Small group discussions in upper extremity: Are they effective when delivered online?

Small group discussion (SGD) is a well-known educational method to promote active learning. Best practices for running SGDs in face-to-face, on-site events are described in the literature; however, little has been reported about online versions. When the upper extremity education taskforce proposed and received AO Trauma Education Commission approval to conduct an online series of SGDs, the AO Education Institute engaged two surgeons, Nele Roels from Belgium and Murat Bilici from Switzerland, to conduct educational research to evaluate the effects of group size and structure, etc.

A series of eight modules with online SGDs was delivered over eight Wednesday evenings in September and October 2020, with 16 to 20 faculty per week and an average of 55 participants from Europe, Middle East, and Africa. Each module consisted of a 10-minute overview presentation (10 min), three or four cases for the 75-minute SGD, and five-minutes of take-home messages. Participants were preassigned to groups of either one faculty with five participants or two faculty with eight participants. Faculty from the regions were paired and participants were mixed as much as possible.

Modules and moderators:

1. Clavicle (Franz Kralinger)
2. Scapula (FP du Plessis)
3. Proximal humerus (Martin Kloub)
4. Humeral shaft (Sami Roukoz)
5. Distal humerus (Lee van Rensburg)
6. Elbow/forearm (Denise Eygendaal)
7. Distal radius and ulna (Diane Nam)
8. Carpus and hand (Paul Binhammer)

Based on data gathered after each module and after the course, and on focus groups with participants and faculty, we report that small group discussions can be run effectively online.

The study’s data shows high acceptance and identifies (and reinforces) the key requirements: All faculty and participants must meet the technical requirements regarding web cameras, audio, and strength of internet connection, and faculty need to adapt their roles to combine their existing skills with some new techniques to be effective online. The entire research project is being submitted to a journal and as a medical education conference presentation. Below, the key findings are summarized and some feedback from faculty and participants is presented.

Summary of the findings

For the course participants, the optimal way to run online an online small group discussion was:

• Having two faculty with 4–5 participants (80 percent)
• Rotating to different faculty every week (67 percent)
• Interacting with peers from different countries (95 percent)

Precourse assessment questions and prerecorded presentations enhanced the online discussions for 82 percent, and 83 percent agreed that each 90-minute module was adequate for three cases. Forty-six percent reported that eight weeks made the course too long and 86 percent suggested that online SGDs should continue once face-to-face, on-site education resumes.

From open text comments, the research team identified what worked well (cases/content, faculty, participant engagement, technical support) and what could be done differently (more extensive technical and connectivity checks, different time scheduling, and more supporting materials).

Some feedback and comments from participants and faculty

“Each case discussed was an opportunity to refresh knowledge, exchange surgical solutions, or discuss new approaches, indications, or surgical techniques. It was always beneficial and I encourage everyone to participate.”
Mustapha Ben Aziz, Tunisia

“It has gone surprisingly well resulting in actual discussions—participants have had different levels of experience (and definitely varying internet connections) and being from all around Europe and the Middle East fueled the discussions with many different possible solutions to often quite challenging cases. I’d do it again.”
Johan Scheer (faculty), Sweden

“I think that education face-to-face is more fun and makes interaction with the participants easier and more rewarding. Despite my doubts, the participant from my hospital thinks it was great, that the SGD works surprisingly well and he learned a lot! He also found it interesting to be in the same group as participants from very different backgrounds.”
Carl Ekholm (faculty), Sweden

“I truly enjoyed the course and learned at every discussion. This is what the AO family is all about: a lifelong learning experience.”
Odette Koch (faculty), South Africa

For further details, please contact Michael Cunningham.

Impressions from the AO Trauma Online Small Group Discussions—Upper Extremity, September−October 2020
FacultyFocus 1 | 2021

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