There were four groups in this study, with a group size varying from six to nine students. All groups had three physicians and the number of nurses varied from one to three. The rest of the members came from other healthcare professions, such as physiotherapy, occupational therapy and speech therapy. Each group had a tutor. Over the six-week period, the activity of all four tutorial groups was dominated by task-oriented behavior, but their group-dynamics differed and their development over the observed period took different paths. Groups 1 and 3 (Figs. 1a, b and 3a, b ) became more cohesive, whilst Group 2 (Fig. 2a, b) became more fragmented and Group 4 (Fig. 4a, b) more polarized.
In Figs. 1a, b to 4 a, b, each person is mapped in SPGR field diagrams. Each person is marked by a circle. If the person shows mainly task-oriented behaviour, the circle is positioned in the upper sector of the diagram, mainly caring behavior in the lower right sector and mainly opposing behavior in the lower left sector. Larger circle sizes indicate dominant behavior. The left field diagram represents observations from the first group session and the right diagram from the last.
Tutorial Group 1
Tutorial group 1 consisted of one tutor and seven students; three physicians (Phy1a, Phy1b and Phy1c), three nurses (Nur1a, Nur1b and Nur1c), and one other healthcare profession (Fig. 1a, b).
The First Tutorial Group Session
The predominant behavior of all members was task-oriented (located in the upper sector of the diagram). The group was somewhat fragmented. Nur1b and Phy1b join in a subgroup toward the opposing sector (lower left). Phy1a and Tutor1 are the most dominant members (largest circle size), while Nur1a and Nur1b are the most submissive. The position of Phy1c and Tutor1, with balanced task-oriented and dominant behaviors, indicates that they played leading roles and were willing to support other group members. For example, when Nur1c had trouble starting an online contact group, Phy1c immediately presented his/her laptop and offered to help; Phy1c: “If you access this page... wait, I'll show you.” This is in contrast with Nur1b’s reaction when Nur1c was late for the session; Nur1b: “Showing up on time is important, isn’t it?” and Nur1c’s reaction: a gentle smile, downward gaze and closed body-language. Tutor1 mostly used non-verbal behaviors such as nodding and consistently looking at whoever was speaking, but, as her large circle indicates, this had a significant influence on the group.
The Last Tutorial Group Session
During this session, the group displayed more cohesion, with all members contributing more equally (larger and equally sized circles) to the task. Phy1b has moved from opposition to show supportive behaviour, albeit in a submissive manner. Nurs1c had moved from being submissive to the most enthused. Tutor1 is not as much in charge and instead plays a highly supportive role.
Summary of the Tutorial Group’s Development
Over the six weeks of interprofessional work, the tutorial group had evolved into a more cohesive group and the initial pattern of subgroups and fragmentation had dissipated. All the nurses acted according to their professional stereotypes; being fairly submissive in the first session and more balanced and active in the last. The entire group moved slightly towards the lower right sector, representing more relationship-oriented behavior.
Tutorial Group 2
Tutorial group 2 consisted of one tutor (Tutor2) and eight students. Three physicians (Phy2a, Phy2b and Phy2c), two nurses (Nur2a and Nur2b) and three students from other healthcare professions. The averages of observed behavior for each person in the two sessions are presented in Fig. 2a, b.
The First Tutorial Group Session
Two members, Tutor2 and Phy2a, show strong task-orientation and dominance, polarized to the other members that are rather submissive (smaller circle sizes). Phy2c is the only one showing mostly relation-oriented behavior and is the one farthest away from the group. All physicians showed behavior more dominant than the nurses and strongly influenced the group’s work, again according to their professional stereotypes. This is illustrated by an interaction during the meeting between Phy2a and Phy2c. After some back and forth discussion of when individual contributions should be delivered, Phy2a stated firmly “You who’ve got children, just upload your work when the children are in bed”. Phy2c replied with a gentle smile: “We are just talking about one or two pages, not a thesis.” When evaluating the group’s work, Phy2c stated: “Some have worked more than others!” which was confirmed by another member: “Yes, it feels like we’ve let the others do the job for us.” Tutor2 was rather authoritarian, for example when telling the group what to include in their texts: "There must be some facts in some way. But you do understand that it can’t be 17 pages, it gets far too long." Interactions in the group are best described as fragmented, with several members appearing withdrawn and evasive.
The Last Tutorial Group Session
In this session, the group dynamic was quite different. Phy2a and Tutor2 still have dominating roles but are now accompanied by Nur2b and Phy2c. Phy2c’s nurturing role in the first session is now handled by two others in combination. Phy2b and especially Nur2a are now in opposition to the rest of the group, and the group is even more fragmented than in the first session.
Summary of the Tutorial Group’s Development
The fragmentation and tendency to polarization that were observed in the first session emerged more clearly in the last session. Over the intervening six weeks, all members have become more active, but not more collaborative and two members (Phy2b and Nur2a) are now in opposition.
Tutorial Group 3
Tutorial group 3 (Fig. 3a ,b) comprised two tutors (one in the first session and one in the last session) and six students: three physicians (Phy3a, Phy3b and Phy3c), two nurses (Nur3a and Nur3b) and one other healthcare profession. Their tutors are labeled Tutor3 in both cases
The First Tutorial Group Session
All members showed task-oriented but submissive behavior, except Tutor3 who was both dominant and demanding. For example, when Phy3a asked: “Should we decide on our topic now?” Tutor3 replied firmly: “No, we are still brainstorming!” instead of throwing the question back to the group to encourage them to reflect on their own process and collaboration. Group 3 may be labeled a “strong leader – follower” group. This is seen in Fig. 3a, b, which shows one large circle around Tutor3a, with the other members represented by small circles (submissive behavior).
The Last Tutorial Group Session
In this session, Phy3a and Phy3b played more leading roles and all members contributed more equally. For example, when the group talks about how the social service demands that healthcare should promote social participation and Phy3b says: "I think that 30 minutes with someone cooking for him [the patient] would make a difference in many ways." The members agree, followed by a series of suggestions on how healthcare could promote social participation. Although Tutor3 still showed firm and dominating leadership, the group had become more cohesive.
Summary of the Tutorial Group’s Development
In the first session, the group consisted of a strong leader, Tutor3, and followers. By the last session, the group had become more cohesive with more equally contributing members, even though Tutor3 remained authoritarian.
Tutorial Group 4
Tutorial group 4 (Fig. 4a, b) consisted of a tutor (Tutor4) and nine students: three physicians (Phy4a, Phy4b and Phy4c), three nurses (Nur4a, Nur4b and Nur4c) and two other healthcare professionals.
The First Tutorial Group Session
Most members showed mostly task-oriented behavior. Tutor4, Phy4c and another member formed a leading coalition, while Phy4b and Nur4c show passive opposition. A subgroup of followers (Nur4a, Phy4a and Nur4b) was somewhat in opposition to the leading coalition, with Nur4a in a leading role (the largest circle). An example of submissive behavior occurred when Phy4a said to another student who was standing writing at the board, in a very quiet voice, that the message needed to be repeated. An example of passive opposition is Nur4c’s constant checking of his/her mobile phone whilst the others were involved in discussion.
The Last Tutorial Group Session
In this session, a change of the group’s dynamics was evident, with even stronger polarization between two more distinct sub-groups. One dominant and opposing sub-group (Nur4a, Phy4c, Tutor4 and another) versus a cohesive and submissive sub-group (Phy4a, Nur4b, Nur4c, Phy4b and one other), trying its best to be supportive and encouraging. A typical example of communication between the sub-groups occurred during the discussion of whether a patient with dementia should drive a car or be offered a travel service. Phy4c: “We do not know enough; we only have his [the patient's] statement.” Nur4a: “What should we do then?” Phy4c “There is a test with different scales that are recommended...”.
Summary of the Tutorial Group’s Development
During the six weeks, tutorial group 4 developed from a fragmented and somewhat polarized group to a strongly polarized group, with an opposing and dominant subgroup towards a cohesive and submissive sub-group committed to task-oriented collaboration. Tutor4 was part of the dominating sub-group in both sessions.