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 Table of Contents  
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 103-106

My students surprise me everyday

Department of Medical Education; Department of Pharmacology, American International Medical University, Gros Islet, Saint Lucia

Date of Web Publication16-Jun-2017

Correspondence Address:
P Ravi Shankar
American International Medical University, Beausejour Road, Gros Islet
Saint Lucia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2321-4848.208218

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The author has been using small-group, active learning methods among undergraduate medical students for nearly 17 years. Many medical teachers are not fully confident about the ability of medical students to learn on their own with minimal support from the teacher or facilitator. In this article the author shares perspectives from the various small group sessions which he has conducted and also provides tips for facilitating active, small group learning.

Keywords: Active learning, caribbean, medical students, Nepal, small group

How to cite this article:
Shankar P R. My students surprise me everyday. Arch Med Health Sci 2017;5:103-6

How to cite this URL:
Shankar P R. My students surprise me everyday. Arch Med Health Sci [serial online] 2017 [cited 2020 Jul 6];5:103-6. Available from: http://www.amhsjournal.org/text.asp?2017/5/1/103/208218

  Introduction Top

Pokhara is a small town in Western Nepal located at the foothills of the Annapurna Himalayas. Manipal College of Medical Sciences, Pokhara, was started in the early 1990s by the Manipal Education and Medical Group from India. The students were mainly from Nepal, India, and Sri Lanka, and in the early 2000s, most faculties were from India though the number of faculties from Nepal has steadily increased since then.

In the early decades of the twenty- first century, the author (PRS) was working in the Department of Pharmacology as a lecturer. Small group learning methods such as case presentations and student seminars had been initiated, but didactic lectures and “traditional practical” sessions continued to be the predominant teaching-learning methods. Modern medical education emphasizes self-directed learning (SDL) by a student and advocates a teacher guiding the students toward SDL.[1] The authors of the cited article mention that medical teachers should create a conducive environment for discussion, questioning, and debate without any fear or intimidation so that students' needs are effectively communicated to a teacher who can act as a mentor.

  Small Group learning in Pharmacology at Manipal College of Medical Sciences Top

Teaching-learning activities in Pharmacology were modified to introduce more active, learning sessions in small groups. Among the sessions introduced were students counseling simulated patients acting out different disease conditions about the use of medicines and management of their condition, and this was assessed using an objective structured practical examination station with a simulated patient.[2] Later, a number of other sessions/activities including critical analysis of pharmaceutical advertisements, understanding and responding to pharmaceutical promotion, and personal or P-drug selection were introduced.[3],[4] Students' feedback about these sessions was positive, and problem-stimulated learning sessions, competent teachers, accessibility of teachers, and teachers facilitating the development of concepts were regarded as the strengths of the department.[5]

  Active Learning Top

For a number of decades, students were regarded as “empty vessels” into which knowledge was added (filled in) by the teacher. An analogy would be filling up an empty bottle or jar with a liquid. Malcolm Knowles developed the concept of “andragogy” in the 1970s forming the basis of “adult learning principles” which are widely employed today. He stated that students come with prior knowledge and skills and the purpose of education is to help them become increasingly self-reliant.[6] Learners see education as helping them to achieve their full potential in life.

  Critical Appraisal Skills Top

The traditional focus of medical education has been on the transfer and acquisition of knowledge. With modern technology becoming increasingly widespread, access to knowledge is becoming easier and more democratic. Smartphones are owned by the majority of physicians and most students and doctors had 1–5 medical-related applications (apps) on their smartphones.[7],[8] Smartphones were used for patient care and monitoring, communication, education and research, and reference.[8] An increasingly important skill for doctors, medical students, and others in today's world is the ability to critically interpret and analyze the vast amounts of readily available information. Clinical trials are an important source of primary data and the author (PRS) had conducted sessions for medical students on critical appraisal of randomized clinical trials in Nepal [9] and had been involved in designing modules on critical appraisal of scientific literature in Aruba.[10]

  Medical Humanities Top

For the last 10 years, the author (PRS) has been involved in developing and implementing a medical humanities (MH) module at two medical schools in Nepal and a medical school in Aruba, Dutch Caribbean.[11],[12],[13] The modules in different schools provided the author and his cofacilitators with a greater understanding on how to stimulate greater student participation and to obtain a greater understanding of the student perspective on the social and economic consequences of being sick, the patient perspective, the patient–doctor relationship, and the medical student among others. The author and cofacilitators have conducted the module among students from Nepal, India, Sri Lanka, the United States, Canada, and the Caribbean. At present, the author (PRS) is working in a medical school in Saint Lucia with students predominantly from India and South Asia and the West African nations of Nigeria and Ghana. Small group sessions in Pharmacology have been initiated and the students' response seems to be positive.

  Student Readiness for Active Learning Top

Over the last 17 years, it has been the authors' observation that students are increasingly motivated and prepared to take a more active role in their own learning. Most students seem to have good managerial and group working skills. Most classrooms have internet access and many students have devices (ranging from a laptop, a tablet, or a smartphone) for internet access. The students are technology savvy and familiar with different software and applications. The role of the facilitator is to help them critically analyze the quality of health information available on the internet. At a medical school in Western Nepal, the author (PRS) had organized sessions for students on assessing the quality of internet health information and communicating this to patients.[14] These days though the author does not conduct formal sessions on this topic, the issue is addressed during various small group sessions.

  High-performing Groups Top

Most student groups perform to or exceed expectations. As a facilitator, the author usually ensures that each group has students who are performing well academically and weaker students. It is also important to ensure the gender and ethnic diversity of the groups, wherever possible. The author has observed that the high-performing groups are the ones where the members have a cooperative attitude and work efficiently toward completing the assigned task. The academically stronger students are involved in helping the weaker students and the group realizes that they can only progress together; explaining concepts to a student requiring help is useful for the stronger student to revise and further develop his/her ideas or concepts.

  Teacher's Guide to Good Prescribing Top

The publication by the World Health Organization (WHO) titled “Teacher's guide to good prescribing” mentions practical hints for problem-based teaching which I have found very useful over the years. The teacher/facilitator should not be in the traditional position at the head of the class or at the lectern but should sit at a corner of the room or among the students.[15] The facilitator should address the group as a whole and not focus on individual students. Interventions by the facilitator should only target the group processes and should not be directed toward the content of the discussion. Quiet students in the group can be asked to summarize the deliberations.

  Initiating Active Learning Strategies Top

In the MH module facilitated by the author, students create brief 100 word stories about the scene depicted in the paintings and also explore the scenarios provided using role plays. The author and cofacilitators have published the transcripts of some of the role plays designed by the students.[16],[17] Many faculty members, especially those trained in the traditional school as subject experts and without further training in education in medicine, are often skeptical about students' ability to learn on their own with minimal support from the teachers. Active learning strategies are beginning to be widely used in an increasing number of high school classrooms.[18],[19] Occasional disciplinary problems may arise as some students may try to exploit the relatively greater freedom which an active learning session provides. These may require careful but firm handling as the facilitator should ensure that while disruptive behavior is not tolerated, the freedom and active learning environment will be preserved. The educational fellowship programs offered by the various Foundation for Advancement of International Medical Education and Research institutes offer a good introduction to small group, active learning strategies and access to a community of educators which will be useful for help and support in the initial stages.[20]

  Facilitating Small Groups Top

An article had examined student perceptions of effective small group teaching.[21] Students identified tutor characteristics, a nonthreatening group atmosphere, clinical relevance, integration of material and use of course material, and problems that promoted independent learning and problem solving as important. The Association for Medical Education in Europe has described the various roles of a medical teacher.[22] In addition to the traditional role as an information provider, other roles such as role model, facilitator, curriculum planner, and resource provider are emphasized. A recent article provides 12 tips to facilitate the learning of millennials.[23] Among these are for the facilitator to educate himself/herself about generational differences, recognize the cultural and environmental forces which can influence the millennial learner, help learner make sense of and understand the vast amount of resources available today predominantly through the internet, learn to use current e-learning technologies, recognize that millennials value and expect esthetically appealing educational presentations, recognize the importance of team learning and collaboration, be fair and straightforward, and identify the limits of multitasking.

  Tips for Facilitating Active Small Group learning Provided by the Author Top

  • Be familiar with various resources and materials related to facilitating small group learning
  • If possible, enroll for a fellowship in health professions education or similar courses in education
  • Obtain help from the medical education unit or other faculty members who are using small group, active learning methods
  • Identify the learning objectives and prepare a lesson plan for the session
  • While allocating groups, it is important to ensure that each group has male and female students and students from different backgrounds
  • Clarify various roles in the small group. The important roles are the group leader, recorder, presenter, and timekeeper
  • Ensure these roles are rotated among team members during different sessions
  • A proper team size is 4–8 students
  • Make clear the ground rules for the session right at the beginning
  • Do not stand at the lectern or in front of the classroom but walk among the students and sometimes sit near or with the groups
  • Be nonthreatening
  • Try to provide support and inputs only with regard to group dynamics and the process of the session
  • Help students find answers on their own and do not act as a content expert
  • Encourage participation of various group members
  • Classrooms where seating can be rearranged to form small groups are helpful.

Over the last 17 years, the author has been privileged to have facilitated small group, active learning programs and modules for health science students and faculty members in a variety of settings in Nepal, India, and the Caribbean. With the explosion of knowledge and the need to develop critical appraisal and team working skills among medical students, doctors, and other health professionals, the author believes that it is time for educators to have a more positive outlook about and greater belief in students' capabilities!


Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Pandey AS. Learning to teach learning. In: Dixit H, Joshi SK, editors. Modern Trends in Medical Education. Kathmandu, Nepal: Kathmandu Medical College; 2009. p. 28-36.  Back to cited text no. 1
Shankar PR, Mishra P. Student feedback on the objective structured component of the practical examination in pharmacology. J Nepal Med Assoc 2002;41:368-74.  Back to cited text no. 2
Giri BR, Shankar PR. Learning how drug companies promote medicines in Nepal. PLoS Med 2005;2:e256.  Back to cited text no. 3
Shankar PR, Palaian S, Gyawali S, Mishra P, Mohan L. Personal drug selection: Problem-based learning in pharmacology: Experience from a medical school in Nepal. PLoS One 2007;2:e524.  Back to cited text no. 4
Shankar PR, Dubey AK, Palaian S, Mishra P, Saha A, Deshpande VY. Favorable student attitudes towards pharmacology in a medical college in Western Nepal. J Int Assoc Med Sci Educ 2005;15:31-8.  Back to cited text no. 5
Knowles M, editor. What is andragogy? In: The Modern Practice of Adult Education from Pedagogy to Andragogy. Cambridge Adult Education, Englewood Cliffs, NJ 1988. Available from: http://www.hospitalist.cumc.columbia.edu/downloads/cc4_articles/Education%20Theory/Andragogy.pdf. [Last accessed on 2017 May 08].  Back to cited text no. 6
Payne KB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): A regional survey. BMC Med Inform Decis Mak 2012;12:121.  Back to cited text no. 7
Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: A review of current and potential use among physicians and students. J Med Internet Res 2012;14:e128.  Back to cited text no. 8
Shankar PR, Subish P. Learning sessions on critical appraisal of randomized clinical trials: Student feedback. J Clin Diagn Res 2007;1:3-9.  Back to cited text no. 9
Shankar PR, Balasubramanium R, Dwivedi NR, Nuguri V. Student feedback about the integrated curriculum in a Caribbean medical school. J Educ Eval Health Prof 2014;11:23.  Back to cited text no. 10
Shankar PR. A voluntary medical humanities module at the Manipal College of Medical Sciences, Pokhara, Nepal. Fam Med 2008;40:468-70.  Back to cited text no. 11
Shankar PR, Piryani RM, Thapa TP, Karki BM. Our experiences with 'Sparshanam', a medical humanities module for medical students at KIST Medical College, Nepal. J Clin Diagn Res 2010;4:2158-62.  Back to cited text no. 12
Shankar PR, Rose C, Toor A. Student feedback about the medical humanities module in a Caribbean medical school. Educ Med J 2016;8:41-53.  Back to cited text no. 13
Shankar PR. Assessing medical student learning in assessing the quality of health information on the internet and communicating the skill of critical appraisal to patients. Inform Prim Care 2007;15:151-6.  Back to cited text no. 14
Hogerzeil HV, editor. The role of the teacher. In: Teacher's Guide to Good Prescribing. Ch. 1. Geneva: World Health Organization; 2001. Available from: http://www.apps.who.int/medicinedocs/documents/s15940e/s15940e.pdf. [Last accessed on 2017 May 08].  Back to cited text no. 15
Shankar PR, Singh KK, Dhakal A, Shakya A, Piryani RM. Transcripts of a medical education in humanities module: Selection of role plays. Int J User Driven Healthc 2012;2:63-76.  Back to cited text no. 16
Shankar PR, Singh KK, Shakya A, Dhakal A, Piryani RM. Role plays used during ahumanities in medicine module: Selected transcripts Part 2. Int J User Driven Healthc 2014;4:24-33.  Back to cited text no. 17
Davidson J. Active Learning in the Secondary Mathematics Classroom: The Effect on Student Learning. Senior Honors Thesis. Colorado State University-Pueblo; 2015. Available from: https://www.dspace.library.colostate.edu/bitstream/handle/10217/172443/2015_Spring_Jennifer_Davidson.pdf?sequence=1. [Last accessed on 2017 May 08].  Back to cited text no. 18
Sekwena GL. Active Learning in a High School Economics Class: A Framework for Learner Engagement. Master Degree in Education Thesis. South Africa: University of Free State; 2014. Available from: http://www.scholar.ufs.ac.za: 8080/xmlui/bitstream/handle/11660/2091/SekwenaGL.pdf?sequence=1&isAllowed=y. [Last accessed on 2017 May 08].  Back to cited text no. 19
Shankar PR. Unique design features of the FAIMER fellowship in health sciences education. Educ Med J 2011;3:e70-4.  Back to cited text no. 20
Steinert Y. Student perceptions of effective small group teaching. Med Educ 2004;38:286-93.  Back to cited text no. 21
Harden RM, Crosby J. AMEE Guide no. 20: The good teacher is more than a lecturer-The twelve roles of the teacher. Med Teach 2000;22:334-47.  Back to cited text no. 22
Roberts DH, Newman LR, Schwartzstein RM. Twelve tips for facilitating Millennials' learning. Med Teach 2012;34:274-8.  Back to cited text no. 23


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