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Cooperative learning as a teaching strategy.

Cooperative or team learning is an excellent way to increase comprehension and improve writing and communication skills in new laboratorians.

THE BEST WAY to learn something is to teach it. Teaching forces one to become organized and learn how to explain material, which reinforces subject knowledge.

Cooperative learning (CL) is a technique wherein students become teacher and learner. It is a structured, instructional strategy in which heterogeneous groups of students work in teams toward achievement of a common academic goal.|1~ Cooperative learning team exercises have a positive effect on a wide range of outcomes, including student achievement and self-esteem.|2~ In many ways CL is ideally suited to the rigors of teaching clinical laboratory science--especially to the immigrant groups that are increasingly attractive as a source of new laboratorians.

The advantages of cooperative learning are listed in Figure 1. CL stresses the interdependence of students--all students on the team are responsible for assuring that all other students complete the assigned task, for example. Students learn content through their own efforts as well as through reinforcement by their peers. Therefore, comprehension is higher and learned items are retained longer.

* Structured learning. For several reasons, structured exercises are a critical feature of team learning.|3~ Clinical lab science students traditionally prefer teacher-structured learning over student-structured learning and may not be receptive to a new instructional mode.|4,5~ They also tend to be more resistant to change and place a higher value on structure than creativity. (This is not necessarily a negative trait; creativity in the performance of blood tests is hardly encouraged.) It is common, before participating in CL, for a clinical science student to state, for example, "I learn best alone."

* Cultural diversity. Those who speak English as a second language often choose to study an applied scientific discipline in an American university because they think that communication skills are not as important for the sciences as they are to, say, education or law.

At California State University, Dominguez Hills, in southern California, about 10% of clinical science students are residents with foreign documents (RFDs). These students are immigrants (most of whom are American citizens or permanent residents) who conducted part of their previous college education in one or another foreign language.

Most RFDs speak English as a second or even third language. Of the students whose college careers have been entirely American, many are first-generation Americans who speak a language other than English at home.

Because of these unique demographics, our faculty must be culturally sensitive, yet instill in the students the values that will be expected of them by American employers and patients. Helping them develop strong writing and speaking skills, for example, is an important goal.

* Features of CL. Figure 2 lists several aspects of cooperative learning that are critical to the success of this instructional strategy.|6~

It is important that you start by describing CL and explaining its critical features. Also start with introductory team-building exercises before moving on to academic tasks. Such exercises are helpful in increasing team identity and interdependence among members. For example, have team members interview one another about their educational and professional backgrounds and about personal and recreational interests.

Encourage members to choose a name for the team that reflects the members' backgrounds. Names such as "the Force MT" and "D'Unknowns" have been selected by teams in my classes.

* Team makeup. Teams should be assigned by the instructor rather than established by the students.|7~ So doing avoids turning the teams into social groups and insures that each group has a diversity of members.

The best teams are heterogeneous, reflecting students with both high and low academic achievement, varying ethnic backgrounds, and both genders. Heterogeneity lends diversity and strength to the groups.|8~ I have found the optimum number for a team to be between four and six members.

The membership of the teams should be consistent over a period of time; teams can fail if not stable enough for a team identity to develop.|7~ Make sure teams have enough assignments during the course of a teaching module to become a cohesive working unit. Do not give them so many assignments that the team is overwhelmed, however.

Assign each team member a particular role:

The leader explains assignments, leads discussions, and makes sure everyone contributes.

The recorder takes notes and writes the assignment.

The monitor tracks attendance, time, and team grades, and informs absent members of assignments.

The reporter reports the team response to the class.

The researcher locates and makes available necessary reference materials.

Having an assigned role promotes involvement in team activities, lends further structure to the team process, and encourages the development of leadership skills.

The role of the instructor during team exercises is that of facilitator, observer, and cheerleader.

Observe how students learn from one another and diagnose learning difficulties. Students generally prefer that you be available to formalize the process as well as to detect any misunderstanding of an assignment.|4~ Monitoring is necessary to insure that groups remain focused on the task at hand, comprehend the assignment, and implement the appropriate tools to accomplish the assignment.

* Interdependence vs. individual responsibility. One of the most important aspects of the team exercises is the recognition of interdependence among members. Each member is responsible for the others' learning. All should be prepared to support and defend a group decision reached by consensus. This interdependence promotes communication, group identity, and analytic skills. Quiet members, for example, quickly learn to speak up when they realize that a grade depends on a team response.

It is important to have a team performance dimension in the grading system in order to provide incentive for teamwork.|2,7~ The incentive can be points for participation in team activities, for attendance, for improvement of the average grade of the team on an exam, or for the quality of a product. An incentive can account for as little as 5% of the final grade and still remain effective.

A team grade also tends to reduce the number of "freeloaders" who resist involvement in the team process, yet who are more than willing to accept the incentive points. Consensus is an important part of the team assignment and, therefore, the team grade. Because team members are responsible not only for themselves but for each other, individual academic achievement tends to be greater.|1,2~

The team experience, however, supplements, not supplants, individual responsibility for learning. Individual accountability and personal grades remain a very critical part of cooperative learning.|2~

* Summary sessions. Summary sessions help to hold groups accountable for their assignments. Since written answers generally require more thought than verbal responses, they tend to give a better indication of the team's consensus. But verbal summations should be required as well because they allow students to receive immediate feedback from other teams on their work and correct any misunderstandings. Defending their response to you and other teams reinforces analytic skills and the reasoning process behind the response.

* Team assignments. In addition to being highly structured, team assignments should be directly relevant to the content of the course and difficult enough to stimulate team interaction.

For each team exercise, you should provide specific written objectives and a deadline. To address any students' preferences for teacher-structured learning, you should be present during team exercises to validate the process, to provide a resource if necessary, and to keep the teams on target.

* Evaluating case studies. Figure 3 illustrates a favorite form of CL and a very useful learning experience--evaluating case studies.

Teams appraise patient background information and laboratory data, then answer questions about the patient's diagnosis, prognosis, additional laboratory tests, etc. The groups pose a tentative diagnosis, suggest more lab tests to confirm that diagnosis, name other disorders that also fit the data, and describe possible lab results following treatment. Questions on the exercise might relate to QC or instrument malfunction as factors to consider when reporting lab test results.

* Teaching statistics. A statistics course, for example, can easily be adapted to incorporate cooperative learning.

After a lecture on the student's t-test, form teams to evaluate selected research papers from the literature that use the t-test to draw conclusions. Ask teams to:

* Identify the research question and the null hypothesis.

* Explain the meaning of p |is less than~ 0.05.

* Explain the reason that the t-test, rather than another statistical tool, was used to describe the conclusions drawn from the data.

* Explain what other statistics might have been helpful in the evaluation of the problem.

The team exercise, therefore, reinforces the use of the t-test and helps students understand how statistics are used in the evaluation of a clinical problem.

* Other assignments. Teams can also be used for completion of other assignments, some of which are detailed in Figure 4. In addition to such technical issues as the development of flow charts in microbiology, you might ask your teams to tackle management or ethical issues. There are many areas in which team learning can provide a positive learning experience.

As in any curriculum, the best exercises are those that are difficult enough to stimulate discussion, yet easy enough for the students to develop a response within a defined period of time. Consider using sample, short-answer, essay questions from upcoming exams for beginners. Not only will the students perform better on the exam, but there will probably be more energetic participation in the exercise since they know similar questions will be on the exam.

* Improving communication skills. Cooperative learning in a clinical science curriculum is particularly valuable as a tool for improving communication and problem-solving skills,|9~ which are considered to be among the most essential skills for entry-level practitioners.|10~

Cultivating communication skills has also been recommended as a way to improve the low image of medical technologists.|11~ Therefore, the team exercises of cooperative learning may not only help to better prepare clinical laboratory scientists for their careers but help to build a strong foundation for a positive professional image.

Writing skills. In certain of my classes at CSU Dominguez Hills, I instituted a peer-review editing requirement for each written paper. I did this on the theory that a team approach to correcting grammar would improve the writing of both the editor and the writer. Each draft paper must be brought to class by a deadline, then reviewed and edited by the team, and resubmitted a week later in final form. Ten percent of each student's paper is based on the average grade for the team on the paper, so each student has a vested interest in a high grade for the others.

I have had remarkable success with this technique with students who are confident enough to give and take constructive criticism. Their writing was greatly improved and almost flawless after peer editing. In other classes, a few students with poor writing skills preferred to take the penalty for a late submission rather than allow other students to review their papers. One student with excellent writing skills complained of multiple requests to help his colleagues. Peer editing in CL teams can be a valuable tool for improving written communication, if correctly designed and implemented as a nonthreatening course requirement.

Verbal skills. Cooperative learning improves verbal communication skills as well because team members must articulate a proposed solution to a problem or a response to a question and make it understandable to other members.

Small groups of students with the same ethnic origin tend to study together and socialize in their common language. CL groups encourage these students to use English both inside and outside the classroom. Since each team member is responsible for reporting the result of the team exercise, more fluent students help those with less developed language skills to present themselves more clearly, often with remarkable success.

* Overcoming resistance. To overcome student resistance to incorporating CL into our curriculum, I explain briefly how the teams work and what the characteristics of good team members are. My bottom-line explanation, however, is that teams are a required part of the course. I do not explain that most students love the teams once they become used to them; students discover the benefits themselves through participation, and value them more because of their own discovery.

An important way to overcome resistance is to leave the room for about 10 minutes during the first few team sessions. This gives team members just enough time to organize themselves without an instructor to view their discomfort or provide direction. Their initial interactions without instructor oversight are an important factor in overcoming their resistance to the team process and to building team identity.

After several successful team exercises, students generally form teams eagerly and it becomes no longer necessary for me to leave the room. You should, however, be present during CL to validate the process, to provide a resource if necessary, and to keep the teams on task.

* Common excuses. The most commonly cited reason for not using CL, especially in an applied science curriculum, is that there won't be time to cover the lecture material.

Those of us committed to CL are convinced that students learn far more from the CL technique than from lectures. Our point of view remains in the minority, however.

To promote faculty implementation of CL, I find it helpful to suggest specific cooperative learning exercises as a tool for improving teaching and sharing successes (and failures) with colleagues. Suggesting essay questions from an exam is an easy way to implement CL, as mentioned above. Most faculty have a review session scheduled into the course anyway; team study can be suggested as a method for review. An instructor teaching a laboratory can usually carve out a half hour for CL without sacrificing too much lecture time. Once team learning has been used successfully, faculty should be encouraged to find ways and the time to further build it into the curriculum.

* Pluses and minuses. It is becoming common for returning students to comment on how much the team (rather than the course or the program) affected their educational experience. Frequently, a current student will ask for CL teams in a class. Although there are some students who resist team involvement, most find that it greatly enhances their learning. Figure 5 lists typical comments, both pro and con.

Team exercises promote academic achievement, develop higher-level cognitive skills, and improve problem solving and communication skills.|1-3,8,9~ Cooperative learning stresses interdependence of students, since all students on the team are responsible for assuring that all others learn the assigned task. They learn more information faster, and retain the information longer.

Grades depend almost entirely on individually completed tests and papers, so learning is still the ultimate responsibility of each student. A grade for team work, however, provides an incentive for active teams.

Teams change the roles of both teacher and student. Although courses may need to be restructured to accommodate cooperative learning, this teaching strategy can be a powerful one for the professional development of clinical science students. With a little imagination, almost every part of the learning process can be adapted to incorporate cooperative learning techniques.

Figure 1

Advantages of cooperative learning

* Promotes student achievement

* Develops higher level cognitive skills

* Improves problem solving and communication skills

* Stresses interdependence of students

* Promotes self-esteem

* Increases level of comprehension

Figure 2

Features of CL teams

* Description to the team of cooperative learning

* Use of team-building exercises

* Definition of members' roles

* Selection of teams by the instructor

* Heterogeneity of teams

* Interdependence of team members

* Stability of teams

* Use of relevant structured exercises

* Role of instructor as facilitator

* Writing of a team outcome or report

* Scheduling of a summary session

* Accountability of individuals

* Use of a team grade

Figure 3

Using the case study

Have each team:

* Evaluate the case study

* Pose a tentative diagnosis

* Suggest additional laboratory tests

* Name other disorders that fit the data

* Describe possible laboratory results following treatment

* Evaluate quality control data

Figure 4

Sample team exercises

* Develop flow charts in microbiology

* Compare instruments in chemistry

* Compare kinds of anemias in hematology

* Investigate management problems

* Develop testing protocols

* Evaluate case studies

* Discuss ethical issues

* Compose answers for exam essay questions

Figure 5

Typical student comments


* Teamwork sometimes interrupted by extraneous conversation

* Quick thinkers are frustrated by slow thinkers, and vice-versa

* Some team members are uncooperative

* It's easy to get on the wrong track

* I work better alone


* It's very effective and practical

* Less time is needed to study at home

* I pay more attention in lectures so that I can help my team

* It puts a little life into empirical knowledge

* I hope to have more teamwork in future classes

* I'm impressed with and stimulated by group participation

* It gets students to interact with one another

* There is more interaction with the professor

* It makes the class more interesting


1. Slavin RE. An introduction to cooperative learning research. In: Slavin R, Sharan S, Kagan S, et al, eds. Learning to Cooperate, Cooperating to Learn. New York: Plenum Press; 1985: chap 1.

2. Slavin RE. When does cooperative learning increase student achievement? Psychol Bull. 1983; 94: 429-445.

3. Bouton C, Rice B. Developing student skills and abilities. In: Bouton C, Garth RY, eds. Learning in Groups. San Francisco: Jossey-Bass Inc.; 1983: chap 4.

4. Rezler AG, French RM. Personality types and learning preferences of students in six allied health professions. J Allied Health. Winter 1975; 4: 20-25.

5. Vittetoe MC. A study of learning style preferences of medical technology and physical therapy students. Am J Med Technol. 1983; 49(9): 661-664.

6. McEnerney K. Cooperative learning as a strategy in clinical laboratory science education. Clin Lab Sci. 1989; 2(2): 88-89.

7. Feichtner SB, Davis EA. Why some groups fail: A survey of students' experiences with learning groups. Organizational Behav Teaching Rev. 1984; 9(4): 58-71.

8. Sharan S. Cooperative learning in small groups: Recent methods and effects on achievement attitudes and ethnic relations. Rev Educ Res. 1980; 50: 241-271.

9. Bouton C, Garth RY. Students in learning groups: Active learning through conversation. In: Bouton C, Garth RY, eds. Learning in Groups. San Francisco: Jossey-Bass, Inc.; 1983: chap 8.

10. Karni KR, Seanger DG. Management skills needed by entry-level practioners. Clin Lab Sci. 1988; 1: 296-300.

11. Martin BG, Reyes EL. The low image of MTs as professionals: Reasons and solutions. MLO. 1988; 20(7): 31-32.

Kathleen McEnerney is professor and chairperson in the department of clinical sciences at California State University, Dominguez Hills, in Carson, Calif.
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Author:McEnerney, Kathleen
Publication:Medical Laboratory Observer
Date:Oct 1, 1993
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