Learning and teaching in small groups: characteristics, benefits, problems and approaches

Small group learning may be defined as a group of learners demonstrating three common characteristics; active participation, a specific task and reflection. This article provides an overview of small group learning and teaching, describes the characteristics of this form of small group work, benefits, problems, potential causes of less than optimal sessions, and summarises specific approaches. These include tutorials, free-discussion groups, brainstorming, snowballing, buzz groups, paired (or one-to-one) discussion, clinical teaching, simulations, seminars, plenary sessions, problem-based learning, team-based learning, role plays, games and IT approaches. The article concludes with an emphasis on the importance of the teacher and a check list for use when planning, teaching and evaluating a small group session.     

The computer as a teaching aid: with particular reference to anaesthesia

Computers have been used by a few anaesthetists for teaching purposes for a number of years. Well constructed programs have the capacity to realistically present material which would not be available by other teaching methods. The advent of small portable computers has made this powerful teaching aid potentially available to a much larger group. It is likely that computer aided learning has a significant future in anaesthetic training and, in particular, for continuing medical education.     

SMALL BOWEL OBSTRUCTIONS: THE CASE FOR INVESTIGATION FOR OCCULT LARGE BOWEL CARCINOMA

Over the last century, the incidence of adhesive small bowel obstructions has increased as the rate of operative management of abdominal conditions has risen. Concurrently, the rate of colonic cancer has also increased. One of the ways in which colonic cancer may present is as an isolated small bowel obstruction. Three cases of resolving small bowel obstruction secondary to occult carcinoma are presented and a survey of the literature is made. The conclusion is that all patients who present with a small bowel obstruction, which resolves, and who are in the cancer age group should be investigated for colonic cancer, especially when the putative causative operation was carried out some years previously; otherwise, large bowel tumours presenting as an isolated small bowel obstruction may pass undiagnosed.     

Computer-assisted learning in the teaching of anaesthesia

A comparison of computer-assisted learning and small tutorial group teaching was carried out in the instruction of final year medical students in anaesthesia. The scores attained by fifteen of the sixteen students were higher after computer-assisted learning than after small group teaching. Statistical analyses of the results demonstrated that in this study computer-assisted learning was significantly better than small tutorial teaching.     

Evidence for a link between mortality in acute COPD and hospital type and resources

BACKGROUND: The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme. METHODS: Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients. RESULTS: Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9-19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources. CONCLUSION: Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit.     

小肠移植后肠管早期吸收功能的研究

目的探讨小肠移植后早期移植肠管吸收功能状况。方法采用改良的Ｍｏｎｃｈｉｋ法施行大鼠节段性原位小肠移植。分为对照组（ＷｉｓｔｅｒＷｉｓｔｅｒ）和排斥反应组（ＢＮＷｉｓｔｅｒ）。移植后定期测量体重、血糖吸收值及病理组织学检查。结果麦芽糖吸收试验显示各组在移植３０分钟后血糖吸收值明显下降（Ｐ＜０．０５）,然后逐渐恢复;急性排斥反应发生时,与对照组相比血糖吸收值明显下降（Ｐ＜０．０５）。病理学检查再灌注后肠管粘膜呈再灌注损伤性改变;急性排斥反应组于移植后４日前与对照组相同,之后逐渐出现粘膜层炎性细胞浸润、肠管淋巴结肿大、结构破坏。结论小肠移植后早期,移植肠管存在着吸收功能,由于再灌注损伤,吸收功能低下。移植后１周左右肠管吸收功能基本上得到恢复。     

社区护理课程系统教学计划的实施

目的改革社区护理的教学设计并探讨其实施效果。方法将2007级大专护生分为实验组(n=48)和对照组(n=46),对照组采取课堂讲授法,辅以案例分析、课题报告等方式帮助学生巩固所学知识;技能课以老师示教-学生练习-老师指导程序教学。实验组采用经教学系统设计后的教学模式,由课题组及授课教师从教学目标、教学内容、教学方法、教学评价等方面进行系统的教学设计,据此实施教学活动。结果实验组社区护理理论、技能成绩显著高于对照组(P<0.05,P<0.01)。结论系统的教学设计有利于提高学生的学习兴趣和解决实际问题的能力。     

Modern ways to enhance surgical teaching skills

Extrinsic pressures are influencing ways in which medical students and trainees learn, and are taught surgery and surgical principles. As a surgical educator it is useful to understand some of the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.     

Team-based learning methods in teaching topographical anatomy by dissection

Background: While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described. Methods: In the recently reintroduced 7‐week elective anatomy by whole body dissection course for senior medical students at Sydney Medical School, team‐based learning (TBL) principles were used in the course design and implementation. In the 2011 course, 42 senior medical students participated. The effectiveness of TBL pedagogy was assessed by knowledge acquisition and retention and by administration of a questionnaire to evaluate the impact of the principles of this pedagogy. Results: The course produced a marked increase in topographical anatomical knowledge. The median pre‐course assessment score was 9/20 (interquartile range 5) and the median post‐course assessment score was 19.5/20 (interquartile range 1.75). The difference was statistically significant (P < 0.001). There was near universal agreement by students that five key principles of TBL (small groups, instructor selected allocation to groups, regular assessments, inter‐ and intra‐group competitiveness, and prescribed out‐of‐class preparation), contributed to this knowledge acquisition. Conclusion: The application of TBL methodology to teaching human anatomy by dissection enables a large group of students to have small group experiences without a large number of teachers. It results in effective acquisition of topographical anatomical knowledge and appears to provide better acquisition of such knowledge than the previous methods of anatomy teaching to which these students had been exposed.     

Chirurgische Forschung in den Niederlanden Holländische Erfahrungen mit klinischen Studien in der Chirurgie

A large number of good surgical studies have been published in The Netherlands, putting the country at the top of the list in the Western world. It is remarkable that the highest productivity was found in small countries and in countries with a low population. Most of the large European countries have a low scientific output according to the method used in the present study. The Scandinavian countries, Holland, and Switzerland have the best scientific index according to these results. It could be that the larger countries, such as Germany, Italy, France, and Spain, tend more to publish in national journals. Perhaps it is not common in some some countries and regions to publish data in English--which certainly has a negative effect on the scientific index of such a country. The high productivity found among Dutch surgeons could be explained by the fact that the 700 surgeons in a small country with a relatively high population are well organized: Almost all Dutch surgeons are members of the national surgical society. All of them can speak and write English very well. Participation in the activities organized by the national society is high. Scientific meetings where surgeons and assistants get together for a day or two are held twice a year. In addition quality controls are carried out at all teaching and nonteaching hospitals. Through this the surgeons in this relatively small country know each other quite well, which promotes cooperation when studies are undertaken. The Netherlands is just large enough for relevant clinical studies to be conducted and it may be that we initiate a relatively large number of such studies. It is a democratic country in which surgeons and researchers are offered the freedom and opportunity to conduct research and publish their results as they like without being hindered by hierarchic structures. Together, these factors create a scientific climate in The Netherlands which stimulates the organization of multicenter and clinical studies.     

An evaluation of the value of group education in recently diagnosed diabetes mellitus

Diabetic patients have a 12% to 25% lifetime risk of developing foot complications leading to significant morbidity and mortality. The objective of this study was to assess the effectiveness of group education in improving patient awareness of foot care. The authors evaluated the effect of group size and areas in which knowledge seemed to be most affected. Patients attending a 2-hour teaching session between November 2005 and March 2006 were recruited. Patients filled in an 18-part questionnaire before and after the teaching session to assess knowledge. Fifty-nine patients recently diagnosed with diabetes mellitus or foot complications were recruited for 7 sessions. Analysis of the data showed a statistically significant improvement in foot care knowledge after the teaching session compared with before (69% to 85%, P < .001). Patients in the smaller group (n < 10) had significantly higher scores compared with the bigger groups (n > 10; P < .025). These data show the benefit of group education about foot care for patients with diabetes. Smaller groups benefited more than larger ones did, which could be attributed to the sizes allowing for better interaction between the tutor and patient. As patient knowledge is variable from individual to individual, smaller teaching sessions may allow patients to address specific concerns.     

基于小规模限制性在线课程的急危重症护理学教学改革

目的探讨基于小规模限制性在线课程的急危重症护理学教学改革及效果。方法将2012级护理本科生按照班级随机分为对照组68人和观察组66人。对照组《急危重症护理学》采用传统教学法,观察组采用基于小规模限制性在线课程的教学改革,构建网络平台,设立5个学习模块,借助网络资源结合传统教学,采用线上线下混合式在线教学模式。结果课程学习结束时,观察组课程结业理论考试成绩显著优于对照组;临床急诊ICU实习结束,观察组护生临床实践自评显著优于对照组,临床带教老师对护生的实习评价(除师生关系融洽外)显著优于对照组(均P0.01)。结论基于小规模限制性在线课程的急危重症护理学教学改革,有利于提高学习效果及培养护生急救综合素质。     

Teaching on the run: teaching skills for surgical trainees

BACKGROUND: Increasing recognition of the need for training in teaching skills for clinical teachers has coincided with data that registrars and residents conduct much 'on the job' teaching as part of their routine work. While attention has been devoted to training consultants, support for the teaching role of the junior staff has been relatively neglected. The aim of the present report is to describe the teaching experiences of surgical registrars and the impact of a registrar teaching workshop. METHOD: A half-day programme combining presentation and discussion of surgical teaching with practical skills sessions was designed for surgical registrars at Prince of Wales Hospital. The programme included observation and feedback of brief teaching simulations at the bedside of volunteer patients to newly commenced clinical students, and small group sessions on clinic and operating theatre teaching. A pre-workshop questionnaire sought information about the registrars' own teaching, and a survey 3 months after the workshop determined if any changes to teaching practice had occurred. RESULTS: The registrars were generally moderately to very confident with their teaching ability but more than 75% felt that they were more confident after the workshop. Only three of 39 registrars had received any instruction aimed at improving their teaching skills, yet 34/39 had taught either on the ward, in the clinics or in the operating room. Follow-up after 3 months revealed that most registrars were enjoying their teaching tasks more, and half had increased their teaching since the workshop and began discussing teaching with their surgical colleagues. CONCLUSIONS: The present project demonstrates that relatively brief interventions focused on skill development may enhance the confidence and enjoyment of junior clinical teachers and increase the frequency of 'teaching on the run'.     

Seed size influence on germination responses to light and temperature of seven pioneer tree species from the Central Amazon

In Amazon secondary forests are dominated by pioneer species that typically produce large amounts of small and dormant seeds that are able to form a persistent soil seed bank. Seed dormancy in this group of species is overcome by environmental conditions found in open areas, such as high irradiation or alternating temperatures. Nevertheless, a variety of germination responses to environmental factors is known among pioneers; some of them may germinate in diffuse light or in darkness condition at constant temperature. Seed mass can be considered as one of the factors that promotes this variety. Regarding species with very small seeds, it seems that the trigger for germination is light and for larger seeds temperature alternation may be a more important stimulus. In this study we established a relationship between seed mass and germination response to light and alternating temperature for a group of seven woody pioneer species from the Amazon forest. We found that an increase in seed mass was followed by a decrease in the need for light and an increase in the tolerance to alternating temperatures. Understanding germination strategies may contribute with the knowledge of species coexistence in high diverse environments and also may assist those involved in forest management and restoration.     

Perioperative evaluation of the obese patient

There is rapidly increasing prevalence of obesity throughout Western societies and increasing numbers of patients undergoing surgery are obese. Obesity is a condition of chronic systemic inflammation and is associated with an increased burden of comorbidities. Despite traditional teaching, obesity may not be an independent risk factor for poor postoperative outcomes. The Obesity Paradox describes the observation that small amounts of excess body fat may be protective against postoperative complications.     

Apoptosis and CD8 and CD54 cell expression in rat small bowel transplantation

The importance of activated CD8 cells expressing IL-2R in small bowel and other organ rejection has been reported. Some authors even consider that a positive correlation might be demonstrated between the number of apoptotic enterocytes and the degree of graft rejection. In addition, moderate to intense activation of endothelial molecules in small bowel allograft in rats has been reported in chronic rejection. The aim of the present paper is to ascertain, in a heterotopic small bowel transplantation (HSBT) in rats, whether CD3, CD4, CD8, and CD54 cell expression in the allograft infiltrates shows some relationship with allograft enterocyte apoptosis when rejection is present. Wistar Furth male rats were allotted to two groups: group A was the control group without transplantation; group B received a heterotopic small bowel allograft from Fisher rats and an im dose of FK506 (0.25 mg/kg/day). A significant increase of CD8, CD54 cell receptor expression, and apoptosis in the group undergoing HSBT showed rejection. No significant differences have been observed in the variables under study between the control and HSBT without rejection groups or in CD3 and CD4 among the three groups. We observed a significant correlation between apoptosis and rejection, between CD8 and CD54 with apoptosis and with rejection, and between CD8 and CD54. This indicates that the activation of endothelial molecules and cells may play an important role in established HSBT chronic rejection. We consider that this study may contribute to the knowledge of small bowel allograft chronic rejection and its immunomodulation.     

基于网络的PBL模式在老年护理学教学中的应用

目的提高老年护理学教学效果。方法将56名护理大专学生随机分为对照组和实验组各28人。对照组实施传统教学模式,即课前预习、课堂讲授、课后复习、考核;实验组实施基于网络的PBL教学模式,即通过网络平台呈现问题情境并提出问题,组织学习小组并明确个人分工,网络获取资源自主学习并分析问题,团结协作、解决问题及网络展示学习成果并评价反思。结果实验组学生理论成绩、实践操作能力和批判性思维能力评分显著优于对照组(P<0.05,P<0.01)。结论在老年护理学教学中开展基于网络的PBL教学法有助于提高教学效果。     

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility

Aim

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland.

Methods

We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009–2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility.

Results

A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions.

Conclusions

Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.     

Immunotherapy of Inflammatory Myopathies: Practical Approach and Future Prospects

The inflammatory myopathies, a group of chronic myopathic conditions, are potentially treatable, so proper diagnosis and early initiation of therapy are necessary. The most common types are polymyositis (PM), dermatomyositis (DM), necrotizing autoimmune myopathy (NAM), and inclusion body myositis (IBM). This review provides practical advice on treatment and identifies emerging new therapies. Although IBM is difficult to treat, PM, DM, and NAM respond to appropriate immunotherapies, if diagnosed early and treated aggressively. In uncontrolled studies, PM and DM respond to prednisone to some degree and for a period of time. The commonly used immunosuppressive drugs (azathioprine, cyclosporine, mycophenolate, or methotrexate) may offer some non-evidence-based “steroid-sparing” effect but provide minimal benefit on their own. As a result, the second-line therapy is intravenous immunoglobulin (IVIg), which a controlled study has shown to be effective in DM and which appears to be effective in PM and NAM; it offers minimal and transient benefit to only a small number of IBM patients, however. Uncontrolled series have suggested that rituximab and tacrolimus may offer additional benefit to some patients not adequately controlled with the aforementioned therapies. IBM is usually resistant to most therapies, but early initiation of therapy may be helpful at times. Emerging agents against T cells, B cells, transmigration, or transduction molecules are discussed as potential new treatment options.     

小规模私密限制性在线课程教学对护生自主学习能力的影响

目的探讨小规模私密限制性在线课程平台翻转课堂教学应用于护理专业核心课程对护生自主学习能力和学习效果的影响。方法采用随机整群抽样法从某高校2014级护理本科生中随机抽取2个班,分别作为实验组(32人)和对照组(30人),实验组在《内科护理学》、《外科护理学》、《基础护理学》3门专业课程中采用翻转课堂教学,对照组采用传统教学法。比较两组教学后护生的课程成绩和自主学习能力,并调查实验组护生对学习方法的评价。结果教学后,实验组学习成绩、自主学习能力总分及自我管理、学习动机维度得分显著高于对照组(P0.05,P0.01)。71.88%~93.75%实验组护生认为该种授课方式对学习效果产生了积极影响,仅6.25%护生认为难以适应该种教学模式。结论小规模私密限制性在线课程平台的翻转课堂教学能有效提高护生护理专业课程的自主学习能力,提高学习成绩。