Letters to the editor

Mohsen Tavakol & Reg Dennick, Medical Education Unit, The University of Nottinghham, Nottingham, UK. E-mail: [email protected] Declaration of interest: The authors report no conflicts of interest.

Reference Norcini JJ. 2005. Setting standards. In: Dent JA, Harden RM, editors. A practical guide for medical teachers. Edinburgh: Elsevier Limited. pp 293–301.

The use of jigsaw learning technique in teaching medical students prescribing skills

Dear Sir Cooperative learning is not just a matter of grouping some students to complete a task. The jigsaw learning technique


(Aronson et al. 1978) assigns each group member an equally important role in their learning of a final product (e.g., knowledge, skills). However, a literature search returns limited evidence of its use in medical education. The Prescribing Initiatives for Life-long Learning Skills (PILLS) team in our institution initiated the jigsaw learning technique in the prescribing skills workshops for final-year medical students. The lesson of the workshop was divided into six learning areas: (1) defining patient’s problem and specifying therapeutic objective; (2) selecting P-drugs (a personal-choice drug for a standard patient with a specific condition); (3) verifying the suitability of P-drugs; (4) sources of information and costing; (5) prescription writing and dosage calculations; (6) giving information, instruction and warnings, and monitoring (stopping?) treatment. Each student is assigned to learn an area and therefore six ‘‘Expert’’ groups were formed. Each ‘‘Expert’’ group was assigned a facilitator, and students solved specific tasks to support their learning. Next, students re-gathered to form ‘‘Jigsaw’’ groups. Each ‘‘Jigsaw’’ group consisted of different student-experts from each learning area. The ‘‘Jigsaw’’ group was required to solve 6 cases. Each case was designed such that one student-expert would have mastered the required knowledge (or skills) from the relevant ‘‘Expert’’ group so that he/she could teach other peers. Each ‘‘Jigsaw’’ group took turn to present their cases. The facilitators challenged the presenters to provide rationales for their answers or inquired about the alternatives. We incorporated interprofessional learning into the jigsaw learning technique. Final-year pharmacy students also participated in the workshop. At both ‘‘Expert’’ and ‘‘Jigsaw’’ groups, we observed that pharmacy and medical students learning from each other. The workshop took 3–3.5 hours and students’ feedback was collected for improvement. In conclusion, our workshop ignites a stronger culture of cooperative learning. Students recognize that they cannot learn the day’s lesson well unless they receive guidance from capable peers, and at other times facilitate weaker peers to master the day’s lesson. Si Mui Sim, Chan Choong Foong, Choo Hock Tan, Pauline Siew Mei Lai, Siew Siang Chua & Mohamed Mohazmi, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Email: [email protected]

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referencing, and hence cannot be described as fair since the performance of an individual is dependent on the performance of the cohort. By computer-based modelling the Hofstee method using both normal and non-normal exam data, we have shown that the pass mark does not change significantly when fail rate and pass mark boundaries are varied. For example, we have created a model using a large sample size in which we have varied the upper and lower pass rates and the upper and lower fail rates by wide margins and demonstrated that the pass rate varied by only 1–2%. Given that the Hofstee method is widely described and recommended in text books of standard setting, this degree of pass mark variation seems too small to use for making judgements about student performance. For example, with the fail rate fixed between 2% and 10%, changing the acceptable pass mark boundaries between 30% and 80% varies the pass mark between only 54% and 56%. In some cases changing these boundaries produces no discernable change in pass mark at all. That such a small variation in the pass mark is generated by such wide boundary changes seems counter-intuitive as a method of standard setting. Another problematic feature of the Hofstee method which has been commented on by Norcini (2005) is that sometimes the diagonal does not cross the cumulative frequency curve at all. In this case it is recommended that the minimum or maximum pass mark is selected by default, hence the Hofstee method is not actually used since the fail rate values are ignored. Therefore we recommend that individuals and organisations using the Hofstee method should investigate its use further – based on our experimental data it does not create a credible method of standard setting.

Declaration of interest: The authors report no conflicts of interest.

Reference Aronson E, Blaney N, Stephan C, Sikes J, Snapp M. 1978. The jigsaw classroom. Beverly Hills, CA: Sage.

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The use of jigsaw learning technique in teaching medical students prescribing skills.

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