Factors influencing implementation of team-based learning in health sciences education

Team-based learning in Indonesian midwifery education: Implementation research

AIM

This study aims to implement team-based learning (TBL) and assess the impact on faculty members and students within midwifery education in Indonesia.

METHODS

Proctor's Framework for Implementation Research serves as the guiding approach in investigating the role of implementation strategies in implementing TBL within the context of midwifery education. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was utilized to assess the outcome.

RESULTS

In this study, the implementation of TBL has demonstrated significant reach, with broad participation among both faculty and students in two schools. The efficacy of TBL is evident through enhanced student knowledge, engagement and active learning. Adoption of TBL was observed in both schools, with faculty and students expressing interest and active participation. High levels of implementation fidelity were maintained, even though with challenges related to preparation and implementation. These findings suggest that TBL can be successfully integrated into midwifery education, with positive implications. Regarding maintenance, faculty members have expressed their intention to continue using TBL in various topics for future lectures.

CONCLUSIONS

The implementation of TBL in Indonesian midwifery education has shown substantial reach and efficacy. Faculty and students are highly interested in adopting TBL for future use. Despite some implementation challenges, the study suggests that TBL can be effectively incorporated with minor adjustments, emphasizing its feasibility and potential impact. This research contributes to understanding TBL's applicability in various educational settings, especially in low-resource institutions.

Collaborative Teaching plus (CT+): A Timely, Flexible, and Dynamic Course Design Implemented during Emergency Remote Teaching in an Introductory Biology Course

Student-centered pedagogies promote student learning in college science, technology, engineering, and mathematics (STEM) classrooms. However, transitioning to active learning from traditional lecturing may be challenging for both students and instructors. This case study presents the development, implementation, and assessment of a modified collaborative teaching (CT) and team-based learning (TBL) approach (CT plus TBL, or CT+) in an introductory biology course at a Minority-Serving Institution. A logic model was formulated depicting the various assessment practices with the culminating goal of improving the student learning experience. We analyzed qualitative and quantitative data based on students and instructors' behaviors and discourse, and student midsemester and end-of-semester surveys. Our findings revealed that the integration of multiple instructors allowed for knowledge exchange in blending complementary behaviors and discourse practices during class sessions. In addition, the frequent ongoing assessments and incorporation of student feedback informed the CT+ design during both in-person and emergency remote teaching. Furthermore, this course design could be easily adapted to a variety of STEM courses in higher education, including remote instruction.

What Use is Anatomy in First Opinion Small Animal Veterinary Practice? A Qualitative Study

Despite the uncontested importance of anatomy as one of the foundational aspects of undergraduate veterinary programs, there is still limited information available as to what anatomy knowledge is most important for the graduate veterinarian in their daily clinical work. The aim of this study was therefore to gain a deeper understanding of the role that anatomy plays in first opinion small animal veterinary practice. Using ethnographic methodologies, the authors aimed to collect rich qualitative data to answer the question "How do first opinion veterinarians use anatomy knowledge in their day-to-day clinical practice?" Detailed observations and semi-structured interviews were conducted with five veterinarians working within a single small animal first opinion practice in the United Kingdom. Thematic analysis was undertaken, identifying five main themes: Importance; Uncertainty; Continuous learning; Comparative and dynamic anatomy; and Communication and language. Anatomy was found to be interwoven within all aspects of clinical practice; however, veterinarians were uncertain in their anatomy knowledge. This impacted their confidence and how they carried out their work. Veterinarians described continually learning and refreshing their anatomy knowledge in order to effectively undertake their role, highlighting the importance of teaching information literacy skills within anatomy curricula. An interrelationship between anatomy use, psychomotor, and professional skills was also highlighted. Based on these findings, recommendations were made for veterinary anatomy curriculum development. This study provides an in-depth view within a single site small animal general practice setting: further work is required to assess the transferability of these findings to other areas of veterinary practice.

Drug development and the process of transitioning to team-based learning in a qualitative way

BACKGROUND AND PURPOSE

The North American Pharmacist Licensure Examination and the Pharmacy Curriculum Outcomes Assessment are two standardized tests that evaluate students' preparedness to progress into pharmacy practice. Pharmacy educators are responsible for ensuring individual learners are engaged in course material and take appropriate steps to succeed in meeting learning outcomes. Whenever a new pedagogy is adopted in a previously existing course, understanding the impact on learners is critical.

EDUCATIONAL ACTIVITY AND SETTING

Team-based learning (TBL) was implemented within a novel Drug Discovery and Development course to measure the impact in active participation and student performance within the second year of pharmacy school. Survey data was collected to gather pharmacy students' perspectives regarding the pedagogy change. Examination competency scores and active participation were tracked to measure student engagement.

FINDINGS

Survey results revealed students agreed or strongly agreed that Drug Discovery and Development was enjoyable when taught with a TBL model, created a conductive learning environment, and improved their perceived knowledge, communication skills, and confidence. Average attendance scores were > 90% in a TBL setting. No change in block exam competency scores were noted across the three academic cohorts.

SUMMARY

Students agreed that Drug Discovery and Development was enjoyable when taught using TBL, created a conductive learning environment, and improved their perceived knowledge, communication skills, and confidence. Additional research should be conducted to quantify student engagement and active attendance within similar courses. Similar styles of TBL implementation could be incorporated at other colleges of pharmacy to measure its potential benefits.

Unpacking Medical Students' Mixed Engagement in Health Systems Science Education

Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: "How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?" Approach: Following large-scale health systems science curricular changes in their medical school, we used students' open-ended comments obtained from course evaluations related to 1^st-, 2^nd-, and 4^th-year courses and performed a qualitative thematic analysis to explore students' perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students' traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.

The Facilitator Instrument for Team-Based Learning (FIT)

Construct: We sought to evaluate the quality of Team-Based Learning facilitation in both large and small group settings. Background: Team Based Learning (TBL) is an increasingly popular small group instructional strategy in health science education. TBL facilitation skills are unique and differ from those needed to lecture or facilitate other types of small groups. Measuring facilitation skills and providing feedback to TBL instructors is important, yet to date no valid instrument has been developed and published for this purpose. Approach: We created an 11-item instrument (ratings of each item on a 7-point scale) designed to assess TBL facilitation skills, considering major sources of validity. Twelve experts in TBL facilitation and training developed the content of the FIT. To ensure response processes were valid, we used an immediate retrospective probing technique with 4th year medical students who were not part of the study. The Facilitator Instrument for Team-Based Learning (FIT) was piloted with 2,840 medical students in 7 schools in large (year 1 and 2) and small (year 3) courses. The internal structure of the FIT was analyzed. Results: In total, 1,559 and 1,281 medical students in large and small TBL classes, respectively (response rate 88%) rated 33 TBL facilitators. The composite mean score for the FIT was 6.19 (SD = 1.10). Exploratory factor analysis and Cronbach's alpha indicated that all items loaded on 1 factor, accounting for 77% of the item variance. Cronbach's alpha for the 11 items was 0.97. Analysis of facilitator variables and course context indicated that FIT scores were statistically significantly correlated with type of class (pre-clinical or clinical) and size of class as well as the facilitator enjoyment in using TBL as a method. Gender and the amount that facilitators used TBL each year was weakly correlated, with other factors not correlated (years facilitating TBL, confidence in facilitating TBL, and age). Conclusions: Analysis of FIT scores from 2,840 medical students across multiple institutions and teaching settings suggests the utility of the FIT in determining the quality of TBL facilitation across a range of medical education settings. Future research is needed to further analyze course contexts and facilitator variables that may influence FIT scores with additional facilitators. Additionally, FIT scores should be correlated with additional measures of TBL facilitator quality, such as direct observations, especially if these data are used for summative decision-making purposes.

Team-Based Learning in the Clinical Setting: Perspectives of Doctor of Nursing Practice Students

Background

Team-based learning is a teaching modality that meets at the intersection of active learning, teamwork, and assimilation of complex course concepts to prepare students for lifelong learning. Yet little is known about how principles of team-based learning could be employed outside of the classroom.

Objective

To provide direction as to how principles of team-based learning could be applied to the “real-world” clinical setting.

Methods

The synthesis is the result of a class discussion among practicing DNP (Doctor of Nursing Practice) students (n = 16) at an urban university.

Results

Students perceived that the application of team-based learning in the clinical setting could reduce isolationism and improve interprofessional communication, job satisfaction, respect, quality of care, cost effectiveness, coordination of care, efficiency, and patient safety. Projects that might benefit from this approach include those that involve difficult or complex cases in which the correct answer is challenging or debatable. Nevertheless, logistical, financial, and complicated power dynamics were perceived as potential barriers

Conclusions

Team-based learning can be effectively applied to the clinical setting, although perceived barriers must be addressed.

Implications for Nursing

When applied to an appropriate clinical problem or clinical setting, team-based learning may have the potential to advance lifelong learning by following a structured, yet provider-centric approach.

Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles

BACKGROUND

Medical schools have a critical need to develop roles for students that are "value-added," defined as "…experiential roles that can positively impact health outcomes while also enhancing student knowledge, attitudes, and skills in Clinical or Health Systems Science." Following implementation of value-added clinical systems learning roles for all first-year students, authors investigated student perceptions of the educational value from these patient-centered experiences.

METHODS

Between 2014 and 16, authors collected logs from students following their working with patients; authors also performed six, 1:1 student interviews, which were audio recorded and transcribed verbatim. Authors used thematic analysis to explore students' perceptions of the experience and educational benefits from these roles. Authors identified themes, and agreed upon results and quotations.

RESULTS

A total of 792 logs from 363 patients and six interviews were completed and analyzed. Students reported six educational benefits of performing value-added clinical systems learning roles in the health system, including enhanced understanding of and appreciation for a patient's perspective on health care and his/her health, barriers and social determinants of health, health care systems and delivery, interprofessional collaboration and teamwork, clinical medicine, and approach to communicating with patients.

CONCLUSIONS

Students' reported educational benefits from value-added clinical systems learning roles span several learning areas that align with clinical and Health Systems Science, i.e. the needs of future physicians. These roles have the potential to shift learning from the physician-centric identity to one more fully aligned with patient-centered, team-based providers, while also potentially improving health today.

Implementation and assessment of a pulmonary diseases elective course for third-year pharmacy students

BACKGROUND

Given the significant public health burden of pulmonary diseases and the vital role pharmacists play in management across the continuum of care (and within transitions in care), an elective course for pharmacy students focused on pulmonary diseases was developed.

EDUCATIONAL ACTIVITY

A month-long elective course for third-year pharmacy students consisting of 12 class sessions delivered in two-hour periods three times per week, was implemented. The course was delivered using the team-based learning (TBL) format in addition to hands-on skills and simulation sessions. Knowledge and skills assessments were administered before and after completion of the course. Student perceptions of self-confidence and ability regarding management of pulmonary diseases pre- and post-course and their perceptions of the course and TBL as a teaching strategy for this course were evaluated upon course completion.

CRITICAL ANALYSIS

Nine students completed the course. Mean scores on knowledge and skills assessment significantly improved after completion of the course (54.5% pre-course vs. 79.3% post-course; p < 0.05% and 60.3% pre-course vs. 93.2% post-course; p < 0.05, respectively). Student perceptions of their ability to care for patients with pulmonary diseases significantly increased, compared to pre-assessments, in all areas taught in the course (p< 0.05). Additionally, students' confidence in managing specific disease states significantly improved in all areas (p < 0.05) except for spirometry (p = 0.06). Students' knowledge, skills, and confidence regarding management of common pulmonary disease states improved following this month-long elective course delivered using a combination of TBL activities and hands-on skills sessions.

Student preparation time for traditional lecture versus team-based learning in a pharmacotherapy course

BACKGROUND AND PURPOSE

Determine how much time students spent preparing for traditional lecture versus team-based learning (TBL) for a pharmacotherapy course and determine if time spent in each pedagogy was within stated expectations for the course.

EDUCATIONAL ACTIVITY AND SETTING

Instructors used a combination of traditional lecture and TBL to deliver material. Before each lecture, instructors recorded the amount of time students spent preparing for each method using a one-question clicker-response survey.

FINDINGS

Instructors delivered 16 hours of TBL, 32 hours of traditional lecture, and eight hours of a mix of TBL and traditional lecture. The median of students completing the survey each week was 89. A large percentage of the class (40.9%) did not prepare for traditional lecture while only 3.4% did not prepare for TBL. About 61% of students spent between 30 min and two hours preparing for a two-hour TBL session and only 10% spent more than three hours preparing.

DISCUSSION AND SUMMARY

Results of this project show students spend little time preparing for traditional lectures without in-class accountability, which may give students the perception that TBL requires too much preparation time.

Feasibility of a Comprehensive Medical Knowledge Curriculum in Internal Medicine Using Team-Based Learning

BACKGROUND

Team-based learning (TBL) is an active learning strategy with descriptions of its use in resident education limited to pilot studies.

OBJECTIVE

We developed a comprehensive medical knowledge TBL curriculum for an internal medicine residency, and assessed feasibility.

METHODS

We developed a 135-topic TBL curriculum to replace a noon conference lecture series, and implemented it over a 3-year period (2013-2016). In this article we describe the planning, curricular design, faculty recruitment and development, and lesson structure. We assessed feasibility in terms of faculty participation, resident preparedness, resident and faculty satisfaction, and costs.

RESULTS

Most faculty initially were unfamiliar with TBL. Through faculty resource materials and flexible faculty development, participating faculty increased from 3 to 74. In a 2015 faculty survey (N = 64, 69% response rate), 73% (32 of 44) reported faculty development was adequate, 70% (31 of 44) indicated lesson preparation time reasonable, and 95% (42 of 44) reported preparation materials were helpful. A 2016 resident survey (N = 89, 72% response rate) revealed that most residents completed reading assignments in advance, 78% (50 of 64) found readings manageable, and 77% (49 of 64) felt they learned better from TBL compared to lectures. Costs included compensated time for 1 faculty TBL "champion" and an assistant.

CONCLUSIONS

Implementing a comprehensive medical knowledge curriculum using TBL in an internal medicine residency was feasible, and resulted in high faculty acceptance and learner satisfaction. Departmental support of a TBL champion, flexible faculty development, and well-designed resource materials were determinants of success.

Effectiveness of the team-based learning (TBL) strategy on medical students' performance

Objectives

Team-based learning (TBL) represents a new and interesting educational strategy. It helps to enhance students' professional competencies and ideally works to prepare them in their pursuit of lifelong learning. The aim of this study is to evaluate the effectiveness of TBL as an educational strategy on medical students' performance in a problem-based learning (PBL) curriculum.

Methods

A cross-sectional study was conducted through a self-designed questionnaire. It was constructed to examine several aspects of TBL, including cognition, social skills, high school educational system, and personal development. A total of 112 students were invited to participate in the study and 100 completed the survey. Individual-readiness assurance test (IRAT) and group-readiness assurance test (GRAT) scores were collected and the data were analysed and compared to the results of the final assessment using Statistical Package for the Social Sciences (SPSS).

Results

A total of 52 students (52%) described TBL as fostering a cooperative learning environment and 64 students (64%) found the materials to be easier to understand when discussed among themselves as a group. Compared to final examination results, there was a significant correlation (p = 0.0001) between IRAT performance and final exam score. In addition, there was a significant correlation between high school education system and IRAT score, where the best performance was observed among students coming from schools using the British curriculum.

Conclusions

The overall perception and attitude of students toward the TBL system was positive and promising. Nevertheless, there are some notes and areas of concern that must be re-examined and remedied to improve TBL as an educational tool.

Is lecture dead? A preliminary study of medical students' evaluation of teaching methods in the preclinical curriculum

OBJECTIVES

To investigate medical students' perceptions of lecture and non-lecture-based instructional methods and compare preferences for use and quantity of each during preclinical training.

METHODS

We administered a survey to first- and second-year undergraduate medical students at the University of Alabama School of Medicine in Birmingham, Alabama, USA aimed to evaluate preferred instructional methods.  Using a cross-sectional study design, Likert scale ratings and student rankings were used to determine preferences among lecture, laboratory, team-based learning, simulation, small group case-based learning, large group case-based learning, patient presentation, and peer teaching. We calculated mean ratings for each instructional method and used chi-square tests to compare proportions of first- and second-year cohorts who ranked each in their top 5 preferred methods.

RESULTS

Among participating students, lecture (M=3.6, SD=1.0), team based learning (M=4.2, SD=1.0), simulation (M=4.0, SD=1.0), small group case-based learning (M=3.8, SD=1.0), laboratory (M=3.6, SD=1.0), and patient presentation (M=3.8, SD=0.9) received higher scores than other instructional methods. Overall, second-year students ranked lecture lower (χ²_{(1, N=120)} =16.33, p<0.0001) and patient presentation higher (χ²_{(1, N=120)} =3.75, p=0.05) than first-year students.

CONCLUSIONS

While clinically-oriented teaching methods were preferred by second-year medical students, lecture-based instruction was popular among first-year students. Results warrant further investigation to determine the ideal balance of didactic methods in undergraduate medical education, specifically curricula that employ patient-oriented instruction during the second preclinical year.

Team-based learning in large enrollment classes

The goal of this review is to highlight the key elements needed to successfully deploy team-based learning (TBL) in any class, but especially in large enrolment classes, where smooth logistics are essential. The text is based on a lecture and workshop given at the American Physiological Society's Institute on Teaching and Learning in Madison, WI, in June 2016. After a short overview of the TBL method, its underpinning in learning theory, and a summary of current evidence for its effectiveness, we present two case studies from our own teaching practices in a new medical school. The first case study explores critical elements of design and planning for a TBL module, and the second explores best practices in classroom management. As medical educators in the fields of physiology, pediatrics, nephrology, and family medicine, we present the objective views of subject matter experts who adopted TBL as one teaching method rather than TBL experts or advocates per se. The review is aimed primarily at faculty contemplating using TBL for the first time who are interested in exploring the significant benefits and challenges of TBL.

The Integrated Clinical Anatomy Program at Alfaisal University: an innovative model of teaching clinically applied functional anatomy in a hybrid curriculum

Anatomy has historically been a cornerstone in medical education regardless of specialty. It is essential for physicians to be able to perform a variety of tasks, including performing invasive procedures, examining radiological images, performing a physical examination of a patient, etc. Medical students have to be prepared for such tasks, and we can assist this by changing the way that we educate students in medical schools. Thus, newer medical curricula need to be designed according to needs of future physicians. In this report, we describe a unique program called the Integrated Clinical Anatomy Program (ICAP). The ICAP was developed at the College of Medicine of Alfaisal University in the Kingdom of Saudi Arabia. Here, we describe the unique features of this program, including the structure and facilities of the Anatomy Resource Center. The Anatomy Resource Center plays a pivotal role in engaging the students for faculty-directed structured laboratory sessions as well as peer-assisted uniform student-centered learning. The ICAP has shown great promise, as reflected by early results from a nationwide progress test. Students from all years of the Alfaisal University medical school scored significantly higher than the national average on the anatomy and physiology component of the nationwide progress test examination, with P values of 0.0179 and 0.0015, respectively. We believe that the ICAP can be used as a model for teaching clinically applied functional anatomy to medical students in a hybrid curriculum around the world.

Five heads are better than one: preliminary results of team-based learning in a communication disorders graduate course

BACKGROUND

Clinical problem-solving is fundamental to the role of the speech-language pathologist in both the diagnostic and treatment processes. The problem-solving often involves collaboration with clients and their families, supervisors, and other professionals. Considering the importance of cooperative problem-solving in the profession, graduate education in speech-language pathology should provide experiences to foster the development of these skills. One evidence-based pedagogical approach that directly targets these abilities is team-based learning (TBL). TBL is a small-group instructional method that focuses on students' in-class application of conceptual knowledge in solving complex problems that they will likely encounter in their future clinical careers.

AIMS

The purpose of this pilot study was to investigate the educational outcomes and students' perceptions of TBL in a communication disorders graduate course on speech and language-based learning disabilities.

METHODS & PROCEDURES

Nineteen graduate students (mean age = 26 years, SD = 4.93), divided into three groups of five students and one group of four students, who were enrolled in a required graduate course, participated by fulfilling the key components of TBL: individual student preparation; individual and team readiness assurance tests (iRATs and tRATs) that assessed preparedness to apply course content; and application activities that challenged teams to solve complex and authentic clinical problems using course material.

OUTCOMES & RESULTS

Performance on the tRATs was significantly higher than the individual students' scores on the iRATs (p < .001, Cohen's d = 4.08). Students generally reported favourable perceptions of TBL on an end-of-semester questionnaire. Qualitative analysis of responses to open-ended questions organized thematically indicated students' high satisfaction with application activities, discontent with the RATs, and recommendations for increased lecture in the TBL process.

CONCLUSIONS & IMPLICATIONS

The outcomes of this pilot study suggest the effectiveness of TBL as an instructional method that provides student teams with opportunities to apply course content in problem-solving activities followed by immediate feedback. This research also addresses the dearth of empirical information on how graduate programmes in speech-language pathology bridge students' didactic learning and clinical practice. Future studies should examine the utility of this approach in other courses within the field and with more heterogeneous student populations.

Student Perceptions of Team-based Learning vs Traditional Lecture-based Learning

OBJECTIVE

To evaluate pharmacy student perceptions of team-based learning (TBL) vs traditional lecture-based learning formats.

METHODS

First professional year pharmacy students (N=111) at two universities used TBL in different courses during different semesters (fall vs spring). Students completed a 22-item team perceptions instrument before and after the fall semester. A 14-item teaching style preference instrument was completed at the end of the spring semester. Data were analyzed using Wilcoxon signed rank test and Mann-Whitney U test.

RESULTS

Students who experienced TBL in the fall and went back to traditional format in the spring reported improved perceptions of teams and preferred TBL format over a traditional format more than students who experienced a traditional format followed by TBL. Students at both universities agreed that the TBL format assists with critical-thinking, problem-solving, and examination preparation. Students also agreed that teams should consist of individuals with different personalities and learning styles.

CONCLUSION

When building teams, faculty members should consider ways to diversify teams by considering different views, perspectives, and strengths. Offering TBL early in the curriculum prior to traditional lecture-based formats is better received by students, as evidenced by anecdotal reports from students possibly because it allows students time to realize the benefits and assist them in building teamwork-related skills.

The effects of case-based team learning on students' learning, self regulation and self direction

INTRODUCTION

The application of the best approaches to teach adults in medical education is important in the process of training learners to become and remain effective health care providers. This research aims at designing and integrating two approaches, namely team teaching and case study and tries to examine the consequences of these approaches on learning, self regulation and self direction of nursing students.

MATERIAL & METHODS

This is a quasi experimental study of 40 students who were taking a course on mental health. The lessons were designed by using two educational techniques: short case based study and team based learning. Data gathering was based on two valid and reliable questionnaires: Self-Directed Readiness Scale (SDLRS) and the self-regulating questionnaire. Open ended questions were also designed for the evaluation of students' with points of view on educational methods.

RESULTS

The Results showed an increase in the students' self directed learning based on their performance on the post-test. The results showed that the students' self-directed learning increased after the intervention. The mean difference before and after intervention self management was statistically significant (p=0.0001). Also, self-regulated learning increased with the mean difference after intervention (p=0.001). Other results suggested that case based team learning can have significant effects on increasing students' learning (p=0.003).

CONCLUSION

This article may be of value to medical educators who wish to replace traditional learning with informal learning (student-centered-active learning), so as to enhance not only the students' knowledge, but also the advancement of long- life learning skills.

Twelve tips for facilitating team-based learning

BACKGROUND

Team-based learning (TBL) has become a more commonly recognized and implemented pedagogical approach in curricula of numerous disciplines. The desire to place more autonomy on the student and spend less in-class time delivering content has resulted in complete or partial adoption of this style of learning in many educational settings.

AIM

Provide faculty with tools that foster a well facilitated and interactive TBL learning environment.

METHODS

We examined the published literature in the area of facilitation - specifically in TBL environments, and explored learning theories associated with team learning and our own experiences to create these facilitation tips.

RESULTS

We created 12 tips for TBL facilitation designed to assist faculty to achieve an effective and engaging TBL learning environment.

CONCLUSIONS

Applying these twelve tips while facilitating a TBL classroom session will help to ensure maximal participation and optimal learning in a safe yet stimulating environment.

Is a Team-based Learning Approach to Anatomy Teaching Superior to Didactic Lecturing?

OBJECTIVES

Team-based learning (TBL) is used in the medical field to implement interactive learning in small groups. The learning of anatomy and its subsequent application requires the students to recall a great deal of factual content. The aims of this study were to evaluate the students' satisfaction, engagement and knowledge gain in anatomy through the medium of TBL in comparison to the traditional lecture method.

METHODS

This study, carried out from February to June 2012, included 30 physical therapy students of the Shiraz University of Medical Science, School of Rehabilitation Sciences. Classic TBL techniques were modified to cover lower limb anatomy topics in the first year of the physical therapy curriculum. Anatomy lectures were replaced with TBL, which required the preparation of assigned content, specific discussion topics, an individual self-assessment test (IRAT) and the analysis of discussion topics. The teams then subsequently retook the assessment test as a group (GRAT). The first eight weeks of the curriculum were taught using traditional didactic lecturing, while during the second eight weeks the modified TBL method was used. The students evaluated these sessions through a questionnaire. The impact of TBL on student engagement and educational achievement was determined using numerical data, including the IRAT, GRAT and final examination scores.

RESULTS

Students had a higher satisfaction rate with the TBL teaching according to the Likert scale. Additionally, higher scores were obtained in the TBL-based final examination in comparison to the lecture-based midterm exam.

CONCLUSION

The students' responses showed that the TBL technique could be used alone or in conjunction with traditional didactic lecturing in order to teach anatomy more effectively.

Enhancing team-based active learning through hands-on experience with nicotine replacement therapy

OBJECTIVES

To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session.

DESIGN

A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use.

ASSESSMENT

Students' scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students' perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive.

CONCLUSION

Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students' confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product's characteristics.

Team-based learning in US colleges and schools of pharmacy

OBJECTIVE

To characterize the use of team-based learning (TBL) in US colleges and schools of pharmacy, including factors that may affect implementation and perceptions of faculty members regarding the impact of TBL on educational outcomes.

METHODS

Respondents identified factors that inhibit or enable TBL use and its impact on student learning. Results were stratified by type of institution (public/private), class size, and TBL experience.

RESULTS

Sixty-nine of 100 faculty members (69%) representing 43 (86%) institutions responded. Major factors considered to enable TBL implementation included a single campus and student and administration buy-in. Inhibiting factors included distant campuses, faculty resistance, and lack of training. Compared with traditional lectures, TBL is perceived to enhance student engagement, improve students' preparation for class, and promote achievement of course outcomes. In addition, TBL is perceived to be more effective than lectures at fostering learning in all 6 domains of Bloom's Taxonomy.

CONCLUSIONS

Despite potential implementation challenges, faculty members perceive that TBL improves student engagement and learning.

Team-based learning from theory to practice: faculty reactions to the innovation

BACKGROUND

Limited studies have examined the factors associated with the implementation of team-based learning (TBL).

PURPOSE

The purpose of this study was to identify faculty reactions (successes and challenges) associated with the implementation of a modified TBL in undergraduate anatomy teaching.

METHOD

To obtain faculty reactions to the TBL approach, data collection included focus groups, observations, and document analysis. Using the constant comparative method, our analysis yielded four key themes.

RESULTS

Four themes based on faculty reactions to the implementation of TBL included transportability and local adaptations, faculty/tutor role confusion, student preparedness, and teacher-targeted bullying.

CONCLUSIONS

Future physicians will need educational programs that embrace the theory and practice of teamwork. Schools adopting team-based learning approaches will need to carefully consider their local environments so as to successfully transport innovative practices alongside local adaptations. As front-line implementers faculty will require initial and ongoing professional development. The TBL method is amenable to local modifications and holds promise as a pedagogical strategy to garner increased student engagement and student achievement in their learning.

Long-term gain after team-based learning experience in a pediatric clerkship

BACKGROUND

Team-based learning (TBL) increases student engagement, value of teamwork, and performance on standardized evaluations.

PURPOSE

The authors implemented a 3rd-year pediatric TBL curriculum, evaluating its effect on satisfaction, engagement, value of teamwork, and short-term and long-term academic performance.

METHOD

Students evaluated the TBL curriculum and core lectures through satisfaction, engagement and value of team surveys. Scores on short-term and long-term examinations were compared to historical data.

RESULTS

The first implementation year, students were less likely to enjoy TBL sessions compared to lectures. The 2nd year, this difference lessened. Through both years, students reported dramatic increases in classroom engagement during TBL compared to lecture. Students developed a greater value for teams after participating in TBL. Short-term and long-term examination scores improved significantly.

CONCLUSIONS

Both short-term and long-term performance improved with implementation of TBL, emphasizing the benefits of a curriculum that allows students to critically engage with material.

Is transferring an educational innovation actually a process of transformation?

Recent debates question the extent to which adopting an educational innovation requires compromise between the innovation's original design and the adoption site's context. Through compromises, the innovation's fundamental principles may be transferred, transformed, or abandoned. This paper analyzes such compromises during the piloting of Team-Based Learning (TBL). We ask: When is the process of transferring an innovation actually a process of transformation? This study is an autoethnography of our research team's implementation process. Autoethnographies are personalized accounts where authors draw on their own experiences to extend understanding of a particular topic. To conduct this autoethnography, we used an in-depth, interactive interview with the piloting clinician educator. In the analysis of TBL's fundamental principles, some aspects of the principles transferred easily, while others were transformed. Analysis raised concerns that the transformations threatened the foundational principles of TBL. While an educational innovation's techniques may seem to be surface structures, they are realizations of deeper fundamental principles. The fundamental principles are themselves realizations of the innovation's foundational philosophy. When techniques and/or principles are modified to a context, it is important to analyze if the modifications continue to uphold the innovation's philosophy.

Team-based learning: a relevant strategy in health professionals' education

For about a decade, team-based learning (TBL), as an educational strategy, has been growing in use in the US and in several other international medical schools. It is a learner-centered, small group instructional strategy with good academic outcomes and considerable potential to address many of the professional competencies that are critical for the practice of medicine. For it to be successful in a course or curriculum, its essential components must be used properly. This article explains the importance and relevance of TBL in healthcare education, supports its inclusion as an effective learning strategy, and encourages the reader to explore additional resources, including the recently published AMEE Guide in Medical Education related to the topic (Parmelee et al, 2012).

Team learning and innovation in nursing, a review of the literature

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing.

Team-based learning: a practical guide: AMEE guide no. 65

Team-based learning™ (TBL) is an instructional strategy developed in the business school environment in the early 1990s by Dr Michaelsen who wanted the benefits of small group learning within large classes. In 2001, a US federal granting agency awarded funds for educators in the health sciences to learn about and implement the strategy in their educational programs; TBL was put forward as one such strategy and as a result it is used in over 60 US and international health science professional schools. TBL is very different from problem-based learning (PBL) and other small group approaches in that there is no need for multiple faculty or rooms, students must come prepared to sessions, and individual and small groups of students (teams) are highly accountable for their contributions to team productivity. The instructor must be a content-expert, but need not have any experience or expertise in group process to conduct a successful TBL session. Students do not need any specific instruction in teamwork since they learn how to be collaborative and productive in the process. TBL can replace or complement a lecture-based course or curriculum.

The educational theory basis of team-based learning

BACKGROUND

Health care providers require the ability to use critical thinking skills and work effectively in a team as a part of an overall set of competencies. Therefore, educational programs should use appropriate methods based in educational theory to effectively graduate learners with these abilities. Team-based learning (TBL) is a method that has been introduced in healthcare education to foster critical thinking skills while students work in high functioning teams.

AIMS

This article will show how TBL follows the principles of constructivist learning theory.

METHOD

The principles of constructivist learning theory are discussed in relation to the teaching method of team-based learning. The effectiveness of TBL in healthcare education is then reviewed.

RESULTS

TBL is learner centered with the teacher acting as an expert facilitator and also provides students with opportunities to expose inconsistencies between their current understandings and new experiences thus stimulating development of new personal mental frameworks built upon previous knowledge. The learning is active using relevant problems and group interaction. Teamwork skills are strengthened by focused reflection on new experiences during the group sessions and on teamwork success by providing feedback to group members.

CONCLUSION

Since these aspects are all essential components of constructivist educational theory, TBL is solidly grounded in the theory and is a promising method to strengthen healthcare education.

Team-based learning in anatomy: an efficient, effective, and economical strategy

Team-based learning (TBL) strategy is being adopted in medical education to implement interactive small group learning. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL that required preparation of assigned content specific discussion topics (in the text referred as "discussion topics"), an individual self-assessment quiz (IRAT), analysis of the discussion topics, and then the team retaking the same quiz (GRAT) for discussion and deeper learning. Embryology and clinical correlations were given as lectures. Unit examinations consisted of graded IRAT and GRAT. The National Board of Medical Examiners (NBME) Subject Examination was the comprehensive final examination. To evaluate the effect of TBL on student performance we compared the departmental and NBME subject examination scores between the traditional and TBL curricula. We collected five years of data on student performance in TBL-based anatomy and lecture-based preclinical courses. Our results show that departmental and NBME subject examination scores for TBL-based anatomy were higher than those for lecture-based anatomy. We subsequently compared average NBME scores for anatomy with those in other preclinical courses that were lecture-based. Average NBME anatomy scores were significantly higher than those for all the lecture-based preclinical courses. Since the introduction of TBL in anatomy, student performance has progressively improved in the NBME subject examination. Students perceived TBL as a motivator to be a responsible team member and to contribute to collective learning by the team. Further, it reinforced self-directed learning and fostered an appreciation for peer respect. Interestingly, these perceptions were uniform irrespective of student course performance.

Comparing team-based and mixed active-learning methods in an ambulatory care elective course

OBJECTIVES

To assess students' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members' perceptions of team-based learning.

METHODS

Using the 2 teaching methods, students' grades were compared. Students' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning.

RESULTS

The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course.

CONCLUSIONS

Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning.

Using team-based learning to teach pharmacology to second year medical students improves student performance

BACKGROUND

Team-based learning (TBL) is an innovative instructional method that fosters active learning. It has been shown to improve student performance in some health care education courses.

AIM

To examine the effect of teaching pharmacology using a TBL approach on second year medical students' satisfaction and performance.

METHODS

A modified TBL method was used in two case-based discussion sessions of the second year pharmacology course: a relatively easy drug metabolism/pharmacogenetics session and a more challenging pharmacokinetics/pharmacodynamics (PK/PD) session. Individual and group answers to all questions were recorded, and an evaluation form was collected for each session. Class performance on a summative quiz was compared to previous years.

RESULTS

Students provided positive feedback. Group performance was better than individual performance during the TBL exercises. TBL was less successful when the questions were very difficult, with a difficulty range of 30-70% being the most appropriate. Performance of the class on the pharmacology summative quiz showed significant improvement over that in previous years in the PK/PD part, but was unchanged in other topics taught traditionally.

CONCLUSION

The results suggest that TBL provides a better outcome for students, and provide insight into appropriate design of TBL exercises.

[Change in the job description of physicians. Consequences for medical education]

After receiving the final degree at the age of about 25 years, physicians are going to practice a minimum of 40 years. Therefore, one can assume that after graduation physicians are confronted with many occupational challenges which were not and could not be covered during their studies. This implies that medical education does not only have to provide intensive knowledge about established methods but above all about potential future techniques. Throughout the educational period and continuing during professional life, physicians have first to learn and then to be able to seek information and to conduct a critical appraisal - systematically examining research evidence, assessing its validity and the relevance of the results. The increasing velocity of innovation in the realm of medicine requires students to be prepared for life-long learning and continuous, autonomous professional development.