. Have the objectives been achieved? Was the educational experience of a high standard? Students may be asked to complete an evaluation questionnaire. Alternatively, the session can be peer reviewed. Teachers should consciously self-evaluate the session.
    2. Reflect on the experience: Evaluation, formal or informal, is pointless if no change in practice results.


    Small group methods have a valuable role to play in undergraduate medical curricula. The student-centred focus and active participation enhance the likelihood of deep rather than surface learning. Decisions to be made are how much time to schedule for small group work, and what kind of small group work to adopt. If small groups are used, they must be valued and must not be seen as isolated from other aspects of the curriculum - or from the culture of the medical school. Staff and students must fully appreciate the process of small group work - including its aims and intended outcomes. Staff development is important. Success of small group learning depends on good planning, effective facilitation and a movement away from teacher-centred learning. For a real and sustained shift in medical education, students must be encouraged to learn rather than merely catching the output of teachers.

    Further reading on the topic:

    Jacques D (1986). Learning in Groups. Second Edition. London, Kogan Page

    Tiberius R G. (1990). Small Group Teachers: A Trouble Shooting Guide. Town, publisher

    © 2002 AMEE

    The full text of this guide comprises 33 pages and 31 references and is available from:

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