A systematic review of the published literature on team-based learning in health professions education

Student feedback on team-based learning in a preclinical oral surgery course: A pilot study

Objectives

Team-based learning (TBL) is a student-centered method where learning can be promoted and facilitated by changing the traditional teaching lecture into an active, dynamic, and more engaging problem-solving process. The present study evaluated the student's learning experience and satisfaction using a TBL method in a preclinical oral surgery course.

Methods

Twelve TBL sessions were designed for second-year dental students. Six 3-h and 2-h sessions with various preclinical topics were conducted in academic Terms 1 and 2, respectively. Teaching activities such as tests and group discussions were included in the sessions. The last post-session questionnaire sought students' feedback and satisfaction to assess four parameters related to students' knowledge acquirement, interpersonal skills enhancement, learning environment, and teacher-student relationships.

Results

Most average scores of the responses agreed with the related statements in the four parameters. The results of the Pearson's correlation test revealed that there was a significant relationship (r = 0.735; P < 0.05) between the parameters of the 3-h and 2-h sessions.

Conclusion

The TBL method yielded positive and high levels of satisfaction, which may be attributed to the proper implementation of TBL methodology by the teacher and students.

Using Simulation-Based Mastery Learning to Achieve Excellent Learning Outcomes in Physical Therapist Education

INTRODUCTION

The 2 aims of this observational study are (a) to describe the implementation and feasibility of a bed mobility skills simulation-based mastery learning (SBML) curricular module for physical therapist students and (b) to measure learning outcomes and student perceptions of this module.

REVIEW OF LITERATURE

Simulation-based mastery learning is an outcome-based educational approach that has been successful in other health professions but has not been explored in physical therapy education.

SUBJECTS

Eighty-seven students in a single cohort of a Doctor of Physical Therapy program.

METHODS

The SBML module in this pretest-posttest study included a pretest, instruction, initial posttest, and additional rounds of instruction and assessment as needed for all learners to achieve the minimum passing standard (MPS) set using the Mastery Angoff and Patient Safety methods. Outcome measures were bed mobility assessment pass rates and scores, additional student and faculty time compared with a traditional approach, and student perceptions of their self-confidence and the module.

RESULTS

All students achieved the MPS after 3 rounds of training and assessment beyond the initial posttest. Mean Total Scores improved from 67.6% (12.9%) at pretest to 91.4% (4.8%) at mastery posttest (P < .001, Cohen's d = 1.8, 95% CI [1.4-2.1]); mean Safety Scores improved from 75.2% (16.0%) at pretest to 100.0% (0.0%) at mastery posttest (P < .001, Cohen's d = 1.5, 95% CI [1.2-1.9]). Students who did not achieve the MPS at the initial posttest (n = 30) required a mean of 1.2 hours for additional instruction and assessment. Survey results revealed an increase in student confidence (P < .001) and positive student perceptions of the module.

DISCUSSION AND CONCLUSION

Implementation of this SBML module was feasible and resulted in uniformly high levels of bed mobility skill acquisition. Based on rigorous learning outcomes, feasible requirements for implementation, and increased student confidence, SBML offers a promising approach for wider implementation in physical therapy education.

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.

Opening the black box of team-based learning (TBL): A study of verbal interactions in online application sessions

CONTEXT

In team-based learning (TBL), an instructional strategy that encourages in-depth team discussion and deep learning, interactions in terms of sharing, co-construction, constructive conflict and procedural interactions are important. Since TBL has also been applied online in recent years, the question is whether these interactions are sufficiently present in an online setting.

AIM

Gain insight into the nature and extent of these types of interactions in online TBL application sessions and to what extent these vary between teams and sessions.

METHODS

We made audiovisual recordings of 12 TBL teams in two online application sessions during assignments. Transcripts were coded and analyzed using a framework derived.

RESULTS

Teams spent more than 85% of their time on all four types of interactions in both sessions. The largest proportion of time was spent on sharing and co-construction. Constructive conflict occurred to a limited extent. We observed variation in proportion of time spent on and the distribution of the four types of interactions between teams and sessions.

DISCUSSION

All interactions important for achieving deep learning occurred in online TBL application sessions. However, the effective use of these types of interaction should not be left to chance.

Systematic review of feedback literacy instruments for health professions students

Successfully managing and utilizing feedback is a critical skill for self-improvement. Properly identifying feedback literacy level is crucial to facilitate teachers and learners especially in clinical learning to plan for better learning experience. The present review aimed to gather and examine the existing definitions and metrics used to assess feedback literacy (or parts of its concepts) for health professions education. A systematic search was conducted on six databases, together with a manual search in January 2023. Quality of the included studies were appraised using the COSMIN Checklist. Information on the psychometric properties and clinical utility of the accepted instruments were extracted. A total 2226 records of studies were identified, and 11 articles included in the final analysis extracting 13 instruments. These instruments can be administered easily, and most are readily accessible. However, 'appreciating feedback' was overrepresented compared to the other three features of feedback literacy and none of the instruments had sufficient quality across all COSMIN validity rating sections. Further research studies should focus on developing and refining feedback literacy instruments that can be adapted to many contexts within health professions education. Future research should apply a rigorous methodology to produce a valid and reliable student feedback literacy instrument.

Foundational and Clinical Science Integration in a Team-Based Learning Module Modeling Care of a Patient With Dyslipidemia

Introduction

Foundational and clinical science integration, a long-standing goal of undergraduate medical education, benefits learners by promoting retention of critical knowledge and skills as well as their transfer to the clinical setting. We implemented a team-based learning (TBL) module in which foundational knowledge and skills from the disciplines of biochemistry, nutrition, and genetics were leveraged in a simulated patient encounter for diagnosis and management of a patient with dyslipidemia.

Methods

The TBL was deployed in a first-year medical student cardiovascular system course with 125 students over three academic years. Following individual and team readiness assurance tests (iRAT and tRAT, respectively), teams participated in an initial application exercise requiring consideration of clinical and laboratory data and other risk factors to engage the patient in a shared decision-making process. Using dietary and family history narratives in subsequent application exercises, teams completed recommendations for an individualized diet plan and an assessment of potential disease inheritance patterns to formulate appropriate patient care management strategies.

Results

Student engagement with prelearning materials and session team activities was high as judged by RAT performance and application exercise outcomes: iRAT question performance ranged from 89% to 99% for individual items, and tRAT performance was routinely 100%. Learners reported that the exercises were impactful and believed the learned foundational knowledge and skills were transferable to future patient care.

Discussion

The dyslipidemia TBL module provides an illustration for early clinical learners of how foundational knowledge and skills can be operationalized and transferred for optimal patient care.

Team-based learning versus traditional teaching effect on pharmacy Students' Performance: A systematic review and Meta-Analysis

Background

Several pharmacy schools have implemented team-based learning (TBL) in their curriculum worldwide. Yet, TBL's effectiveness compared to traditional teaching in improving students' outcomes in pharmacy education is yet to be assessed collectively. Thus, the aim of this meta-analysis is to compare the performance of pharmacy students following the implementation of team-based learning (TBL) in the pharmacy curriculum as opposed to traditional learning methods.

Methods

This systematic review and meta-analysis included studies that assessed students' performance after TBL was implemented in a pharmacy curriculum. Adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, the review conducted searches in Embase, MEDLINE, and Google Scholar until July 26, 2023.

Results

A total of 11 studies comparing TBL against traditional teaching methods and assessing students' performance were included. The pooled analysis, involving 2,400 students from 10 studies, demonstrated a mean difference (MD) in favor of TBL (MD = 2.27, 95 % CI [-0.85, 5.40]). However, notable heterogeneity was observed with an I2 value of 82 %, and the observed difference did not reach statistical significance.

Conclusion

TBL exhibited enhanced student performance in pharmacy education compared to traditional teaching, although the difference was not statistically significant. The meta-analysis findings support the use of TBL in pharmacy education for various pharmacy courses (pharmaceutical and clinical sciences courses) and students at different levels. However, there is a need for more robust studies to comprehensively evaluate TBL, considering aspects such as students' performance and engagement, skills development, and satisfaction.

Beyond Collaborative Learning: a Comparison of Small Groups in Face-to-Face and Online Settings

Small group-based instructional approaches such as case-based learning (CBL) and team-based learning (TBL) are widely used in medical education to promote collaboration and team learning. During the pandemic, many medical schools shifted from face-to-face instruction to online settings. While CBL/TBL are intended to foster collaborative skills, it is unclear how its use evolves in an online setting and whether the online setting impacts students' perceptions and behaviors in collaboration. This study examined how the change from in-person to online CBL/TBL impacted students' collaboration. We used a mixed-methods sequential design, first collecting and analyzing retrospective cohort quantitative data with the Class of 2023 through peer evaluation surveys followed by six focus groups. Students' assessment of their peers was generally positive. Nonparametric testing showed significant differences for two questions with less positive perceptions in the virtual setting compared to when students had in-person CBL/TBL. The focus group results identified several themes related to collaboration and learning communities. In the virtual setting, students not only lost collaboration opportunities with their group members in CBL/TBL, but also learning opportunities and social connections with other groups and the community as a whole. Virtual learning environments may have presented challenges for collaborative learning and the establishment of a sense of community.

Implementing mind mapping in small-group learning to promote student engagement in the medical diagnostic curriculum: a pilot study

BACKGROUND

Medical diagnostics is a pivotal bridge curriculum that receives much less attention from undergraduates in non-clinical medicine health profession programs with less student engagement and poor performance. Mind mapping is an active learning strategy for graphically presenting radiant thinking to culture clinical reasoning. The purpose of this study was to explore whether students' comprehensive diagnostic skills are enhanced through increased student engagement by employing mind mapping.

METHODS

We implemented mind mapping in small-grouped workshops with 86 junior undergraduates from preventive medicine program, for physical diagnostic sessions including physical examination (PE) maneuver, electrocardiogram (ECG) interpretation and medical history collection. We also conducted assessments of the above skills, as well as online surveys regarding their expectation on this course, self-evaluation of mind mapping in teaching and the learning process of all the modules.

RESULTS

Group members employing mind mapping in all PE sessions obtained higher scores in the heart and lung systems during the PE maneuver exam. Similarly, groups that made more in-depth mind maps achieved higher scores on the ECG quiz. In addition, groups displaying mind maps for history taking from normal classes and reformed class exhibited greater completeness of medical history with both standardized patients and real patients, which was consistent with increased collection of accompanying symptoms. Mind mapping was valued by the majority of students for its benefits in terms of acquiring PE maneuver, theoretical knowledge, medical history collection and medical records writing, clinical reasoning, communication skills, sense of teamwork and cooperation, professionalism and humanistic literacy.

DISCUSSION

The visual feature of mind mapping evoked extensive behavioral engagement in all groups, as did cognitive and emotional engagement, as the majority of students expressed their willingness and affective reactions. In the short term, the positive feedbacks encourage growing engagement. The continuous benefits of mind mapping require long-term observation.

Ready or Not: A Crossover Study of (Un)graded Individual Readiness Assurance Tests in Team-Based Learning

OBJECTIVE

This study aimed to measure the effects of graded vs ungraded individual readiness assurance tests (iRATs) on the students' test scores and achievement goals in a team-based learning classroom.

METHODS

A 2 × 2 crossover study was conducted in a required second-year pharmacotherapy course. Teams 1 to 8 were assigned to a UG iRAT during the first half of the course, followed by a G iRAT the second half of the course (G/UG group). Teams 9 to 16 were assigned to the opposite grading sequence (ie, UG/G). A multivariate analysis of variance was used to analyze the differences in test scores, as measured using iRAT and examination scores. A separate multivariate analysis of variance was used to examine the differences in achievement goals.

RESULTS

There was a significant difference in test scores based on the iRAT grading condition. Individual readiness assurance tests were higher in the G condition (72.51% vs 67.99%); however, the examination scores were similar in the G and UG conditions (81.07% vs 80.32%). There was no statistically significant difference in the achievement goals based on the iRAT grading condition.

CONCLUSION

In a required second-year pharmacotherapy course that uses team-based learning, student performance on the iRAT was modestly lower in the UG iRAT condition; however, the students' examination scores were unchanged. Achievement goals were unchanged based on the iRAT grading condition.

A comparative study on the effectiveness of online and in-class team-based learning on student performance and perceptions in virtual simulation experiments

BACKGROUND

The swift transition to online teaching in medical education has presented the challenge of replicating in-class engagement and interaction essential for active learning. Despite online team-based learning (TBL) offering potential solutions through structured cooperative activities, its efficacy in virtual simulation experiment courses remains scantily researched. This study investigates the effectiveness of online TBL for teaching virtual patient experiments in a basic medical laboratory course and contrasts it with traditional offline teaching in terms of student performance and perceptions.

METHODS

A comparative analysis involved 179 Year 3 medical students using online TBL, face-to-face TBL (FTF-TBL), and the flipped classroom (FC) approach. The learning outcomes were assessed based on experiment reports, IRAT scores, TRAT scores, and final exam performance. Students' perceptions of both online and in-class TBL methodologies were also surveyed.

RESULTS

Both online and in-class TBL groups demonstrated comparable academic outcomes and surpassed the FC group in academic performance. Students displayed a marked preference for the TBL format (whether online or in-class), valuing its enhancement of learning interest and practical knowledge application. Nevertheless, refinements in discussion efficiency, platform convenience, and student-instructor interaction were indicated as potential areas of improvement in the online setting.

CONCLUSIONS

Online TBL, along with its in-class counterpart, showed superior academic performance and a more positive learning experience compared to the FC group. These findings underscore the potential of online TBL in adapting to modern pedagogical challenges and enriching medical education through virtual simulation experiments.

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.

Is team-based learning an alternative approach for UK undergraduate dental education? A scoping review of the literature

Introduction Team-based learning (TBL) is a dialectic, student-focused method of teaching which has become increasingly popular in international institutions for delivering undergraduate dental education. Despite several dental schools in the UK using dialectic teaching methods, such as problem-based learning, none appear to use TBL.Aims This scoping review aims to identify the literature investigating the use of TBL compared with other teaching pedagogies in delivering undergraduate dental education.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were adopted. A search strategy was developed using appropriate MeSH (medical subject headings) terms and key words. Medline, Scopus and the Cochrane Databases were searched.Results Overall, five studies were identified for inclusion. Of these, three studies compared TBL to traditional, didactic teaching methods (such as lectures) and found both student satisfaction and student performance to be greater with TBL. The remaining two studies compared TBL to other dialectic methods of teaching. The results on student performance in these studies were conflicting.Conclusions There is some limited but promising evidence that TBL is effective at delivering undergraduate dental education; however, the scarcity of research evidence highlights the need for more robust exploration.

Online Physiology Practice with Team-Based Learning During the COVID-19 Pandemic

Background

The spread of the coronavirus disease (COVID-19) has significantly affected medical education. In particular, conducting practical training in a face-to-face format has become difficult.

Purpose

To address this problem, online physiology practice combined with team-based learning (TBL) for deep learning of renal physiology was conducted among second-year medical students.

Participants and Methods

The experiment was performed by a group of students, while other students watched online. After the experiment, all students were grouped using breakout rooms. Following a discussion of the data, a clinical case study related to the experiment was conducted using TBL. To examine the effect of online practice in a case study under TBL, the participants completed an anonymous, open-ended, web-based questionnaire after the program, enabling us to compare their expectations and satisfaction. The questionnaire consisted of questions examining students' opinions on the appropriateness of online practice, degree of understanding, ease of asking questions, time efficiency, and the usefulness of case studies using TBL.

Results

There was no change in the number of students who participated in the online practice before and after class. After class, more students considered the level of understanding easier and displayed better on-time efficiency than with regular face-to-face training. However, these questions are difficult to answer.

Conclusion

Online-based physiology practice combined with clinical case studies under TBL helped maintain students' expectations and satisfaction with the training.

Planning and implementation of participant-centric group activity on research methodology: perceptions of postgraduate medical students in physiology

Knowledge about the key steps in "research methodology" is necessary for all postgraduate students who are enrolled in the medical profession. The objective of the present study was to plan, design, and implement a participant-centric postgraduate skill development activity to inculcate the key principles and components of research methodology. It included 3 goal-oriented component group exercises, namely, 1) framing a research question, 2) critiquing a research article, and 3) writing a research protocol. Out of 25 eligible postgraduate students of our department, 20 participated in all three component group exercises, and they were included in the study. Feedback was obtained from them on a five-point Likert scale after the group exercises. In addition, students were also asked to provide open-ended comments for further improvement of the session. Data from participants' feedback suggested that the majority of the participants expressed satisfaction regarding the plan, conduct, and learning experience of the postgraduate activity. Therefore, participant-centric group activity could be an innovative approach in postgraduate medical education to inculcate the basics of research methodology. It can provide additional emphasis on the components of self-directed learning through individual exercises and unsupervised group dynamics. Supervised group dynamics can inculcate skills in critical thinking, acceptance, communication skills, and teamwork.NEW & NOTEWORTHY Postgraduate medical education is underpinned by supervised and unsupervised learning processes. The current study incorporates an innovative approach to inculcate the basic skills of "research methodology" through three goal-oriented participant-centric group exercises, namely, 1) framing a research question, 2) critiquing a research article, and 3) writing a research protocol. The activities encompass components of self-directed learning through unsupervised group dynamics. They focus on critical thinking, acceptance, communication skills, and teamwork during supervised group dynamics.

Effectiveness of the refined health literacy course on improving the health literacy competencies of undergraduate nursing students: quantitative and qualitative perspectives

People with limited health literacy comprise a high-risk group for adverse health outcomes. Nurses must be made aware of the importance of health literacy and communicate with patients in plain language, which will solve the obstacles for patients using health care services. Providing health literacy education for nurses is an important strategy for health literacy practices. This study aimed to develop a refined health literacy course for nursing students and evaluate its effectiveness. The study used a single-group pre- and post-test quasi-experimental design and conducted focus group interviews. The intervention was an eight-hour course and applied team-based learning combined with various teaching methods. The study enrolled second-year nursing students of a university in eastern Taiwan via convenient sampling. A self-reported structured questionnaire was used to compare the participants' familiarity with health literacy, attitude, confidence in oral communication, and ability in written communication before and after the course. To discuss the learning experience of the course, the study held two focus groups with 12 participants. A total of 81 participants completed the pre- and post-test questionnaires. The results showed that familiarity with health literacy (t=9.12, t<.001), attitude (t=4.89, t<.001), confidence in oral communication (t=4.12, t<.001), and ability in written communication (t=8.83, t<.001) showed improvement after the course. Data analysis of focus group interviews yielded two categories and seven themes for the learning experience, most of which showed participants' positive learning experiences in the health literacy course. The course effectively enhanced the nursing students' knowledge and attitude toward health literacy and the ability to communicate with patients using health literacy principles. The results can provide a reference for integrating health literacy education into the undergraduate nursing curriculum.

Active learning in undergraduate classroom dental education- a scoping review

INTRODUCTION

Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dental education.

METHODS

The review was guided by Arksey & O'Malley's multi-step framework and followed the PRISMA Extension Scoping Reviews guidelines. MEDLINE, ERIC, EMBASE, and Scopus databases were searched from January 2005 to October 2022. Peer-reviewed, primary research articles published in English were selected. Reference lists of relevant studies were verified to improve the search. Two trained researchers independently screened titles, abstracts, and full-texts articles for eligibility and extracted the relevant data.

RESULTS

In total, 93 studies were included in the review. All studies performed outcome evaluations, including reaction evaluation alone (n = 32; 34.4%), learning evaluation alone (n = 19; 20.4%), and reaction and learning evaluations combined (n = 42; 45.1%). Most studies used quantitative approaches (n = 85; 91.3%), performed post-intervention evaluations (n = 70; 75.3%), and measured student satisfaction (n = 73; 78.5%) and knowledge acquisition (n = 61; 65.6%) using direct and indirect (self-report) measures. Only 4 studies (4.3%) reported faculty data in addition to student data. Flipped learning, group discussion, problem-based learning, and team-based learning were the active learning strategies most frequently evaluated (≥6 studies). Overall, most studies found that active learning improved satisfaction and knowledge acquisition and was superior to traditional lectures based on direct and indirect outcome measures.

CONCLUSION

Active learning has the potential to enhance student learning in undergraduate classroom dental education; however, robust process and outcome evaluation designs are needed to demonstrate its effectiveness in this educational context. Further research is warranted to evaluate the impact of active learning strategies on skill development and behavioral change in order to support the competency-based approach in dental education.

Technology-Enhanced Learning in Medical Education Collection: Latest Developments

Technology-enhanced learning (TEL) refers to learning activities and environments that are potentially improved or enhanced with information and communication technologies (Shen and Ho, 2020; Wasson and Kirschner, 2020). TEL may be implemented in face-to-face, distance/remote and blended or hybrid modes; in various environments such as online, classrooms, workplaces, communities, and other built and natural environments; include a range of learning designs and pedagogies/andragogies; involve synchronous and asynchronous interactions amongst students, teachers, workplace staff and clients, and/or community members; and delivered with the support of various technologies (Wasson and Kirschner, 2020). To date, the Technology-Enhanced Learning in Medical Education collection, part of MedEdPublish, has received submissions relating to several technologies to support learning, including web conferencing, web 2.0, e-textbooks, e-portfolios, software, generative artificial intelligence, simulation mannequins and wearables for point-of-view video, often in combination. Learning designs included flipped classroom with interactive case discussions (Imran et al., 2022), e-portfolios (Javed et al., 2023), didactic teaching followed by demonstrations of clinical skills on a simulation mannequin (Zwaiman et al., 2023), interdisciplinary case discussions to promote interprofessional learning (Major et al., 2023), patient panels to share narratives and perspectives (Papanagnou et al., 2023), and team-based learning (Lee & Wong, 2023). In the four papers that included evaluation, participant reaction (feedback on learning activities) and/or learning (self-reported through surveys, with pre- vs post-training comparisons or at different timepoints during learning) were reported, corresponding to levels 1 and 2 of the commonly used outcomes-focused Kirkpatrick model of evaluation (Allen et al., 2022). Two papers focused on the work of health professions educators, including conducting the nominal group technique, a qualitative research method, via web conferencing (Khurshid et al., 2023); and using ChatGPT to assist with various medical education tasks (Peacock et al., 2023).

The Perceptions and Experiences of Undergraduate Healthcare Students With Debriefing Methods: A Systematized Review

SUMMARY STATEMENT

We performed a systematized review examining the existing literature on undergraduate healthcare students' perceptions and experiences with debriefing methods in simulation-based education. Twenty empirical research articles published in English between 2008 and 2020 were identified during a systematic search of 4 electronic databases. Data derived from these articles underwent critical appraisal and thematic analysis.Students valued the opportunity in debriefing for reflection, raising self-awareness of skills and learning. They preferred structured debriefing for promoting analytic skills and transfer of learning, favored video-assisted debriefing for fast recall and improving communication skills, and benefited most from instructor-led rather than peer-led debriefing. However, students appreciated group debriefing for aiding the construction of new understandings. There was no consensus on the preferred timing of debriefing, and students highlighted their concern about the disclosure of errors across different debriefing methods. Recommendations for educators to improve debriefing experiences and for future research are considered.

Learning needs of nursing postgraduates in Southwest China based on Hutchinson's learning needs theory: a qualitative research

BACKGROUND

The process of education is mutual. The learning needs of students need to be paid attention to and can affect the learning outcome. In order to make nursing postgraduates' curriculum better, meet the learning needs of students, and help to achieve the learning objectives of students, this study based on Hutchinson's learning needs theory, aims to collect the learning experience of nursing graduates, as well as the gap between learning needs and target needs, and explore the benefits and barriers of nursing graduates in the curriculum learning. It may provide beneficial reference for further optimizing teaching content and improving teaching methods.

METHODS

This study was designed as a qualitative research. Purposive sampling was used to recruit 17 nursing postgraduates in the only two universities in Chongqing, Southwest China, 2021. Semi-structured, in-depth individual interviews were conducted to explore how they subjectively experience the benefits and demands of the professional curriculum. Data was analyzed using Colaizzi's seven-step analysis.

RESULTS

Three main themes "clear learning cognition and goals," "positive learning attitude," and "the gap between learning goals and actual needs" were identified from the original data. Respectively, Subthemes concerning the first theme included "improve scientific research capabilities, enlighten thinking and broaden your horizons, and learn new knowledge and new skills." Subthemes of the second theme were "improve abilities in practice and actively seek diversification of course content and format." Subthemes of the third theme included "the course has a certain depth and breadth, but the course study does not meet the needs of scientific research, the course contents are theoretical, not knowing how to use the research method in certain conditions."

CONCLUSIONS

The learning needs of nursing postgraduates in Southwest China could be divided into two parts: benefits and barriers, among which the benefits were participants had clear learning goals and positive learning attitudes. When curriculum could not meet their needs, they actively sought methods (e.g., networks or off-campus resources) to close the gap between those needs and their goals. Follow-up educators should focus on learning needs and build curricula by optimizing the contents and methods of existing teaching resources.

Team-based learning vs. lecture-based learning in nursing: A systematic review of randomized controlled trials

Introduction

Our study aims to identify, appraise, and summarize randomized controlled trials (RCT) on the effectiveness of team-based learning (TBL) versus lecture-based learning (LBL) in nursing students.

Methods

We searched PubMed, Ovid, Embase, Cochrane, CBM, VIP, CNKI, and Wan Fang databases from inception to 22nd July 2022 to enroll RCTs that compared TBL versus LBL. The studies reporting the performance of nursing students receiving TBL pedagogy compared to those receiving traditional lecture-based learning (LBL) were to be analyzed. Scores of academic or nursing abilities were considered the primary outcome, and the results of nursing competencies, students' engagement with, behaviors, attitudes toward, experience, satisfaction, or perceptions of TBL were considered the secondary outcome. This systematic review was conducted following the guidelines of the Cochrane Reviewer's Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results

A total of 1,009 participants in 10 RCTs were enrolled in this study. Of the 10 RCTs, eight studies investigated undergraduate students, one involved vocational college students, and one enrolled secondary school students. The most reported outcomes were class engagement survey toward TBL (n = 8); students' ability (n = 5), academic knowledge or performance (n = 4); students' experience (n = 4), satisfaction or perceptions of TBL (n = 4).

Conclusion

This review suggested that the TBL was an effective pedagogy in improving academic performance and general ability in nursing students. High-quality trials are needed, and standardized outcomes should be used.

Preparing for Next Generation NCLEX ® Through Team-Based Learning: Student Perspectives

ABSTRACT

The Next Generation NCLEX ® requires higher levels of understanding for new registered nurses to practice safely. Team-based learning (TBL) offers a rigorous but pragmatic approach to achieve that aim. TBL employs collaborative strategies for structured problem-solving, a key focus of contemporary nurse educators. In this prospective study, a faculty team at a second-degree, accelerated baccalaureate nursing program within the southeast United States evaluated student perspectives of TBL. Overall findings revealed positive student experiences ( n = 30, with three students on an alternate plan of study) in all aspects of the method.

Teaching perspectives on the communication of difficult news of genetic conditions to medical students

Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.

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.

Re-orienting healthcare for healthy living communities: A qualitative exploration of nursing students utilising the salutogenic theory for community health practice

BACKGROUND

Salutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community.

OBJECTIVE

This study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application.

DESIGN

A qualitative study using framework analysis.

SETTING

A tertiary institution in Singapore.

PARTICIPANTS

Nursing students who were taught the salutogenic theory for 'Healthy Community Living' module.

METHODS

Data were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework.

RESULTS

Four themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited.

CONCLUSION

Much work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community.

Active learning: a consideration in collection development in health sciences libraries?

Purpose

Active learning is an important component of medical education and information literacy instruction. The purpose of this study is to provide a preliminary investigation to determine whether health sciences librarians consider active learning when making decisions about the library collection.

Design/methodology/approach

An online survey was conducted among health sciences librarians.

Findings

Nineteen librarians completed the survey and most are not considering active learning when making collection decisions.

Originality/value

Very little literature has been published about active learning as a consideration in collection development decisions by health sciences librarians.

Inserting an Erroneous Element in the Answer Key of Grouped Team Readiness Assurance Test in Team-Based Learning: A Randomized Controlled Trial in Clinical Toxicology

PURPOSE

Team-based learning (TBL) is an interactive instructional strategy designed to enhance student engagement. Few studies reported that TBL needs to be more interactive, concerns were raised regarding the insufficient instructor feedback, and students feel that TBL gets less attractive with time. One method of boosting students' interaction and performance is adding an element of challenge or positive stress. Therefore, we hypothesized that inserting an erroneous answer in the answer key would generate an observable improvement in the selected outcomes in terms of better satisfaction, interaction, interest in learning, better academic performance, and better development of competencies compared to traditional TBL.

METHODS

This randomized controlled trial aimed to determine if inserting an erroneous element in the answer key of a grouped team readiness assurance test (GRAT) would update TBL and whether this intervention would enhance students' performance and satisfaction.

RESULTS

A total of 55 medical students were recruited (88.7% response rate). Erroneous elements were inserted in the answer key of the experimental group and students enrolled in traditional TBL were considered as controls. Compared to the control group (p < 0.001), the experimental group revealed significantly higher academic performances in GRAT and team evaluation test (TET). Analysis of students' perception of the implemented TBL revealed better perception among the experimental group (33.7 ± 6.4) than the control group (30.1 ± 7.0). Moreover, significantly higher team dynamics were reported among the experimental group than the control group (33.0 ± 6.3 and 27.8 ± 7.6 for both groups, respectively; p = 0.005). The reported advantages were in-depth understanding, easier information retrieval, and development of problem-solving skills. Students considered time and effort as their main limitations.

CONCLUSION

Adding a few erroneous answers in the GRAT is well perceived by students, enhances their learning competencies and overcomes some TBL challenges.

In-Person or Online? The Effect of Delivery Mode on Team-Based Learning of Clinical Reasoning in a Family Medicine Clerkship

In health professions education, team-based learning (TBL) has been used to help learners develop clinical reasoning and decision-making skills. The COVID-19 pandemic has challenged institutions to move curriculum delivery from largely in-person to online. With the anticipated return to in-person instruction and arguments made in favor of online instruction in certain circumstances, evidence is needed to support decision making in curriculum planning. The purpose of this study was to examine the effect of delivery mode (in-person vs. online) on student learning of clinical reasoning and clinical decision-making (CR/CDM) in the family medicine clerkship. Data from three cohorts of third-year medical students were included in the study: 2018/2019 cohort, in-person; 2019/2020 cohort, half of the cohort in-person, half of the cohort online; 2020/2021 cohort, online. Students’ performance data—individual readiness assurance test (IRAT) and group readiness assurance test (GRAT) scores—were used. The Generalized Estimating Equations (GEE) analysis was performed. As expected, students scored higher in GRAT than IRAT across the three cohorts. No significant IRAT-GRAT differences were observed between in-person and online delivery of TBL sessions. Student learning of CR/CDM in TBL is comparable between the two modes of delivery in the family medicine clerkship. Future research in other clerkships, years of medical education, and professional programs is needed to inform decision making regarding the TBL delivery mode.

Incorporating modified team-based learning into a flipped basic medical laboratory course: impact on student performance and perceptions

BACKGROUND

Basic medical laboratory courses (BMLCs) play an essential role in medical education and offer several benefits to students. Although various student-centered and active learning strategies have been increasingly incorporated into medical education, their applications in BMLCs are limited. This paper aimed to explore the educational effects of a flipped classroom (FC) combined with team-based learning (TBL) strategy in BMLCs at Zhejiang University School of Medicine.

METHODS

Four hundred eight 3rd-Year medical students were assigned to either the FC-TBL group (n = 235) or the FC group (n = 173) to complete three experiments on the respiration block of BMLCs. The two groups' immediate and long-term academic performance were compared, and the FC-TBL students' perceptions of different instructional strategies were surveyed.

RESULTS

Students in the FC-TBL group scored higher on the immediate post-tests after class and higher on the final exams in two of the three experiment sessions. They preferred FC-TBL to FC for its higher engagement, more feedback, and better learning environment. Students felt the FC with TBL blended instructional strategy stimulated their interest in learning and deep thinking.

CONCLUSIONS

Compared with the FC group, students in the FC-TBL group improved academic performance and had a more positive experience overall. Our findings support the feasibility and advantage of the flipped classroom with team-based learning as a blended learning strategy in the BMLC curriculum.

Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4-10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards. In this paper, we propose the following: (1) this monitoring be assigned to independent medical education units (MEUs), rather than to an infrastructure of the dean's office, and such MEUs to be part of the school governance and draw their authority from university institutions; and (2) the differences in the importance of the accreditation standards be addressed by discerning between the "most important" standards that have been shown to improve student well-being and/or patient health outcomes; "important" standards associated with student learning and/or performance; "possibly important" standards with face validity or conflicting evidence for validity; and "least important" standards that may lead to undesirable consequences. According to this proposal, MEUs will evolve into entities dedicated to ongoing monitoring of the education program for compliance with accreditation standards, with an authority to implement interventions. Hopefully, this will provide MEUs and faculty with the common purpose of meeting accreditation requirements, and an agreed-upon prioritization of accreditation standards will improve their communication and recommendations to faculty.

Health literacy training program for community healthcare providers using hybrid online team-based learning in Taiwan

BACKGROUND

Health literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model.

METHODS

A quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants' learning experiences.

RESULTS

The comparison showed that the participants' familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p < .001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p = .004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p < .001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ± .53 points, the average helpfulness to practice was 4.13 ± .55 points, and the overall feedback on satisfaction with learning was 4.06 ± .58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program.

CONCLUSION

The use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers.

The Effectiveness and Student Perceptions of Peer-Conducted Team-Based Learning Compared to Faculty-Led Teaching in Undergraduate Teaching

BACKGROUND

Today's professionals need to be capable of independent information retrieval, teamwork, and lifelong learning. To meet these demands, more active learning methods are needed in university teaching. Team-based learning (TBL) is a learner-centered method which enables activation of students in large classes.

OBJECTIVE

The aim of this study was to compare a method combining peer teaching and TBL (peer-conducted TBL; pTBL) with faculty-led seminar teaching. More precisely, students' opinions about teaching methods and immediate and long-term learning outcomes were aimed to compare.

METHODS

A faculty-led design was compared to a pTBL design when teaching pediatric and dermatological allergy in a seminar setting for 5^th year medical students. For that purpose, students were randomly split into two learning groups. In a faculty-led seminar (n = 44 students) the instructor first lectured on each subject; then, named students from each group were asked to present clinical cases given to them beforehand and them raising questions were answered. In a pTBL group (n = 50) student's prior knowledge was first tested. Then, randomly selected, pre-prepared students took a tutors role in a seminar and presented clinical case to be solved in groups by all students. Students' performance was equally tested after both sessions and 5-6 months afterwards. Students' opinions were asked by an electronic survey.

RESULTS

In this study, pTBL was significantly preferred over faculty-led learning (mean grade 8.5 vs 6.5). Those participating in pTBL group studied pre-learning material more actively than those in faculty-led group. However, there was no difference in learning outcomes (immediate or long term) between the groups.

CONCLUSION

Students prefer teaching method in which they are self in active role. Combining TBL and peer teaching may further increase the accumulation of non-academic skills like expertise and proficiency.

Impact of Team-Based Learning Versus Lecture-Based Learning on Chinese Radiology Education: A Scoping Review and Meta-Analysis

This meta-analysis aimed to evaluate the effectiveness of team-based learning in radiology education. Data sources and selection criteria Databases were searched from inception up to August 2019 and included Pubmed, Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Wanfang Database, and Chinese VIP. Randomized trials comparing teaching approaches for medical imaging of which provide the outcomes of theoretical scores and/or practical scores were included. Data were extracted independently by two authors and double-checked for accuracy. Outcomes included knowledge scores and practical scores. We pooled data using random-effects meta-analysis. Twelve trials involving 1,371 participants were included. Team-based learning teaching method had positive impacts on theoretical scores compared with the lecture-based learning or traditional teaching method (SMD = 1.07, 95% CI [0.50, 1.63]) and it positively improved skill scores (SMD = 0.68, 95% CI [0.19, 1.17]). Team-based learning could not only improve theoretical and skill scores in medical imaging courses but also encourage students to learn by themselves. Participants believed team-based learning raised their learning interest, team cooperation ability, and interpersonal communication skills. The heterogeneity of the included studies must be noticed and large well-designed and well-conducted trials are urgently needed.

An intensive anatomy by whole‐body dissection elective: a longitudinal study

Whole body dissection, once a long‐held method of learning and teaching in anatomy medical education, has largely been replaced by cost and time‐reduced methods of teaching. This paper reports on a longitudinal study of student knowledge acquisition and retention, following six annual intensive eight‐week elective anatomy by whole body dissection (AWBD) courses implemented between 2010 and 2015, utilizing a modified team‐based learning (TBL) pedagogy. A total of 160 students completed the intensive full‐time courses. During each course, students, in groups of five or six, completed the dissection of a whole cadaver. Students were assessed by a standardized practical test involving the accurate identification of 20 different tagged anatomical structures. All students (n = 160) completed pre‐course and end‐course individual assessments. Seventy students were assessed again 1 month after the course ended. A further 71 students were assessed 7 months later. A marked increase in topographical relational anatomical knowledge was demonstrated. The median pre‐course score was 9/20 (interquartile range 5). The median end‐course score was 19/20 (IQR 2), a statistically significant increase (p < 0.001). The assessments for the 70 students reassessed 1 month after the course ended showed no significant statistical change. The assessments for the further 71 students assessed 7 months later also showed no significant statistical change. The results of this study demonstrate that AWBD, provides significant acquisition and maintenance of three‐dimensional regional relational anatomical knowledge. As an elective, AWBD has a place in the medical curricula, particularly for students interested in a surgical or procedural based specialty career.

Medical student engagement in small-group active learning: A stimulated recall study

BACKGROUND

Active learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small-group active learning settings, teachers could be facilitated in effectively engaging their students.

METHODS

We conducted a video-stimulated recall study to explore medical students' engagement during small-group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi-structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components.

RESULTS

The analysis uncovered three main findings: (1) In-class student engagement followed a spiral-like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable.

DISCUSSION

This study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re-)engage students in their classrooms.

Team-Based Learning in Medical Colleges: Need, Scope, and the Potential Factors for Successful Implementation

Owing to the rapid advancements in the field of medicine, it is a major challenge for the medical educators to prepare the medical students to be ready and competent in their future clinical practice. It is a must that the medical students should not only be knowledgeable and skilled but also acquire the trait of being a lifelong learner. The adoption of team-based learning is an effective teaching-learning strategy to prepare the medical students for all the above roles, as it envisages working in teams to resolve the clinical-practice-related issues. In conclusion, team-based learning is an effective teaching-learning method that advocates practical application of the learned knowledge and encourages teamwork for the resolution of medical problems. However, successful implementation of team-based learning in a medical college is dependent upon the support from administrators, faculty members, and active participation of the medical students.

The effect of online and in-person team-based learning (TBL) on undergraduate endocrinology teaching during COVID-19 pandemic

BACKGROUND

Team-based learning (TBL) combines active and collaborative learning, while incorporating aspects of the flipped classroom approach and problem-based learning. The COVID-19 pandemic presented certain challenges in the delivery of TBL in class. In this study, we investigated the impact of TBL on the academic performance of final year Biomedical Sciences' undergraduate students in the context of an "Endocrine Disorders" study block. We did so by comparing the classical in-person approach and online delivery due to the COVID-19 pandemic.

METHODS

A non-compulsory TBL session was introduced to the curriculum of this block, which followed the traditional 2-h lecture delivery. Comparative analysis was performed for the exam and coursework performance of students who attended the TBL sessions (online and in-person) and those that did not.

RESULTS

Both cohorts of students who attended either in-person (n = 66) or online TBL sessions (n = 109) performed significantly better in their exams (p < 0.05) and a related coursework (p < 0.001 and p < 0.05, respectively) when compared to those that did not attend. For both these cohorts the exam mark distribution was much narrower compared to those that did not attend the TBL sessions where the majority of fails and "no shows" were recorded.

CONCLUSIONS

Online and in-person TBL, can successfully supplement traditional lecture-based teaching and enhance the learning/performance, for complex medical subjects/topics. Our findings demonstrate that it is possible to deliver these sessions online with demonstrable benefit for students suggesting that there is greater flexibility in the use of TBL in higher education.

Collaborative case-based learning with programmatic team-based assessment: a novel methodology for developing advanced skills in early-years medical students

BACKGROUND

Imperial College London launched a new, spiral undergraduate medical curriculum in September 2019. Clinical & Scientific Integrative cases (CSI) is an innovative, flagship module, which uses pioneering methodology to provide early-years learning that [1] is patient-centred, [2] integrates clinical and scientific curriculum content, [3] develops advanced team-work skills and [4] provides engaging, student-driven learning. These aims are designed to produce medical graduates equipped to excel in a modern healthcare environment.

METHODS

CSI has adopted a novel educational approach which utilises contemporary digital resources to deliver a collaborative case-based learning (CBL) component, paired with a team-based learning (TBL) component that incorporates both learning and programmatic assessment. This paper serves to explore how first-year students experienced CSI in relation to its key aims, drawing upon quantitative and qualitative data from feedback surveys from CSI's inaugural year. It provides a description and analysis of the module's design, delivery, successes and challenges.

RESULTS

Our findings indicate that CSI has been extremely well-received and that the majority of students agree that it met its aims. Survey outputs indicate success in integrating multiple elements of the curriculum, developing an early holistic approach towards patients, expediting the development of important team-working skills, and delivering authentic and challenging clinical problems, which our students found highly relevant. Challenges have included supporting students to adapt to a student-driven, deep learning approach.

CONCLUSIONS

First-year students appear to have adopted a patient-centred outlook, the ability to integrate knowledge from across the curriculum, an appreciation for other team members and the self-efficacy to collaboratively tackle challenging, authentic clinical problems. Ultimately, CSI's innovative design is attractive and pertinent to the needs of modern medical students and ultimately, future doctors.

Effect of Seating Arrangement on Class Engagement in Team-based Learning: a Quasi-Experimental Study

INTRODUCTION

This study investigated the effects of seating distance and orientation on engagement in novice and experienced learners in a large classroom explicitly designed for team-based learning (TBL). Learning what affects TBL engagement may improve its implementation.

METHODS

Participants were novice first-year and experienced second-year undergraduate medical students in Singapore (male = 103, female = 57). Their age ranged from 18 to 23 (M = 19.5, SD = 1.06). This quasi-experimental study considered two factors. Firstly, the distance from the teams' table to the tutor's table. Secondly, students' orientation at each table, with either their front or back facing the tutor. Engagement was measured using two instruments, Situational Cognitive Engagement Measure and Classroom Engagement Survey at two TBL sessions - before and after swapping seating arrangements.

RESULTS

For experienced students, seating distance did not significantly affect engagement (p = 0.08-0.89). Novice student's engagement levels decreased significantly for those who moved further; M = 3.30 to 2.98 (p = 0.009-0.023). However, overall engagement also decreased post-swap regardless of direction moved; M = 3.26 to 3.00 (p = 0.004). For both cohorts, seating orientation did not significantly affect engagement (p = 0.07-0.62). Those unaffected by seating arrangement commended the classroom's design, such as screens all around and quality audio-visual system. Novice students exhibited a stronger preference to sit nearer to the tutor than experienced students. Both groups preferred sitting with their front-facing the tutor.

DISCUSSION

Within specially designed TBL classrooms, seating distance and orientation did not significantly affect engagement. Technologically enhanced team-centric spaces provide a favourable environment for TBL, though students' preferences for seats may change with more TBL experience.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01469-7.

Team-Based Learning in Prosthodontics Courses: Students’ Satisfaction

The goal of this cross-sectional observational study was to assess dental students’ satisfaction regarding team-based learning (TBL) methodology in prosthodontics courses taught at College of Dentistry, Princess Nourah bint Abdulrahman University, Saudi Arabia. Undergraduate dental students at second, third, fourth, and fifth years were taught prosthodontics courses through traditional and TBL pedagogies. TBL sessions consisted of preparation, readiness assurance, and application. At the end of each prosthodontics course, the students were asked to complete a self-administered questionnaire that was divided into four sections to assess the effect of TBL on the following parameters: information acquisition, interpersonal skills improvement, classroom environment, and the students-instructors interaction. The responses of the questionnaire followed the Likert scoring method (scaled from 1 to 5). The t-test and ANOVA statistical analyses were performed using SPSS. Results. The response rate to the questionnaire was 86%. There were a significant relationship and correlation between TBL pedagogy and student satisfaction ( $P$ values ≤ 0.05) for all levels. The means of the responses for the second and fifth years were 4.36 and 4.56, respectively, where the means for the third and fourth years were 3.54 and 3.59, respectively. The parameter notably affected by TBL was interpersonal skills enhancement. All students strongly agreed that TBL enhances personal flexibility and boosts their self-esteem. Conclusion. Students showed positive perceptions about TBL pedagogy in terms of active engagement, knowledge acquisition, and improvement of interpersonal skills leading to more efficient learning outcome.

Enhancing Toxicology Achievement by the VARK and the GRSLSS-mixed Models in Team-Based Learning

Toxicology is needed to implement in the occupational health and safety (OHS) curriculum. Teaching toxicology is very challenging as its multidisciplinary science. Keeping students engaged in learning is a difficult issue when introducing solely theoretical framework. To enhance student performance, educators need to be aware of different learning styles and teach students accordingly. This study aimed to examine preferred learning styles and to further investigate the impact of learning style on team allocation and the effectiveness of team-based learning (TBL) in toxicology. A cross-sectional study of OHS students was performed. The visual, aural, reading/writing, and kinesthetic (VARK) learning style questionnaire and the Grasha–Reichmann Student Learning Styles Scale (GRSLSS), which identifies independent, dependent, collaborative, participant, competitive, and avoidant learning styles, were used with 101 study participants. After classification, participants studied three aspects of toxicology in three respective situations: (i) individual learning, (ii) TBL with students of the same VARK learning style, and (iii) TBL with students of varying VARK learning styles. Afterward, participants wrote a test on each of the aspects. The dominant VARK and GRSLSS learning styles were reading/writing (33.33%) and collaborative (50.00%), respectively. The participants achieved the highest test scores (88.31%) when they studied in a team with the various VARK styles, followed by studying in a team with the same VARK style (83.43%). Individual learning produced the lowest average score (69.79%). The results of this study suggest that creating a successful heterogeneity team based on the preferred learning styles is an effective teaching method in toxicology. It might be useful to toxicology educators and research studies from a wide range of disciplines to enhance student performance.

Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review

BACKGROUND

In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions.

METHODS

A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method.

RESULTS

After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner's level of self-regulated learning, teacher's role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom.

CONCLUSION

This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review

PURPOSE

Team-based learning (TBL) has gained popularity across the health professions, including in interprofessional contexts. The authors conducted this systematic review to summarize the published evidence regarding the extent, design, and practice of interprofessional TBL within health professions (including medical) degree programs to inform interprofessional education (IPE) educators and curricula designers.

METHOD

In June 2020, the authors searched PubMed Central, CINAHL, Web of Science, and ERIC for original research articles describing TBL programs with student representation from multiple health professions degree programs that were published between January 2010 and June 2020. Included articles underwent data extraction for study characteristics (e.g., country of origin, topics covered, class descriptors) and the 7 core design elements of TBL: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 Ss (significant problem, same problem, specific choice, and simultaneous reporting), incentive structure, and peer review.

RESULTS

Twelve articles were included. Significant variability was noted in the application and reporting of the 7 core design elements of TBL, which highlighted challenges to the implementation of interprofessional TBL.

CONCLUSIONS

Although the structured format of TBL provides a suitable pedagogy for IPE, this review identified challenges associated with the effective integration of IPE into TBL, including: the unequal distribution of students to teams as a result of there being multiple disciplines from different programs; varied levels of student experience with the pedagogy of TBL; a lack of resources required for large groups of students; timetabling requirements for multiple disciplines from different programs; inability to provide more than 1 TBL session; design of patient cases that suit multiple disciplines; alignment of topics within the curricula of multiple disciplines, programs, and universities; inequities in grading for different students within the same TBL program; and limited opportunity for peer review.

Assessing Medical Students' Knowledge of Genetics: Basis for Improving Genetics Curriculum for Future Clinical Practice

PURPOSE

The knowledge of genetics among medical students was assessed to identify and analyze gaps that serve as bases for the revision of the current genetics curriculum of the (Bachelor of Medicine, Bachelor of Surgery) MBBS Program of the College of Medicine at Princess Nourah bint Abdulrahman University (PNU).

METHODS

A 65-item multiple-choice (MCQs) test in Genetics was administered to 71 second and fourth-year medical students to assess their knowledge in Genetics. MCQs were validated and tested for their reliability. Self-assessment of students' genetics knowledge was also determined by asking them whether their knowledge in genetics is sufficient or not sufficient for their future clinical practice. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.

RESULTS

Forty-one second-year and thirty fourth-year medical students took the Genetic test. Exam results showed insufficient knowledge of Genetics, with 43.85% among the students answering the exam correctly. In self-assessment, the majority (83.3% to 87.8%) of the respondents considered their knowledge of genetics insufficient for future clinical practice. A higher knowledge level of basic genetics compared with clinically related genetics concepts was observed. Generally, second-year students significantly scored higher in molecular and cytogenetics (P=0.012), principles of genetic transmission (P=0.022), and inheritance of genetic diseases (P=0.024), compared with the fourth-year medical students who only scored higher in items related to cancer genetics (P=0.022).

CONCLUSION

Medical students' genetics knowledge is insufficient, especially on clinically oriented concepts like genetic testing and genetic counseling and should be strengthened for future clinical practice. The fourth-year medical students do not retain the knowledge of genetics; thus, integrating medical genetics in clinical years is imperative.

Differential effects of team-based learning on clinical reasoning

BACKGROUND

Clinical reasoning (CR) is the ability to integrate information, knowledge and contextual factors for patient care. Few studies have explored effects of team-based learning (TBL) on neurological CR. This study compared simplified TBL (sTBL) against interactive lectures (IL) for teaching CR in neuroanatomical localisation (NL) and neurological emergencies (NE), assessed using a validated Script Concordance Test (SCT).

METHODS

A crossover study was conducted with third- and fifth-year undergraduates, randomly assigned to two groups, from the Yong Loo Lin School of Medicine in Singapore. Group 1 was taught NE with sTBL and NL with IL, whereas Group 2 was taught NL with sTBL and NE with IL. Teaching was conducted sequentially over 3 h followed immediately by the SCT. The primary outcome was the difference in mean SCT scores of NE and NL taught with sTBL versus IL.

FINDINGS

A total of 179 students (Group 1, n = 81; Group 2, n = 98) participated. Mean NL SCT scores for students taught with sTBL were significantly higher compared with IL (64.8% vs. 61.7%, mean difference 3.1%, 95% confidence interval [CI] 0.6%-5.5%, p = 0.013); effect size was 0.38. Mean NE SCT scores were similar between students taught with sTBL or IL (66.6% vs. 67.0%, mean difference -0.4%, 95% CI -2.2% to 3.1%, p = 0.75).

CONCLUSIONS

sTBL was superior to IL for teaching NL, whereas both methods were comparable for teaching NE. TBL may be suitable for teaching more complex neurological topics involving diagnostic reasoning through development of problem representation, hypothesis generation and illness script selection.

Bootstrapping implementation research training: A successful approach for academic health centers

Demand for building competencies in implementation research (IR) outstrips supply of training programs, calling for a paradigm shift. We used a bootstrap approach to leverage external resources and create IR capacity through a novel 2-day training for faculty scientists across the four Texas Clinical & Translational Science Awards (CTSAs). The Workshop combined internal and external expertise, targeted nationally established IR competencies, incorporated new National Institutes of Health/National Cancer Institute OpenAccess online resources, employed well-known adult education principles, and measured impact. CTSA leader buy-in was reflected in financial support. Evaluation showed increased self-reported IR competency; statewide initiatives expanded. The project demonstrated that, even with limited onsite expertise, it was possible to bootstrap resources and build IR capacity de novo in the CTSA community.

Online Team-Based Learning Teaching Strategy for Developing Caring Competencies in Nursing Students under COVID-19 Pandemic Restrictions

(1) Background: The COVID-19 pandemic impacted education systems globally, and numerous strategies were used to transform education into online learning. Caring is recognized as a core competency in nursing; this competency is difficult to cultivate and measure. This study aimed to explore the effect of online team-based learning (TBL) on cultivating nursing students' caring competency. (2) Method: A mix-methods study design with convenience sampling was used for this study. The intervention was online TBL with field observation. Quantitative data were collected by the modified Peer Caring Measurement (PCM) and analyzed using descriptive and inferential statistics. Qualitative data were collected by dialog in social media and analyzed by content analysis. (3) Result: Both the quantitative and qualitative data showed a significant increase in caring competency. A paired t-test of modified PCM showed significant improvement (p < 0.001), and female students had greater learning performances compared with male students in academic and affective dimensions. Three themes emerged, including that online TBL possesses remarkable benefits, students felt in charge of their learning, and changes in the students' caring competency were revealed. (4) Conclusion: This online TBL strategy works well in teaching and fostering caring in an online environment among nursing students, which is necessary under COVID-19 restrictions.