The purpose of tutorials is to interact with students in small groups and to shift emphasis from acquiring knowledge during lectures to data evaluation and problem solving. Class size is vital in determining the efficiency of teaching and discussion in a tutorial. However, due to the large student intake and the lack of facilities, teaching staff and time, tutorials may be conducted for students in groups as big as 30. With such large tutorial groups, it is difficult to even give each a chance to speak in class or get to know all the students. In a traditional tutorial, students often have to be called to answer questions, and the quieter students or those who are less prepared can easily 'hide' behind the more vocal or better prepared students.

One possible solution to overcome the problem of a big class is to 'divide and conquer'. By dividing the tutorial group of 30 students into smaller teams of 5-6, students are instructed to prepare the answers and participate in the tutorial as a team rather than individuals. When the tutor poses questions to the class, these teams will be given an opportunity to discuss and answer as a team through a representative, with other members chipping in when necessary. This ensures that there are no 'sleeping members' during tutorials.

I had the opportunity to test out the feasibility and effectiveness of this method on four groups each consisting of 28 second-year students from Yong Loo Lin School of Medicine, in two different tutorials conducted in September 2005. One tutorial, entitled "Critical Evaluation of Clinical Trial", was based on a critical appraisal of a paper on a clinical trial and the other, entitled "Critical Evaluation of Appropriate Use of Statistical Tests", was about problem solving in biostatistics. These tutorials were part of the module on "Principles in Evidence-based Medicine" for second year medical students. For both tutorials, reading materials and questions were distributed to students in advance. One of two groups in each tutorial was randomly assigned to be the team-method group. Instructions were emailed to students in the two team-method groups one week in advance of their tutorials so that they can divide themselves into teams of 5-6 (according to the alphabetical order of their names) for pre-tutorial discussions.

Tutor's Experience

Before the tutorials for groups using the team-method, I arranged the chairs into five small circles to facilitate group discussions. This was not easy in a small tutorial room. Students came prepared with written answers, presumably from their earlier team discussions. Teams took turns to present their answers and for certain questions, I had to allow for 'buzzing' within the teams. The noise level was high during discussion time, and the room sounded like a market-place. In the two-hour tutorial, I did less didactic teaching and spent more time commenting on the teams' different answers.

Students' Feedback Through Questionnaires at the End of the Tutorials

I collected students' feedback through questionnaires at the end of the tutorials. 60% of students indicated that they would usually discuss tutorial questions with their classmates before attending the tutorial. For those who did not do this, the reasons given were: "not seeing a need since questions would be discussed during tutorials" (32.3%); "not thinking of doing such a thing" (29.0%); "not having the time to do so" (25.8%) and "not being able to find classmates who would want to do this together" (12.9%).

Among students in the team-method groups, 76.1% agreed or strongly agreed that the pre-tutorial team discussions were useful and 62.2% agreed or strongly agreed they were enjoyable. Students were asked what their greatest source of learning was at the end of the tutorial. The contrast in response between the two groups was statistically significant (p=0.006).

Table 1. Feedback from students in team-method versus conventional method tutorial groups

In additional feedback questions posed to the team-method groups, 66% agreed and another 17% strongly agreed that this method was more enjoyable than the conventional method. Finally, 76% said they would recommend pre-tutorial discussions in teams, as "it enforced better preparation before the tutorial" (40.0%); "it allowed me to interact with my classmates" (32.4%); "it facilitated learning" (22.7%) and that "it was fun" (4.9%). Similarly, 76% of students in the team-method groups also recommended conducting the tutorials in teams as "it allowed me to learn more from classmates" (25.9%); "it was a more active way of learning" (28.2%); "it widened the scope of discussion" (18.8%); "it was less intimidating" (12.9%); "students could be less reliant on tutor" (7.1%) and "it promoted self-learning" (7.1%).

Conclusion

This simple study has shown that the team-method of conducting tutorials in teams may enhance student-initiated and -directed learning during tutorials, although a formal assessment of the students will be necessary to prove that this is a more effective method of learning. A majority of students do discuss the tutorial questions with classmates before the class. Hence, formalising team formation for pre-tutorial discussions will facilitate such activities. Students feel less intimated if asked to answer as a team rather than as individuals and are therefore more involved in class discussion. For medical students, this also provides an opportunity to work in teams and learn from their peers, which they have to do as doctors subsequently. However, suitability of tutorial material and size of tutorial rooms are important considerations for the success of this method.