A model of small group discussion as a teaching - learning reinforcement tool involving the medical students in the Department of Anatomy: a prospective analytical study

The advancement of medical education technology has changed teaching methods from one-way, didactic lectures to two-way, self-directed, and self-motivated active teaching-learning methods. First-year MBBS students are exposed to small group teaching to learn different aspects of anatomy. An innovative module through small group discussions (SGDs) was implemented as an additional teaching-learning method to highlight the differences with small group teaching (SGT). In SGT, the teacher is the active person, while the students are the passive listeners, whereas in SGDs, students are active participants, and the faculty are facilitators. In the present study, we have evaluated the efficiency of SGDs as a teaching – learning reinforcement tool for medical students in the Department of Anatomy. To determine the effect of the SGD module on the academic performance of medical students in the Department of Anatomy. 150 first-year MBBS students from the 2022 and 2023 academic years. In total, 96% of the study participants agreed that the SGD module is a better method for the active participation of students and also serves as a platform for a deeper understanding of the subject. The mean score of test 1 was 74.9, and that of test 2 was 89.4. The pass percentage of study participants increased by 44% with the introduction of the SGD module. The p -value from the paired t-test was 0.001, which shows a statistically significant improvement in scores from Test 1 to Test 2. The SGD, as a student-centered teaching–learning module, alongside a traditional teaching method, was associated with improved student learning outcomes. Its implementation is feasible within the current medical curriculum with minimal additional resources, even though factors such as familiarity with the examination and assessment pattern and efforts in preparation for assessment between the two tests might have played a role in the improved performance recorded. While the observed improvement cannot be attributed solely to the SGD module, its implementation was associated with improved student performance, suggesting that SGDs have contributed to the outcome.

As research in medical education advances, there has been a shift in teaching methods from one-way didactic lectures to two-way, self-directed, and self-motivated active teaching-learning methods (Roy et al., 2023). As we transform our Indian medical graduates into competent global medical professionals through the implementation of a competency-based medical curriculum, medical teachers undergo various training sessions on teaching-learning methods to upgrade the quality of their teaching and to deliver the best quality medical education to our students (Medical Council of India, 2019). Some of the methods administered in faculty development programs by the National Medical Commission include early clinical exposure (ECE), attitude, ethics and communication (AETCOM), self-directed learning (SDL), among others (Medical Council of India, 2019). As part of our commitment to advancing medical education and enhancing its quality in our institute, we are in a continuous process of adapting new methodologies to our curriculum for the benefit of student outcomes. Small group teaching (SGT) is the most commonly used mode of teaching in the Department of Anatomy during practical and demonstration sessions in the histology laboratory, osteology laboratory, and radiological anatomy classes. However, we felt the need to develop a comprehensive process of learning when we introduced a modified method, the small group discussion module, as an additional teaching-learning method. In SGT, the teacher is the active person, while the students are passive listeners, whereas in SGD, the students are active participants and the faculty are facilitators. SGDs enhance learning by creating an urge to engage more with the given topic and to deliberate effectively on it with the help of teachers and peers (Pritha et al., 2015; Singh et al., 2013). The aim of our study was to determine the effect of the small group discussion module on the academic performance of medical students in the Department of Anatomy. In the present study, we evaluated the SGD module as a teaching – learning tool reinforcement. We also obtained feedback from the students and facilitators to understand their perceptions of the SGD module used in our department.

The study was conducted in the Department of Anatomy, AIIMS Raebareli, after obtaining approval from the Institute Ethics Committee. MBBS students pursuing their first MBBS Professional year and participating in small group teaching in the Department of Anatomy at AIIMS Raebareli, with a minimum attendance rate of 75% in the first and second semesters, were included in the study. Accordingly, 150 students of first year MBBS were included on the basis of the performance and attendance (75 students out of 100 from each of the 2022 batch and 2023 batch) while 25% of the students were excluded due to the following factors- 1. Irregular college attendance

2. Discontinuation of course

3. Poor performance despite having adequate attendance).

Following the admission of the new MBBS cohorts (2022 and 2023), the first semester was conducted under the standard instructional curriculum. At the end of the first semester, Test 1 was conducted, and the performance of students was recorded. During the second semester, the small group discussion (SGD) module was introduced as a supplement to the regular teaching program. In this module, the students were divided into groups of 16–17. Each group was facilitated by one faculty member. In each session, students discussed all the selected topics while the faculty played the role of facilitator, with minimal intervention when required. Every lecture was followed by a small group discussion the next day. The students had sufficient time to prepare for active participation in small group discussion. Test 2 was conducted at the end of the second semester and, again, the performance of students was recorded. Performances in the first and second semester were compared to find out the effect of the small group discussion module on the academic performance of medical students in the Department of Anatomy (Figure 1). The assumption of normality was assessed before performing the paired analysis. The distribution of the paired differences (post-intervention score−pre-intervention score) was evaluated using the Shapiro–Wilk test, along with visual assessment using histograms and Q–Q plots. A p -value >0.05 in the Shapiro–Wilk test was considered indicative of no significant departure from normality. Based on the normality assessment, the paired t-test was used.

Our department comprised six faculty members and one senior resident, four of whom served as facilitators in the small-group discussion module. Two faculty members and the senior resident were involved in preparing and validating the study questionnaire and preparing and standardizing an assessment of the knowledge and skills gained for Test 1 (at the end of the first semester without the SGD Module) and Test 2 (at the end of the second semester with the SGD Module). The faculty involved in the assessment of the students followed the standard assessment procedure for both Test 1 and Test 2. Question papers and practical assessment settings for Test 1 and Test 2 were standardized to ensure assessment equality: 15% of the questions were based on application, 20% were based on skill, and 65% of the questions were based on knowledge. The Microsoft Office Excel Data Analysis ToolPak was used to calculate descriptive statistics, and a paired t-test was used to establish statistical significance. An instrument (questionnaire) was developed using a 5-point Likert scale, with answers “strongly agree,” “agree,” “neutral,” “disagree,” or “strongly disagree”. The following steps were followed in validating the instrument: 1. The item pool was generated; 2. The instrument pattern was prepared, 3. A review by experts was conducted; 4. The content validity index of each item was calculated using the formula (Sum of proportion relevance rating)/(number of experts) (Yusoff, 2019), 5. Items with a content validity index of 1 were selected, and 6. The final instrument with a qualified item pool was generated. The reliability of the instrument was confirmed using Cronbach's alpha, which was calculated as 0.87, which is considered good (DeVellis, 2016). The validated instrument was utilized to collect feedback from the students and faculty. Data from the assessment tests and feedback survey were analyzed using Microsoft Office Excel 2021 data analysis tool, and the effectiveness of the small group discussion module was evaluated.

In the present study, first-year MBBS students from the 2022 and 2023 cohorts were introduced to the SGD module. Students from the Department of Anatomy with a minimum attendance of 75% in both the first and second semesters were selected for the assessment of the SGD module and to obtain feedback on it. In total, 82 students qualified with 75% attendance in the first semester from the MBBS 2022 cohort, while 79 students qualified with 75% attendance in the second semester from the MBBS 2022 cohort. A total of 76 students qualified with 75% attendance in both semesters from the 2022 cohort. A total of 89 students qualified with 75% attendance in the first semester from the MBBS 2023 cohort. A total of 86 students qualified with 75% attendance in the second semester from the MBBS 2023 cohort. A total of 79 students qualified with 75% attendance in both semesters from the 2023 cohort. The first 75 highest-performing students were selected from each cohort for the study to give equal advantage to both cohorts of MBBS students.

The first semester was conducted with the regular teaching program and, at the end of the first semester, Test 1 was conducted, and scores were recorded. In the second semester, the ’small group discussion module’ was added to the teaching program. Test 2 was conducted at the end of the second semester, and scores were recorded. The scores of the two tests were subjected to statistical analysis, and the pass percentage of the study participants was recorded (Table 1) (scores of 80 (50%) and above out of 160 were considered a pass). The study participants showed a pass percentage of 34.7% in test 1 (at the end of the first semester without the SGD module) and 78.7% in test 2 (at the end of the second semester with the SGD module), with a significant increase of 44% (Table 1). The above findings demonstrate an association between the implementation of the SGD module and improved overall academic performance among the students. To understand how students and faculty felt about the SGD module, a validated instrument was used to obtain feedback. The results from feedback by study participants (students) show that 147 [98%] participants agreed that the SGD module is a student-centered method, 145 [96.6%] participants agreed that students actively participated in the SGD module, 125 [83.3%] participants acknowledged that the SGD module creates interest in the subject, 128 [85.3%] students agreed that this module creates self-motivation, 134 [89.3%] students agreed that the SGD module encourages further study, 135 [90%] agreed that this module helps the faculty provide individual attention to the students, and 124 [82.6%] agreed that the SGD module in the Department of Anatomy, AIIMS Raebareli, is well organized (Figure 2).

Facilitator feedback was overwhelmingly positive (Figure 3). All four facilitators (100%) agreed that the SGD module is student-centered, stimulates interest and self-motivation, encourages further study, enables individualized attention, and is well-organized within the Department of Anatomy at AIIMS Raebareli. Additionally, three facilitators (75%) agreed that students actively participated during the sessions.

Statistical analysis

In the present study, the null hypothesis was that there is no significant difference in participant assessment scores between Test 1 (administered at the end of the first semester without the SGD module) and Test 2 (administered at the end of the second semester with the SGD module). The mean scores for Tests 1 and 2 were 74.9 and 89.4, respectively (Table 1), which clearly shows that student performance improves with the incorporation of the SGD module. The p -value from the paired t-test is <0.001 (Table 2), and the p -value from the McNemar test is also <0.001 (Table 3), which is less than the significance level of 0.05; therefore, the null hypothesis (there is no difference between scores of test 1 and test 2) is rejected. The results of our study indicate that implementation of the small group discussion (SGD) module was associated with improved academic performance among the study participants.

The small group discussion module was successfully implemented in the Department of Anatomy, AIIMS Raebareli, for academic cohorts of MBBS Students with significant positive results. Meo reported that small group learning modules promote active participation, enhance the communication abilities of students, and help students to work as active team members, as well as increasing their interest and motivation for in-depth learning (Meo, 2013). Mir et al. in their study provided guidelines for effective planning of small group sessions and also stated that timely changes are necessary for successfully conducting small group sessions on a regular basis (Mir et al., 2019). Ahmed and Roy stated that small group modules are vital to the undergraduate medical curriculum (Ahmed and Roy, 2017). Edmunds and Brown reported that communication and cognitive skills are vital in small group teaching-learning modules (Edmunds and Brown, 2010). Burgess et al. reported in his study that feedback provides valuable input for successfully organizing small group teaching-learning sessions (Burgess et al., 2020). Sanap and Malewadkar states that students actively participated in SGD sessions and small group sessions had a more clinical approach (Sanap and Malewadkar, 2017). Bhide and Singh in a study, concluded that small group sessions are very valuable in medical teaching programs, with students having a positive attitude toward this teaching-learning approach (Bhide and Singh, 2019). Sutthiyuth et al. reported that the IFS (individual facilitator summary) model was more effective than the CS (central summary) SGD module (Sutthiyuth et al., 2021). Rad et al. stated that the SGD module significantly helped students in understanding the clinical applications of embryology (Rad et al., 2018). Savkar et al. concluded that more SGD modules along with didactic lectures will enhance the critical thinking of students in pharmacology (Savkar et al., 2016). Sahu et al. in their study, reported that the SGD learning module is effective and faculty training has an important role in the successful implementation of small group learning sessions (Sahu et al., 2018). Worrall-Davies stated that facilitative interventions by teachers in small group sessions will encourage student participation (Worrall-Davies, 1999). Agnihotri and Ngorosha stated that SGD modules enhance effective learning (Agnihotri and Ngorosha, 2018). The results from our study were aligned with the literature that supports that the SGD module will improve the learning outcome of students when supplemented alongside a traditional teaching curriculum.

In addition, Bruner et al. reported that clinical cases make small-group teaching in basic sciences more integrated, student-centered, and developmentally appropriate, fostering a deeper understanding of the subject and its clinical applications (Bruner et al., 2023). Yousaf et al. concluded that self-directed learning in combination with small-group discussions will enhance the academic performance of the students (Yousaf et al., 2023). Moin et al. compared the Jigsaw technique with traditional SGD and concluded that students exposed to the Jigsaw module performed better compared to those exposed to SGD (Moin et al., 2024). Robinson opined that small-group learning activities improve participation, peer interaction, and constructive learning among students (Robinson, 2023). Xue et al. reported that small group modules helped students to improve their self-learning abilities (Xue et al., 2021). Sato et al. applied the small group discussion module prior to surgery, which resulted in enhanced surgical education and surgical-skill learning (Sato et al., 2025). From the above literature, it is evident that small group discussion module incorporation as an addition teaching learning tool is associated with better learning outcomes among students.

As discussed above, evidence across multiple studies indicates that small-group sessions provide an ideal platform for fostering active student participation, enhancing self-motivation, and enabling faculty to provide individualized attention. Our study also helped participants to enhance their ability to communicate and express their understanding of the subject with their peers in the SGD sessions. Assessment and survey findings from the present study indicate that incorporation of the SGD module into the undergraduate medical curriculum was associated with improved overall academic performance and better subject understanding among the study participants. The SGD module is added as part of our regular teaching program in the Department of Anatomy at our institute. Despite certain limitations, the findings suggest that the SGD module is feasible as a supplementary approach to traditional teaching, with minimal additional resources needed, and is associated with improved learning among medical graduates. Several additional factors, such as understanding of the examination pattern, familiarity with the examination and assessment pattern, and efforts in preparation for assessment between the two tests, might have some role in the improved performance. Although the observed improvement in student performance cannot be attributed solely to the SGD module, its implementation was associated with the improved performance outcomes observed among the students, which was substantiated by the positive feedback of the faculty and students alike.

Study limitations

This pilot study was limited to 150 participants across two consecutive MBBS cohorts at our institution. In order to apply its outcome to other teaching programs, we need to conduct a study with a larger number of participants at different institutes to get a statistically significant output. The analysis of scores from a single test cannot establish that the SGD module is the sole factor for the improvement in students’ performance. Other contributing factors, such as understanding of the examination pattern, familiarity with the assessment pattern, and efforts in preparation for assessment between the two tests, might have some role in the better scores in Test 2. Therefore, the improvement in scores should be interpreted as an overall effect associated with the implementation of the SGD module rather than as evidence of a direct causal effect of the module alone.