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Case-Based Module Small Group Learning
Tutor / Facilitator Interactive Workshop
William K. Hettenhausen
DDS FACD FICD FPFA
Associate Professor of Health Sciences - Clinical Sciences Division
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Learning Objectives
After attending this session, the participant should be able to:
1. Tutor/facilitate case-based small group learning
sessions including initial “icebreaker” orientation,
“ground rules & house keeping”, role development
and discussion of expected participation dynamics.
2. Create a learning environment that supports selfdirected research and encourages a model of guided
discovery, collegial resource sharing and interaction.
3. Assess participation performance of learners in CBL
and TOS sessions.
4. Assess professional behaviour in small group sessions.
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Overview of Small Group Learning
The goal of case-based small group learning at the
Northern Ontario School of Medicine is to provide students
with the knowledge, inter-professional skills and attitudes
necessary to practice medicine in northern, rural and remote
communities.
CBL (Case Based Learning) and TOS (Topic Oriented Sessions)
are designed with this overall goal as the guiding principle.
To focus small group learning, faculty tutors are used
to facilitate the learning process. The role of the tutor is that
of a mentor or guide, open-ended questioner and student
assessor.
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Overview of Small Group Learning
To describe small group learning, is to describe an ever
moving target. The learning dynamic, not only varies from group
to group, it is constantly evolving and adapting to the interactive
experiences of the tutor/facilitators and their students.
The NOSM curriculum development teams provide online small group learning guides for students and facilitators,
drawing on the latest demographics & epidemiologic studies
of northern rural and remote communities.
This ensures that the students will be well prepared to
meet the medical health care needs of the patients they will
encounter during their Integrated Community Experiences (ICE).
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CBL (Case-Based Leaning)
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Once a week, the students meet in groups of eight
to ten for a two hour CBL session. These sessions set the
stage for the following TOS (Topic Oriented Session) by providing
an opportunity to learn about the background or community
context, that the patient encounter will occur in.
The session’s learning objectives are centred in:
Theme 1: Northern & Rural Health
Theme 2: Personal & Professional Aspects of Medical Practice
Theme 3: Social & Population Health
Students are encouraged to research population
demographics, available community health care resources
and the underlying determinants of health, as a background
to individual patient care.
TOS (Topic Oriented Session)
Twice a week, the students meet in groups of eight
to ten for a two hour TOS.
The session’s learning objectives are centred in:
Theme 4: Foundations of Medicine
Theme 5: Clinical and Communication Skills in Health Care
The first session involves the case presentation of a
patient encounter. In the student guide, they are given
details of the patient’s condition upon presentation, the
findings of a physical examination, and any available test
results. The students discuss and determine the key topics
and issues that they will need to research prior to the
second TOS.
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WGS (Whole Group Sessions)
A WGS is held between the 1st and 2nd TOS session.
During this session a content expert presents a power point
overview of the clinical sciences relevant to the TOS and
fields questions. This helps the students to assess whether
the key topics and issues they identified during their first
TOS were on track or not. It also provides them with any
overlooked content they may need to address the learning
objectives during the debriefing part of the second TOS.
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TOS (Topic Oriented Sessions)
During the first half of the second TOS, they will
debrief and discuss the implications of the patient’s medical
history, physical examination findings, laboratory test results,
differential diagnosis, treatment planning, patient care and
prognosis. In the remaining half of the session, new topics
and issues arising from the second patient encounter will
be discussed, and key topics and issues determined prior to
the debriefing at the beginning of the next week’s TOS.
The students are encouraged to discover the key
topics and learning issues in the context of the core medical
sciences. (Anatomy, biochemistry, genetics, microbiology / immunology,
pathology, pharmacology & physiology as well as diagnostics and prevention.)
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“MyCurriculum”
An on-line facilitator’s guide provides tutor/facilitators
with key topics and issues, which serve as a check-list for the
student’s progress. It also includes some suggested questions
to prompt the students in their quest to reach and understand
the module’s learning objectives.
Students are encouraged to take on a role like that of
Sherlock Holmes in solving the case. The same detectivelike skills are needed to arrive at an accurate medical
diagnosis. The tutor/facilitators, on the other hand, are
encouraged to take on a role like that of Dr. Watson, who
says, “Unfortunately, I have no answers, only questions.”
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Small Group Learning Dynamics
Self-directed learning is just that. Student groups may
choose to tackle CBL or TOS scenarios differently, dependant
on their content. They may choose to appoint someone to
keep everyone focused on the learning objectives; they may
choose a scribe or note taker, and a session time keeper.
Some groups may choose to e-mail important articles,
definitions, and URL links to each other directly, while others
may choose to use MS Office OneNote, Google Docs or other
folder sharing software to synchronize the results of their key
topic and issues research during their sessions.
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Small Group Learning Dynamics
When members of small learning groups with different
learning styles first mix, there may be differences of opinion
and challenging discussions. The facilitator’s role, during this
initial interaction, is that of a moderator.
It is important in arriving at an appropriate self-directed
small group learning model, that each member of the team is
given every opportunity to express their views and is shown
proper respect.
Facts students think are relevant, questions about
aspects of the case they would like clarified, things that they
didn't know or that they personally found to be particularly
interesting, all qualify as avenues for active participation.
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Mid-Point & End-Point Module Assessments
Midway through the Case-Based Modules, the Tutor/
Facilitator is asked to provide each student with a Mid-Point
Assessment of their learning skills, and the group process.
This includes comments on the learner’s strengths and any
areas in need of improvement.
It provides an assessment of the student’s professional
behaviour and ability to demonstrate:
“Respect for others, communication skills, responsibility,
self-awareness and self-evaluation”.
The assessment also indicates whether the student’s
performance does not meet standards (= F), is marginal and
in need of some improvement (= P) or meets standards (= P).
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Mid-Point & End-Point Module Assessments
The Mid-Point assessment is formative and not
summative, in that it is intended to give the student some
initial feedback on how they are performing during the
sessions and to adjust their performance accordingly.
The End-Point Assessment is summative and
provides the student with a final performance assessment.
Time is allotted in the last CBL & TOS session of each
module for the tutor/ facilitator to privately discuss the
assessment with each student and to address any
questions or concerns regarding their performance.
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Overview Conclusions
One of the hidden benefits of small group
case-based learning is that it encourages students
to work together as members of a health care team,
and to develop the skills to interact collegially with
both their peers and other health care professionals
in the provision of optimal patient & family centred care.
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Simulated Small Group Learning
The 2nd segment of today’s
session is designed to simulate the
Small group learning model. Each
table has 9 chairs. One is for a
tutor/facilitator and the rest are for
“students”.
Each group will begin by
choosing an experienced tutor/
facilitator, who will then initiate
group discussion on “Icebreaking”
and round table introductions.
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Simulated Small Group Learning
In your handouts, there is a
simulated small group learning page
with observation note boxes for each
participant.
During round table introductions
and the “Icebreaking”, each participant
will record the name, of everyone. Any
other notes or observations throughout
the session will also be recorded here.
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Simulated Small Group Learning
Each group will select a flip chart scribe to record the
discussion under the following six topic headings:
Focus
Topic Encounter
Learning Tasks
Learning Objectives
Key Questions & Issues
Mid & End of Module Assessments
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Simulated Small Group Learning
Time permitting, a spokesperson from each group
will give a brief overview from the flipchart of their group’s
discussion of each separate topic heading.
Following the overviews, the floor will be open to
a general discussion of case-based module small group
learning including, comments, questions, & suggestions.
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Simulated Small Group Learning
Focus: Sharing facilitation strategies that appear to work best
Topic Encounter: Small Group Learning Overview (Group read)
Learning Tasks: Identifying & resolving tutor/facilitator challenges
Learning Objectives: Creating an optimal learning environment
Key Questions & Issues: Discuss the use of technology
Smart boards, laptops, tablets etc.
Mid & End of Module Assessments: Discuss possible directions
for Tutor/Facilitators
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Dr. William Hettenhausen DDS, FACD, FICD, FPFA
william.hettenhausen@nosm.ca