Small groups

I am fresh from a week of watching comedy shows at the Edinburgh Fringe and it made me think of my earlier post about successful presentations to larger groups and how some of this “success” relates to being a performer, even though the size of some of the Fringe venues were about the size of my bedroom and had space for a large small group only!  Certainly the comics were very well prepared – down to the smallest “ad lib” – but these sessions also highlighted to me the differences between speaking to groups and “facilitating” a group (both in purpose and aims).

If you explore the literature you will find that much of it refers specifically to Problem Based Learning (which I experienced as a medical student) and which has quite specific criteria for how groups function.  Despite the many years of PBL, studies on outcomes are still variable which demonstrates how difficult educational research is.  On the other hand, financial stringencies are moving some schools back to lectures, larger small groups or onto online options.  Given this, it would be good to know what we might be losing.

In immediate evaluations registrars in vocational training often rate small groups highly but this may also be because of the added value of interpersonal contact, debriefing, support and so forth, in addition to educational “effectiveness”.

Groups can serve many purposes

They aren’t generally for delivering information but they can function as tutorial groups following on from lectures (undergraduate model) but in post grad training they often function as a framework for case discussion, topic exploration or debriefing. They can be part of Flipped Classroom models. The dynamics of a small group can be used to enhance educational value.  As an educational method, the small group requires more listening and drawing out and sometimes it requires ad hoc changes in direction in response to group needs.  A small group may have a joint purpose and be more than the sum of its individual parts. The facilitator assists the group to achieve their purpose and often feels more responsibility for the development of each member of the group. In addition to the acquiring of information, there is a package of benefits – don’t underestimate the power of social interaction.

group chairs

How hard is it to run a good small group?

Some institutions seem to mistakenly believe that being a health professional automatically qualifies you to run groups but skills are required.  I have to confess that when I trained initially as a social worker, I opted for “casework” over “groupwork” as I much preferred the one-to-one interaction and that probably remains true.  However, that is in a therapeutic rather than educational context and small groups do appear to be powerful tools in medical education.  I find it a pleasure to observe educators with skills (natural or acquired) facilitating groups in a more effective way than I know I do myself.  Registrar comments easily identify what not to do when running a small group – be condescending, fail to contain domineering members, appear unprepared.  I have run groups at all levels and the good thing about registrar groups is that they are very motivated (although sometimes more critical) and generally have good background knowledge. You are often consolidating and applying knowledge rather than just passing it on.

What works best? 

Groups are easier if the members are known to you, as has often been the case in my experience.  It is more difficult if you are parachuted into a workshop situation and told to “facilitate” a random group. This is not really best practice.  Numbers are important and most of the literature agrees on somewhere between five and ten – with minimal hard evidence. Facilitator or not?  This depends very much on the topic and the level of experience of the members.   Registrars often like an educator to be there as a resource but if this is not possible then it is a good idea to have a clear structure for the discussion

Hints for running a small group

  • Set ground rules if need be (and the goals of the group discussion to avoid disappointed expectations)
  • Assign roles to encourage engagement (scribe, timekeeper, facilitator, resource finder)
  • Have a good structure with appropriate resources on hand
  • Utilise member skills if you know the background of your group members eg If you have a reproductive medicine topic defer to someone who has just done a year in obstetrics
  • You can use some similar methods to larger groups (ice breaker, split into pairs)
  • You can’t be an expert on everything and members should be thinking for themselves, so feed questions back to the group
  • Involve everyone. Look out for quiet members and use strategies to quieten the overly noisy contributors.  Have some prepared questions to direct to individuals.
  • If you utilise more senior learners to facilitate groups they need to feel they are also learning and not just being used.

waterfallSmall groups can have many side benefits.  They enable you to get to know students better, to flag those who are struggling in various ways and to encourage further specific learning.  However, these are often seen as intangible benefits when institutions consider the cost efficiency of various methods. It is a meaningful challenge to think how you might evaluate different educational methods.

Practice Based Small Group Learning (PBSGL)

I thought it worth mentioning this interesting approach which has been used for many years in Canada for continued professional development.  It has subsequently been adapted for use in the UK (and particularly Scotland).  It is an interesting way of organising nationwide CPD with some uniformity of topic and approach although it does involve fees.  It has also been implemented in GP Training in Scotland and I was able to sit in with one of these small registrar groups in Aberdeen a few years ago after prior discussions on email with the organisers.  It is obviously a relatively economical approach and I would think it would be very appropriate for more senior registrars.  It provides structured cases and resources on pre-determined topics.  If you are interested have a look at

I would love to see the Colleges consider this for CPD.

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