Small Group Tutorials Research Articles

Maximizing the value of feedback for individual facilitator and faculty development in a problem-based learning curriculum

Background: Recruiting and retaining facilitators in problem-based learning requires considerable staff development. Providing meaningful feedback to individual facilitators should contribute to improved management of the tutorial group.Aim: To ascertain the value ascribed by facilitators to feedback they received (based on student input) regarding their performance in the small group tutorial in a new problem-based learning curriculum.Methods: Thirty-seven facilitators from a purposive sample, selected for their facilitation experience during the 2001–2003 period, completed a comprehensive survey regarding their experiences. The aspect currently being reported deals with the perceived usefulness of the feedback they received from students and from Faculty following the evaluation of their participation in the small group tutorial. Data are reported for medically qualified and non-medically qualified facilitators.Results: Both clinical (50%) but more notably the non-clinical (70%) facilitators found the feedback (individual facilitator and general report) useful. Facilitators generally preferred the qualitative comments provided by students in the open-ended section of the evaluation to the Likert scale items. Student comments were valued for the specific direction they offered facilitators to reflect and improve on their management of the small group. For this feedback to be more useful, however, facilitators believed that it needed to be completed by more students who took time to critically engage with the criteria and reflect more honestly on their experiences. In addition, facilitators requested for feedback reports to be made available sooner such that they could improve their facilitation skills for the next group of students.Conclusions: Both qualitative and quantitative feedback are important for facilitator development and training. While quantitative feedback is important for summative purposes (e.g. quality assurance and promotion), individual student comments provide more formative feedback, allowing facilitators to reflect on and improve their management of the small group. In order for the feedback to be valid, the majority of students had to participate. Facilitators should receive feedback in time to allow them to modify their activities for the new group.

Real-Time Case Simulation to Enhance Faculty-Student Partnerships of Practice in Medical Education: Interactive Case-based Online Network (ICON).

BACKGROUND: We have developed a user-driven learning system, the Interactive Case-based Online Network (ICON), to enhance teaching in the neuroscience curriculum, foster student’s teamwork skills, facilitate knowledge integration, and encourage active participation of faculty in the student’s learning1. To emulate the non-linear, time-sensitive nature of real patient care and to increase urgency in learning, cases in ICON unfold “live,” in real-time, eliminating the traditional paper case. METHOD: An interdisciplinary group of faculties assumes the roles of virtual patient, attending, and consultant in the case. As the patient’s situation unfolds, students are responsible for the practice of the science, communicating with the patient and the attending, requesting consults, and coordinating the team’s activities. Teams consist of n=8 students and a faculty mentor in small group tutorials. Students communicate with each other and case characters using pagers and instant messaging, facilitating asynchronous and synchronous interactions. As cases progress live, new information and discussions are organized into core learning modules. To measure the impact of ICON on the “process” of learning, we conducted entrance/exit surveys during the 2004 and 2005 ICON iterations (n=80 students). RESULTS: Comparing aggregate responses, significant changes (p<0.05) were reflected in four domains: 1) increased discussion hours outside of tutorials (p=0.004); 2) increased relative contribution by peers (p=0.02); 3) increased active participation of case character faculty in the student’s learning (p=0.00003); 4) decreased relative contribution by the faculty mentor in tutorial (p=0.009). CONCLUSION: These results suggest: 1) students’ learning became less dependent on faculty mentors due in part to interaction with case characters; 2) peer contribution increased and surpassed faculty mentor’s contribution in tutorial. Taken together, the ICON system is a suitable pedagogy for engaging students through urgency in learning and for building an interdisciplinary faculty-student partnership of practice2.

Revival of the case method: a way to retain student-centred learning in a post-PBL era

Background: In current renewal of medical education, problem-based learning (PBL) is the predominant approach. PBL is afflicted with limitations, which cause uncertainness about its future. A profoundly different approach is the case method, developed a century ago and today attracting much less interest in developmental work than PBL.Aim: To compare the characteristics of PBL and the case method and ask the question of whether the case method may serve as an alternative approach to student-centred learning.Method: The comparison was literature-based.Results: PBL implicates fostering of self-directed learning and its prospects deal with depth and retention of knowledge and clinical reasoning skills. Problems are used to define learning goals and to stimulate students’ interest in various aspects of an item, rather than just for problem-solving. In the small-group tutorials of a PBL curriculum, the teacher is assigned to facilitate the process of self-directed learning and needs not necessarily be a subject-matter expert. In spite of its exciting philosophy and an increased input of students’ and teachers’ time, the superiority of PBL as a mode of learning has not been convincingly demonstrated, either in terms of acquisition of knowledge or in clinical performance. Moreover, dysfunction is a well-recognized phenomenon. In some PBL tutorials, indifference towards the group discussion is encountered, including individual quietness or dominant behaviour and incomplete attendance. To cope with dysfunctional problems, efforts are recommended aiming to increase PBL tutors’ and students’ understanding of the group process. As opposed to PBL, the case method relies strongly on teacher-directed learning. Students are placed in a dilemma or a problem to be solved. After preparatory work, they meet for a discussion, lead by a subject-matter expert, who preferably has experienced the case in reality. As a chairperson, the teacher is supposed to stimulate the discussion and detect gaps and misunderstandings. Due to its teacher-dependent approach to learning, the case method is less susceptible to group dysfunction. The case method is also less resource consuming, primarily because it can be practised in groups several times larger than those of PBL.Conclusion: A revival of the case method seems warranted as an alternative means of interactive learning, which is simpler, easier to realize and less time-consuming with regard to both institutions and students.

The Effect of an Interactive Tutorial on the Prescribing Performance of Senior Medical Students

Objectives: To evaluate the effectiveness of small group tutorials in teaching senior medical students the requirements of prescription writing.Design: Random allocation to interactive tutorial or didactic lecture with blinded evaluation.Subjects: All 1999 6th year medical students, the University of Adelaide.Results: The Tutorial Attenders (mean 13.3, SD 2.6) performed significantly better than the Lecture Group (mean12.2, SD 3.0) p=0.041 and the Non-attenders (mean10.7, SD 3.1) p=0.041 and the Non-attenders (mean10.7, SD 3.1) p= 0.001. The 13 individual OSCE items formed four logical subgroups, and the Tutorial Attenders performed significantly better in Prescription Writing in all comparisons.Conclusion: A single, one-hour interactive tutorial is likely to be the minimum amount of intervention that will be effective in improving prescribing skills.

What Do We Know About Cognitive and Motivational Effects of Small Group Tutorials in Problem-Based Learning?

Students collaborating in small groups is a characteristic of problem-based learning (PBL) that is receiving increased consideration in the literature. In this paper findings from studies in this area are synthesized and discussed. A distinction is made between studies focusing on cognitive effects of group learning and studies focusing on motivational effects of group learning. Studies concentrating on the cognitive effects of small-group PBL seem to demonstrate that activation of prior knowledge, recall of information, causal reasoning or theory building, cognitive conflicts leading to conceptual change and collaborative learning construction take place in the tutorial group. Studies focusing on the motivational effects of PBL demonstrate that group discussion positively influences students' intrinsic interest in the subject matter under discussion. The studies also demonstrate that a haphazard discussion in the tutorial group or a discussion that just scratches the surface, probably caused by students being less motivated, inhibits student learning. Several studies are reported providing suggestions on how to optimize group work in PBL. Although the studies demonstrate that group learning in PBL may have positive effects, much more research is needed to obtain more evidence and deeper insight in the cognitive and emotional effects of small group learning in PBL.

A collaborative approach to developing “learning synergy” in primary health care

Supporting and enhancing clinical learning for pre registration nursing students continues to be a challenge for nurse educators. The drive of recent and contemporary nurse education policy in the United Kingdom (UK) has re-emphasised the need for nurse educators to be instrumental in the support and development of clinical learning [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), 1999. Fitness for Practice (The Peach Report). UKCC, London; Department of Health, 1999. Making a Difference. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare, DOH, HMSO]. This paper presents a preliminary study of an action research project, identifying how nurse educators can facilitate new ways of learning in practice. Predominantly, a first person inquiry approach is adopted, supplemented by qualitative approaches, reflecting the journey of the author in relation to her role as nurse educator in practice. This was enriched by engaging with students and mentors from the author's clinical link area, who had participated in a new initiative to develop small tutorial groups designed for students undertaking their primary health care placement, within year two of a Fitness for Practice programme within the UK. Students' and mentors' experiences and stories, were appraised using qualitative and self-reflexive techniques. The role of the nurse educator in clinical practice is demonstrated, as is the importance of successful collaboration between educators and practitioners to establish high quality learning environments for students.

Clinical role models are important in the early years of a problem-based learning curriculum

Following a comprehensive study of the role models identified by the first five years of students in a traditional medical programme, it was hypothesized that with curriculum reform clinical role models would assume greater importance earlier in the undergraduate medical programme. Indeed, when compared with their first- and second-year traditional curriculum colleagues, more problem-based learning students identified role models. Almost four times as many identified faculty role models (largely medically qualified) in comparison with their traditional curriculum counterparts. Concomitant with this increase was a decline in the selection by the PBL students of family members, friends and other students as role models. For all cohorts, however, the mother was the most important role model. Since students in integrated curricula have earlier clinical experience and patient contact, they interact with clinicians in hospitals and clinics as well as in the academic environment of the small-group tutorial and lecture theatres. Academic faculty members, particularly clinicians, need to be aware that students take note of their attitudes and behaviour as members of the medical profession, a profession that students had chosen as a career. Retraining of senior doctors from the traditional curriculum might be necessary to ensure that all clinicians have an equivalent understanding of patient care.

Knowledge Integration and Reasoning as a Function of Instruction in a Hybrid Medical Curriculum

This study investigates the effect of curricular change on knowledge integration and reasoning processes during problem-solving by medical students. The curricular change involved the introduction of problem-based, small group tutorials into a conventional health science curriculum (CC). Students at three levels of training were asked to provide diagnostic explanations of two clinical cases, both before (spontaneous) and after (primed) being exposed to basic science information relevant to the clinical problems. Data were analyzed using techniques of propositional and semantic analysis. Based on theories of instruction and cognition, we expected that the instructional changes would facilitate knowledge integration and influence the reasoning patterns of the students. The results show that students generated fewer inferences and used more information from the basic science text (text-based) to explain the clinical problems. However, they generated a greater number of elaborations during explanations using a mixture of data-driven and hypothesis-driven strategies. The spontaneous and primed problem-solving conditions produced more hypothesis-driven and data-driven strategies, respectively, as would be expected in a hybrid curriculum. We conclude that a) problem-based, small group tutorials facilitate integration of clinical and biomedical knowledge through the use of elaborations and hypothesis-driven strategies, and b) aspects of problem-based learning can be successfully integrated into traditional curricula.

Development of professional confidence by post diploma baccalaureate nursing students

Professional confidence should be nurtured in a caring nursing curriculum, however there is a lack of clarity as to what confidence means, how it is perceived by students, and what educators can do to instill professional confidence in nursing students. A qualitative study using focus groups was conducted to explore the components of professional confidence as perceived by diploma-prepared registered nurses enrolled in a two-year student-centered, problem-based baccalaureate degree program. Students identified professional confidence as developing through a two-phase process. During the first phase, Becoming Informed, students reported acquiring knowledge, theory and critical thinking in the supportive environment of small tutorial groups, which in turn enabled them to examine nursing practice and defend decisions with clarity and confidence. In Finding a Voice of My Own they clearly articulated an evidence-based nursing position in both academic and clinical environments with a sense of ownership and congruence with their own values. Each phase was further composed of four processes: feeling, knowing, doing and reflecting. When supported through these phases, students felt prepared (i.e. confident) to assume broader roles in health care. Post diploma programs should acknowledge and build on the skills and abilities nurses bring to the educational setting, yet challenge learners to develop critical self appraisal.

MERIT-BASED REARRANGEMENT OF STUDENTS FOR BETTER INTERACTIONS

IlluminationsMERIT-BASED REARRANGEMENT OF STUDENTS FOR BETTER INTERACTIONSSatheesha Nayak, K. Ramnarayan, S. N. Somayaji, and Seetharama BhatSatheesha NayakMelaka Manipal Medical College, Manipal Campus Madhav Nagar, Manipal, Udupi District Karnataka State 576 104, India E-mail: , K. RamnarayanMelaka Manipal Medical College, Manipal Campus Madhav Nagar, Manipal, Udupi District Karnataka State 576 104, India E-mail: , S. N. SomayajiMelaka Manipal Medical College, Manipal Campus Madhav Nagar, Manipal, Udupi District Karnataka State 576 104, India E-mail: , and Seetharama BhatMelaka Manipal Medical College, Manipal Campus Madhav Nagar, Manipal, Udupi District Karnataka State 576 104, India E-mail: Published Online:01 Sep 2005https://doi.org/10.1152/advan.00006.2005MoreSectionsPDF (45 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInEmailWeChat We at Melaka Manipal Medical College (Manipal campus) have an integrated curriculum. The maximum student enrollment is 150 students per admission. However, the number of students per class varies from 125 to 150 students per year. The students joining the program have no university experience. They join this program after completing high school. In the first year, the students learn Anatomy, Physiology, and Biochemistry. The curriculum includes lectures, practical classes, and tutorials. The class of 150 students is divided into smaller groups of 25 students per group for dissections of cadavers and for small group tutorials. Earlier, the grouping was conducted according to the students' roll numbers. This method of grouping presented several concerns. For example, in each group, some students dominated all of the interactions. These students dominated all of the interactions and activities. In this situation, these students answered most of the questions, performed most of the dissections of the cadavers, and dominated the majority of the activity. There were a few students who did not show much motivation. They were shy to answer questions and often stood silently behind others during dissections. Their interactions with their peers as well as their tutors were poor. To overcome this problem, and to improve student-student and student-teacher interactions, we rearranged the groups according to the students' academic performance. Specifically, the students were ranked based on their scores on all exams up to the midterm. Group 1 included the academically weakest students, and group 6 had the academically strongest students. Groups 1 and 2 included many of the students who stood away from the dissection table and remained silent during small group discussions. After the redistribution, we observed better interactions among the members of the groups. Each group contained students of almost equal understanding of the subject. With this redistribution, tutoring was more effective as tutors taught students who were at almost the same level. The academically weak students were encouraged to interact with their group members and to dissect the cadaver. The redistribution helped these students to overcome their reluctance to answer questions during the tutorials as all the members of the group were of the same level. Once this system was introduced, the students knew their strengths and weaknesses and they started interacting with their peers and teachers better, and the scores improved in the subsequent examinations. For example, the mean scores in the block exams were 79.5 ± 1.83 before and 97.1 ± 1.63 after the redistribution (P = 0.0001). A questionnaire was given to the students to understand their opinions of the redistributions. Only 20% of the students did not like the redistribution. However, the 20% agreed that there was an improvement in their examination scores. This method redistribution caused an uneasiness; however, it did improve exam performance.This article has no references to display. Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation More from this issue > Volume 29Issue 3September 2005Pages 183-183 Copyright & Permissions© 2005 American Physiological Societyhttps://doi.org/10.1152/advan.00006.2005PubMed16109801History Published online 1 September 2005 Published in print 1 September 2005 Metrics

Evaluation of an Interactive Case-based Online Network (ICON) in a Problem Based Learning Environment

This study sought to assess the introduction of a web-based innovation in medical education that complements traditional problem-based learning curricula. Utilizing the case method as its fundamental educational approach, the Interactive Case-based Online Network (ICON) allows students to interact with each other, faculty and a virtual patient in difficult neurological cases. Given the paucity of available metrics to benchmark online systems, we complement user perceptions with data on system utilization. We describe a case study of distinct, small group tutorials over 2 years as part of the Human Nervous System and Behavior (HNSB) course at the Harvard Medical School. Participating students and faculty were interviewed following completion of the course and their utilization of the system was recorded and examined. Students each spent 3.2+/-1.3 h (mean+/-SD) through 8.6+/-2.8 accessions per week using ICON outside of required tutorial time. Faculty each spent 4.8+/-3.4 h through 16.6+/-8.9 accessions per week on ICON. Students identified real-time engagement, stronger relationships with faculty, increased accountability to the tutorial group and self-selected pace as the most beneficial characteristics of the ICON-based tutorial in comparison to traditional problem based learning (PBL) tutorials. Faculty identified enhanced collaboration with students and more realistic student experiences as the most beneficial characteristics. Both students and faculty reported that limitations of ICON included increased time investment for faculty and increased reliance on good faculty mentorship. This is the first study of the ICON learning system in undergraduate medical education, a platform designed to facilitate collaboration outside of the classroom. Data on user perceptions and system utilization suggest that both faculty and students chose to adopt this online learning system as a means for collaboration. The study also outlines future avenues for research in assessing novel online technologies.

Helping students understand their learning styles: Effects on study self‐efficacy, preference for group work, and group climate

Small tutorial groups in higher education are often composed without regard to students’ gender or broad knowledge background, for example, yet research indicates that composing groups on the basis of gender and prior qualifications may have significant effects on assessment outcomes. Previous studies have also investigated the effects of composing groups on the basis of learning style preference and found no effects. The effect of combining group composition with training in learning styles is unclear, however. In this study we report on the effects of workshop training in learning styles on balanced group members’ study self‐efficacy, preference for group work, group climate, and assessment performance. Although we found no effects, students reported greater self‐awareness of their own learning and acceptance of others’ styles. We conclude that in collaborative learning environments, training may need to go beyond facilitating growth in students’ self‐awareness to include a focus on how to apply this understanding to improving group function and helping others to learn.

Assessment of an electronic voting system within the tutorial setting: A randomised controlled trial [ISRCTN54535861

BackgroundElectronic voting systems have been used in various educational settings with little measurement of the educational impact on students. The goal of this study was to measure the effects of the inclusion of an electronic voting system within a small group tutorial.MethodA prospective randomised controlled trial was run at the Royal Adelaide Hospital, a teaching hospital in Adelaide, Australia. 102 students in their first clinical year of medical school participated in the study where an electronic voting system was introduced as a teaching aid into a standard tutorial. Long-term retention of knowledge and understanding of the topics discussed in the tutorials was measured and student response to the introduction of the electronic voting system was assessed.ResultsStudents using the electronic voting system had improved long-term retention of understanding of material taught in the tutorial. Students had a positive response to the use of this teaching aid.ConclusionElectronic voting systems can provide a stimulating learning environment for students and in a small group tutorial may improve educational outcomes.

Influence of new educational technology on problem-based learning at Harvard Medical School

Computers with 50-inch, wall-mounted plasma screens and broadband Internet access were installed in all small group tutorial rooms at Harvard Medical School. This study examines how the introduction of this educational technology impacted on the problem-based learning tutorials. A total of 37 tutorial groups, stratified by year of student, were observed at separate timepoints (autumn 2002, spring 2003) to document the patterns of use of the technologies. Based on these observations, end-of-course surveys were developed and distributed to students and tutors. Observational field notes and open-ended survey responses were qualitatively analysed for themes. Using a 5-point rating scale, both students and tutors indicated that the technologies had a positive impact on their tutorials. In autumn 2002, plasma screens were used for an average of 17.8 and 22.1 minutes per 1-hour observation in Year 1 and 2 tutorials, respectively; in spring 2003, usage declined to 6.9 and 5.9 minutes, respectively. Resources utilised included Internet sites (54% total use time), PowerPoint presentations by students (22%), and course-specific postings (24%). Marked course-specific variation in usage was noted. Observational and survey data revealed that the technologies interrupted the flow of tutorial discussion. Students and tutors expressed concerns that the plasma screens might be altering the process of problem solving in the tutorials. Both students and tutors reported that the introduction of computers and wall-mounted plasma screens had impacted positively on tutorials. Questions were raised as to how this technology might alter tutorial dynamics. Further research will be needed to investigate these pedagogical concerns.

A framework for lab work management in mass courses. Application to Low Level Input/Output without hardware

This paper describes a complete lab work management framework designed and developed in the authors’ department to help teachers to manage the small projects that students are expected to complete as lab assignments during their graduate-level computer engineering studies. The paper focuses on an application example of the framework to a specific lab work related to Low Level Input/Output. Special emphasis is laid on the most complex aspects of such environments. The management framework provides specific tools for dealing with these issues: the management of student work delivery and evaluation results accessibility, automatic or semi-automatic assessment of student work, and detection of lab assignments that are highly suspect of having been copied. Additionally, the lab work framework represents a method through which a closer peer-to-peer or one-to-many communication with students can be attained. The lab work described in the paper is a small project based on a specification document. It is designed to get students to gain an in-depth knowledge of the computer Input/Output subsystem. While the framework has been in use for over 10 years, the specific Input/Output lab work has been managed by the framework tool-chain for the last 6 years, and used by over 2000 students. The lab work management framework is a step towards the feasibility of a closer-to-the-student higher education system, where the main interaction between students and teachers can be based on individual or on small group tutorials. Using the tool-chain, the academic load of teachers in mass course environments can be kept at acceptable levels, making for higher quality education.

Development of an Instrument to Assess Individual Student Performance in Small Group Tutorials

Recognizing the need for a valid and reliable method to assess individual tutorial performance in a problem-based learning curriculum, we developed a 31-item instrument from theoretical frameworks and items used elsewhere. A scale was developed for each of three broad learning domains: self-directed learning (SDL), critical thinking (CT), and group process (GP). The instrument demonstrated high internal consistency (SDL = .88, CT = .90, GP = .83) on a sample of 18 tutors and 167 students. Tutor-student interrater reliability coefficients were estimated to be low (SDL = .16, CT = .18, GP = .14) due to lack of variance on the response scale. The instrument showed high correlation (r = .82) with other forms of summative evaluation. In its current form, this standardized and validated instrument is unreliable in differentiating strong from weak tutorial performance but can have a steering effect on student tutorial behaviors. The process of instrument development has general application to other educational programs.

What can we learn from facilitator and student perceptions of facilitation skills and roles in the first year of a problem-based learning curriculum?

BackgroundThe small group tutorial is a cornerstone of problem-based learning. By implication, the role of the facilitator is of pivotal importance. The present investigation canvassed perceptions of facilitators with differing levels of experience regarding their roles and duties in the tutorial.MethodsIn January 2002, one year after problem-based learning implementation at the Nelson R. Mandela School of Medicine, facilitators with the following experience were canvassed: trained and about to facilitate, facilitated once only and facilitated more than one six-week theme. Student comments regarding facilitator skills were obtained from a 2001 course survey.ResultsWhile facilitators generally agreed that the three-day training workshop provided sufficient insight into the facilitation process, they become more comfortable with increasing experience. Many facilitators experienced difficulty not providing content expertise. Again, this improved with increasing experience. Most facilitators saw students as colleagues. They agreed that they should be role models, but were less enthusiastic about being mentors. Students were critical of facilitators who were not up to date with curriculum implementation or who appeared disinterested. While facilitator responses suggest that there was considerable intrinsic motivation, this might in fact not be the case.ConclusionsEven if they had facilitated on all six themes, facilitators could still be considered as novices. Faculty support is therefore critical for the first few years of problem-based learning, particularly for those who had facilitated once only. Since student and facilitator expectations in the small group tutorial may differ, roles and duties of facilitators must be explicit for both parties from the outset.

Is computer aided learning as effective as traditional tutorials?

Aim The aim of this study was to compare the effectiveness of a computer assisted learning (CAL) programme with that of traditional small group tutorials in teaching theoretical and practical aspects of periodontal pocket charting. Method Sixty-one third year undergraduate dental students were randomized to either receive a tutorial or to work through the CAL programme. Students using the CAL programme completed questionnaires relating to previous computer experience and the ease of use of the programme. All students were assessed immediately after the intervention by means of a confidence log, a practical exercise and a further confidence log. They were assessed again three weeks later by means of a confidence log and a multiple-choice written test. Results There were very few significant differences between groups for any of the assessments used. However, subjective comments indicated that students occasionally felt disadvantaged if they had not received a tutorial. Conclusion CAL and traditional teaching methods are equally effective in teaching periodontal pocket charting to undergraduate dental students.

How does the introduction of computers and wall-mounted plasma screens Impact small group tutorials? Preliminary results.

How does the introduction of computers and wall-mounted plasma screens Impact small group tutorials? Preliminary results.

The Supplemental Instruction Project: peer-devised and delivered tutorials

The purpose of this study was to determine whether student devised and delivered supplemental instruction is beneficial and acceptable to first-year medical students. A student-run Supplemental Instruction Project (SIP) was developed and delivered by second-year medical students and offered free of charge to all first-year medical students at Memorial University of Newfoundland taking the Integrated Study of Disease I course in 1999 and again in 2000. Small-group tutorials focused on subject material that second-year medical students identified as 'difficult'. Five 60- to 90-minute sessions covering topics in cardiology, nephrology and respirology were offered. Student and tutor perceptions about the project were collected using anonymous questionnaires. Students were quizzed before and after each tutorial session. Post-tutorial quiz scores were significantly greater than pre-tutorial scores. Student and tutor perceptions of SIP were positive. It is concluded that the SIP is an acceptable, practical and effective method to supplement delivery of challenging material to first-year medical students.