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The Community Health Project
The undergraduate medical curriculum in the Yong
Loo Lin School of Medicine is a five-year course.
In the third year, medical students are posted to the
Department of Community, Occupational and Family
Medicine for a four-week module-"Community
Health Project" (CHP). The primary objective of CHP
is to give students an opportunity to conduct a study
within a defined community so that factors relevant
to an important health problem can be described and
assessed.
Dividing the Work
A faculty member divides students into six groups,
each of about 40 students. At the end of the project,
each group gives a 45-minute presentation of its
findings to the class, academic staff and invited
guests to showcase its work. The group also submits
its findings to a scientific report that closely follows
the submission format required of a scientific
journal.
When a large group is involved in a multifaceted
task, it is inevitable that work will not be distributed
equally. In our experience, we have learnt some
useful pointers about group work and they are:
- Accept that the division of work will not be
equal
It is not possible or practical to have everyone
contributing an equal share in a large group.
Often, work distribution in a big group will follow
a bell-shaped distribution (see Figure 1). While
the supervisor tries hard to ensure that most of
the work is distributed equally among students,
some will either by choice or nomination, take
up leadership or administrative roles and spend
more time on the project. There will be a minority
who seemingly contributes less due to reasons
or excuses which may be genuine or otherwise.
As supervisors, we explain to the groups at the
beginning that grades awarded to individual
students will correspond with the distribution of
work.
 Figure 1
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- Define the essential and elective learning tasks
In a complex project involving a diverse range
of tasks, the supervisor should define essential
tasks that all students should do for their learning.
Since the CHP's primary objective is for students
to learn about an important health problem in
a community, it is imperative that they go out
and conduct interviews with participants in the
selected community. All students are also required
to perform literature reviews and contribute to
group discussions on data interpretation and
forming of conclusions. In addition, the supervisor
should spell out a list of elective tasks (e.g. data
analysis, making presentations and manuscript
writing) from which students can choose. Defining
the essential and elective learning tasks allows
students to divide the latter among themselves and
ensures that students achieve minimum learning
through performing the essential tasks.
- Sometimes students need to be appointed
In a large group, students may feel shy about
volunteering for leadership or public speaking
roles though they are best suited for these tasks.
When this happens, the supervisor may need to
help identify suitable students in the group and
gently persuade them to take up these roles.
- Reward the hard-working students
Finally, it is important to reward the hard-working
students not just with better grades. As student
leaders spend more time with tutors, we often
end up mentoring these students long after the
CHP is over. Since learning often happens through apprenticeship in medicine, students
benefit from the extra time they spent with the
tutors.
Conflict Management
In today's complex world, it takes more than
professional knowledge and technical skills for
medical graduates to succeed in their career. Thus,
medical education needs to equip future doctors
with communication and social skills that will
enable them to work well with others in a wide range
of social situations. The CHP encourages teamwork
and collaborative learning. However, conflict may
arise between individual students, student groups
or with the tutor/supervisor. When this happens,
tutors can utilise the resolution process as a positive
experience that teaches students to solve the
problem in steps, brainstorm for ideas and through
effective communication and negotiation, create a
final resolution that establishes mutual respect.
Managing Difficult Students
In a group of mature students, the majority often
positively influences and checks difficult students.
However, we do occasionally encounter difficult
students and the following are some tips on how to
manage them:
- The monopoliser (or the 'know-it-all' or
'dominator')
The first step in managing such a student is to
determine whether he is the 'truly-know-it-all'
or the 'thinks-he-knows-it-all'. Then, we will get
the former to participate but not dominate the
session and the latter to realise that he has gaps
in his knowledge.
- The distracter (or the 'heckler')
If a student was hindering group learning, the
tutor could try steering the group's discussion
back to the material at hand. However, if he
persisted, we suggest talking to the student
privately to understand his motives and rebuke
him tactfully if necessary.
- The cynic (or the 'challenger' or 'disrespector')
As tutors, we welcome criticism and comments.
However, we have occasionally encountered
students who are disrespectful to their colleagues
and/or us and disregard constructive discussion.
In such cases, we suggest reiterating the ground
rules of mutual respect and courtesy or talk with
the student on how his behaviour class impedes
progress during the break or after the class.
- The non-participant (or the 'passive learner' or
'non-listener')
We first ask ourselves whether the student is
not participating because of genuine learning
problems (e.g. not understanding the material),
shyness or a negative attitude. We would talk
with the student with learning problems privately
and suggest ways to help him catch up. If the
student was shy, we would remind him that active
participation is a ground rule. For a student with
negative attitude, we would talk to him about our
concerns and rebuke him if necessary.
Though being an enthusiastic, nurturing mentor
with good facilitation skills is helpful in preventing
difficult student behaviour, the following are also
useful in group-building:
- Build cohesive groups
Well-formed and cohesive learning groups
are often easier to manage because students
inf luence one another positively. In building
such groups, ensure that (1) the characteristics
of members (e.g. gender, ethnicity, previous
experience) are evenly distributed across groups,
(2) students are accountable for the quality of their
individual and group outputs (i.e. the group gets
marks for both individual and group outputs), (3)
students receive immediate and frequent feedback
and (4) team assignments promote both learning
and team development.
- Keep sub-groups small
We often forget that big groups can be broken
down into smaller sub-groups. Healthy and
friendly competition between sub-groups can
promote intra-group cohesion, reduce non-participation
and encourage quality work.
- Devise reward systems that recognise both
individual and group success
Create grading systems that encourage and
reward both individual and group outputs
to encourage individuals to do their best
without being inconsiderate towards other group
members.
Conclusion
Conducting the CHP module has taught us many
lessons in incorporating group work into our
teaching. We hope that by sharing our experience,
we can help colleagues to execute, manage and use
group work effectively in their teaching.
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