Team-based learning in a medical gross anatomy and embryology course

The outcomes of team-based learning vs small group interactive learning in the obstetrics and gynecology course for undergraduate students

INTRODUCTION

Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship.

MATERIAL AND METHODS

The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated.

RESULTS

Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction.

CONCLUSIONS

We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes.

The impact of three learning methods on dental students' satisfaction and knowledge acquisition

OBJECTIVES

Health professionals' education presents unique challenges including clinical application of knowledge and interprofessional collaboration. Additionally, institutions suffer from faculty shortages while class sizes increase. Therefore, educators seek innovative andragogical techniques utilizing minimal resources. Several active learning methods have been introduced as a solution. The aim of this study is to assess the impact of lecture (LBL), case (CBL), and team (TBL) based learning on the students' satisfaction and knowledge attainment.

METHODS

A total of 134 sophomore dental students are taught pediatric dentistry course using LBL, CBL, and TBL techniques. At the end of the course, students are invited to participate in a satisfaction survey. Statistical analysis is conducted using a two-sided chi-square goodness of fit test. Students' comments are used for qualitative analysis. Final exam analysis is administered via Examsoft software.

RESULTS

A total of 98% of the students participated in the survey out of which 83% met the inclusion criteria (N = 110). Students chose LBL as the method that helped them learn in a comprehensive way, provided the most comfortable environment, and presented the overall highest satisfaction with statistically significant difference (p value = 0.001). LBL questions scored the highest point biserial and discrimination index. The percentage of correct answers and difficulty level was highest for TBL.

CONCLUSION

Students preferred LBL over the other learning methods. Final exam psychometrics showed favorable results for LBL and TBL. Students could potentially benefit from combining both techniques. However, more research is needed to assess the effectiveness of various teaching methods on the short- and long-term learning outcomes.

Team-based learning (TBL) in clinical disciplines for undergraduate medical students-a scoping review

BACKGROUND

Team-based learning (TBL) is an evidence-based pedagogical method that has been used in undergraduate medical education since 2001. However, its use in clinical disciplines is rarely reported, and the impact of its implementation is not known. The aim of this study was to explore and map the published literature on the impact of implementing TBL in clinical disciplines in undergraduate medical education.

METHODS

A comprehensive search of Medline, Education Resources Information Center (ERIC), and Web of Science databases was performed on November 24, 2021 and updated April 6, 2023, using relevant Medical Subject Headings (MeSH) and free-text terms. Original research studies reporting on the implementation of TBL in clinical disciplines in undergraduate medical education published in peer-reviewed English language journals were included irrespective of their methodological design.

RESULTS

The initial search identified 2,383 records. Of these, 49 met the inclusion criteria. Most of the studies (n = 44, 90%) described the implementation of a modified version of TBL in which one or more TBL steps were missing, and one study had undefined protocol for the implementation. The most reported outcomes were knowledge acquisition (n = 38, 78%) and students' satisfaction or attitudes toward TBL (n = 34, 69%). Despite some differences in their results, the studies found that implementing TBL is associated with increased knowledge acquisition (n = 19, 39%), student engagement (n = 6, 12%), and student satisfaction (n = 31, 63%).

CONCLUSIONS

Most of the studies reported positive results in students' satisfaction and students' engagement, whilst the results on knowledge acquisition and retention were more contradictory. In most of the studies, TBL was implemented in a modified form and diverse comparators were used. The methodological quality also varied. Thus, no unequivocal conclusions could be drawn regarding the value of implementing TBL in clinical disciplines. More studies with rigorous methodologies are needed in this field.

Body painting, ultrasound, clinical examination, and peer-teaching: A student-centered approach to enhance musculoskeletal anatomy learning

The presented course, established 2016 as a compulsory elective for 22nd-year bachelor medical students, aimed to enhance deep learning of upper and lower limb anatomy from a clinical perspective by a maximum of student-centered activities combining hands-on skills training with team-learning. Three cohorts (in total 60 students) participated in this study. Students rotated through body painting, ultrasound, and clinical investigation supervised by faculty or an experienced clinician. Teams of 3-4 students prepared presentations on clinical anatomy and pathological conditions, which by teacher- and peer assessments on average achieved >85% (mean 17.8/20 points ± 1.06). After each activity session, the students reported their learning experience through a reflective diary. Fifty students (83%) evaluated the course by a voluntary anonymous questionnaire combining Likert-type scale and free-text questions to assess, predominantly, perception of course activities and their perceived influence on learning anatomy. Journal reports and questionnaires revealed that the students highly valued the course, and 92% (29 females, 17 males) rated group work satisfying or well-perceived. The highest appreciation achieved ultrasound followed by clinical examination and body painting, which one third proposed to integrate into the regular dissection course. All students recommended the course to their younger peers. This course was feasible to integrate in the pre-existing curriculum. Limiting factors to offer this elective course to more students are availability of clinical teachers, technical equipment, and education rooms. Being student-directed tasks, body painting and reflective diary-writing would be feasible to implement without additional faculty, which we recommend to educators for student engagement activation.

Assessment of the Effectiveness of Team-based Learning Activities on Learning Outcomes in the Undergraduate Immunology Classroom

Immunology is inherently interdisciplinary. Understanding how the immune system functions requires knowledge from several scientific disciplines, including molecular biology, cellular biology, genetics, and biochemistry. Furthermore, immunology is conceptually complex, requiring the identification of a plethora of immune components and mastery of a large volume of new vocabulary. These attributes can pose challenges to student learning in the undergraduate immunology classroom. Team-based learning (TBL) is a pedagogical method used to increase student engagement in learning, improve student collaboration, and develop communication skills. In a variety of educational settings, TBL activities have been shown to foster a deeper understanding of complex topics, increase student confidence in course content, and improve learning outcomes. In this study, we examined differences in the impact of traditional lecture versus TBL activities on student learning outcomes for four different topics presented in an undergraduate adaptive immunity course composed largely of academically high-performing students. We matched content across two student cohorts, delivered via team-based learning methodology (T cell development and Ab-mediated functions) and traditional lecture (B cell development and T cell effector functions). Student learning was assessed using content questions across a range of Bloom's taxonomy levels, which demonstrated that the TBL activities did not improve examination performance over lecture-based learning in this course. However, students found this learning tool to be valuable, indicating that the TBL activities assisted with preparation for examinations and provided a necessary opportunity to address misconceptions.

The influence of collaborative learning and self-organisation on medical students' academic performance in anatomy

BACKGROUND

In 2021, university teaching at the Faculty of Medicine Tuebingen was transferred to a digital setting. Due to the discontinuation of face-to-face teaching, students lacked the temporal and spatial framework of the curriculum and the possibility to socialise with fellow students was extremely limited. Increased demands were placed on the students' self-organisation, and the possibility of collaborative learning was drastically limited. The present study investigated the extent to which these study conditions affected the academic performance of medical students in the oral exam after the 60-hour introductory anatomy lecture. Specifically, collaborative, and organisational learning strategies were considered.

METHODS

Learning strategies of 146 students were assessed by means of a questionnaire. The anatomy exam was used to assess the academic performance. In addition, students were asked to rate their own oral exam performance.

RESULTS

Students used strategies of collaborative learning (M = 3.30, SD = 0.88) and self-organisation (M = 3.28, SD = 0.72) about equally as often. A significant correlation was found between the use of collaborative learning strategies and the ability for realistic self-assessment (ρ = -0.22, P =.02). Collaborative behaviour could be divided into Initiative Collaborative Learning and Subordinate Collaborative Learning. Only the former had an influence on the ability for realistic self-assessment. Neither organisational learning strategies nor collaborative learning strategies had an influence on academic performance.

DISCUSSION AND CONCLUSION

Initiative collaborative learners showed a higher degree of realistic self-assessment. This could be explained through a more distinct social referencing, as fellow students' knowledge levels can be related early on to their own academic performance. There was no correlation between the learning strategies used and the exam result.

Understanding medical professionalism using express team-based learning; a qualitative case-based study

Medical Professionalism (MP) defined as values, behaviours and attitudes that promote professional relationships, public trust and patient safety is a vital competency in health profession education. MP has a distinctive uniqueness due to cultural, contextual, conceptual, and generational variations. There is no standard instructional strategy to probe the understanding of MP in a cohesive, structured, interactive manner. This study aimed to investigate undergraduate medical students' understanding of MP using express team-based learning (e-TBL) at both campuses of Royal College of Surgeons Ireland (RCSI). Using the key principles of a sociocultural theoretical lens in adult learning theory, we designed e-TBL as a context-learning-based educational strategy. We conducted three e-TBL sessions on cross-cultural communication and health disparities, a reflective report on clinical encounters, and professionalism in practice. We collected, collated, and analyzed the student experiences qualitatively using data gathered from team-based case discussions during e-TBL sessions. A dedicated working group developed very short-answer questions for the individual readiness assurance test (IRAT) and MP-based case scenarios for team discussions. In this adapted 4-step e-TBL session, pre-class material was administered, IRAT was undertaken, and team-based discussions were facilitated, followed by facilitator feedback. A qualitative inductive thematic analysis was performed, which generated subthemes and themes illustrated in excerpts. Our thematic analysis of data from 172 students (101 from Bahrain and 71 from Dublin) yielded four unique themes: incoming professional attitudes, transformative experiences, sociological understanding of professionalism, and new professional identity formation. This qualitative study provides a deeper understanding of medical students' perceptions of medical professionalism. The generated themes resonated with divergent and evolving elements of MP in an era of socioeconomic and cultural diversity, transformative experiences, and professional identity formation. The core elements of these themes can be integrated into the teaching of MP to prepare fit-to-practice future doctors.

Evaluation of Knowledge among Medical Students Attending an Obstetrics and Gynecology Preparatory Course: A Non-Experimental Study

BACKGROUND

Preparatory courses are frequently utilized strategies to assist, simplify, prepare, and give receivers a better understanding of varied knowledge. Nonetheless, data on this topic are rare throughout the Middle East, particularly in Saudi Arabia.

OBJECTIVES

This study aimed to look at the progress of students who took the "Obstetrics and Gynecology (OBGYN) Made Easy" course, a preparatory course for the fifth-year medical students studying OBGYN for the first time, at our institute.

MATERIALS AND METHODS

This is a non-experimental study performed in August 2021 among fifth-year medical students who attended the course at our university institute in Jeddah, Saudi Arabia. An online questionnaire with 13 questions covering various course contents was used to collect data. Each student completed the identical questionnaire twice with randomized assortment: as a pretest and as a post-test of their knowledge. The qualitative data were described using the mean and standard deviation. P < 0.05 was considered significant when used to determine whether the difference in scores was statistically significant.

RESULTS

This research involved a total of 66 female students. These students' mean pre-course test score was 7.32 ± 1.807 out of 13. The mean post-course test score was 9.52 ± 2.054. There was a significant difference between the pre- and post-course outcomes when they were compared (P = 0.01).

CONCLUSION

According to this study's findings, the students who took the course improved their post-course exam performance. The "OBGYN Made Easy" course should be offered for medical students to assist and guide them in preparing for their rotation in OBGYN.

Impact of modified teaching strategies used in a gross anatomy course on the academic performance of dental students during the COVID-19 pandemic

INTRODUCTION

Modified teaching strategies (MTS), asynchronous online teaching and smaller dissection groups, were applied to a gross anatomy course for dental students in the National Taiwan University in April 2020 in response to the COVID-19 pandemic. This study aimed to investigate the effects and perceptions of MTS on dental students.

MATERIALS AND METHODS

Scores for anatomy examinations for 2018-2019 (without MTS) and 2019-2020 (with MTS) cohorts were compared to explore the effect on academic performance. Moreover, questionnaire from the 2019-2020 cohort was analysed to determine dental students' perceptions about MTS.

RESULTS

The lecture performance in the final examination of the second semester for the 2019-2020 cohort was significantly higher than that of the first semester (pre-COVID-19) and that for the 2018-2019 cohort. However, the laboratory performance in the midterm examination of the second semester for the 2019-2020 cohort was significantly lower than that for the 2018-2019 cohort and showed no difference in the final examination of the first semester. The questionnaires revealed that the majority of students displayed positive attitudes towards MTS and agreed with the importance of peer discussion during laboratory dissection.

CONCLUSIONS

Asynchronous online learning for anatomy lecture may be beneficial for dental students; however, a smaller dissection group accompanied by reduced peer discussion may temporarily exert negative effects on their laboratory performance at the beginning of the application. Furthermore, more dental students exhibited positive perceptions towards smaller dissection groups. These findings could illuminate the learning condition of dental students in anatomy education.

A multi-year evaluation of medical student performance on and perceptions of collaborative gross anatomy laboratory examinations

Collaborative testing and its benefits have been reported in diverse disciplines across different types of academic institutions. However, there has been minimal research conducted on collaborative assessments in medical schools, particularly in the gross anatomy laboratory. The objectives of this study were to explore the effect of collaborative anatomy laboratory examinations on student performance and to gauge student perceptions of this assessment format. This study examined five academic years of medical students' performance on a two-stage, collaborative anatomy laboratory examination wherein each student's overall score was a weighted combination of scores from the individual and team examination. Analyses of a descriptive survey capturing students' perceptions of the assessment method were also performed. Individual examination averages increased since implementing the collaborative assessment (p < 0.001), and team examination averages were higher than individual examination averages (p < 0.001). Teams outperformed each of their team members 98% of the time. Teams had a greater than 0.90 incidence of answering a question correctly if more than one person in the group got the answer correct on the individual portion, and a 0.66 incidence of answering correctly if only one person in their group answered correctly on the individual portion. Student feedback identified the discussions and learning that took place during the team portion to be a beneficial feature of this assessment format. Students also reported that this collaborative assessment made them feel a higher level of responsibility to perform well, and that it improved their understanding of gross anatomy.

A Large-Scale, Multiplayer Virtual Reality Deployment: A Novel Approach to Distance Education in Human Anatomy

The arrival of COVID-19 restrictions and the increasing demand of online instruction options posed challenges to education communities worldwide, especially in human anatomy. In response, Colorado State University developed and deployed an 8-week-long large-scale virtual reality (VR) course to supplement online human anatomy instruction. Students (n = 75) received a VR-capable laptop and head-mounted display and participated in weekly synchronous group laboratory sessions with instructors. The software enabled students to remotely collaborate in a common virtual space to work with human anatomy using an artist-rendered cadaver. Qualitative data were collected on student engagement, confidence, and reactions to the new technology. Quantitative data assessed student knowledge acquisition and retention of anatomical spatial relationships. Results indicated that students performed better in the online course (mean = 82.27%) when compared to previous in-person laboratories (mean = 80.08%). The utilization of VR promoted student engagement and increased opportunities for student interaction with teaching assistants, peers, and course content. Notably, students reported benefits that focused on unique aspects of their virtual learning environment, including the ability to infinitely scale the cadaver and walk inside and around anatomical structures. Results suggested that using VR was equivalent to 2D methods in student learning and retention of anatomical relationships. Overall, the virtual classroom maintained the rigor of traditional gross anatomy laboratories without negatively impacting student examination scores and provided a high level of accessibility, without compromising learner engagement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01751-w.

Medical Faculty Perspectives Toward Cadaveric Dissection as a Learning Tool for Anatomy Education: A Survey Study in India

Cadaveric dissection, as a learning tool, has been a part of Indian medical education. Worldwide, with reforms in medical education and the introduction of new learning modalities, cadaveric dissection has been complemented with other modalities such as living anatomy and virtual anatomy. This study aims to collect the feedback of faculty members regarding the role of dissection in the present context of medical education. The method of the study involved a 32-item questionnaire to collect responses; they were collected using the 5-point Likert scale along with two open-ended questions. In general, the closed questions covered these sections: learning styles, interpersonal skills, teaching and learning, dissection, and other learning modes. The principal component analysis was used to explore the multivariate relationships among the items' perceptions. The multivariate regression analysis was conducted between the construct and the latent variable to develop the structural equation model. Four themes, PC1 (learning ability with structural orientation), PC2 (interpersonal skill), PC3 (multimedia-virtual tool), and PC5 (associated factors) had positive relation and were treated as a latent variable motivation for dissection, and theme 4 (PC4, safety) had a negative correlation and was treated as a latent variable repulsion for dissection. It was found that the dissection room is an important place for learning clinical and personal skills, along with empathy, in anatomy education. Safety issues and implementation of stress-coping activities during the induction phase are required. There is also a need to use mixed-method approaches that integrate technology-enhanced learning such as virtual anatomy, living anatomy, and radiological anatomy with cadaveric dissection.

Meeting the challenge of teaching bioethics: a successful residency curricula utilizing Team-Based Learning

BACKGROUND

Despite recognition by both the Accreditation Council of Graduate Medical Education (ACGME) and the American Board of Paediatrics (ABP) of the importance of bioethics education, curricular crowding, lack of perceived significance, and insufficient administrative support remain significant barriers to trainees gaining competency in bioethics. Few bioethics curricula at the graduate medical education level are evidence-based or comprehensive. We sought to develop and assess the effectiveness of a Team Based Learning (TBL) curriculum in improving residents' bioethics knowledge and their ability to evaluate ethical dilemmas.

METHODS

We integrated L. Dee Fink's curricular design principles of "Significant Learning," Jonsen et. al's "Four-Box Method" of ethical analysis, and ABP bioethics content specifications to create 10 TBL bioethics sessions. Paediatric residents at a major academic centre then completed a 3-year longitudinal, integrated TBL-based bioethics curriculum. Primary outcomes included individual and group readiness assessment tests (iRAT/gRAT), pre-work completion, and satisfaction with sessions.

RESULTS

The TBL-based bioethics curriculum contains 10 adaptable modules. Paediatric residents (n = 348 total resident encounters) were highly engaged and satisfied with the curriculum. gRAT scores (mean 89%) demonstrated significant improvement compared to iRAT scores (72%) across all TBLs and all post-graduate years (p < .001). Higher gRAT scores correlated with higher level of training. Although pre-work completion was low (28%), satisfaction was high (4.42/5 on Likert scale).

CONCLUSIONS

Our TBL-based bioethics curriculum was effective in improving knowledge, practical and flexible in its implementation, and well-received. We attribute its success to its grounding in ethical theory, relevance to ABP specifications, and a multi-modal, engaging format. This curriculum is easily modified to different specialties, virtual formats, or other specific institutional needs.Key messagesDespite formidable challenges to teaching bioethics in residency education, evidence-based methods such as Team-Based Learning (TBL) can be employed to increase knowledge and satisfaction.This study reports the first successful TBL bioethics curriculum, planned and executed longitudinally over 3 years, with paediatric residents at a large academic children's hospital in the US.TBL can be utilised to teach bioethics at the graduate medical education level and is adaptable to different situational factors, disciplines, and levels of clinical experience.

Has pedagogy, technology, and Covid-19 killed the face-to-face lecture?

The lecture has been around for centuries and has featured as a popular and frequent component in higher education courses across many disciplines including anatomy. In more recent years, there has been a growing shift toward blended learning and related pedagogies that encourage active participation of students in both face-to-face and online learning environments. Unfortunately, in many cases, the lecture, which has typically focused on the transmission of information from educator to student has not been adapted to become a more learner-oriented approach with opportunities for students to actively interact and engage. As a result, the future of whether the lecture should continue has once again become a center of debate. The consequence of the Covid-19 pandemic and its aftermath have added to this with institutions now looking to stop all lectures or offer them in an online format only. This commentary argues that lecture-style components could still feature within face-to-face and online provision, but only if they are used sparingly within a blended curriculum, have a defined use that aligns well to learning outcomes, are assessed as the most effective method pedagogically, and importantly integrate approaches and activities that promote student engagement. Anatomy educators have demonstrated for years that they are able to be at the forefront of pedagogical change and evidenced during the pandemic their agile and innovative ability to adapt and do things differently. Therefore, the fate of the lecture, at least in anatomy, may well be in their hands.

Investigating the effectiveness of three-dimensionally printed anatomical models compared with plastinated human specimens in learning cardiac and neck anatomy: A randomized crossover study

Three-dimensional printing (3DP) technology has been increasingly applied in health profession education. Yet, 3DP anatomical models compared with the plastinated specimens as learning scaffolds are unclear. A randomized-controlled crossover study was used to evaluate the objective outcomes of 3DP models compared with the plastinated specimens through an introductory lecture and team study for learning relatively simple (cardiac) and complex (neck) anatomies. Given the novel multimaterial and multicolored 3DP models are replicas of the plastinated specimens, it is hypothesized that 3DP models have the same educational benefits to plastinated specimens. This study was conducted in two phases in which participants were randomly assigned to 3DP (n = 31) and plastinated cardiac groups (n = 32) in the first phase, whereas same groups (3DP, n = 15; plastinated, n = 18) used switched materials in the second phase for learning neck anatomy. The pretest, educational activities and posttest were conducted for each phase. Miller's framework was used to assess the cognitive outcomes. There was a significant improvement in students' baseline knowledge by 29.7% and 31.3% for Phase 1; 31.7% and 31.3% for Phase 2 plastinated and 3DP models. Posttest scores for cardiac (plastinated, 3DP mean ± SD: 57.0 ± 13.3 and 60.8 ± 13.6, P = 0.27) and neck (70.3 ± 15.6 and 68.3 ± 9.9, P = 0.68) phases showed no significant difference. In addition, no difference observed when cognitive domains compared for both cases. These results reflect that introductory lecture plus either the plastinated or 3DP modes were effective for learning cardiac and neck anatomy.

Anatomy in Practice: How Do Equine and Production Animal Veterinarians Apply Anatomy in Primary Care Settings?

To successfully prepare veterinary undergraduates for the workplace, it is critical that anatomy educators consider the context in which developing knowledge and skills will be applied. This study aimed to establish how farm animal and equine general practitioners use anatomy and related skills within their daily work. Qualitative ethnographic data in the form of observations and semi-structured interviews were collected from 12 veterinarians working in equine or farm animal first-opinion practice. Data underwent thematic analysis using a grounded theory approach. The five themes identified were relevant to both equine and farm animal veterinarians and represented the breadth and complexity of anatomy, its importance for professional and practical competence, as well as the requirement for continuous learning. The centrality and broad and multifaceted nature of anatomy was found to challenge equine and farm animal veterinarians, highlighting that essential anatomy knowledge and related skills are vital for their professional and practical competence. This aligns with the previously described experiences of companion animal clinicians. In equine practice, the complexity of anatomical knowledge required was particularly high, especially in relation to diagnostic imaging and assessing normal variation. This resulted in greater importance being placed on formal and informal professional development opportunities. For farm animal clinicians, anatomy application in the context of necropsy and euthanasia was particularly noted. Our findings allow anatomy educators to design appropriate and effective learning opportunities to ensure that veterinary graduates are equipped with the skills, knowledge, and resources required to succeed in first-opinion veterinary practice.

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser-Meyer-Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of x ² (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.

Active Learning: A Shift from Passive Learning to Student Engagement Improves Understanding and Contextualization of Nutrition and Community Health

Challenging the notion of “teaching by telling,” active learning utilizes a student-oriented approach by emphasizing the concept of knowledge retention through peer interaction. To further examine the potential of active learning, we created a workshop based on didactic education and student collaboration. Participants included undergraduate students from traditionally underrepresented and disadvantaged backgrounds. The workshop was part of our summer academic enrichment program run in an urban, medically underserved community. The workshop focused on clinical and biochemical nutrition, wherein students synthesized information by discussing dietary choices and the socioeconomic aspects of nutrition. Student reception of the workshop was adjudged by anonymous surveys. The survey questions were designed to gauge how the workshop objectives were achieved. Cronbach alpha (0.276) confirmed that there was more than a single theme contained in the questions. The majority of students (97%) agreed that the workshop met the learning objectives: (1) acquire basic clinical knowledge, (2) gain a better understanding of nutrition, (3) formulate a linkage between clinical nutrition and disease, and (4) benefit from peer interaction. Students’ performance in the post-quiz (100% correct answers) had improved significantly compared to the pre-quiz (25% correct answers) suggesting acquisition, understanding and application of nutrition aspects taught in the workshop. Overall, the present study demonstrated the engagement and understanding of students with respect to learning about nutrition and community health in an active learning setting. These types of active-learning-based sessions may have broad applicability for any academic discipline to improve student engagement and knowledge retention.

A constructivist approach to teach neuroanatomy lab: Students' perceptions of an active learning environment

BACKGROUND

A recent trend in medical education is developing a more dynamic and integrated curriculum. Team-based learning (TBL) increases students' engagement and the active construction of anatomical knowledge. This initial study aimed to empirically observe medical students' perceptions of their achievement of learning outcomes and the construction of their neuroanatomy knowledge, critical thinking, and problem-solving using an interactive whiteboard (IWB) as a teaching strategy.

METHODS

An independent neuroanatomy lab survey collected students' perceptions and comments about their learning experiences using the IWB on a questionnaire using a 5-point Likert scale.

RESULTS

Student participants felt that using the IWB has facilitated their learning experience. 94.2% of student participants endorsed feelings that new technology has helped them achieve their learning outcomes, helped them integrate both their basic science and clinical science/skills knowledge (90.4%), enhanced their problem-solving skills (92.3%), facilitated their interaction with the neuroanatomy faculty (96.2%) and increase their critical thinking (88.4%).

CONCLUSION

Collecting such empirical data about students' perceptions and their learning environment should help neurosciences faculty in medical schools better outline their activities to faculty at other medical institutions. Applying these methods may enhance the learning process, save time during neuroanatomy lab, and it could also help overcome the shortage of qualified neuroanatomy educators.

The use of active methodologies for the teaching of human embryology: A systematic review

Embryology is a basic science, of the medical curriculum and of the health area, it serves as a foundation for the understanding of the phenomena that occur in normal development and its alterations. Over the years, active methodologies have been increasingly used as innovative tools in the academic training of health professionals. In this work we aim, through an integrative review, to search for the active methodologies used in the teaching of embryology. The PICo strategy was used to form the guiding question, the results were presented through the Prisma Flow diagram. The databases consulted were PubMed, Embase, Scopus, Web of Science, Science Direct, Medline, Scielo and LILACS, searching for articles until the year 2021. Our results show that embryology is a science still to be explored in the field of methodologies active, few works were found, most using TBL or digital platforms; however, the authors agree that active methodologies are valuable tools in the teaching of embryology, capable of improving student motivation and engagement.

Evaluating the reliability and validity of a questionnaire used to measure experiences of teamwork among student pharmacists in a quality improvement course

INTRODUCTION

The psychometric properties of instruments used to capture student pharmacists' perspectives of teamwork have not been well assessed. This study measured the reliability and validity of an instrument designed to assess teamwork experiences among student pharmacists in a quality improvement (QI) class at one United States pharmacy school.

METHODS

The psychometric properties of a previously conducted 17-item questionnaire (response options: "strongly agree," "agree," "disagree," or "strongly disagree") about second-year student pharmacists' teamworking experiences were assessed. A Rasch rating scale model was used to construct measures of teamwork experience. Principal component analysis (PCA) assessed unidimensionality. Item- and person-fit statistics were assessed. Construct and content validity and reliability were estimated utilizing student and item separation indices (SI) and reliability coefficients (RC).

RESULTS

Sixty student pharmacists were included. PCA conveyed a unidimensional construct. Four items with infit and outfit mean-squared values outside the suggested range were removed. Item responses "disagree" and "strongly disagree" were merged to improve scale functionality. The average person measure was 1.74 ± 2.03 logits. Student and item RC were 0.81 (SI = 2.04) and 0.97 (SI = 2.17), respectively. The easiest item endorsed was team's ability to reach consensus, while the most difficult item was interest to do collaborative work again. Mismatch of student experience and item difficulty level on the continuum scale suggested additional items are needed to match student teamwork experience.

CONCLUSION

The instrument demonstrated evidence of reliability and validity to measure student pharmacists' teamwork experience in a QI class, but additional instrument modifications are recommended.

Team-based learning in neuroanatomy

OBJECTIVE

Team-based learning (TBL) is an active learning method in which student teams participate in individual work, teamwork, and the application of learned concepts to problem solving. It has been widely adopted in the education of health professions. The aim of this study was to assess whether TBL in tutorials would be beneficial to students' assessed knowledge and subjective sense of satisfaction as compared to traditional modes of teaching.

METHODS

In 2018, TBL was introduced into the tutorials of a clinically oriented undergraduate course of neuroanatomy, and its benefits in improving student grades and satisfaction were assessed. The Welch 2 sample t test was used for group differences in continuous variables, and Pearson's χ2 test with Yates' continuity correction was used for group differences in dichotomous variables. Linear modeling was used to look for group differences while adjusting for significant baseline characteristics.

RESULTS

Our study found that in comparison to more traditionally delivered teaching, TBL did not improve grades or alter overall satisfaction. A post hoc pairwise comparison of satisfaction among lectures, tutorials, and practical classes showed that students appeared to be most dissatisfied with the TBL.

CONCLUSION

Analysis of our methods, results, student comments, and the literature indicate that the length of the tutorials, at 1 hour, was too short to conduct TBL to the standards required. In addition, there is an imperative to persist in preparing students for a different knowledge-transfer paradigm, and it takes a few iterations to improve the approach and application of this method of teaching.

The Effectiveness of Collaborative Augmented Reality in Gross Anatomy Teaching: A Quantitative and Qualitative Pilot Study

In the context of gross anatomy education, novel augmented reality (AR) systems have the potential to serve as complementary pedagogical tools and facilitate interactive, student-centered learning. However, there is a lack of AR systems that enable multiple students to engage in collaborative, team-based learning environments. This article presents the results of a pilot study in which first-year medical students (n = 16) had the opportunity to work with such a collaborative AR system during a full-day gross anatomy seminar. Student performance in an anatomy knowledge test, conducted after an extensive group learning session, increased significantly compared to a pre-test in both the experimental group working with the collaborative AR system (P < 0.01) and in the control group working with traditional anatomy atlases and three-dimensional (3D) models (P < 0.01). However, no significant differences were found between the test results of both groups. While the experienced mental effort during the collaborative learning session was considered rather high (5.13 ± 2.45 on a seven-point Likert scale), both qualitative and quantitative feedback during a survey as well as the results of a System Usability Scale (SUS) questionnaire (80.00 ± 13.90) outlined the potential of the collaborative AR system for increasing students' 3D understanding of topographic anatomy and its advantages over comparable AR systems for single-user experiences. Overall, these outcomes show that collaborative AR systems such as the one evaluated within this work stimulate interactive, student-centered learning in teams and have the potential to become an integral part of a modern, multi-modal anatomy curriculum.

Introduction of team-based learning improves understanding of glucose metabolism in biochemistry among undergraduate students

Team-based learning (TBL) is an active learning method used in many educational institutions. However, there are few examples of its use in basic medicine, such as biochemistry in medical schools. This study used TBL to teach glucose metabolism to first-year medical students. The process was in four phases: preclass preparation, readiness assurance tests, advanced questions, and a TBL test, with peer evaluation and a questionnaire. There were positive correlations between the TBL test, peer evaluation, and individual readiness test performance. Tests were taken immediately after learning and 2 weeks later, and scores decreased significantly less with TBL than traditional lectures (-2.3% vs. -17.5%). This suggests that TBL was more effective than traditional lectures in supporting knowledge retention. We used a Moodle system to facilitate communication between students and teachers, and this was evaluated positively by both groups. It was particularly useful for managing TBL. These findings suggest that TBL could be used to improve student performance in biochemistry.

Spending Wisely: The Role of Cost and Value Research in the Pursuit of Advancing Anatomical Sciences Education

Studies of "cost and value" in anatomical sciences education examine not only what works, but at what cost, thus evaluating the inputs and outputs of education. This research provides insights into how to use available resources (e.g., academic time, budgets, infrastructure) as a mechanism to obtaining the maximum outcomes available. The purpose of this viewpoint article is to expand on the application of cost and value concepts to anatomical sciences education, contextualizing these concepts through a deeper dive into the more costly educational approaches of human donor dissection. In doing so, both questions and opportunities are raised for the discipline of anatomical sciences going forward. Educational decisions, inclusive of cost and value appraisals, consider the range of outcomes for which the activity is designed to achieve, and the activity's integration with the philosophy of the educational program it is contributing to; these decisions, thus, evaluate more than just cost alone. Healthcare students' engagement with human donor dissection pedagogy offers an array of reported non-economic benefits, including non-traditional discipline-independent skill (NDIS) development (e.g., professionalism, teamwork skills). These skills are often harder to measure, but are no less important to the final pedagogical decision-making process. The goal of cost and value research is to create an evidence-base toward education that delivers maximum value for a given spend. Anatomy educators, researchers, and decision makers who embrace cost and value dialogue, and interpret and apply findings from studies of educational costs, are best positioned to improve the educational value for their learners and provide effective outputs for all stakeholders.

Evaluation of the effectiveness of student learning and teacher instruction on team-based learning during quality control of diagnostic imaging

Background: Team-Based Learning (TBL), which is a student-centered instructional approach, has been applied in various health-related courses, but research on the effectiveness of TBL in radiologic technology is limited. More research is needed to examine the effectiveness of TBL within the field of radiologic technology as well as to study teachers' reflective practices for instructional development in TBL.Objectives: This study examines the effectiveness of TBL on students' learning and course instructors' instructional development during quality control activities in diagnostic imaging.Design: This study employed an action research approach with mixed-methods. The study was categorized using four TBL modules as the topics: film/screen receptors and processors, radiography, mammography, and computed tomography. Quantitative data included pre-test scores on individual readiness assurance tests (IRAT-pre), group readiness assurance tests (GRAT), and post-test scores on individual readiness assurance tests (IRAT-post). Qualitative data included students' responses to open-ended questions about their experience with TBL and transcripts of instructors' interviews.Results: Forty junior college students participated in the study. A non-parametric test was conducted to compare the scores. The results showed that the GRAT score was significantly higher than the IRAT-pre-score, and the IRAT-post score was significantly higher than the IRAT-pre-score. The IRAT-post score was significantly higher than the GRAT score for the first and fourth modules, but IRAT-post score was significantly lower than the GRAT score on the second and third modules. Using direct content analysis, five themes were coded around instructional development, while 15 themes were coded to understand students' experiences with TBL.Conclusions: TBL can be an effective instructional approach to improve students' understanding of radiologic technology content. The results of this research can help instructors decide what action plan to implement to increase the effectiveness of TBL when further employing it for radiologic technology courses.

Interprofessional team-based learning in basic sciences: students' attitude and perception of communication and teamwork

OBJECTIVES

To explore whether a team-based learning strategy applied to an interprofessional course on basic science changes students' perception of communication and teamwork skills and attitudes as related to interprofessional learning.

METHODS

A mixed-methods approach was utilized. The participants were selected through an opportunity sample of 33 first-semester anatomy students from occupational therapy and orthoptics programs. Students completed an interprofessional questionnaire before and after the course. The data were analyzed descriptively. Fourteen students were selected randomly for group interviews. Qualitative data was interpreted using thematic analyses.

RESULTS

The pre-test scores for 'communication and teamwork skills' and 'interprofessional learning' were high with mean values of 26.58 and 34.24, respectively. The post-test scores were 27.30 and 34.27, respectively, indicating no relevant changes in students' perception and attitudes. Qualitative data suggested that team-based learning represents a valid strategy to encourage communication and teamwork skills but revealed a lack of interprofessional exchange during the course. Students reported that classroom activities must require the professional knowledge of all participating groups in order to prevent a negative attitudinal shift towards interprofessional education in the later years of their studies.

CONCLUSIONS

Implementing team-based learning in basic sciences can encourage communication and teamwork among students. Mixed classes can help socialize students of different professional groups, although they carry a risk of a negative attitudinal shift towards interprofessional education. Whether, and in what ways, effective interprofessional exchange during the teaching of basic sciences can be achieved needs further investigation.

Comparison of Team-Based Learning versus Traditional Lectures in Neuroanatomy: Medical Student Knowledge and Satisfaction

Neuroanatomy is often considered a difficult subject to teach, due to its broad scope, multitude of terms, and high degree of complexity. Thus, newer educational strategies that facilitate learning while also stimulating students by allowing increased student autonomy and group discussions should be carefully considered. This study aimed to evaluate the impact of introducing team-based learning (TBL) in the traditional discipline of neuroanatomy and to measure student knowledge acquisition and perception relative to traditional lectures (TL). A quasi-experimental, nonrandomized study was performed using two consecutive TBL classes (intervention group, n = 157 students, 25% content using TBL) with a TL class (control group, n = 76). Team-based learning sessions included all stages according to the classic description of the method. Student knowledge acquisition was assessed in regularly scheduled tests during the discipline, and their perception regarding TBL was evaluated using a questionnaire (developed by the authors). The groups presented a similar sociodemographic profile (sex and age) and the same performance in another anatomy discipline before the study. Team-based learning was significantly associated with greater acceptance, higher motivation, better student perception, and feelings that the methodology was able to integrate clinical and basic sciences. Nevertheless, according to tests, knowledge acquisition was similar between the TBL and lectures. In conclusion, since TBL is comparable to TL for knowledge acquisition, TBL seems to be a promising strategy to improve the teaching of neuroanatomy in medical schools. It fosters group discussions and increases satisfaction and the perception of integration between clinical and basic sciences.

Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol

OBJECTIVES

To develop and evaluate a serious game to deliver knowledge about the cleft lip with or without cleft palate (CL/P) protocol used in Craniofacial Center, Chiang Mai University.

METHODS

The game "Cleft Island" was developed then extensively evaluated using different criteria, including the measured knowledge gained by participants, and gameplay experience. A group of 53 fourth and fifth-year medical students (male: 24, female: 29) were recruited to take part in an experiment. They were from the Faculty of Medicine, Chiang Mai University, and had just rotated to the Department of Surgery. Three evaluations were conducted: 1) to test whether the players had competently gained CL/P knowledge; 2) to evaluate the usability of the game according to the System Usability Scale (SUS); and 3) to evaluate the game experience in terms of a Game Experience Questionnaire (GEQ) test.

RESULTS

The results indicate a statistically significant improvement of medical students' knowledge after performing the Wilcoxon Signed-Ranks test (p < 0.5) between pre-test and post-test scores of the same medical student group; the acceptable average SUS score (M = 55.28) of the serious game; a moderate degree of experience of the GEQ components including positive affect (M = 2.64), competence (M = 2.49), and immersion (M = 2.21).

CONCLUSIONS

Cleft Island can be used as an effective supplementary instructional material, which has the potential to provide significant knowledge of CL/P treatment protocol for the players. As far as the authors are aware, this is the first study to implement and assess a serious game for training in CL/P protocol.

Did Clinical Reasoning and Knowledge Questions During Team-Based Learning Enhance Dental Students' Performance in Esthetic Dentistry?

The aim of this study was to assess whether clinical reasoning and factual knowledge questions used in team-based learning (TBL) enhanced dental students' performance in esthetic dentistry. Ninety-seven third-year dental students enrolled in esthetic dentistry in a dental school in Korea in 2018 were assigned to 16 teams consisting of five or six students each. A four-step TBL sequence (pre-study, readiness assurance test, appeal/feedback, and final test) was designed to examine how clinical reasoning and knowledge questions affected academically high- and low-achieving students. The analysis was conducted with 87 students' data because ten students failed to answer some questions. The results showed that team performance in TBL was consistently better than individual performance. The TBL sessions enhanced students' critical thinking skills, though it did not affect their knowledge acquisition. The clinical reasoning questions especially benefited the academically low-achieving students. Overall, TBL was an effective method for teaching these dental students using small-group learning in esthetic dentistry. Team-based cooperative learning facilitated a deeper understanding of esthetic dentistry because students were motivated to think critically and solve problems rather than simply memorize factual knowledge.

Express Team-Based Learning (eTBL): A Time-Efficient TBL Approach in Neuroradiology

RATIONALE AND OBJECTIVES

Team-based learning (TBL) is a student-centred, teacher-directed instructional method that promotes active learning. The application phase of TBL stimulates group discussion and critical thinking, which could be useful for learning radiology. We designed and evaluated two modified TBL-sessions on computed tomography and magnetic resonance imaging diagnostics in neuroradiology. Our aim was to examine what effects engaging students in in-class team application tasks had on student learning.

MATERIALS AND METHODS

A cross-over study was conducted, including 105 third-year medical students using two modified TBL sessions as the active learning intervention compared with two traditional lectures as a control. Student learning was assessed by results on the neuroradiology part of the end-of-year written examination. Student engagement and perceptions were assessed using the Student Self-Report of Engagement Measure and an additional four Likert-type items.

RESULTS

There were no statistically significant differences in student scores on the examination. Students reported high levels of engagement, and reported being more satisfied overall with the TBL sessions than traditional lectures. Students rated the TBL sessions higher than lectures on ability to make difficult material comprehensible, ability to engage students and to give them feedback.

CONCLUSION

The modified TBL sessions halved in-class teaching time and by omitting the readiness assurance tests, there was more in-class time to focus on problem-solving of real clinical cases. Moreover, shorter sessions may ease implementation of TBL in the curriculum and allow for more frequent sessions. Students were more satisfied with eTBL than lectures, and reported high levels of engagement.

Implementing a Competency-Based Approach to Anatomy Teaching: Beginning With the End in Mind

BACKGROUND

The shift in the medical education system from a time-based to a competency-based model has encouraged its adoption and application in competency-based education in anatomy classrooms, such as team-based learning models and flipped classroom models. This pilot study aimed to build on previous work of the linkages between anatomy-based learning (a flipped classroom model inspired by a modified team-based learning) and student learning and engagement, and further to assess the linkage between anatomy-based learning and academic performance.

METHODS

A sequential mixed-methods design was employed to first gather and analyse quantitative data, including confidential student first semester scores in anatomy: gender, stream, anatomy-based learning, and final anatomy overall mark. The quantitative phase was followed by a qualitative phase in which a series of 8 anatomy laboratories were observed (4 anatomy-based learning and 4 traditional). Thematic analysis was performed on the observation data.

RESULTS

Aggregate anatomy-based learning and traditional stream tests, and final unit scores were compared. The anatomy-based learning and final unit scores showed little difference between students in the anatomy-based learning and students in the traditional stream. Students using anatomy-based learning had an aggregate score of 1.15 and final aggregate mark of 72, whereas students in the traditional section had an aggregate score of 1.19 and final mark of 79. Qualitative phase was undertaken to try to assess the linkages between anatomy-based learning and student learning. Observations showed that students in the anatomy-based learning section spent more time on task as compared with their peers in the traditional stream. The anatomy-based learning students also seemed to practice more self-directed learning and employed more multimodal learning strategies than the traditional section stream.

DISCUSSION/CONCLUSIONS

Although the quantitative results of this study showed no significant difference in mean scores between anatomy-based learning and traditional designs, it was possible to observe the potential of flipped classroom model in engaging students in individual preparation, in team-based learning, and in consensus-based learning approaches.

Application of Modified Team-Based Learning Approach for Enhancing Undergraduate Medical Educational Seminars

BACKGROUND

Team-Based Learning (TBL) is an instructor-led, structured form of cooperative learning that promotes self-directed learning and teamwork while equipping students with the problem-solving and collaborative skills needed to meet the demands of their future professions. This study examines the impact of applying a modified TBL approach to enhance educational seminars in a PBL-adopted curriculum.

METHODS

A total of 300 students participated in the study. Students' Individual Readiness Assurance Test (IRAT) mean scores were compared with mean scores of the same students' Group Readiness Assurance Test (GRAT). Student satisfaction was determined on a scale with 6 options in response to 13 questions to compare different aspects of traditional and TBL educational seminars.

RESULTS

Comparison between IRAT and GRAT scores showed consistently higher GRAT scores. The majority of students expressed their overall satisfaction in favor of the TBL seminar, especially regarding seminar organization, knowledge acquisition, and team work skills.

CONCLUSION

Application of the TBL approach in educational seminars increased second- and third-year medical students' engagement and satisfaction and improved their test performance.

Student Learning of Radiological Anatomy Through Team-Based Learning Modules: Early Successes and Qualitative Analysis

Knowledge of the anatomy of radiological images is an essential foundation from which medical students may begin to build clinical skills. This foundation can be laid within an anatomy course optimizing student opportunity to compare cadaveric structures with medical images, possibly improving a student's visual-spatial abilities. Strong visual-spatial abilities allow students to perform better on examinations in medical anatomy. Team-based learning has enhanced the opportunities for active student learning allowing the acquisition of more skills for medical students in a time-limited curriculum. Other less measurable contributions can also be expected from a pedagogy that encourages students to work in teams.

Training the next generation of Africa's doctors: why medical schools should embrace the team-based learning pedagogy

BACKGROUND

As far back as 1995, the Cape Town Declaration on training Africa's future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the 'hard skills' such as knowledge and clinical acumen while doing little to develop 'soft skills' such as effective communication, teamwork, critical thinking or life-long learning skills. By reviewing literature on Africa's epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent's complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both 'hard' and 'soft' skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa.

CONCLUSION

For its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa's fit-for-purpose doctor.

The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review

BACKGROUND

Peer evaluation can provide valuable feedback to medical students, and increase student confidence and quality of work. The objective of this systematic review was to examine the utilization, effectiveness, and quality of peer feedback during collaborative learning in medical education.

METHODS

The PRISMA statement for reporting in systematic reviews and meta-analysis was used to guide the process of conducting the systematic review. Evaluation of level of evidence (Colthart) and types of outcomes (Kirkpatrick) were used. Two main authors reviewed articles with a third deciding on conflicting results.

RESULTS

The final review included 31 studies. Problem-based learning and team-based learning were the most common collaborative learning settings. Eleven studies reported that students received instruction on how to provide appropriate peer feedback. No studies provided descriptions on whether or not the quality of feedback was evaluated by faculty. Seventeen studies evaluated the effect of peer feedback on professionalism; 12 of those studies evaluated its effectiveness for assessing professionalism and eight evaluated the use of peer feedback for professional behavior development. Ten studies examined the effect of peer feedback on student learning. Six studies examined the role of peer feedback on team dynamics.

CONCLUSIONS

This systematic review indicates that peer feedback in a collaborative learning environment may be a reliable assessment for professionalism and may aid in the development of professional behavior. The review suggests implications for further research on the impact of peer feedback, including the effectiveness of providing instruction on how to provide appropriate peer feedback.

The Efficacy of Frontline Near-Peer Teaching in a Modern Medical Curriculum

Within medical education a reduction in curriculum time for subjects, such as anatomy puts pressure on educators to ensure the same learning outcomes are conveyed in less time. This has the potential to impact negatively on student experience. Near-peer teaching (NPT) is often praised as an effective revision tool, but its use as a frontline teaching resource remains unreported. The study explores the potential for NPT to promote delivery of learning outcomes and maximize student experience within a neuroanatomy module for second year medical students. The study occurred in three educational settings, (1) frontline NPT of cranial nerves, (2) revision session NPT of cranial nerves, and (3) NPT alongside faculty staff in laboratory-based neuroanatomy practical exercises. For the first and second components, knowledge was measured using a pre- and post-session test and student perception was ascertained with a questionnaire. For the third component, student perception was assessed with an end-of-module survey. The results show that overall, NPT was well received by learners. A significant knowledge gain was seen between the pre- and post-session test of the frontline NPT session. The study presents evidence in favor of using NPTs to supplement the delivery of learning outcomes in a time and resource constrained curriculum. In particular, for the effective delivery of frontline material. Anat Sci Educ 0: 1-9. © 2018 American Association of Anatomists.

Using the Jigsaw Method to Teach Abdominal Anatomy

This study evaluates a cooperative learning approach for teaching anatomy to health science students incorporating small group and peer instruction based on the jigsaw method first described in the 1970's. Fifty-three volunteers participated in abdominal anatomy workshops. Students were given time to become an "expert" in one of four segments of the topic (sub-topics) by allocating groups to work-stations with learning resources: axial computerized tomography (CT) of abdominal structures, axial CT of abdominal blood vessels, angiograms and venograms of abdominal blood vessels and structures located within abdominal quadrants. In the second part of workshop, students were redistributed into "jigsaw" learning groups with at least one "expert" at each workstation. The "jigsaw" learning groups then circulated between workstations learning all sub-topics with the "expert" teaching others in their group. To assess abdominal anatomy knowledge, students completed a quiz pre- and post- workshop. Students increased their knowledge with significant improvements in quiz scores irrespective of prior exposure to lectures or practical classes related to the workshop topic. The evidence for long-term retention of knowledge, assessed by comparing end-semester examination performance of workshop participants with workshop nonparticipants, was less convincing. Workshop participants rated the jigsaw workshop highly for both educational value and enjoyment and felt the teaching approach would improve their course performance. The jigsaw method improved anatomy knowledge in the short-term by engaging students in group work and peer-led learning, with minimal supervision required. Reported outcomes suggest that cooperative learning approaches can lead to gains in student performance and motivation to learn. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.

Is learning outcome after team based learning influenced by gender and academic standing?

Team based learning (TBL) is a time tested teaching-learning (T-L) tool involving collaborative learning but has hardly been tested for teaching clinical biochemistry to undergraduate medical students. The present study was designed to (a) compare problem solving skills of first year MBBS students after attending a TBL session on 'organ function test' with that of the students taught the same topic by didactic lecture, (b) assess their perception towards TBL and (c) evaluate if difference in academic standing and gender influence the learning outcome of TBL.One Hundred first professional MBBS students were divided by stratified randomization into two groups. Group I was exposed to TBL to teach 'organ function tests', while group II was taught the same topic by traditional lecture. The outcome of the T-L sessions was assessed by a test for problem solving skills. Student perception towards TBL was assessed from students' response to a questionnaire. No significant difference between the two groups in problem solving skills could be discerned. High achievers performed better after TBL session, while the low achievers were more benefited by traditional lecture method. The female students showed better academic performance after TBL in comparison to male students. The students gave positive feedback for TBL as an instructional technique. We conclude that TBL gives satisfaction, is not inferior to lecture in effectiveness and hence should be used as a T-L method for undergraduate medical students. Moreover, being more effective for female students and high achievers, it is judicious to utilize TBL more frequently for them in an attempt to provide the best individualized teaching. © 2018 International Union of Biochemistry and Molecular Biology, 47(1):58-66, 2018.

Student engagement and higher order skill proficiency: a comparison of traditional didactic and renewed integrated active learning curricula

A large, multicampus, public medical school underwent curricular renewal, emphasizing a student-centered approach with 50% of all course contact time devoted to active learning. Determining the impact of active learning on student engagement and higher order skill (HOS) proficiency was the primary aim of this study. Following Institutional Review Board approval, two cohort groups of first-year medical students were enrolled. The first cohort ( n = 54) included students before curriculum reform in the legacy curriculum (LC). The second cohort ( n = 73) included students completing studies in the renewed curriculum (RC). Near the end of the first year of medical school, both cohorts completed a validated survey of student engagement, and a proctored problem-based assessment of HOS proficiency [Collegiate Learning Assessment (CLA+)]. Results indicated RC students perceived greater levels of engagement than LC (39.5+5.8 vs. 33.3+5.6), and greater reliance on HOS, including analysis, synthesis, and application. However, there were no significant differences between cohorts in proficiency of HOS when assessed by the CLA+ (LC = 1,878 ± 161 vs. RC = 1,900 ± 157). Additionally, poor correlation between engagement and HOS for both LC and RC indicated more engaged students do not necessarily possess greater HOS proficiency. Ceiling effect may explain results as medical students enter medical school as highly skilled learners with potentially little room for improvement. It will be informative to continue to track engagement and HOS of both cohort groups as they continue their medical studies.

Team-Based Learning Activities for First-Year Medical Students: Perception of the Learners

OBJECTIVES

Team-based learning (TBL) is an active learning strategy that is used increasingly in medical education to promote critical thinking, knowledge application, teamwork, and collaboration. The aim of this study was to assess the students' perspective on the utility of TBL compared with traditional lectures.

METHODS

We used a validated TBL student assessment instrument comprising three subscales studying accountability, preference for lecture or TBL, and student satisfaction. First-year medical students enrolled at the University of Florida College of Medicine in spring semester 2016 were asked to complete the questionnaire.

RESULTS

The response rate was 50% (70/138). Although 81% of students reported that they had to prepare before TBL and believed they had to contribute to the learning of their team, only 52% believed that they were accountable for team learning. The majority believed that TBL activities are an effective approach to learning (74%), with 78% agreeing that TBL activities helped them recall information. Fewer than half (45%), however, believed that TBL helped improve their grades.

CONCLUSIONS

Students reported a preference and satisfaction with TBL over traditional lectures, but a mixed response was noted on the questions pertaining to accountability for team learning.

Influence of study approaches and course design on academic success in the undergraduate anatomy laboratory

Many pre-health professional programs require completion of an undergraduate anatomy course with a laboratory component, yet grades in these courses are often low. Many students perceive anatomy as a more challenging subject than other coursework, and the resulting anxiety surrounding this perception may be a significant contributor to poor performance. Well-planned and deliberate guidance from instructors, as well as thoughtful course design, may be necessary to assist students in finding the best approach to studying for anatomy. This article assesses which study habits are associated with course success and whether course design influences study habits. Surveys (n = 1,274) were administered to students enrolled in three undergraduate human anatomy laboratory courses with varying levels of cooperative learning and structured guidance. The surveys collected information on potential predictors of performance, including student demographics, educational background, self-assessment ability, and study methods (e.g., flashcards, textbooks, diagrams). Compared to low performers, high performers perceive studying in laboratory, asking the instructor questions, quizzing alone, and quizzing others as more effective for learning. Additionally, students co-enrolled in a flipped, active lecture anatomy course achieve higher grades and find active learning activities (e.g., quizzing alone and in groups) more helpful for their learning in the laboratory. These results strengthen previous research suggesting that student performance is more greatly enhanced by an active classroom environment that practices successful study strategies rather than one that simply encourages students to employ such strategies inside and outside the classroom. Anat Sci Educ 11: 496-509. © 2018 American Association of Anatomists.

Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in-class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom-made, three-dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students' preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in-class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011-2013; n = 242) and three years after (2014-2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi-cumulative laboratory examination, scores were significantly higher in the post-flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection-based course. Anat Sci Educ 11: 385-396. © 2017 American Association of Anatomists.

Team-based learning in an undergraduate pathology curriculum and its effects on student performance

Objectives

Team-based learning (TBL) is a student-centered learning modality in which high and low achievers are organized in groups where students learn from each other at their own pace. The purpose of this study was to explore the correlations between TBL scores and final examination scores and student perceptions of a TBL system.

Methods

A cross-sectional survey was conducted on a sample obtained using quota sampling of a population of second-year students enrolled in the College of Medicine, University of Sharjah, Sharjah, United Arab Emirates. A self-administered questionnaire was employed to collect data on the students’ perceptions and opinions, TBL scores, and final examination scores. The data were processed and analyzed using SPSS Version 22.

Results

A sample of 101 students participated in the study. The Team Readiness Assurance Test scores were consistently higher than the mean Individual Readiness Assurance Test (IRAT) scores. The results found a statistically significant correlation between the IRAT and the final examination scores (r = 0.46, p < 0.001). About 57% of the sample agreed that TBL increased the understanding of course content, 45% reported that TBL was a useful learning activity, and 67% indicated that TBL enhanced interpersonal and communication skills.

Conclusion

The findings imply that TBL is an effective tool to facilitate inter-professional and team-based learning outcomes. Collaborations among TBL group members help learners to develop communication and interpersonal skills and to gain knowledge.

Benefits of extracurricular participation in dissection in a prosection-based medical anatomy program

The purpose of this study was to evaluate the extracurricular cadaveric dissection program available to medical students at an institution with a modern (time-compressed, student-centered, and prosection-based) approach to medical anatomy education. Quantitative (Likert-style questions) and qualitative data (thematic analysis of open-ended commentary) were collated from a survey of three medical student cohorts who had completed preclerkship. Perceived benefits of dissection included the hands-on learning style and the development of anatomy expertise, while the main barrier that limited participation was the time-intensive nature of dissection. Despite perceived benefits, students preferred that dissection remain optional. Analysis of assessments for the MD2016 cohort revealed that dissection participation was associated with enhanced performance on anatomy items in each systems-based unit examination, with the largest benefits observed on discriminating items that assessed knowledge application. In conclusion, this study revealed that there are academic and perceived benefits of extracurricular participation in dissection. While millennial medical students recognized these benefits, these students also indicated strong preference for having flexibility and choice in their anatomy education, including the choice to participate in cadaveric dissection. Anat Sci Educ 11: 294-302. © 2017 American Association of Anatomists.

How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement

The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (β = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.

A Case of Pancreatic Cancer: Abdominal Anatomy Team-Based Learning Module for Medical Students

Introduction

Team-based learning (TBL) is an instructional method utilized by the University of Alabama School of Medicine to facilitate collaboration and integration of concepts introduced in undergraduate medical training. This TBL was created for the Gastrointestinal module and facilitates understanding of anatomy of the retroperitoneal space, posterior abdominal wall, and neurovasculature of the abdomen. This module integrates topics from abdominal anatomy, radiology, and clinical decision-making for medical students.

Methods

Prior to the TBL, students were provided with a set of learning objectives and three instructional video podcasts. During the in-class portion of the activity, learners completed the readiness assurance phase, which consisted of individual and team assessments. During the application phase, teams of five to six students collaborated on multiple-choice questions centered on the presentation, diagnosis, surgical intervention, and palliation of a patient with pancreatic cancer. TBL sessions were cofacilitated by an anatomist and a physician.

Results

Since the TBL's institution in 2014, medical students have consistently performed better on the readiness assurance test in teams rather than individually. On a 5-point Likert scale, over 90% of students in the 2016 (M = 4.12) and 2017 (M = 4.20) Gastrointestinal modules agreed or strongly agreed on an end-of-course evaluation that the TBL activity was effectual for learning.

Discussion

In a medical climate that continues to rely heavily on cross-sectional imaging, early integration of gross anatomy and cross-sectional anatomy is essential and can facilitate acclimation to the clinical years. This TBL would be a valuable addition to other undergraduate medical programs.

Simulating the multi-disciplinary care team approach: Enhancing student understanding of anatomy through an ultrasound-anchored interprofessional session

Quality of healthcare delivery is dependent on collaboration between professional disciplines. Integrating opportunities for interprofessional learning in health science education programs prepares future clinicians to function as effective members of a multi-disciplinary care team. This study aimed to create a modified team-based learning (TBL) environment utilizing ultrasound technology during an interprofessional learning activity to enhance musculoskeletal anatomy knowledge of first year medical (MD) and physical therapy (PT) students. An ultrasound demonstration of structures of the upper limb was incorporated into the gross anatomy courses for first-year MD (n = 53) and PT (n = 28) students. Immediately before the learning experience, all students took an individual readiness assurance test (iRAT) based on clinical concepts regarding the assigned study material. Students observed while a physical medicine and rehabilitation physician demonstrated the use of ultrasound as a diagnostic and procedural tool for the shoulder and elbow. Following the demonstration, students worked within interprofessional teams (n = 14 teams, 5-6 students per team) to review the related anatomy on dissected specimens. At the end of the session, students worked within interprofessional teams to complete a collaborative clinical case-based multiple choice post-test. Team scores were compared to the mean individual score within each team with the Wilcoxon signed-rank test. Students scored higher on the collaborative post-test (95.2 ±10.2%) than on the iRAT (66.1 ± 13.9% for MD students and 76.2 ±14.2% for PT students, P < 0.0001). Results suggest that this interprofessional team activity facilitated an improved understanding and clinical application of anatomy. Anat Sci Educ 11: 94-99. © 2017 American Association of Anatomists.