title: Difficult incidents and tutor interventions in problem-based learning tutorials.
abstract: BACKGROUND
  Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors.
  
  
  OBJECTIVE
  The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses.
  
  
  METHODS
  Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure.
  
  
  RESULTS
  The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully.
  
  
  CONCLUSIONS
  Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.
authors.affiliation: Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. pkindler@interchange.ubc.ca
authors.forename: Pawel
authors.initials: P
authors.lastname: Kindler
authors.forename: Christopher
authors.initials: C
authors.lastname: Grant
authors.forename: Steven
authors.initials: S
authors.lastname: Kulla
authors.forename: Gary
authors.initials: G
authors.lastname: Poole
authors.forename: William
authors.initials: W
authors.lastname: Godolphin
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods*; D006126:Group Processes; D006801:Humans; D010379:Peer Group; D018794:Problem-Based Learning / Q000379:methods*; D013337:Students, Medical / Q000523:psychology*