Working in Tutor Groups

Tutorial groups form the core of the first year and a half of the professional curriculum. Each group is composed of six to eight students that typically meet in three, two-hour sessions per week. You will be assigned to a new group for each course. Students are presented with a case designed to draw out topics for study. The group identifies and prioritizes learning issues as they work through the case. Between group sessions, all members are responsible for researching the learning issues and then returning to group ready to share and discuss the topic. Tutorial group sessions provide the opportunity to share, apply, synthesize and integrate your work, and to refine your comprehension of the material as you work together as a group. Lectures, wet labs, computer cases and large group discussions supplement tutorial discussions and autonomous learning.

Why Problem Based Learning?

Why problem based learning (PBL)?  Here are some comments from students:

"Students teaching students is a more interesting and better way to learn." 
Many students have stated that they feel best about the tutorial experience when the group works together to build a knowledge base:  "I like the opportunity we have to discuss the material and work things out even when we don't think we can."  Other students appreciated the opportunity for "more intellectual discussions and interactions."  One student described how this works on a personal level:  "It helped my learning greatly to hear from other students who understood certain material better than I did -- I was less hesitant to ask them to explain. I personally am very hesitant to ask questions during lecture, so the small group was a good place for me to get better answers from the tutor and other students.  It also helps me learn better when I do understand something to explain it out loud.  This exposes gaps in logic, etc., that I might not otherwise work out."

"Concepts discussed in the small groups are easier to remember."
Through group discussion, most students feel not only do they understand the material more thoroughly, but the knowledge is more permanent.  Memory is based on associations, like a spider web.  The more levels that link concepts, the more easily that information is accessed.  PBL cases provide an example of clinical application to emphasize the importance of the learning issues.  Cases also provide a structural framework in which to integrate learning issues and help forge a complete understanding of the big picture.  One student commented that the entire active learning process of finding the sources, sorting out the relevant facts and then digesting the information has meant that "I've understood concepts more thoroughly and have been able to integrate facts better." Another student has described how active learning allows "the knowledge you acquire [to creep up] on you until it is really a part of your thinking." "Small group discussion about cases develops my clinical reasoning skills." Several students have mentioned that the small groups help them to think "clinically."  They approach the animal broadly at first and then focus in on the problem presented.  "You learn to think about what you want to know [about the patient] and why."  Learning how to develop and rule out a list of differential diagnoses is a critical aspect of clinical skills.  In addition, cases are presented complete with radiographs and results of diagnostic tests, when appropriate.  Students enjoy the repeated exposure to this type of data, increasing their comfort level and analytical abilities.

"Working in small groups helps me improve my interpersonal skills and learn about my classmates."
A positive experience in a tutorial group appears to be linked to mutual respect and sensitivity.  Students note that different personalities and learning styles are inevitable in a small group, but tolerance and understanding are needed to work well together.  Most students agree that diversity within tutorial groups facilitates discussion of the case.  For example, having varied backgrounds in veterinary medicine leads to "bouncing ideas off one another and figuring a lot out before looking at any reference books."  One student commented that the "exposure to different ways of looking at some problems" was particularly valuable coming from peers rather than faculty. Working through problems in group and developing mutual respect lead to critical lifelong skills.  As a professional, you will need to work with the diverse personalities of your colleagues and clients.  Many students have commented that they enjoy the increased interaction and "bonding with faculty and classmates." 

"Working in small groups helps me evaluate my own progress."
he small group discussions provide an opportunity to compare your level of  understanding to that of the other students. Most students judge their level of knowledge on their ability to participate in the group discussion, either by asking pertinent questions or contributing information.  As one student said, "I was able to tell the level other students had reached in the material I was working on.  I was able to get immediate feedback on my understanding of the material."

"It allows me flexibility with my time and my learning".
Many students enjoy not being "chained to a lecture hall." Time management and self-motivation are essential skills for success in this curriculum.  The freedom to manage one's own time allows students to maintain a job, personalize study habits, and volunteer in CPS, the wild-life clinic, ENICU, etc. The ability to ensure a balanced life allows for a much happier, healthier, more positive student.

In sum: "The curriculum has enabled me to polish my communication skills and to become more involved in the entire learning process.  In doing this, it has also helped to foster greater scientific curiosity as well as helped to perfect problem solving skills."

The Role of the Tutor

The faculty tutor is included in the group session to ensure your success. The tutor’s job is to help you and your group achieve each of the goals of the curriculum, and realize the potential of the tutorial process. He or she must walk the finest line between guiding the group and leading it. The tutor’s job is to listen to the group's discussion, to guide by asking probing questions, and to challenge the group's depth of knowledge. The tutor helps to refocus the discussion from inevitable tangents and to clarify the issues when the discussion gets messy. The tutor ensures all important learning issues are identified, and helps summarize and integrate the learning issues back into the case  discussion.  The tutor accomplishes all of this by turning the questions back onto the group.  In keeping with their role as facilitators rather than lecturers, the tutor is not there to give mini-lectures or give “the answers” to the group, but to help the group work effectively together.  They often only ask questions to lead the group to explore a different aspect or to help refocus the discussion.  A key to effective tutoring is identifying problems and knowing what, when, and how much to interject. 

In summary, one student described the tutor's role in relation to the group process:
"A successful tutorial group works through a case in a systematic manner, develops attainable, well thought out goals for the case and the Block in general, follows through on learning issues and explores them in detail.  An effective tutor ensures the above happens by asking pertinent questions, keeping the group on track, clarifying objectives, and picking up loose ends for additional learning issues."

Tutors are also often used as moderators for processing group problems or personal advisement.  They can be used outside of group sessions as resource faculty on any issue.  Most are reluctant to answer direct questions in group, feeling these questions are learning issues for the group to research.  
While the tutor is there to help, you are responsible for your own education. Be willing to work through difficulties and to actively change what does not work to optimize your educational experience.

Learning Issues

The cases are written to reveal specific topics for study.  What defines a learning issue?  Anything you don't know that comes up in a case.  Learning issues are developed and tailored to fit the course, the case and the previous knowledge base of the group members.  Often detailed or tangential learning issues are proposed. These can aid greatly in understanding the big picture.  However, these issues are usually just researched in the context of the case to understand the complexities and interrelations of systems. When listing and prioritizing learning issues, first of all, remember which course you are in!  This will save you from studying physiology in Block 1 and medicine in the physiology Block 3. 

Developing Learning Issues
You will need to learn quickly how to manage your own learning in order to make good use of your tutorials and independent study time. Each case is carefully written to prompt study of particular topics. As you discuss a case you will make note of many things that you don’t yet know by keeping a running list of potential learning issues on the flip chart provided in your tutorial room. At the end of each tutorial session you will review, refine and prioritize that draft list into the actual learning issues that you will study for the next tutorial session. Studies of students’ learning in problem based learning have shown that student-generated learning issues serve as the main starting point for students’ individual study and help structure and direct the discussion in the next tutorial. Given the central role of learning issues in the tutorial process, it is wise to consider what makes good learning issues. 

In addition to prioritizing and refining your learning issues at the end of each tutorial, it can be helpful to agree on an agenda to start the next tutorial. Which learning issue will you start discussion with? How will you present or discuss it? Who will start the discussion? Major learning issues are researched and studied by all group members. Case discussions are richer if everyone is prepared to discuss the topic and, ultimately each individual will be ac-countable for their understanding of the major learning is-sues. However, there are often tangential or minor learning issues that emerge in a case discussion that would help the group better understand the case or simply satisfy  curiosity. Those minor or tangential learning issues are often divided up among the members.  

Good Learning Issues Are:
1.    Relevant to the case. Learning issues should clearly arise from prioritized hypotheses and must be both relevant and fundamental to addressing the concepts that arise in the case.
2.    Related to the course objectives. While the case might prompt many issues that you are unfamiliar with, your learning issues should be framed primarily by the objectives of the course in which you are enrolled. The course objectives and concept maps printed in your course guides are a useful tool for prioritizing learning issues. Your learning issues for each case should be consistent with the overall course objectives and concepts. 
3.    Specific and well-defined, rather than broad. (Review topics can be broader since you are already familiar with those areas.)
4.    Realistically manageable in your time limits. You will want to pare down your list of learning issues, prioritize them, and define them in ways that make them doable before the next tutorial.
5.    Clearly stated, so that you, your group mates, and your tutor understand them.
6.    “Owned”by the students. Learning issues should be generated by you (not your tutor) and be meaningful to you, as they form the foundation of your independent study. They should be at an appropriate level, given the previous knowledge of the members of the group. 

Students often find that the hardest part of PBL is learning to trust themselves in the development of the learning issues, and in particular, deciding for themselves the appropriate depth and breadth to pursue. While this can be a difficult task for students who are accustomed to having teachers define exactly what they need to study, the skill and practice of managing and directing your own learning is invaluable. When you get to the CUHA, faculty will expect you to read up on the cases. Like your tutors in the early part of the curriculum, they will not hand you articles or textbooks and tell you what to read for the  following morning. They will expect you to locate and review relevant  readings yourself. After graduation, you will also need to continue to learn about new cases you encounter and new developments in  medicine and science. You will be making the choices about how to  address those learning needs and determining the appropriate breadth and depth to pursue. In that regard, the problem based learning  process treats you like a professional from the first day of your  veterinary education and simulates the learning situations you will  encounter throughout your career. 

Preparation for Tutorial Group

Using Available Resources
There are many resources available to you, including a world-class library with its Core Resource Center and reserve materials; the Modular Resource Center; dry lab modules; web resources, your own classmates and faculty. One of the greatest benefits of diversity within your class is the wealth of knowledge gained from collective past experience in one field or another. You also have access to faculty experts in many fields who want to help. The resources available are endless, but it will be up to you to seek them out and make the most of them. 

Each course guide contains an annotated bibliography of texts that may be helpful for that course and a list of associated resource faculty who have expertise that relates to the cases in that course. Multiple copies of suggested texts are held on reserve or in a special  “Core Resources” section in the library. Nevertheless, students do buy their own reference texts to build a professional library for use through-out the DVM program and in their future practice. Which texts you buy and when you choose to buy them are your own decisions. You may want to try several texts before making a purchase. Upper-class students also can offer advice on which texts they’ve found most useful. Borrowing or buying used books from other students can be another cost-efficient way of accessing books, although be wary of used books for sure. The best references may be the ones that upper-class students keep, not the ones they choose to sell. 

As there isn’t an assigned reading list for each week, you will need to choose your own sources that best answer the questions that arise during your tutorial discussion and best address your learning issues. In addition to textbooks, you will use a number of other learning resources. You will learn to use Medline—a bibliographic database of citations in the medically related disciplines—to access current research and literature reviews. Each tutorial group is provided with an allowance for printing, so you can print particularly useful articles for your peers in your tutorial group. To assist students in locating key articles, the College has also developed its own on-line database of references to research papers and chapters that students and faculty have found to be especially good resources for Foundation courses. Rather than search through hundreds of items found on broad search categories in MedLine, you may search and choose among a more se-lect group of papers referenced in the Veterinary College Literature Database. Interactive computer programs available in the Wiswall (Dry) Lab, developed by the College, offer simulations, animations, prediction tables, audio and video elements. In the Modular Resource Center, students can work at learning stations (“modules”) with hands-on, visual exhibits. For each module, students’ exploration of three-dimensional models, radio-graphs, slides, plastinated or wet specimens and other materials is guided by brief written scripts. 

Study Wisely
Reading an overview chapter relevant to your learning issues gives a big picture and introduces complexities that may not have been immediately obvious. With that overview, you can move on to more detailed or specialized sources that go into greater depth, address more specific questions or offer other perspectives on the topic. Taking good notes (be sure to write down the reference from which you are taking your notes) or bringing these sources to tutorial sessions helps to verify facts or share helpful pictures/diagrams. If you find a particularly good reference, you may use your group’s NetPrint account at the library to make copies for others in your group. In addition, while studying it’s a good idea to write down your questions in the margin or on a separate page. This reminds you of your thought process and helps start or focus a discussion in the tutorial. 

As you are studying, it can be easy to lose the forest for the trees. Effective learning requires that knowledge be organized into an understand-able conceptual structure that captures relationships among ideas and intertwined concepts. Each foundation course has a conceptual frame-work of its own presented in the course objectives and course concept map in your course guide and used to structure the entire course. It is critical that you to spend some time thinking about the cases in the con-text of the overall course objectives. You will need to correlate the course concept map and the course objectives with each case. Constructing your own objectives for each case and representing and visually organizing the major concepts of each case will be helpful. Concept maps, diagrams, flow charts or outlines are some of the ways that students organize what they are learning from multiple sources.

Be Prepared
The success of a tutorial depends on the preparedness of the group. Without a common knowledge base upon which to discuss the issues, frustration quickly arises. Tutorials are an opportunity to refine and integrate what you have previously studied and to clarify future learning issues. In one student’s words, “Like everything else - you get out of it what you put into it.” If you focus your study on the learning issues that your group prioritized, make good use of your learning resources, spend some time synthesizing what you have learned from various sources and apply your learning back to questions arising from the case, you’ll be well prepared. 

Keep Up!
The nature of group discussion requires a solid chunk of work done consistently throughout the week. The vast amount of material to learn and the quick progression of cases does not allow time to catch up from previous weeks or to study by cramming. Time management skills are critical in balancing other aspects of your life with your academics. 

If your group is having problems (i.e. interpersonal conflicts) be honest about them, talk about them and work them out—don’t allow them to ruin group dynamics for the entire course. 

Use Your Group
The other members of your group are a valuable resource. They each bring a unique set of experiences and knowledge that can contribute to the success of your discussions. Make use of the individual strengths in the group. You may also want to study with other members of your group outside of tutorial time or arrange a special meeting as a group outside of formal tutorial sessions for extra review or for discussion of a topic not covered due to time constraints. Most tutors are willing to attend extra meetings if the group desires. 

Work together as a class. All of the students in the College share an interest in and commitment to the health and welfare of animals and humans. You do not need to compete with your classmates. You will be working together in class, in the CUHA, and as professional colleagues in the future. Learning to cooperate as part of a team is a valuable skill to take into your future practice, when you will always be working with colleagues, clients and other staff members. 

Working in a Tutorial Group

Tutorials are an important part of your education in your first year and a half. Actively participating in the group process is the most effective way of achieving the educational goals of the program. Participation includes sharing ideas and knowledge, asking for clarification or an explanation, building on (and critiquing) the contributions of others, and facilitating effective group process and problem-solving. Each group will develop its own way of approaching the core parts of the  tutorial process. Both the tutor and students in the group must ensure that all aspects of the tutorial process are given attention. 

As one student put it:
"Any student having difficulty understanding something should speak up right away for two reasons.  First of all, the tutor will be alerted to where you are having difficulties and will be better able to help.  The other students, also, may see your confusion and be able to clear it up -- sometimes even better than the tutor.  Second of all, nobody knows nothing  so if you speak up right away, you can share what you do know as well as what you don't understand.  If you wait until every-body else has spoken, then chances are what you knew was already said, and you will feel like you have nothing to contribute."

Establish Ground Rules
On the first day of a new tutorial group, you’ll introduce yourself and meet your tutor and fellow students. This first session is a good time to clarify your expectations for the group and to establish some group norms or ground rules. Once the ground rules are negotiated and agreed upon, they are a resource that can be referred to later as a part of routine tutorial evaluation, or if conflicts arise. From your own previous experience working in groups, brainstorm the “rules” you want to follow in your tutorials. The following list serves as a guide to some of the things that you might expect of yourself, your group mates and your tutor. Once you agree upon your own ground rules in your own words, you might want to type them up and distribute the agreement to all members and keep a copy in your tutorial room. 

Sample Ground Rules
The purpose of the tutorial is to support students’ learning related to the course objectives. The tutorial is one of several integral parts of the course. The tutor’s role is to facilitate the reasoning and learning process. Working with an understanding of the objectives of the case and the course, knowledge of veterinary medicine, and an appreciation of case based learning, s/he will guide the students toward appropriate areas of study.

Attendance and punctuality are mandatory.  How much time will we wait if someone is late?  Do we start immediately at the dedicated time, whether all members are present or not?  A student, who is sick and must miss a tutorial, must call another group member before the tutorial?  Are there religious holidays that members of the group would like to observe and for which we would like to make alternate arrangements?

Students and the tutor will come prepared for the tutorial. The group cannot skip steps in the deliberation of cases.  They must use all steps (stating facts, raising questions, hypothesizing, listing information needed to confirm hypotheses, identifying learning issues).

Do you want to establish a plan for the next tutorial meeting at the end of each tutorial meeting (e.g. starting with a review of major learning issues)? How do you want to identify learning issues (e.g. write on butcher pa-per as we go along, prioritize at end of session, summarize, decide which issues all group members will research and which are personal learning issues that individuals will investigate)?

Groups must evaluate their process as a group and as individuals on a regular basis. (e.g. at the close of each tutorial). The learning process is cooperative.  All students in the group must contribute to the group by sharing their ideas, useful resources, and thinking aloud so that others can benefit from their reasoning, knowledge and experience. Everyone has something to offer. Sharing will contribute to our common goal of learning. All members of the group share responsibility for maintaining positive group dynamics and advancing the discussion in useful and relevant ways. Students will ask questions when they do not understand and will suggest alternative explanations when appropriate. Students will share material resources equitably—including library re-sources, MRC resources and the copy account.

The tutor and all students will show respect for all members of the group. How do we expect “respect” to be manifested?  Students will speak one at a time and not interrupt their classmates inappropriately? Tutor and students will listen and indicate so with appropriate verbal and nonverbal behaviors?  All members will acknowledge and build on the contributions of other students.

Students will abide by the Honor Code (See Chapter 4, section 2).

Some of us suggest that ground rules be set up from the very beginning so that both the students and the tutor have a safe and comfortable way to express their thoughts and opinions about how the group is functioning. Another suggestion is to have each student rotate through the position of 'leader'; this student would raise issues, ask questions, and draw other students into the discussion rather than having the students sit back and let the tutor fulfill this role. Both the students and the tutor should feel responsible for pointing out problems or even potential problems so they can be dealt with in a timely fashion to avoid the real pitfalls of a dysfunctional group.  As one student put it, "you can't expect students .... to be friends or even have to like [each other], but they got into vet school, they are intelligent and deserve a modicum of respect." Group dynamics need to be regulated.  If there is a problem, work it out before it becomes World War 3, or before there are only two days until assessment.

The Tutorial Ethic:  MUTUAL RESPECT
A core ethic in the tutorials— and the College more broadly— is mutual respect. Each person in your tutorial group brings a different back-ground, different experiences and knowledge, and different perspectives.  All are talented, bright, highly motivated, and desire a veterinary career that will advance animal and human health. If you value the unique experiences that each person brings to the group, the diversity within your group will enhance your group’s interactions and your education as a whole. 

When you walk into your first session, you are placed in a random group with six strangers.  In a situation like this, it is easy to feel isolated or separate from others, sensing differences rather than similarities. Mutual respect allows the effective communication that is essential to success in tutorial groups, class discussions, and clinical interactions.  Assumptions and stereotypes about people can be barriers to that communication.  Make the effort to get to know your colleagues and to appreciate and celebrate each person as an individual.  As previous students have noted, “humility in realizing others have important things to say and teach that you may not know” and the “ability to accept that you may be wrong” go far in establishing a good educational climate. 

Process Regularly
Talking about your experiences in the group and your perceptions of your own and your class-mates’ progress is a vital part of the communication that will help you get to know each other better and work better together.  You should take a few minutes at the end of each tutorial for an informal evaluation of how well you and your group are progressing on the various goals of the tutorial process. This end-of-tutorial evaluation, commonly called processing, is essential in addressing any problems that may arise in the group and making sure that the group functions optimally.

Processing is one aspect of the tutorial process that some people find awkward.  Yet, those few minutes of self and peer evaluation are critical to ensuring that there are open channels of communication within the group, and that everyone is becoming progressively better at the variety of skills and knowledge that the tutorial process is designed to pro-mote.  You may find it helpful to use the forms which are enclosed as guides for the tutorial evaluation process. You may take them to your tutorial (or make copies to leave in your tutorial room) as a tool for enhancing tutor group productivity.

The form entitled “End-of-Tutorial Evaluation” outlines the dimensions of performance that you, your colleagues and tutor are evaluating. These dimensions closely match the educational goals of the tutorial process. While you won’t have time to thoroughly evaluate all of these dimensions every day, you may want to focus on different dimensions at different times to ensure that you are attending to all relevant parts of a successful tutorial. The “Group Process Evaluation Form” is a sample form that describes in more detail satisfactory and unsatisfactory group behaviors on “problem solving and reasoning” and “interpersonal/group process/communication skills.”  Again, while the form is too lengthy to be used in its entirety every day, you might like to select parts of this form as a “checklist” when doing your end-of-tutorial processing. The individual “Feedback by Tutors to Students (and Student Self-Assessment Guide)” form is also a useful tool that you may want to reflect on regularly.  How well are you, individually, doing on each of the items described on that form?  How well are other individuals in the group doing?  Finally, you may want to revisit your ground rules from time to time to ensure that you are all fulfilling the expectations you agreed on at the beginning of the course.

Both students and tutors are responsible for pointing out problems or potential problems so they can be dealt with. Sometimes feedback—particularly when it is criticism of peers or your tutor—can be difficult to give. People often have ideas about how to improve the tutorial, but they just don't know how to communicate it to others for fear of offending or creating tension.  It can be particularly difficult if you are the first one to talk about a problem. But, if one courageous person can break the ice, it’s much easier for everyone else to share their feelings and bring up additional concerns. Following the suggestions on the form “Giving Constructive Feedback” might make it easier to express your feelings and to comment constructively on your peers’ and tutor’s behaviors. These criteria are useful in a variety of contexts where you are giving feedback, including educating clients about animal health and care requirements, communicating with technicians or associates, and even completing written course evaluations at the end of a term. 

Constructive feedback is a way of helping people to consider changing their behavior in ways that will improve their learning or professional development.  It gives information about the effect a person’s work or actions have on other members of the group. Criteria for useful feedback include:
  • Feedback should be directed primarily at a person’s performance or behavior rather than at the person him/herself.
  • Feedback is directed at behavior which the receiver can do something about.  Reminding another person of a shortcoming over which s/he has no control leads to frustration, not learning.
  • Feedback is specific rather than general. Giving specific examples helps illustrate specific points. To make a general statement about another person’ s work as a whole does not tell a person which parts of her/his performance or actions need changing and which might serve as models.
  • Feedback is both positive and negative. A balanced description of a per-son’s behavior or actions takes both the strong and the weak points into account. Both types of feedback provide information that the receiver can learn from.
  • Feedback is descriptive rather than judgmental. Describing one’s own reaction to another person’s work leaves the receiver free to decide whether and how to use the feedback.  Avoiding judgmental language reduces the other’s need to respond defensively.
  • Feedback takes into account the needs of both the receiver and the giver of the feedback.  What you say to people about their performance 

Tutor Room Etiquette

Tutor rooms are favorite places to study for many students. However, there are students from three classes as well as fourth years and faculty who use these 16 rooms for studying and meetings. To avoid conflicts, simple courtesy to others is crucial.

Some basic courtesies include:
  • Clean the room after each use. Pick up your trash, wipe down the table, etc.
  • Do not remove the tutor room resources. They are for use in the tutorial room only. This also includes chairs. Sometimes a meeting involves more people than chairs are available in that room. If you must “borrow” from another room, please put them back.
  • Tutor room scheduling is handled by Kate Davenport in the Office of Student & Academic Services. AV support is managed by Dave Frank and the Educational Support Services team. At certain times throughout the academic year, select tutorial rooms may be available for college functions, scheduled meetings or faculty committees. All other tutor room use is restricted to tutorial group meetings and student study. Rooms are not reserved by the presence of your belongings!

Interpersonal Challenges

When asked to describe the ideal tutor group, certain themes are proposed by almost all students.  These include a positive attitude, an open mind, mutual respect, patience, forgiveness, and humor. Working intensely within a small group necessitates the development of good interpersonal skills, such as active listening and honest, direct communication without attacking or as-signing blame.  The need to respect each others' opinions and thought processes is constantly emphasized by students.  The "humility in realizing others have important things to say and teach that you may not know" and the "ability to accept that you may be wrong" goes far to establish good group dynamics.

Time is allotted in each tutorial session for discussion of problems or thoughts on group interactions or dynamics.  Take advantage of this time to process; use your tutor as a mediator if necessary.  Processing requires tact and naked honesty.  It is difficult to criticize peers and faculty, especially to be the first one to talk about a problem.  If one per-son can break the ice, it's much easier for everyone else to share their feelings and bring up additional concerns.  Deal with problems before they interfere with your education.

Example 1:
Nick has a strong personality and often leads his group in discussions.  Caroline is a bit quieter and doesn't like to argue with Nick because she feels he becomes strongly defensive.  Several times this has stopped Caroline from contributing a conflicting opinion.  Slowly, Caroline be-comes angry and builds resentment towards Nick. Unfortunately, the group has no clue about Caroline's feelings and Caroline, to avoid confrontation, doesn't chase down issues that confuse her.  Caroline begins to dislike the group sessions because she doesn't feel comfortable dis-cussing the learning issues.  Consequently, her contributions decline in quality and quantity, her attitude sours and the whole group begins to feel tension. A problem within the group is a group problem. Caroline needs to ex-press her feelings and discover (with Nick) why he makes her feel reluctant to contradict him.  Nick may be able to adjust his speech patterns, volume, or tone of voice.  It may be that other members have similar feelings as Caroline, but are also reluctant to discuss them.  Once the problem is discussed, the rest of the group is now able to be sensitive to the situation, pick up on subtleties of their interactions, watch their own behavior and in general, be more attentive and thus more able to avoid or resolve situations as they arise.

Example 2:
Heidi is a natural-born leader.  She enjoys working with a group.  Unbeknownst to her, no one likes her as a leader.  When Heidi makes a suggestion or begins to direct the discussion, another group member, Jeff, feels the issue is not the most relevant to discuss.  Jackie also has her own opinions, but Heidi always speaks first and her thoughts aren't  bad ones, so Jackie usually goes along with them.  However, the group sessions end before Jeff and Jackie can bring up their own questions and learning issues. This is one of the most common complaints about group dynamics.  Though Heidi thinks she may be incorporating other people's opinions, she doesn't realize her own assertiveness may be altering the group's process.  The other members of the group need to vocalize their feelings and most importantly, speak up and be assertive throughout the session. If no one will offer another choice, by default, the most outspoken person will dominate.

Example 3:
Becky is a moderate group member.  She will often contribute, loves to draw on the board and will try to motivate her group as necessary.  However, group life is difficult. She has a personality conflict with Ed, a well-meaning, sincere, but trying member.  Ed's learning style is much different.  He has a shorter attention span and often requires people to repeat themselves several times over because he is still writing down the last concept.   Continual disruptions over learning styles leads Becky to "give up" on the group.  She studies the material on her own, but rarely contributes and barely seems to listen to the group discussion.  Much to the other group members' dismay, Becky even falls asleep during a session. An absent group member is just as frustrating as a domineering one.  A positive attitude, motivation, and active participation are truly required for an effective learning process. There are times in group sessions when an individual realizes he isn't understanding the material.  Often times, a quick explanation by the rest of the group is sufficient to fill in the few missing gaps.  Unfortunately, other times, the material is too dense or the individual's gaps are too broad to address in group.  Students tend to understand the difference and know when to pause for an explanation or if they know their own knowledge level is far below the group's, they follow as best able, and study to catch up before next session. Personality conflicts are the most sensitive issues to deal with.  This is a difficult situation.  No one is in the wrong and no one feels they are obligated to adjust their own behavior.  But for this group to work effectively for everyone, a compromise or decision must be reached regarding Becky's and Ed's behavior.  Becky may become more involved in re-viewing concepts (on the board, since she likes it so much), Ed may be able to work on his concentrating skills and come in more prepared.  Groups are often criticized because they are held to the "lowest common denominator," yet this may benefit all members by providing opportunities for peer teaching and repetition.  Teaching the material is the best way to learn it. 

Every group has its own personality. An individual's personality may change depending on the other students in the group. When personalities or learning styles conflict, the only way to improve the situation and make the process an effective learning experience for everyone is to vocalize the problem and make an effort to solve to problem. "Students need to realize that they're working as a group for everyone's educational benefit - everyone needs to participate and offer something. These groups are a major part of their education, actually, the biggest part. If there is a problem with a group, it needs to be dealt with early otherwise everyone's education will suffer."

Troubles With Tutors
Problems don't only exist among the group members; often the tutor's personality and style also conflicts with a student or the group as a whole.

Example 1.  (Absent tutor):
Tim's group, although comprised of good students, has a tutor that rarely speaks and allows the group to ramble around trivial matters and talk themselves in circles.  When the tutor does ask a question, Tim thinks that they had satisfactorily discussed it 15 minutes ago.  Consequently, Tim never knows if they had not covered the information to sufficient depth or if his tutor was just not paying attention. Tim and Molly frequently ask the tutor if they are discovering all the major learning issues.  No matter how well or poorly the group session went, the tutor just says, "You're doing fine, don't worry."  Molly and Tim talk with friends in other groups who seem to be relaxed with the process. The disparity of tutor interaction and styles frustrates them even more. They feel that they are not getting what they need to know. Even more frightening is that they're not sure what they do need to know. Frantically studying, Tim reads every book on the subject covered in the case and spends hours wrestling with minuscule details, while Molly stresses so much she can't even concentrate. The tutor never inspires trust in the group process or even in his own comments. Inadequate tutor participation often leads to mistrust. When students feel the tutor is not fulfilling his role adequately, the group must ad-dress the tutor with their concerns.  Here, the tutor doesn't seem to pay attention, yet tells the group they're doing fine. How can the group believe they're OK if the tutor isn't listening to the discussion?  The tutor needs to clarify what it is that the group is doing fine with.  He may say "You've hit all the major issues" or "that was an good correlation be-tween concepts" or "you narrowed down the differential diagnoses logically."  The group may ask for more reassurance until they are comfort-able with the learning process.  However, one of the goals of PBL is to encourage the students to decide for themselves the depth and breadth of material to study. Repetition of the phrase, "you're doing fine" from a trusted tutor helps to verify the student's own decisions regarding the material.

Example 2.  (Overzealous tutor):
Anne's tutor was very excited with the opportunity to be involved with the tutorial process.  The tutor actively led the discussion, forging far ahead of her understanding.  The tutor would ask very directive, specific questions.  Len seemed to know all the answers and the tutor took his understanding for comprehension from all members of the group.  Anne didn't understand the progression behind the tutor's line of questioning.  She panicked that she wasn't smart enough and wasn't learning the right things.  Ellen was resentful of the tutor "quizzing" her group.  She thought the tutor didn't let the group work for itself.  The tutor seemed to have a specific agenda in mind and so directed the discussion with leading questions instead of allowing them to reason it out on their own.  Ultimately this led to a silent group, unwilling to go where the tutor led them, resentful of the tutor’s misinterpretations of the group process; the six brilliant students had a less than fruitful tutorial experience. A tutor may interfere with the group process by his/her own eagerness.  The PBL learning experience depends on the group process itself, not simply the coverage of material. This group needs to discuss the problems arising from the tutor's extreme directive. The students need to explain to the tutor that they need to discover the progression of questions through their own conversation.  The agenda needs to emerge from the group's need to understand, not the tutor's need to teach.

Example 3.  (well-meaning tutor):
Sue's tutor doesn't direct her group, but his ongoing comments fore-shadow the next day's discussion or the next case.  Frequently, he'll give away the diagnosis or list the case objectives, depriving the group of the opportunity to reason out the case and discover the learning is-sues along the way.  Sue and her group don't feel guided by the tutor's comments, rather, they feel left out of the process entirely.  The group tried to address the problems with their tutor quite early on.  Unfortunately, the tutor reacted poorly.  He felt he was doing the right thing by "helping" the students and felt slighted that the group didn't want his input. Subsequently, the tutor alternately sulked and foreshadowed, leaving the group unsure of his mood and thus more tentative to look to the tutor for guidance. A well-meaning but ineffective tutor may negate the PBL experience.  Again, the whole PBL experience must be derived from the students' own exploration of the issues. The tutor's reaction to the group's criticism only worsened the situation.  The group may seek additional help and advice to manage the tutor, but sometimes the group must pull themselves together and lead each other with their own knowledge and intuition. The expectations that students have regarding the role of the tutor influence their interactions.   Students feel the tutor is obligated to guide them sufficiently to prevent them from dwelling on tangents. However, what might feel off track for one student may feel fine for an-other.  Although the tutors are there to provide guidance, the group may need to guide them in the appropriateness of their timing and comments.

In short, if the functioning of the tutorial group depends upon the inter-action of students and tutor, then it is important that you do your part to develop a good rapport with the tutor and within the group.  Some students have mentioned that individuals in their small groups did not express dissatisfaction with the functioning of the group until after the semester was over (a little late). Use processing time as a format for discussing problems. Talk to the tutor, either as a group or privately regarding your expectations of each other.  The tutors are here for you and are usually most willing to adapt to further your educational needs. If you are not satisfied, seek out others (e.g. the Course Leader, or Dr. Kathy Edmondson) to help resolve the conflict.  Written evaluations are taken seriously and tutors have responded positively from them.