Learner Centered Histopathology Small Groups in a First Year Curriculum

 

     Nicholas P. Ziats, Ph.D., Mark L. Cohen, M.D., Steven N. Emancipator, M.D.
 Institute of Pathology, CASE School of Medicine, Case Western Reserve University, Cleveland, Ohio
 
Introduction

 

The CASE School of Medicine is undergoing a period of extensive revision of its of curriculum.  The new curriculum will include a need for more interactive teaching methods and rely more heavily on active participation of learning by the students. Currently, the first year medical Biological Basis of Disease (BBD) Committee, the longest committee of the first year curriculum, includes a mixture of lectures, laboratories and small group conferences.  Small group conferences prior to last year were led by faculty and although reasonably well attended, student participation was felt to be inadequate.  The BBD organizers felt a change was necessary and thought that student led small group sessions might improve participation as well as have the potential for active learning and hopefully better retention and comprehension of material.

 

Statement of the Problem

 

One current problem in our medical school curriculum has been the lack of interest and/or motivation of medical students towards the learning of histopathology.  We believe that part of the problem lies in the methods used to educate the learners resulting in passive rather than active learning.  It is also recognized that approaches other than traditional lecture format could be used to integrate these disciplines including small-group1,2 and/or team-based learning.  These alternative approaches have distinct advantages over traditional lecture formats, the most important being active versus passive based learning.  We have used small group learning for about five years with faculty as leaders of the small group sessions.  Last year, we introduced student-directed (instead of faculty-directed) small group discussions of clinically relevant diseases of selected topics.  Our goal was to improve the participation, particularly active participation and interest of students without compromising their retention or comprehension of material.
 
Question
Our overall question was: 
 
u Is student-directed (learner-centered) learning better than faculty-directed learning? 
 
Our immediate concern was: 
 
?Do students prefer student-led versus faculty learning as a means to encourage active versus passive learning?
 
Description of the Project
Students were randomly assigned (2 students) to a particular topic and a small group consisting of 15-18 students.  Students were given a case study, references, a “skeleton” PowerPoint and preparatory session one week prior to their presentation.  In the preparatory sessions, student presenters were encouraged to engage their student colleagues.  In addition, faculty presented a first case study on Steatohepatitis, to give the students additional guidelines on presentation.
 
The topics assigned for presentations were:
?Acute Respiratory Distress Syndrome
?Diabetic Wound Healing
?Atherosclerosis
?Stroke
?Lung Cancer
?Colon Cancer
?Transplantation
?Cellular Immunology

Table 1.  Learner-centered small group survey.

 

 

 

Findings to Date
This study is being evaluated utilizing a survey to determine student perception of their learning experiences.  In addition, faculty were asked to evaluate student directed sessions.  Table 1 indicates the results of a survey posed of students after participation in these small group sessions. The study is ongoing and incomplete since approximately 20% of those surveyed had not yet presented. 
 
Our early experience has been quite positive with 70% of the students having a positive experience to student-led versus faculty-led small group learning.  Students felt more engaged, comfortable and felt the pace was slower in student-led discussions.  Most, faculty felt that students were well prepared, appeared more engaged and active in the student-led presentations.  Interestingly, some students did not like doing the presentations and felt that student-directed sessions were not as adequate as faculty led sessions.  Some felt that learning was better from faculty.  However, the majority of students felt this was a positive and different experience and an initial step as a future Physician/Educator. 
 
Key Lessons Learned
Students reported that student or learner-directed small groups helped their overall learning compared to faculty led small groups.  Students perceived that learning was better when they were presenting a particular topic compared to listening (passive) to the presentations by faculty. Learning by the participants (not being a presenter) was considered equally as good from faculty-led versus student-led presentations.  There were some concerns with regard to preparatory sessions.  Facilitators were considered helpful and not a hindrance to the sessions.  Finally, students felt that these sessions were helpful in preparing them as Physicians/Educators.
 
Questions
?Does learner centered or student-directed small group learning improve retention and/or comprehension of histopathologic concepts? 
 
?What is the discrepancy between the learning from faculty or from their student peers?
 
Literature cited
 
1.1. Jacques D. ABC of Learning & Teaching in Medicine: Teaching small groups. Brit. Med. J. 326:492-494, 2003.
2.

2. Canfield P.  An interactive, student-centered approach to teaching large-group sessions in veterinary clinical pathology.  J. Vet. Med. Educ.  29:105-110, 2002.

 
Acknowledgements
Supported by the CASE School of Medicine and by funds from the Institute of Pathology, Case Western Reserve University