One often learns far more from one’s struggles and challenges than from successes which is why I look back on this past academic year as an excellent learning opportunity.  I have now taught at the medical undergraduate level for four years and I have never needed to deal with such a varied group of learners with different learning needs and desires.  Every previous group independently came together to set a tone on their own.  Generally unconsciously the group would gel and develop a consensus on the level of preparedness, the level of seriousness and the level of focus. This group did not go through the stages of group formation¹ and never reached that consensus.    My natural desire is to spend time outside the curriculum and bring my personal experiences and reflections to the group for discussion.  Personalities that reflected my own tended to dominate the group tone.  It is my belief that learners that wanted a more structured and prepared group organization did not have a significant voice in the group dynamic and interpreted the relax structure of the group as a poor learning environment.  It took half the year to receive honest feedback and attempting alter this tone mid-year is difficult.   I believe constructing a group charter at the mid-year point improved the situation but it was too late to create an environment that everyone wanted.  It was difficult to resolve the difference of opinions of those who wanted everything to change vs those who wanted everything to stay the same.

At the end of this year the view of my medical students in general is different.  While they share many characteristics of adult learners, many of Knowles’ assumptions² of andragogy break down.  Medical education is different than most learners’ prior structures and it is difficult for them to draw upon these experiences to provide self-direction.  They come into medical school as laymen with a self-concept of independent learner based on a field often with little clinical relevance.  Given this, I think one of my primary roles as a group facilitator and teacher is to set the tone rather than acquiescing this responsibility.

I feel the lessons contained within Team Based Learning³ and its robust utilization of the reverse classroom represent an ideal framework for creating a beneficial learning environment.  Increasing learner self-preparation will lead to more opportunities to build on their knowledge base.  I think my learners would benefit from high expectations and expectations to be pushed to grow.   Lastly increasing learner self-preparedness will give time for mentoring conversations without taking away from core content.

The tone should be set openly on the first day with a negotiation on group dynamics by forming a team charter.  This is the first draft of what I will propose for the group.  My primary worry about using this methodology is it will increase learner stress, but I think they will ultimate appreciate the approach as they will get more out of the year.

1. Tuckman BW, Jensen MAC. Stages of Small-Group Development. Gr Organ Stud. 1977;2(4):419-427.
2. Taylor DCM, Hamdy H. Adult learning theories: implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach. 2013;35:e1561-e1572. doi:10.3109/0142159X.2013.828153.
3. Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team-based learning: A practical guide: AMEE Guide No. 65. Med Teach. 2012;34(5):e275-e287. doi:10.3109/0142159X.2012.651179.