Understanding and Optimizing Group Dynamics in Case-Based Collaborative Learning: An Educational Quality Improvement Project

Abstract

Medical educators are increasingly searching for instructional formats that can best prepare their students for the demands of practicing in the team-based modern healthcare system. One novel approach is case-based collaborative learning (CBCL), which Harvard Medical School incorporated into its preclinical curriculum in 2015. While students overwhelmingly embrace the format as stimulating and thought-provoking, some students report that negative social dynamics among group members can adversely impact their experience. This mixed methods study first characterizes individual students’ experiences in CBCL and the social dynamics that arise in their groups. Second, we examined the impact of an intervention intended to improve the learning environment. For this purpose, we assessed the utility of the Team Performance Survey (TPS), a questionnaire validated in other team-based learning contexts, as a diagnostic tool to discriminate groups that perform well from those that may benefit from support. We collected data from two consecutive cohorts of first-year students, including free response comments on perceived areas of strength or areas for improvement in their CBCL groups and associated TPS scores. Free responses were inductively coded and thematically analyzed to yield a conceptual model portraying functional CBCL group processes. We stratified free response data across different TPS thresholds to distinguish group performance categories. The intervention allowed students to discuss their experiences with their group mates and develop shared norms going forward. We then analyzed TPS scores and free responses after students had undergone the intervention. Individual responses were aggregated to characterize group profiles. The free responses indicated that students are keenly aware of interactions and processes that do and do not work well for their groups. The resulting model of CBCL group work encompasses both objective behaviors as well as subjective elements of the social environment. The TPS can help identify groups that are experiencing dysfunction. The intervention was well accepted by students and resulted in a significant increase in TPS scores and an improvement in group profiles. This work demonstrates that CBCL groups can function as interdependent learning teams, but students may benefit from support to ensure they form teams rapidly and reliably. We recommend that interventions addressing group dynamics should be considered a critical supplement for regular CBCL classroom activities. Subsequent work will explore the impact of a more extensive supplement in the form of a year-long curriculum designed to further optimize the learning environment and develop students’ interpersonal and communication skills.