Understanding and Optimizing Group Dynamics in Case-Based Collaborative Learning

Teamwork skills are recognized as a core competency of physicians. To more effectively prepare trainees for the demands of their future work, medical educators are increasingly turning to group-based instructional formats. We employ case-based collaborative learning (CBCL) - a format which requires daily in-class discussion and collaboration in assigned small groups. While students overwhelmingly embraced CBCL as stimulating and thought-provoking, some students reported that social dynamics among group members adversely impacted their experience. Using mixed methods, we demonstrate that a short intervention that asked students to discuss how they can best learn together improved small group dynamics, and promoted psychological safety among peers. Importantly, no specific instruction in team work was required, students overall had a clear understanding how they could improve, but they did not know how to start this conversation with each other. To promote team learning, we propose that educators emphasize students' accountability to their peers' learning in addition to their own, and devote some time in class for teams to reflect and discuss how to improve learning with each other. Our observations are of interest to anyone frequently relying on group work without peer assessment or formal feedback on group performance.