- Email: [email protected]
Small group teaching
ARTICLE IN PRESS Current Anaesthesia & Critical Care (2003) 14, 183--186
c 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.cacc.2003.09.002
FOCUS ON:TRAINING
Small group teaching Kathryn A. Price Newcastle General Hospital, Newcastle-upon-Tyne, UK
KEYWORDS teaching methods; education, professional; education, continuing; training programs; anaesthesia
Summary This article explores some of the issues related to small group teaching, which can be challenging to plan and execute.Some trainers may feelthatitis effort that may be better expended in some other teaching activity.There are, however, some major advantages to small group teaching, which relate to the development of life-long learning skills, professionalism and team-working.
c 2003 Elsevier Ltd. All rights reserved.
INTRODUCTION Anaesthesia is a very practical speciality, underpinned by a comprehensive understanding of the relevant basic sciences and appropriate professional behaviour. A large proportion of the learning of anaesthesia still takes place in the operating theatre, the obstetric unit and the intensive care unit. However, with the introduction of a competency-based curriculum and reduction in junior doctors’ hours of working, teaching of anaesthetic practice has had to become more structured.This has led to a much wider use of simulators and small groups for teaching purposes. The ultimate goal of any educational encounter between trainer and trainee must be to improve some aspect of cognitive, psychomotor or behavioural development. Small group teaching can play a valuable role in achieving this goal.
Sadly, every silver lining has a cloud attached. Adult learners also have some less positive characteristics: * *
*
Small group teaching can have many characteristics which particularly benef|t adult learners.They are: * * * * * * * *
ADULT LEARNERS It is important to consider some of the characteristics of adult learners as these impact greatly on the dynamics of a small group. Adult learners have many positive characteristics: * * *
* *
They want to control their own learning. They prefer active learning. They have widely different backgrounds and experiences. They are motivated to learn by a variety of factors. They like regular evaluation and feedback.
Correspondence to: KAP; E-mail: [email protected].
They can be set in their ways and resistant to change. They can experience a gradual decline in their physical and sensory capacities. They have a different learner/teacher relationship.
Encouraging format. Facilitates debate. Can utilise personal experiences. Acts as a forum for exchange of ideas. Allows beliefs to be challenged. Allows a problem-solving approach to be developed. Promotes understanding of differing viewpoints. Learners are encouraged to be more active.
As well as benef|ting adult learners, small group teaching episodes allow trainers to get to know their trainees in an environment that is potentially less stressful than the operating theatre or the ITU. It also allows the trainees to know their trainers better.
PLANNING SMALL GROUP TEACHING Good planning is the key to any educational activity and for small group teaching to be effective it is best viewed as a formal educational encounter with clear educational objectives for the session. It should also be made clear
ARTICLE IN PRESS 184
from the outset that this is not a passive educational encounter and trainees will be expected to participate. It is important to determine the small group size and membership. In a small anaesthetic department this may include all of the anaesthetic trainees at the same time whereas in a larger department it may be thought that some topics for discussion are not suitable for the whole of the trainee population. For example, if the educational objective is to explore aspects of ventilation and perfusion to prepare trainees for the Primary FRCA examination, more senior trainees may not f|nd the subject matter particularly helpful. However, it may be possible to get one of the more senior trainees to act as a small group facilitator for this learning encounter. Some ethical and professional issues may be best discussed in a group with more differing experiences as these are issues which affect all individuals equally. It is important to choose the right environment for the small group teaching.1 This should preferably be a well-ventilated, well-lit room where there is a reasonable expectation of low extraneous noise and little danger of interruptions. It is generally felt better to arrange the seating in a single circle or semi-circle as this allows all group members to see and be seen. This is felt to enhance the ability of all individuals within the group to participate. The trainer should also determine the resources they may need to teach effectively in the session.This may include overhead projectors, flip charts, interactive white boards, internet access, reference articles, low f|delity simulators (e.g. intubation head), etc. The resources the trainer decides upon will depend on: * *
The educational objectives for the session. The format of the small group teaching episode.
FORMATS FOR SMALL GROUP TEACHING Depending on the educational objectives and the group taking part, there are several formats an episode of small group teaching may take.
CURRENT ANAESTHESIA & CRITICAL CARE
The discussion group This is a useful format for exploring controversial topics or diff|cult ethical questions. It can help to promote interaction and exploration of values and attitudes. This format may be more useful if the participants in the group f|rst know each other.
Case studies This is scenario-based learning. It is an excellent format to encourage the exploration and development of clinical reasoning. It can be used in either the classroom or simulator setting and it gives the small group facilitator a chance to assess clinical judgement in a ‘safe’ environment.
The mini-lecture This can be used effectively in a small group teaching session. It may help break up more active small group work. It can be used to deliver a high density of information in a short time. Changing the pace of learning is an effective way to maintain interest within a small group session. The mini-lecture may be given by a facilitator or a trainee and will help develop presentation and communication skills in both.
The debate This format can be used to explore controversial issues and it will help to promote clarity of thought and communication skills. It can also help give alternate views emphasis they might not normally receive.
Role play This depends greatly on the conf|dence and practice of the facilitator. It can be a useful tool for exploring diff|cult areas in communication. It can also promote listening skills, empathy and team building. It is used quite widely in simulators and ATLS training but it can be diff|cult to use effectively in the classroom unless there is a very experienced facilitator.
The seminar
THE FACILITATOR/LEADER
A useful format if there is a relatively large topic area to be covered. The members of the group should be given pre-set tasks to prepare. They should be encouraged particularly to reference their preparation. When the group meets they should present their f|ndings. If well structured by the small group leader, this type of format can help understanding of a whole topic by seeing individuals from the group contributing their own building blocks. It can also help promote research ability, presentation skills and communication skills.
If small group teaching is to be successful, the facilitator’s role is crucial. The facilitator must have the characteristics of an excellent clinical teacher. These characteristics were identif|ed by Cleave-Hogg and Benedict.2 They are: * * * * *
Dedication. Commitment. Enthusiasm for teaching. Willing to give time to teaching. Enjoys his/her own professional work.
ARTICLE IN PRESS SMALLGROUP TEACHING
* *
*
Understands themselves as a role model. Motivated to continuously update and enrich their own learning. Able to establish and maintain interactive professional relationships.
Perhaps the most important of these characteristics is the understanding of self as a role model. Small groups function best when there is trust between the participants.Trainers who are perceived as excellent role models can help to facilitate the development of this trust more quickly. The style of the facilitator can also affect the group atmosphere. Lewin described three differing styles of leadership:3 * * *
Autocratic (authoritarian). Democratic (collaborative). Laissez-faire (detached).
The facilitator has to tread a delicate path, trying to involve everyone, encouraging the meek, restraining the forceful and keeping the group on track. Also, if the facilitator is too autocratic or becomes too much the ‘fount of all wisdom’, it may prevent the group, as a whole, from acting cohesively. Ideally, the facilitator should act as a catalyst to aid discussion within the group and not provide the group with all the answers. Some clinical teachers may f|nd the apparent informality of small group teaching threatening and may prefer to concentrate their teaching commitments to more formal, didactic sessions. As any clinical teaching requires a mix of teaching episodes, this should not be seen as a problem when organizing departmental teaching. It is understood by the trainees that their facilitator is both a member of the group and often the chairman of the group. What may be understood or acknowledged less is that the facilitator is also an assessor. It is particularly important that this role is handled with tact and discretion. This is essential to maintain trust within the group. This can be helped by clearly stated educational objectives for small group teaching, reinforced by positive and constructive feedback at the end of the group session. Tact, empathy and a sense of humour are essential if the facilitator for small group teaching aims to retain their sanity!
Group dynamics Whenever people form groups, social forces become active. An understanding of group dynamics can help the clinician (of whatever speciality) to avoid some of the pitfalls of teaching in small groups. If a group is planning to meet over several sessions, such as a series of small group sessions in an anaesthetic department, knowledge
185
of the stages a group may pass through can help orientate the facilitator and allow them to make appropriate interventions to help the group evolve and develop more effectively. The distinct stages a group may pass through were described byTuckman4 in 1965.They are: 1. Forming. Initially members of the group meet. They then communicate superf|cially with each other and the facilitator testing boundaries. Some members may joke, others may withdraw.The facilitator may start to get a feel of extroverts and introverts within the group. 2. Norming. In this stage, ground rules for the group are set, usually informally. The facilitator may f|nd that there are some expressions of dissatisfaction or frustration about the lack of a def|nite goal. 3. Storming. The feelings of purposelessness are dispelled and natural leaders start to emerge.Various members of the group start to be recognized as having special talents, resources or knowledge. This stage may be associated with strong emotions, particularly anger or impatience. It is the role of the facilitator to help calm and defuse potentially volatile situations and keep the group on an even keel. 4. Reforming. This is sometimes referred to as the ‘Performing’ stage. This is where the group gels. Goals and tasks are set and decisions taken on how to collaborate effectively in order to achieve the goals.The group starts to feel like a cohesive unit. There is much positive emotion at this stage giving group members a ‘feel-good’ factor. 5. Disbanding. The group disbands. There are often expressions of appreciation. Some members may experience a feeling of loss if the group has worked well together. By understanding these group dynamics, the facilitator will not be discouraged at stage 2, will restrain himself from offering quick f|xes at stage 3 and can help counteract the gloom at stage 5. Understanding the group dynamics will help the facilitator deal with the whole group over a period of time. However, the facilitator also has several tasks during the course of each group session. These could be def|ned as opening tasks, maintenance functions and ending the small group session.
Opening tasks Usually the facilitator will deal with the essential ‘housekeeping’ tasks of the small group e.g. teaching location, seating, etc. They may also open a discussion or suggest a timescale for a task.They can also give information and ask for opinions and help to put ideas together. It is helpful if the facilitator helps to encourage the less forceful members of the group contribute at an early stage to help improve their conf|dence. If some record is to be
ARTICLE IN PRESS 186
kept of the task, it may help if the facilitator offered to do this. This can allow the other members of the group more freedom to discuss the issues and stops the facilitator from being constantly applied to for guidance.
Maintenance functions The main tasks for the facilitator are listening, encouraging participation, relieving tension and conflict and helping communication by ensuring clarity. It may also be necessary to diagnose diff|culties in the group’s progress such as questioning false or unclear contributions. It is usually helpful to check every so often that all group members are progressing at a similar rate. This can be achieved by taking a ‘time-out’ and giving a ‘mini-summary’ of the groups’ progress thus far. The facilitator should also be able to deal with negativity or at least have some strategies available to minimize the effects of negativity on the group as a whole. These strategies may include asking for rephrasing of a statement in more moderate terms. Any worthwhile contribution should be complemental, whereas negative statements should not. If necessary, the facilitator can try and f|nd allies within the group or defuse a situation by agreeing to differ. If all else fails, the facilitator could privately request co-operation by an individual. If a member is too dominating, try and suggest a distracting task such as keeping a record of the discussion to lessen their contribution and give quieter members a chance to contribute.
Ending the Session Any educational encounter should have a beginning, a middle and an end and a small group session is no different from a lecture or a demonstration or a supervised operating session. The facilitator should keep to time and be positive. They should try to summarize the outcomes or learning points and, if appropriate, set future tasks. It is often useful to ask for feedback to try and f|nd areas which may be improved in future.
CURRENT ANAESTHESIA & CRITICAL CARE
SMALL GROUP TEACHINGFIS IT WORTH THE EFFORT? This article has demonstrated that small group teaching can be challenging to plan and execute. Some trainers may feel that it is effort that may be better expended in some other teaching activity. There are, however, some major advantages to small group teaching that have only been touched upon so far. These advantages relate to development of life-long learning skills, professionalism and team-working. There is no doubt that learning in a small group is a far more active process than sitting in a lecture. Active learning has been shown to promote a deeper understanding of a subject and hopefully reinforce the culture of life-long learning. Goals set within a group and recognition of the skills of other members help to promote team working. More importantly, small groups help professionals reflect on their practice and hear differing views. This can help develop clinical reasoning and professional judgement.Coles5 stated that though a doctor’s professional development may be construed as ‘knowing more’maybe it should be taken as ‘knowing-how’. Professionals often make judgements which may be moral as well as factual. Small group teaching helps individuals explore moral and ethical dilemmas in a relatively safe environment. By so doing, it is hoped that trainees are better equipped to be reflective practitioners.
REFERENCES 1. Walton H J. Small group methods in medical teaching. ASME Medical Education Booklet No. 1. Edinburgh: Association for the Study of Medical Education, 1997. 2. Cleave-Hogg D, Benedict C. The characteristics of excellent clinical teachers. Can J Anaesth 1997; 44: 577--581. 3. Lewin K. Resolving Social Conflict. New York: Harper, 1948. 4. Tuckman B. Developmental sequence in small groups. Psychol Bull 1965; 54: 229--249. 5. Coles C. A qualitative look at practice. A comment on ‘Analysis of the clinical behaviour of anaesthetists’. Med Educ 1997; 31(6): 448.
c 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.cacc.2003.09.002
FOCUS ON:TRAINING
Small group teaching Kathryn A. Price Newcastle General Hospital, Newcastle-upon-Tyne, UK
KEYWORDS teaching methods; education, professional; education, continuing; training programs; anaesthesia
Summary This article explores some of the issues related to small group teaching, which can be challenging to plan and execute.Some trainers may feelthatitis effort that may be better expended in some other teaching activity.There are, however, some major advantages to small group teaching, which relate to the development of life-long learning skills, professionalism and team-working.
c 2003 Elsevier Ltd. All rights reserved.
INTRODUCTION Anaesthesia is a very practical speciality, underpinned by a comprehensive understanding of the relevant basic sciences and appropriate professional behaviour. A large proportion of the learning of anaesthesia still takes place in the operating theatre, the obstetric unit and the intensive care unit. However, with the introduction of a competency-based curriculum and reduction in junior doctors’ hours of working, teaching of anaesthetic practice has had to become more structured.This has led to a much wider use of simulators and small groups for teaching purposes. The ultimate goal of any educational encounter between trainer and trainee must be to improve some aspect of cognitive, psychomotor or behavioural development. Small group teaching can play a valuable role in achieving this goal.
Sadly, every silver lining has a cloud attached. Adult learners also have some less positive characteristics: * *
*
Small group teaching can have many characteristics which particularly benef|t adult learners.They are: * * * * * * * *
ADULT LEARNERS It is important to consider some of the characteristics of adult learners as these impact greatly on the dynamics of a small group. Adult learners have many positive characteristics: * * *
* *
They want to control their own learning. They prefer active learning. They have widely different backgrounds and experiences. They are motivated to learn by a variety of factors. They like regular evaluation and feedback.
Correspondence to: KAP; E-mail: [email protected].
They can be set in their ways and resistant to change. They can experience a gradual decline in their physical and sensory capacities. They have a different learner/teacher relationship.
Encouraging format. Facilitates debate. Can utilise personal experiences. Acts as a forum for exchange of ideas. Allows beliefs to be challenged. Allows a problem-solving approach to be developed. Promotes understanding of differing viewpoints. Learners are encouraged to be more active.
As well as benef|ting adult learners, small group teaching episodes allow trainers to get to know their trainees in an environment that is potentially less stressful than the operating theatre or the ITU. It also allows the trainees to know their trainers better.
PLANNING SMALL GROUP TEACHING Good planning is the key to any educational activity and for small group teaching to be effective it is best viewed as a formal educational encounter with clear educational objectives for the session. It should also be made clear
ARTICLE IN PRESS 184
from the outset that this is not a passive educational encounter and trainees will be expected to participate. It is important to determine the small group size and membership. In a small anaesthetic department this may include all of the anaesthetic trainees at the same time whereas in a larger department it may be thought that some topics for discussion are not suitable for the whole of the trainee population. For example, if the educational objective is to explore aspects of ventilation and perfusion to prepare trainees for the Primary FRCA examination, more senior trainees may not f|nd the subject matter particularly helpful. However, it may be possible to get one of the more senior trainees to act as a small group facilitator for this learning encounter. Some ethical and professional issues may be best discussed in a group with more differing experiences as these are issues which affect all individuals equally. It is important to choose the right environment for the small group teaching.1 This should preferably be a well-ventilated, well-lit room where there is a reasonable expectation of low extraneous noise and little danger of interruptions. It is generally felt better to arrange the seating in a single circle or semi-circle as this allows all group members to see and be seen. This is felt to enhance the ability of all individuals within the group to participate. The trainer should also determine the resources they may need to teach effectively in the session.This may include overhead projectors, flip charts, interactive white boards, internet access, reference articles, low f|delity simulators (e.g. intubation head), etc. The resources the trainer decides upon will depend on: * *
The educational objectives for the session. The format of the small group teaching episode.
FORMATS FOR SMALL GROUP TEACHING Depending on the educational objectives and the group taking part, there are several formats an episode of small group teaching may take.
CURRENT ANAESTHESIA & CRITICAL CARE
The discussion group This is a useful format for exploring controversial topics or diff|cult ethical questions. It can help to promote interaction and exploration of values and attitudes. This format may be more useful if the participants in the group f|rst know each other.
Case studies This is scenario-based learning. It is an excellent format to encourage the exploration and development of clinical reasoning. It can be used in either the classroom or simulator setting and it gives the small group facilitator a chance to assess clinical judgement in a ‘safe’ environment.
The mini-lecture This can be used effectively in a small group teaching session. It may help break up more active small group work. It can be used to deliver a high density of information in a short time. Changing the pace of learning is an effective way to maintain interest within a small group session. The mini-lecture may be given by a facilitator or a trainee and will help develop presentation and communication skills in both.
The debate This format can be used to explore controversial issues and it will help to promote clarity of thought and communication skills. It can also help give alternate views emphasis they might not normally receive.
Role play This depends greatly on the conf|dence and practice of the facilitator. It can be a useful tool for exploring diff|cult areas in communication. It can also promote listening skills, empathy and team building. It is used quite widely in simulators and ATLS training but it can be diff|cult to use effectively in the classroom unless there is a very experienced facilitator.
The seminar
THE FACILITATOR/LEADER
A useful format if there is a relatively large topic area to be covered. The members of the group should be given pre-set tasks to prepare. They should be encouraged particularly to reference their preparation. When the group meets they should present their f|ndings. If well structured by the small group leader, this type of format can help understanding of a whole topic by seeing individuals from the group contributing their own building blocks. It can also help promote research ability, presentation skills and communication skills.
If small group teaching is to be successful, the facilitator’s role is crucial. The facilitator must have the characteristics of an excellent clinical teacher. These characteristics were identif|ed by Cleave-Hogg and Benedict.2 They are: * * * * *
Dedication. Commitment. Enthusiasm for teaching. Willing to give time to teaching. Enjoys his/her own professional work.
ARTICLE IN PRESS SMALLGROUP TEACHING
* *
*
Understands themselves as a role model. Motivated to continuously update and enrich their own learning. Able to establish and maintain interactive professional relationships.
Perhaps the most important of these characteristics is the understanding of self as a role model. Small groups function best when there is trust between the participants.Trainers who are perceived as excellent role models can help to facilitate the development of this trust more quickly. The style of the facilitator can also affect the group atmosphere. Lewin described three differing styles of leadership:3 * * *
Autocratic (authoritarian). Democratic (collaborative). Laissez-faire (detached).
The facilitator has to tread a delicate path, trying to involve everyone, encouraging the meek, restraining the forceful and keeping the group on track. Also, if the facilitator is too autocratic or becomes too much the ‘fount of all wisdom’, it may prevent the group, as a whole, from acting cohesively. Ideally, the facilitator should act as a catalyst to aid discussion within the group and not provide the group with all the answers. Some clinical teachers may f|nd the apparent informality of small group teaching threatening and may prefer to concentrate their teaching commitments to more formal, didactic sessions. As any clinical teaching requires a mix of teaching episodes, this should not be seen as a problem when organizing departmental teaching. It is understood by the trainees that their facilitator is both a member of the group and often the chairman of the group. What may be understood or acknowledged less is that the facilitator is also an assessor. It is particularly important that this role is handled with tact and discretion. This is essential to maintain trust within the group. This can be helped by clearly stated educational objectives for small group teaching, reinforced by positive and constructive feedback at the end of the group session. Tact, empathy and a sense of humour are essential if the facilitator for small group teaching aims to retain their sanity!
Group dynamics Whenever people form groups, social forces become active. An understanding of group dynamics can help the clinician (of whatever speciality) to avoid some of the pitfalls of teaching in small groups. If a group is planning to meet over several sessions, such as a series of small group sessions in an anaesthetic department, knowledge
185
of the stages a group may pass through can help orientate the facilitator and allow them to make appropriate interventions to help the group evolve and develop more effectively. The distinct stages a group may pass through were described byTuckman4 in 1965.They are: 1. Forming. Initially members of the group meet. They then communicate superf|cially with each other and the facilitator testing boundaries. Some members may joke, others may withdraw.The facilitator may start to get a feel of extroverts and introverts within the group. 2. Norming. In this stage, ground rules for the group are set, usually informally. The facilitator may f|nd that there are some expressions of dissatisfaction or frustration about the lack of a def|nite goal. 3. Storming. The feelings of purposelessness are dispelled and natural leaders start to emerge.Various members of the group start to be recognized as having special talents, resources or knowledge. This stage may be associated with strong emotions, particularly anger or impatience. It is the role of the facilitator to help calm and defuse potentially volatile situations and keep the group on an even keel. 4. Reforming. This is sometimes referred to as the ‘Performing’ stage. This is where the group gels. Goals and tasks are set and decisions taken on how to collaborate effectively in order to achieve the goals.The group starts to feel like a cohesive unit. There is much positive emotion at this stage giving group members a ‘feel-good’ factor. 5. Disbanding. The group disbands. There are often expressions of appreciation. Some members may experience a feeling of loss if the group has worked well together. By understanding these group dynamics, the facilitator will not be discouraged at stage 2, will restrain himself from offering quick f|xes at stage 3 and can help counteract the gloom at stage 5. Understanding the group dynamics will help the facilitator deal with the whole group over a period of time. However, the facilitator also has several tasks during the course of each group session. These could be def|ned as opening tasks, maintenance functions and ending the small group session.
Opening tasks Usually the facilitator will deal with the essential ‘housekeeping’ tasks of the small group e.g. teaching location, seating, etc. They may also open a discussion or suggest a timescale for a task.They can also give information and ask for opinions and help to put ideas together. It is helpful if the facilitator helps to encourage the less forceful members of the group contribute at an early stage to help improve their conf|dence. If some record is to be
ARTICLE IN PRESS 186
kept of the task, it may help if the facilitator offered to do this. This can allow the other members of the group more freedom to discuss the issues and stops the facilitator from being constantly applied to for guidance.
Maintenance functions The main tasks for the facilitator are listening, encouraging participation, relieving tension and conflict and helping communication by ensuring clarity. It may also be necessary to diagnose diff|culties in the group’s progress such as questioning false or unclear contributions. It is usually helpful to check every so often that all group members are progressing at a similar rate. This can be achieved by taking a ‘time-out’ and giving a ‘mini-summary’ of the groups’ progress thus far. The facilitator should also be able to deal with negativity or at least have some strategies available to minimize the effects of negativity on the group as a whole. These strategies may include asking for rephrasing of a statement in more moderate terms. Any worthwhile contribution should be complemental, whereas negative statements should not. If necessary, the facilitator can try and f|nd allies within the group or defuse a situation by agreeing to differ. If all else fails, the facilitator could privately request co-operation by an individual. If a member is too dominating, try and suggest a distracting task such as keeping a record of the discussion to lessen their contribution and give quieter members a chance to contribute.
Ending the Session Any educational encounter should have a beginning, a middle and an end and a small group session is no different from a lecture or a demonstration or a supervised operating session. The facilitator should keep to time and be positive. They should try to summarize the outcomes or learning points and, if appropriate, set future tasks. It is often useful to ask for feedback to try and f|nd areas which may be improved in future.
CURRENT ANAESTHESIA & CRITICAL CARE
SMALL GROUP TEACHINGFIS IT WORTH THE EFFORT? This article has demonstrated that small group teaching can be challenging to plan and execute. Some trainers may feel that it is effort that may be better expended in some other teaching activity. There are, however, some major advantages to small group teaching that have only been touched upon so far. These advantages relate to development of life-long learning skills, professionalism and team-working. There is no doubt that learning in a small group is a far more active process than sitting in a lecture. Active learning has been shown to promote a deeper understanding of a subject and hopefully reinforce the culture of life-long learning. Goals set within a group and recognition of the skills of other members help to promote team working. More importantly, small groups help professionals reflect on their practice and hear differing views. This can help develop clinical reasoning and professional judgement.Coles5 stated that though a doctor’s professional development may be construed as ‘knowing more’maybe it should be taken as ‘knowing-how’. Professionals often make judgements which may be moral as well as factual. Small group teaching helps individuals explore moral and ethical dilemmas in a relatively safe environment. By so doing, it is hoped that trainees are better equipped to be reflective practitioners.
REFERENCES 1. Walton H J. Small group methods in medical teaching. ASME Medical Education Booklet No. 1. Edinburgh: Association for the Study of Medical Education, 1997. 2. Cleave-Hogg D, Benedict C. The characteristics of excellent clinical teachers. Can J Anaesth 1997; 44: 577--581. 3. Lewin K. Resolving Social Conflict. New York: Harper, 1948. 4. Tuckman B. Developmental sequence in small groups. Psychol Bull 1965; 54: 229--249. 5. Coles C. A qualitative look at practice. A comment on ‘Analysis of the clinical behaviour of anaesthetists’. Med Educ 1997; 31(6): 448.