Medical Education at Harvard

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08/08 At This Point in Time: Research in Medical Education

Current Notes from the Directors

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Toni Peters, Ph.D.

The Quiet Student

Small group facilitators are often frustrated when a student fails to participate. In Problem-based Learning (PBL) tutorials, cooperative learning groups, or teams, lack of participation may violate the terms of engagement. While having a highly talkative or domineering student in the group may also pose problems, faculty find the quiet student particularly problematic because they don�t know what he is thinking nor understand why he isn�t taking part. In this essay, we offer some ideas that we have learned from experienced tutors over the years. We pose three questions:

1. Why is the student quiet?
2. Why is a quiet student a problem for the group?
3. What can a tutor do to draw out the quiet student?

Why is the student quiet? Some students are shy by nature, while others have been raised in cultures where assertiveness may be considered rude, competitive or showing off. Many students simply fear looking stupid in front of others whom they perceive to be highly intelligent. Truthfully, some students may fear that the Peter Principle is in effect: i.e., with their acceptance to Harvard Medical School they reached their level of incompetence. This will, no doubt, fade with time. Some may find the discussion boring, beneath their level of knowledge, or a waste of time. And last, some may be depressed.

Why is a quiet student a problem for the group? With the exception of depression, all of the above reasons for quietness hint at an underlying anxiety about or hostility toward group discussion. We generally assume this must be overcome to accomplish immediate and long-term learning goals. First, the practice of medicine is a social endeavor, one that requires practitioners to communicate and interact with one another and with patients. It also often requires practitioners to behave in ways counter to what their mothers taught them: for example, to ask strangers personal questions. Being shy or hesitant in such situations can be a liability. But, more immediately, an underlying assumption of small group learning and teamwork is �all for one and one for all.� That is, everyone is expected to contribute to the product, whether that is the care of a patient or all group members� learning. To fail to take part is to shirk one�s social responsibility.

Small group discussions also provide instructors an opportunity to get to know their students, both in terms of their breadth and depth of knowledge and in terms of attitudes and behaviors relevant to professional development. When a student is silent, instructors have difficulty assessing their knowledge and attitudes in time to help or guide them. There is a danger that instructors may attribute to the student characteristics, beliefs and knowledge he may not have. For example, if instructors base their judgment on a small sample of comments the student made only when he was certain of his answer, they may come to believe the student has more knowledge than is true. If the student stumbles through one explanation only to retreat into silence when he finds himself wrong, instructors may view him as generally lacking in understanding. Or, instructors may label quiet students as lazy, aloof, arrogant, etc.

We have heard students express a variety of attitudes toward quiet students. Some say that the only important factor is whether someone is learning; therefore, they�ll attribute quietness to a student�s learning style and figure that the quiet student is learning by listening. These students view group learning as individualistic, not cooperative. They expect no help from their peers. Others, however, express disappointment when everyone isn�t pulling together and pitching in, especially when the going gets rough. One student�s quietness makes them uncomfortable, and they take it as a judgment against the group.

What can a tutor do to draw out the quiet student? Experienced tutors and small group facilitators have suggested a range of strategies to increase a quiet student�s participation. We offer their suggestions here, with rationales and caveats. What works in one group or with one quiet student may not work with another. Patience and understanding, based upon objective observation of the quiet student over a few classes will help faculty determine the root of the student�s quietness and will then point toward a solution. It is important not to stereotype students (e.g., to expect that students from one ethnic group are typically quiet), nor to attempt an intervention too quickly. Sometimes the group process works itself out.

The following strategies fall into two categories: (1) ways to manage a group to prevent or minimize unbalanced participation; and (2) ways to draw out the quiet student.

General Group Management:

Structure the group (a) at the very beginning of the course and (b) at the beginning of class so that the group is aware of and has accepted the ground rules. The ground rules vary from group to group. Nonetheless, they should be explicit and consistent. One ground rule pertinent to this situation (i.e., having a quiet student in the group) is �everyone must contribute to the discussion.�

Ensure that everyone contributes by establishing a standard strategy for sharing (and this may be established either by the tutor alone or by the entire group when the tutor asks the students to set the rules). Examples include:

Going around the table and taking turns, perhaps allowing students to �pass� if they have nothing to contribute. The downside of this is that, if the quiet student is last, he might feel increasingly anxious as his turn nears. If one were to use this strategy, she might want to begin with or near the quiet student.

Establishing rotating roles, such as synthesizing out-of-class reading for the group, taking a role (such as the patient�s doctor), or summarizing the group�s discussion at the end of class.

Asking all students to write down an answer to a question (e.g., �What would you say to this patient?�), and then read it to the group.

Tell students that you are unable to evaluate them if you cannot observe how they think through problems during class discussion. Depending upon the school�s criteria for evaluating students, you might also note that you want to observe how well students communicate and work with others.

Let the students know that you and they own the group jointly and share responsibility for good group process. When the group is not functioning well, call �time out� and ask the group to discuss whether they perceive an imbalance in participation as a problem.

Managing the Quiet Student:

Choose an appropriate intervention depending upon the diagnosis. Diagnose the reason for quietness by observing and listening to the student during the group discussion. Is the student shy, uninterested, lacking in confidence, or something else? If the student seems depressed, you should refer the student to his society master or Dr. Laurie Raymond.

Speak with the quiet student individually after class to diagnose the problem and to help him find a way to become more involved in the discussion. Quiet students may have a long history of shyness or reticence in class. They may have developed keen observational skills that could be useful to the group. Some tutors note that a student doesn�t speak often but when he does his contributions are very insightful. A tutor might, therefore, capitalize on the quiet student�s strengths by pointing out to him that he might be a careful listener and might be able to identify when the group has not reached a satisfactory level of understanding. If so, he might either explain the concept if he can or point out to the group that they need to read further to achieve understanding. Asking quiet students to summarize or critique is an excellent way to assess what they know and can do and to build their self-confidence.

Use the student�s name and make eye contact with him. However, use all students� names so that it will not seem strange if you address the quiet student directly. It helps to sit across from the student, rather than next to him. It�s important not to embarrass the student by calling on him too often. Therefore, using body language such as eye contact may be more subtle.

Pair students to discuss something briefly so the quiet student has an opportunity to make friends with another student and has a chance to practice talking.

Quiet Student Essay