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Setting ground rules

Teachers need to establish an appropriate micro-culture within the group. This includes the physical environment, the psychological climate, the interactions between the teacher and the group, and between the individual group members. Sometimes the ‘rules’ are assumed and problems are rare, but it usually helps to establish the ground rules from the start. The ground rules can be elicited from the group or determined by the tutor. If tutor-led, then they should be stated verbally or provided to the learners on a handout or slide, with the opportunity for the learners to respond, add more and negotiate the ‘rules’. This provides good role modelling and a transparency about expectations for behaviours. Typical ground rules might be:

  • starting and finishing on time
  • coming prepared
  • listening to others without interruptions
  • participating
  • saying when you don’t understand
  • when anyone is speaking, addressing the whole group and not just the teacher
  • switching off mobile phones
  • treating others’ contributions with respect
  • keeping personal issues out of the session
  • maintaining confidentiality within the group.

In specific learning situations, such as when dealing with interpersonal development, communication skills, in interprofessional groups or learning about difficult situations, the ground rules should always be set out at the start of the session to help ensure that learners feel safe to express their views and make mistakes, and that a congenial, relaxed atmosphere is developed and maintained. This is very important in many aspects of clinical teaching. We are all aware of the ‘teaching by humiliation’ that has been challenged in medical education, but clinicians are in an inherent position of power over their students and juniors, often responsible for carrying out assessments and providing references. Awareness of these power relations can help clinical teachers to become more sensitive to the needs and expectations of learners.

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