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Group learning setting

Guiding questions:

  1. Should students work individually on VPs or in groups?
  2. If in groups, how large should the groups be?
  3. If in groups, what should be the group composition?

Interaction is key when learning clinical reasoning using VPs. Some students appreciate discussing VPs with their peers and teachers [Nagji 2020], whereas some prefer to interact with the technology while working with VPs individually. Both scenarios are possible in VPs [Edelbring 2012]. In some settings, self-directed individual learning might be necessary because of limited opportunities for small-group learning [Johnson 2014]. Yet, there are many advantages of working in small groups. In fact, a meta-analysis of 122 studies found that collaborative learning is more effective on several cognitive, process and affective outcomes in diverse disciplines like health, math or physics, than individual learning [Lou 2001]. Furthermore, working in small groups enables open discussion in a supportive learning environment [Naumann 2016]. Students who solved VPs in teams achieved significantly greater learning gains, better diagnosed cranial nerve palsies and were more satisfied than students working individually. [Johnson 2013, Johnson 2014] Working in groups fosters skills in clinical reasoning, but also in team collaboration [Naumann 2016], allowing the application of cooperative learning strategies [Huwendiek 2008]. The VPs designed for group work can be of lower complexity since the reflection and reasoning will come from the interaction inside of the collaborative working experience [Edelbring 2011, Ellaway 2015]. 

Regarding group sizes, even though there are examples of use of VPs in large groups like lectures [Hooper 2015], smaller groups are advised as they increase the exposure of each student to VPs and impose greater responsibility to each student [Edelbring 2012]. The literature does not specifically define “small groups”. According to Edelbring et al., students felt that working in pairs broadened their reasoning the most when compared to individual and larger groups [Edelbring 2011]. Poulton et al. report that the use of VPs in digital problem-based learning sessions with 6-8 students was accompanied by good performance improvement outcomes [Poulton 2014]. Facing the lack of clear preferences in the literature, we recommend adjusting the decision to local settings.

We did not find firm evidence on how the group composition in student groups working on VPs should look like. Johnson et al. hypothesize, based on Vygotsky’s Zone of proximal development theory, that groups should contain a balanced mix of high and low-performing students [Johnson 2014]. Those struggling with the tasks would be supported in learning by better performing ones. This is indirectly confirmed by their observations that students who had scored low in pretests benefited more from working in teams on VPs than from working individually [Johnson 2013, Johnson 2014]. Another opportunity that comes from working on VPs in teams with specified roles is the development of interprofessional collaboration skills. The feasibility and educational gains of such educational scenarios in teams consisting of medical, nursing, pharmacy, physical and occupational therapy students have been demonstrated in several studies [Shoemaker 2015, Martini 2019, Edelbring 2022]. 

In summary, we would like to encourage the use of VP by students for small group learning, but at the same time notice that VP are flexible enough to be used in various scenarios including individual work in self-study scenarios.

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