Small group discussions allow for active learning and peer teaching. They work best when the facilitator sets clear expectations, encourages participation, and asks questions that promote deeper learning. The facilitator should also establish a safe environment, encourage problem solving, and summarize the discussion before closing. Leading these discussions well involves strategies for engaging all learner levels and keeping conversations focused on the intended topic.

1. A teaching hospital of
Harvard Medical School
Leading a Small Group
Discussion

2. A teaching hospital of
Harvard Medical School
Small Group Discussions Allow:
• Active learning
• Learner-centered experience
• Reflection
• Peer-to-peer teaching
• Case discussion
• Team based learning

3. A teaching hospital of
Harvard Medical School
Small Group Discussion Techniques
• Set clear expectations for the discussion
– Today we are going to discuss how to deliver
difficult news to a patient.
– I am going to ask you to share with the group
how you were taught to perform your first
procedure.
• Ask about the learners’ interests and needs:
– Are there particular questions or areas that you
want to make sure we discuss today?

4. A teaching hospital of
Harvard Medical School
Small Group Discussion Techniques
• Establish a safe learning environment
– Encourage questions and use learners’ names
– Be willing to say, “I don’t know, let’s look that
up.”
– Think out loud with the group: “When I am
confronted with this issue, I find it helpful to…”
• Encourage learner interactivity and
problem solving

5. A teaching hospital of
Harvard Medical School
Small Group Discussion Techniques
• Ask questions that encourage deeper vs surface
level learning:
– What if the patient was 80 y.o. instead of 20?
– When wouldn’t you choose that course of
treatment?
– Why did you choose that answer and not the
other?
– Explain why we can rule out…

6. A teaching hospital of
Harvard Medical School
Summarize and Close the Discussion
• Ask each group member to name one thing
they learned from the discussion or one
thing they are going to change in their
clinical practice
• Leave time for learners to ask clarifying
questions:
• What are some points you would like me to
cover again next time?

7. A teaching hospital of
Harvard Medical School
A Great Case Discussion...
• Starts w/basics, unfolds in bite-sized pieces
• Avoids focus on lab and imaging data too
early; allows full context of patient’s story
• Includes interesting decision points or
clinical pearls
• Teaches general principles by changing
variables in case
• Encourages a discussion of cost-effective,
value-added care

8. A teaching hospital of
Harvard Medical School
Thought Question
• Discuss the following challenges when
leading a small group discussion:
– A student that won’t participate
– A learner that dominates the discussion
– A particularly quiet group
– Unpredictable tangents in the
conversation

9. A teaching hospital of
Harvard Medical School
Thought Question
• Often your small group will have
residents and students at various
learning levels (e.g. the “one room
school house.”)
– What are strategies to engage all levels
of learners at the table?
– What pitfalls do you need to avoid?

10. A teaching hospital of
Harvard Medical School
Thought Question
• Sometimes a group discussion can
turn into a lecture, or at the opposite
end of the spectrum, dissolve into a
conversation completely off topic.
– What are the most effective strategies to
engage the group in a true discussion on
the topic you wish to teach?