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Context and setting The physiology department in our institute uses small-group discussions in addition to traditional teaching methods to promote active self-learning in students. Students are grouped randomly for these small-group discussions.

Why the idea was necessary When the groups are selected randomly, there is often a lack of complete participation by all members of the group. It is common to find that some students do not take part in discussions or that one student dominates the discussion in these groups.

We attempted to resolve these problems by organising the structure of the small groups. Low, medium and high achievers are included in each small group to maintain an effective group session in which all members contribute, thereby optimising small-group interactions and improving students’ performance.

What was done Using student marks on the First Internal Assessment as the criterion for grouping, 150 students were divided into three groups consisting of low (students with scores of ≤ 45%), medium (students with scores of > 45% to 60%) and high (students with scores of > 60%) achievers, respectively. Each group was subdivided equally into a control and a study group. Smaller groups of six or seven students each were formed in both the study and control groups.

The study groups were selected in a stratified manner, so that each small group of six or seven students included two or three low, two medium and two high achievers. Control group members were selected at random.

For 3–4 weeks, all the groups engaged in a weekly discussion on topics previously specified. One such topic was renal physiology, selected after the traditional didactic lecture. An instructor was assigned to each group in a passive role. The instructor’s task was to watch the group at work and to maintain an interaction map.

Evaluation of results and impact Renal physiology mean pre- and post-test scores of study group students were 8.80 ± 3.02 and 9.96 ± 3.41, respectively, indicating an improvement of 13.2%, which was statistically significant (t = 2.571; P = 0.013). Mean pre- and post-test scores of control group students were 8.88 ± 3.41 and 9.29 ± 3.81, respectively, indicating an improvement of 4.6%, which was not statistically significant (t = 0.802; P = 0.426). Evaluation of the interaction maps showed that students in the study groups participated more actively. Mood in the study groups was generally more upbeat, enthusiastic and positive and featured greater levels of cooperation and interest in learning. However, not all students were seen to actively participate in the control groups and the balance of contribution was not equal in many control groups. The body language of control group students ranged from demonstrating disinterest and passivity to indicating interest.

Students’ evaluations of the sessions as assessed by questionnaire showed that the study group students were significantly (P = 0.011) more likely to participate actively during discussions. In addition, study group students strongly agreed that the level of discussion was high in their group (P = 0.017).

Forming an organised group structure by including low, medium and high achievers in each of the small groups was shown to increase interaction and promote more active student participation and should therefore prove more effective in enhancing learning and improving performance.