Independent Learning For MedEd III

A Group Work Model in Education

I have better things to do with my life than read school textbooks to analyse them for the quality of Independent Learning so I have not read many. However, there is one author that I have come across, Chuck Sandy, who stands head and shoulders above the rest. His use of the Independent Learning model is exemplary and to the letter.

Other school textbooks, which have been written by internationally acknowledged educationalists in their own subject, too often slip and get distracted from the basics. It shows the level of discipline that is required in Independent Learning. The writers start thinking about what is interesting to the reader and clever ways to put things and suddenly they have deviated. They have got the basics wrong....

Of course, we all know medical examples of those with experience and especially name and reputation who think that they know better than the basics and can do what the hell they feel like....

I have read Chuck Sandy textbooks for the pleasure of the educational experience and seeing an educational genius at work. He and his co-authors do not try to prove their genius by dumbing down for the sake of popularity. They get the basics absolutely right, dotting the ‘I’s and crossing every ‘t’. Their genius is to culturally add to this model rather than distort it and teach the cultural tools to really make the model work.

And it was in a Chuck Sandy book, Passages 1, that I found an ideal model for group work in the classroom. This impossible genius had used it as a comprehension text with somebody enthusiastically proclaiming how it had changed their life and recommending it to all.

Now that is what I call educational genius!

Corporate Team Building

I had been taught corporate team building by some very expensive experts. It was focused on boardroom decision making and projects using a multidisciplinary team as applied to medical and healthcare. It was not for the classroom or students who are learners rather than experts representing the various points of view and conflicting interests of departments but it was still an educational experience for all. It was a means of creating a whole picture in which all of the basics were taken into account and nothing forgotten. The educational experience of corporate team work is to teach each expert the most important basics of all of the other departments so that they can put their expert knowledge into context.

The short-term aim of corporate teambuilding is good, solid decision making that takes everything into account. The medium-term aim is harmony because every department understands why they cannot always have their own way. It creates a team that is working together rather than trying to tear themselves apart. However, the long-term aim is to create ‘T-shaped’ experts who are both generalists in everything as well as being specialists in their own area.

I learned this for medical purposes, mainly centred around the key worker role in primary care, working in multidisciplinary teams and administering healthcare as a business with varying priorities.

It is the responsibility of each expert to educate the rest of the team about the most basic concepts of their specialist subject as it relates to the issue at hand. The rest of the team must be educated to grasp those fundamental concepts so that they can apply them to the real world problem and solve that problem.

Education by Formal Group Working

The moment I saw this model of group working, I knew I had stuck educational gold. In the corporate setting, the decision making process is the primary consideration and education is an important but secondary part of the process. It is the long term process and effect.

So many elements of the corporate team working structure are appropriate in education. The Kolb Experiential Learning Cycle (http://clinicalarts.blogspot.mx/2013/12/independent-learning-in-meded.html) is all about grasping basic concepts in real world language, Plain English that can be applied to the real world.

Group work is primarily a tool of Reflective Observation where the participants deduce their own rules in their own words for the examples that they have been given in Concrete Experience. This is a fundamental of Reflective Observation before the students are introduced to the jargon of Abstract Conceptualisation.

Of course, practicing the skill of communication in Plain English dramatically improves communication with patients.

One of the main responsibilities of the Co-ordinator (team leader) is to prevent the experts from getting their own way by using incomprehensible language as a weapon of intimidation. They cannot make the non-specialists in their area buy them new toys by talking about the bench test speeds of the XYZ 472 chip as if anybody will know what that means in real life. They must explain how it will help productivity in real life, the cost of software to take advantage of the new computers and whether the secretaries are going to be confused by changing programs and need retraining.

It is the responsibility of the Coordinator to ensure that every member of the team understands what is being said and its real world implications so that they can vote on the issue in an informed manner. They can participate.

In education, this type of group becomes a self-educating process. Those that grasp the concepts are encouraged to explain them to those that did not grasp them. The student becomes the teacher.

The concept of the student teacher is acknowledged as highly effective in the modern educational world. Students often make more adequate teachers than the teachers themselves because they can easier relate to their peer groups and explain things in concepts that belong to their lives. It is enhanced individualised, small group teaching that the teacher cannot compare with.

This is cascading knowledge and understanding. The teacher only has to achieve the understanding of one person in the group. They spend the time explaining it in different ways until all of the group understands the concepts. The Coordinator is responsible for ensuring that all group members understand the concepts.

This is why bigger classes with multiple groups are preferred by the best international modern educationalists. Their humility is the unimportance of the teacher in the process of education. The best education happens in the group work. Counter-intuitively, small classes with more teacher attention are counterproductive to the learning process.

Mixed ability classes are also preferred. The quicker, more capable peers grasp the concepts and explain them better to their less astute peers than a teacher who was usually gifted at their favourite subject and succeeded in a traditionally dependent, theoretical teaching environment.

Traditionally, the failure to learn has been caused by a communication breakdown between the older, more academic teacher and those that do not believe that they are capable of academic competence. This further destroys their confidence in academic work. Cans come in cans, as educationalists say. Academic success breeds more confidence and success. As the lower students succeed more in understanding the subject, they gain confidence and ability.

And it is the role of the Coordinator to ensure that they do not drop out.

The more gifted students also benefit. They are known to clarify their theoretical knowledge as they teach it in the groups to the lower performing students.

It is a common experience that you only really think through and grasp a subject once you have tried to teach it to others. It brings a deeper knowledge and understanding that you did not have as a student. It brings true mastery of that knowledge in place of the superficial.

The participants are there to learn from each other and the experience. That is Independent Learning. Anything that comes from their peers comes from their equals proving what is possible. It does not come from the teacher as expected from somebody who is senior to them. Anybody is capable of it.

They are there to think together. They are learning the skills of making decisions in complex situations where many different factors must be taken into account.

This is a formalised, external representation of the everyday complexities of the best clinical thought processes. It treats the patients as individual, complex human beings with psychosocial influences as well as complex organic beings with multiple interacting organs. A balance must be reached. Nothing must be left to chance. The best treatment plans are multidisciplinary.

As an external representation of this gold standard clinical thought process, it can be observed, analysed and fed back upon. Clinical thought processes can be improved both by experience and evaluation.

Time Limiting Democracy

It is also the Co-ordinator’s responsibility to keep the group focused on the central points so that they cover everything that is important in the time allowed. It is like real life where time is the most precious of all resources. They cannot be distracted into going off at a tangent considering the small point details ad nauseam while neglecting important matters.

Everybody must participate. Nobody should be allowed to dominate the limited time of the group. Mutual respect means allowing others to have their turn too. Minorities of one get their chance to express their views and convince the group but they get no more than their turn before the vote takes place. From then, they must agree with the majority view when a consensus is not possible.

And they soon learn from experience to use their equal share of the time wisely rather than interrupting every discussion. They learn to be concise rather than verbose with their opportunity.

Sorry! You have had your share of time already. Now it is your turn to listen to everybody else.

John. You have not said much. What do you think?

Unstructured, hierarchical groups based on the loudest mouths significantly damage the confidence of those that start with little confidence. Formal and structured groups bring such people out of their shells and improve their self-confidence. They make the over-confident more respectful. They are learning to think of others too.

As the know-it-all, loud mouths are rotated to the role of the Coordinator, they learn some respect for the responsibilities and difficulty of the job. They are placed into this caring role and will be made accountable by their peers.

This is a really profound learning experience.

The Writer

Group work is always working towards a formal presentation that is also time limited to combat the culture of everybody saying whatever they want all at the same time as happens in hierarchical, unstructured groups. The Coordinator should stop this from happening and ensure democratic decisions of the majority or a consensus. The second member of the group’s administrative team that Sandy describes is a back up for this. Only one person in the team is going to write the presentation down.

This assures that the presentation of the opinions of the group is consistent rather than everybody writing down whatever they feel like saying without discussion or debate leading to a shared opinion.

Okay... so what do you want me to write/type for the presentation?

The Speaker

And only one person from the team is going to give the presentation. They are also going to have to field any questions from the audience about what the team thinks about the topic.

It is great for classroom structure. Structured group work kills the chaos.

Some things have to be learned by experience. Negative experience soon teaches in group work. My experience with teachers as participants is that it does not matter how many times you warn the participants. They will not get the fact that if they want their opinion to be expressed, they must express it to the group and particularly the Writer and Speaker or the class will not here that opinion.

As Facilitator, you have to laugh. The results of the first times that the participants work in this structured manner, they are seething. They seethe at the face that they are not allowed to express themselves in the question and answer session.

As they take turns as the Speaker, they appreciate the other side of this. They are standing up their exposed unless the group has fully discussed, debated and decided on its opinions on the matter. The worst case scenario is that the Speak did not have the basics explained to them by the rest of the group and is supposed to be answering question on them in front of the class.

I always get the Speaker to feed back to the group how they felt standing up in front of the class under such vulnerable circumstances. As the Speak role rotates around the group, they quickly learn to fully discuss the topic and educate one another.

It is matter of learning a new culture. It takes time but surprisingly little of it. Massive improvements in group work happen after only a single session and those improvements are dramatic in the third and fourth exercises.

The Final Outcome

This structure of three named and defined roles within the team gives three controls over the group work process. There are three key members of the team that must understand the subject profoundly. It is the responsibility of the rest of the team members to ensure that this happens. It is the theoretical responsibility of the Coordinator to make this happen. It is the practical responsibility of the Writer and Speaker to make sure that they know what the team thinks about every imaginable part of the theme that they have been asked to deal with. If they do not achieve that, painful, stressful disaster ensues.

The most practical team size is seven to eight. That means four or five team members are responsible for explaining all that they know to three others with varying abilities until they understand. This ratio almost guarantees that everybody will understand. It guarantees that knowledge and understanding are presented at a level where everybody can understand.

The Three Administrators

The role of the three administrators of the team, The Coordinator, Writer and Speaker, is to structure the team and its time management for both the group work and the presentation. They ensure that utopian, informed democracy occurs where everybody has an informed point of view and all opinions are heard and respected. Everybody participates and understands the questions involved. They have all been educated on the various points of views by experts with different experience and disciplines. They can make a good decision bearing in mind the greatest context available so that nothing basic is forgotten.

And that is all that the Coordinator, Writer and Speaker do during the formal, flat structured teamwork process. They organise the team. They do not express their own opinions.

The three administrators are already too powerful. No Coordinator will be perfectly fair and objective in their decisions about who talks and when to vote. That is their influence and power. The Writer will always colour what they write for the presentation with their personal opinion. The words of the Speaker are equally coloured.

So these three administrators are not allowed to contribute by expressing themselves in the discussion. They are there to structure and to listen. They do not get a vote either unless the vote is a tie.

If only medical administrators that are supposed to bring the best of corporate practices to the world of healthcare would follow these rules from the gold standards of corporate psychology. Say nothing. Listen to the experts. Make sure that everybody understands the complex issues from all direction and perspectives. Get them to vote without being able to further influence the decision. Accept their majority decision.

At every level, the world would be a much better place for learning the culture of formal, flat-structured teamwork ;)