Applying established guidelines to team-based learning programs in medical schools: a systematic review

A novel approach to clinical thinking training for medical students: the combined World Café discussion and case-based learning experience introduction

It is essential for modern medical students to continuously enhance their clinical thinking abilities. This study aims to evaluate the efficacy of the combined World Café discussion and case-based learning (CBL) approach within the clinical thinking training course. The clinical thinking training course incorporated the combined World Café discussion and CBL approach. The assessment of the accuracy and rationality of clinical symptoms, medical examination, pathological processes, diagnostic results, diagnostic basis, and drug use was conducted through case-related queries. Feedback from students and instructors regarding the teaching content, teaching process, and teaching effect was gathered through questionnaires. The findings indicate that the students achieved high marks in all assessed areas, including clinical symptoms, medical examination, pathological processes, diagnostic results, diagnostic basis, and drug use. The feedback from students and instructors on the teaching content, teaching process, and teaching effect was positive. Medical educators can use our findings to implement the combined World Café discussion and CBL mode to enhance student engagement.NEW & NOTEWORTHY The combined World Café discussion and case-based learning approach was implemented in the clinical thinking training course. Students' scores for clinical symptoms, medical examination, pathological process, diagnostic results, diagnostic basis, and drug use were all excellent. Feedback from both students and teachers on the teaching content, teaching process, and teaching effect was positive.

Formative peer evaluation instrument for a team-based learning course: Content and construct validity

PURPOSE

Team-based learning (TBL) is an evidence-based approach to promote teamwork. Peer evaluation (PE) is an essential component to shape future team engagement and promote reflection. As PEs vary in use, implementation, and assessment, this study establishes the content and construct validity of a formative PE tool for a TBL course.

METHODS

A ten-item instrument was developed based on a comprehensive review of PE literature and was critically edited by a team of experienced educators. Each student in a graduate histology course rated peers at two timepoints on a scale from Never to Always (0-3). The instrument's factor structure was analyzed by dividing the response set (D1 and D2); with D1 utilized for exploratory factor analysis (EFA) and D2 for confirmatory factor analysis (CFA). Cronbach's alpha assessed internal consistency.

RESULTS

Data from 158 students across four cohorts were included in the analyses (D1, D2 = 972). A three-factor solution had good overall internal consistency (alpha = 0.82), and within the subscales ranged from 0.67 to 0.81. The factor structures were resonant with existing literature on (1) preparation, (2) providing feedback, and (3) feedback receptivity and attitude.

CONCLUSION

This study establishes evidence of content and construct validity of a formative PE instrument for a TBL course.

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.

Intraprofessionalism and Peer-to-Peer Learning in American Medical Education

As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge.

Comparing the effects of team-based and problem-based learning strategies in medical education: a systematic review

BACKGROUND

Recently, there has been a concerted effort within medical schools to depart from conventional lecture-based learning approaches to alternative teaching methods such as team-based learning (TBL) and problem-based learning (PBL), with the aim of enhancing both student engagement and instructional efficacy. Despite this shift, a comprehensive review that directly compares the impacts of PBL and TBL methods in medical education is lacking. This study seeks to address this gap by conducting a meta-analysis that compares the effects of TBL and PBL in the context of medical education.

METHODS

Studies from Embase, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Wanfang Database were searched, from inception to July 11, 2023. A meta-analysis was performed using Stata 14.0, and a total of 10 studies (including 752 participants) were included. The standardized mean difference (SMD) was used to estimate pooled effects. Heterogeneity was detected using the I2 statistic and further explored using meta-regression analysis.

RESULTS

Compared with PBL, TBL significantly increased the number of theoretical tests (SMD = 0.37, 95% CI: 0.02-0.73). Additionally, TBL greatly improved teamwork skills compared with PBL. However, there were no significant differences between the TBL and PBL groups concerning practical skill scores, learning interest, or understanding skills.

CONCLUSION

TBL in the theoretical aspects of medical education appears to be more effective than PBL in improving theoretical test scores and teamwork skills, providing evidence for the implementation of TBL in medical education.

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.

How to design and deliver a small group teaching session

RATIONALE AND KEY POINTS

Small group teaching sessions are commonly used in healthcare to deliver education, provide practice updates and support continuing professional development. Such sessions can provide opportunities for participants to acquire new knowledge, foster peer relationships, consolidate learning and develop skills. This article provides a step-by-step guide for nurses and other healthcare professionals on designing and delivering a small group teaching session. • A small group teaching session requires considered, detailed and methodical preparation. • When designing a small group teaching session, it is important to determine its aims, learning outcomes, group characteristics, location and timeframe. • A well-planned small teaching session includes learning activities that are constructively aligned to the aims and intended learning outcomes. • Assessing participant learning and addressing gaps in their understanding is essential during the delivery of small group teaching. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article could improve your practice when designing and delivering a small group teaching session. • How you could use this information to educate your colleagues on small group teaching methods.

Medical School Curriculum Relating to Clinical Ethical Decision Making During a Pandemic: A Scoping Review

Background

The COVID-19 pandemic has demonstrated the need for medical students to be prepared to make adequate decisions during unique challenges presented during pandemics.

Objective

This review aims to provide a comprehensive look into the current global literature that discusses medical curricula on clinical ethical issues during a pandemic.

Methods

The scoping review methodology was divided into three stages. Phase 1, planning, involved identifying key terms, selecting databases, creating a search criterion, and deciding on inclusion and exclusion criteria. Phase 2, study selection and data extraction, included screening the title and abstract, reviewing the complete text, and extracting data. Phase 3, analysis and write-up, comprised analyzing the extracted information and composing the review.

Results

10 studies were included and underwent data extraction as part of the review. The studies varied by country, study design, institution, education setting, and course titles. Ethical issues identified while reviewing the curriculums were resource allocation, healthcare worker obligations, personal protective equipment, disease control, communication, management protocols, and patient care.

Conclusion

This review revealed a lack of literature regarding the curriculum for medical students on ethical issues during a pandemic. This indicates a need for reform in medical education to cover pandemic preparedness and ethical concerns during a pandemic. If medical schools do not address this gap, future physicians may encounter the same issues healthcare workers faced during the COVID-19 pandemic.

Effectiveness of Online Team-based Learning for Pharmacists on How to Conduct Clinical Medication Reviews for Old Patients in Japan: A Randomized Controlled Trial

BACKGROUND/AIM

This study aimed to determine the effectiveness of online team-based learning (TBL) and the factors influencing dropouts from online TBL for pharmacists on how to conduct clinical medication reviews for older adults.

PARTICIPANTS AND METHODS

All participants were randomly assigned to the TBL or non-TBL group by using a random number sequence table matched by their years of experience working as a pharmacist. The primary outcome was whether the score on the team readiness assurance test (TRAT) in the TBL group differed from that on the second individual readiness assurance test (IRAT) in the non-TBL group. The secondary outcome was to identify factors contributing to dropouts from the online TBL program.

RESULTS

The TRAT score in the TBL group was significantly higher than the second IRAT score in the non-TBL group during the first session (p=0.010). There were no differences in TRAT and IRAT scores between groups in two subsequent sessions. Logistic regression analysis revealed that less than 10 years of pharmacy experience was a contributor to dropouts (p=0.039), whereas experience in home-based care prevented dropouts (p=0.026) in our online TBL program.

CONCLUSION

This study revealed the short-term usefulness of online TBL on medication reviews for older adults and elucidated the factors related to dropouts. Although instructors should provide positive feedback to participants with insufficient experience in pharmacy practice and home-based care, online TBL has the potential to improve educational effectiveness for community pharmacists during the COVID-19 pandemic.

Novice medical students' perception about bad news training with simulation and spikes strategy

Objective

To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol.

Methods

Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis.

Results

In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training.

Conclusion

The strategy used for the development of communication skills showed evidence of short-term effectiveness.

Innovation

The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.

Using team-based learning to optimize undergraduate family medicine clerkship training: mixed methods study

BACKGROUND

Team-Based Learning (TBL) is an established educational strategy which has become increasingly popular in the training of healthcare professionals. TBL is highly suitable for teaching Family Medicine (FM) especially that teamwork and collaborative care, in this medical discipline, are at the core of safe and effective practice. Despite the established suitability of TBL for teaching FM, there are no empirical studies that capture the students' perception of a TBL in FM undergraduate learning experience in the Middle East and North Africa region (MENA).

OBJECTIVE

The overall objective of this study was to investigate the perception of students regarding a TBL in FM intervention (in Dubai, United Arab Emirates), that was designed and implemented in alignment with a constructivist learning theory.

METHODS

A convergent mixed methods study design was utilized to develop a thorough understanding of the students' perceptions. Qualitative and quantitative data were concurrently collected and independently analyzed. The output of thematic analysis was systematically merged with the quantitative descriptive and inferential findings using the iterative joint display process.

RESULTS

The qualitative findings shed light on the students' perception of TBL in FM, and the interplay between team cohesion and engagement with the course. As for the quantitative findings, they showed that the percentage of the total average of the Satisfaction with TBL in FM score was 88.80%. As for change in impression of FM discipline, the percentage of the total average was 83.10%. The perception of team cohesion, with a mean of agreement of 8.62(1.34), seemed to be significantly associated with the students' perception of the team test phase component, only (P < 0.05). As for the perception of the level of engagement with the course, with a mean of agreement of 9.29(0.84), it turned out to be significantly associated with the change in impression of FM discipline (P < 0.05). Lastly, the joint display analysis showed how the quantitative and qualitative findings built upon each other, revealing how best to leverage TBL in FM trainings.

CONCLUSION

The current study showed that TBL embedded in a FM clinical clerkship was well-received by students. It is worth leveraging the lessons learned from the first-hand experience reported upon in the current study to optimize the utilization of TBL in FM.

Multidimensional evaluation of teaching strategies for pharmacology based on a comprehensive analysis involving 21,269 students

Background: Given the limitations of traditional pharmacology pedagogical method, diverse novel teaching methods have been widely explored. In this study, we performed a network meta-analysis (NMA) to evaluate the effects of different strategies in pharmacology education.

Methods: Literature databases were searched from their inception to November 2022, and the studies were screened according to predefined inclusion and exclusion criteria to extract important information. Outcomes, including theoretical test scores, experimental test scores, subjective test scores, satisfaction scores, and the proportion of satisfaction, were analyzed using R software (version 3.6.1) and STATA (version 15). The NMA was conducted with a random-effects model under the Bayesian framework to calculate odds ratios (ORs) or mean differences (MDs) with associated 95% credible intervals (95% CIs). Surface under the cumulative ranking curve (SUCRA) probability values were calculated to rank the teaching methods examined.

Results: A total of 150 studies involving 21,269 students were included. This NMA systematically evaluated 24 teaching strategies, such as problem-based learning (PBL), team-based learning (TBL), case-based learning (CBL) and flipped classrooms (FC), etc., The results of the NMA showed that, PBL combined with CBL was most likely to improve students’ theoretical and subjective test scores (SUCRA = 75.49 and 98.19%, respectively), TBL was most likely to improve the experimental test score (SUCRA = 92.38%) and the satisfaction score (SUCRA = 88.37%), while FC had the highest probability of being the best option for improving the proportion of satisfaction (SUCRA = 84.45%).

Conclusion: The current evidence indicates that TBL, PBL combined with CBL, and FC might be optimal strategies for pharmacology education since they have a more beneficial effect on students.

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.

Dyads or quads? Impact of group size and learning context on collaborative learning

Collaborative learning has been widely used in both offline and online contexts to support deep learning, and its effectiveness may be adjusted by the size of the collaborative groups. To examine the effect of learning context and group size on collaborative learning, this study conducted two experiments with 62 third-year undergraduate students enrolled in the course named Application of Modern Educational Technology to compare learning outcomes, learning engagement, and collaborative experience between quad (four-person) and dyad groups in both face-to-face and online learning contexts. The results indicated that learning outcomes and collaborative experience were not significantly affected by group size and learning context, but for peer interaction, the dyad group showed more communication and interaction during the learning process. In general, the dyad group showed higher and more stable scores in all aspects, as well as being able to adapt to changes in learning contexts. Based on the research results, three practical implications were proposed to promote the implementation of collaborative learning in teaching.

Self-paced polling increases medical student engagement in recorded lectures and improves examination performance

Engaging preclinical medical students in the curriculum is challenging. To address this challenge, the investigators developed and implemented self-paced polling with recorded lectures, in which students answered audience response questions at their own pace. In 2021, we retrospectively assigned second-year medical students (N = 165) as Active or Inactive based on their answered polling questions. We subdivided the Active group into two groups, a Live group who predominantly responded to polling in live classes and a Self-paced group who predominantly used polling with recorded lectures. Outcomes were academic performance on customized National Board of Medical Examiners (NBME) examinations and engagement. Compared with the Inactive group, the Self-paced group performed better on the customized NBME examination after extensive self-paced polling. Students answered a significantly larger proportion of questions correctly in self-paced polling compared with live polling. Students who used self-paced polling reported a positive experience and indicated they had emotional, behavioral, or cognitive engagement with the curriculum. This study introduces self-paced polling with recorded lectures, which medical educators can potentially use to enhance student engagement and academic performance.NEW & NOTEWORTHY More medical students utilize recorded lectures than live lectures. Self-paced polling questions allow students to participate while watching recorded lectures. Second-year medical students performed significantly better on examination after actively using the self-paced polling compared with inactive students. They also reported emotional, behavioral, and cognitive engagement with the course material while using the self-paced polling.

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.

Pre‐doctoral dental students’ computer‐aided design/computer‐aided manufacturing‐related education, knowledge, attitudes and behavior: A national survey

OBJECTIVES

Computer-aided design/computer-aided manufacturing (CAD/CAM) technology transformed the world of restorative dentistry. The objectives were to assess pre-doctoral dental students' CAD/CAM-related education, knowledge, attitudes, and professional behavior, and to explore the relationships between the year in dental school and these constructs.

METHODS

A total of 358 pre-doctoral dental students from 17 of the 68 US dental schools responded to a web-based anonymous survey.

RESULTS

CAD/CAM-related classroom-based education was likely to happen in lectures (87.2%) and simulated exercises as part of a class (86.9%). Faculty were most likely to provide CAD/CAM instruction (87.9%), with staff (44.8%) and dental technicians (20.2%) being engaged as well. Preclinical education included video demonstrations (81.8%), demonstrations during a lecture (76.4%) or for smaller groups of students (69.2%), hands-on workshops (65.6%), and individual instruction (50.4%). Considering the digital workflow in clinics, 45.2% reported using intraoral scans. The more advanced the students were in their program, the more CAD/CAM knowledge (r = 0.27; p < 0.001) and knowledge about what can be fabricated with CAD/CAM technology they had (r = 0.25; p < 0.001). However, the student's satisfaction with the education about CAD/CAM did not increase over the years (r = -0.04; n.s.) and remained neutral, while their attitudes became more positive the longer they were in dental school (r = 0.13; p < 0.05). Their attitudes were quite positive, with most students considering that CAD/CAM is the future of dentistry (5 = most positive: Mean = 4.34), agreeing that they enjoyed working with CAD/CAM (Mean = 4.11) and that CAD/CAM has the potential of making them a better dentist (Mean = 4.07).

CONCLUSIONS

The majority of students in the US dental schools appreciate CAD/CAM technology, consider it to be the future of dentistry, and believe it makes them better dentists. The fact that the majority is not satisfied with their classroom-based, preclinical and clinical CAD/CAM-related education should therefore be a call to action to rethink dental school curricula in this content area.

Application of team-based learning to ophthalmology in China

Objectives

The purpose of this study was to explore whether team-based learning (TBL) was more effective than traditional didactic lectures (TDLs) in improving medical students' problem-solving and study skills in the clinical course of ophthalmology. In addition, we were also concerned about Chinese students' satisfaction with TBL.

Methods

Our study program involved 275 students of the 5-year clinical medicine program from Central South China University, of which 140 were enrolled in a modified TBL course. A questionnaire that included closed-ended and open-ended items was distributed to students immediately following the completion of the TBL session, and 108 valid questionnaires were collected. Descriptive statistics were used to analyze quantitative data. The effects of the TBL module on students' performance were measured between the groups using a one-way between-group analysis of variance (ANOVA) test by the individual readiness assurance test (IRAT), the group readiness assurance test (GRAT), and final examination scores (FESs), compared with a class without the TBL session.

Results

With our modified TBL strategy, 140 students achieved a mean test score of 72.65 on test questions that assessed their knowledge of ophthalmology compared to 135 students who achieved a mean score of 70.8 using the TDL method (p = 0.3434). The performance in a pre-class quiz was significantly better in the GRAT compared to the IRAT. In comparison to the TDL session, the modified TBL was preferred and acceptable by most medical students.

Conclusions

By applying the modified TBL to ophthalmology, students improved their performance, self-study, and teamwork, and their class engagement and satisfaction were enhanced. However, TBL should be further optimized and developed to enhance educational outcomes.

Team-based learning (TBL): Each phase matters! An empirical study to explore the importance of each phase of TBL

CONTEXT

In Team Based Learning (TBL), it is, based on theory, assumed that knowledge development in each phase contributes to the subsequent phase and to learning performance. However, there is no empirical evidence for this assumption.

AIM

In order to find support for the relation between TBL and the underlying theory, we determined to what extent each phase of TBL is associated with the knowledge development in the next phase and with the total learning performance.

METHODS

We measured the scientific concepts recalled by 56 second-year undergraduate medical students before TBL, after each of the three phases and after TBL. We used multivariate regression analysis to determine the statistical association between the phases as well as the total learning performance.

RESULTS

Results showed that in each phase, students produced new concepts in addition to those previously recalled. Regression models showed statistically significant explained variance ranging from 0.19 to 0.26, between the three phases and the total learning performance.

DISCUSSION

Each phase of the TBL is significantly associated with knowledge development in the subsequent phase and with the total learning performance, and therefore matters. This study contributes to the scientific underpinning of TBL and offers leads to more elaborate research and interventions to improve TBL.

Student perspectives on programmatic assessment in a large medical programme: A critical realist analysis

BACKGROUND

Fundamental challenges exist in researching complex changes of assessment practice from traditional objective-focused 'assessments of learning' towards programmatic 'assessment for learning'. The latter emphasise both the subjective and social in collective judgements of student progress. Our context was a purposively designed programmatic assessment system implemented in the first year of a new graduate entry curriculum. We applied critical realist perspectives to unpack the underlying causes (mechanisms) that explained student experiences of programmatic assessment, to optimise assessment practice for future iterations.

METHODS

Data came from 14 in-depth focus groups (N = 112/261 students). We applied a critical realist lens drawn from Bhasker's three domains of reality (the actual, empirical and real) and Archer's concept of structure and agency to understand the student experience of programmatic assessment. Analysis involved induction (pattern identification), abduction (theoretical interpretation) and retroduction (causal explanation).

RESULTS

As a complex educational and social change, the assessment structures and culture systems within programmatic assessment provided conditions (constraints and enablements) and conditioning (acceptance or rejection of new 'non-traditional' assessment processes) for the actions of agents (students) to exercise their learning choices. The emergent underlying mechanism that most influenced students' experience of programmatic assessment was one of balancing the complex relationships between learner agency, assessment structures and the cultural system.

CONCLUSIONS

Our study adds to debates on programmatic assessment by emphasising how the achievement of balance between learner agency, structure and culture suggests strategies to underpin sustained changes (elaboration) in assessment practice. These include; faculty and student learning development to promote collective reflexivity and agency, optimising assessment structures by enhancing integration of theory with practice, and changing learning culture by both enhancing existing and developing new social structures between faculty and the student body to gain acceptance and trust related to the new norms, beliefs and behaviours in assessing for and of learning.

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.

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.

Effects of bedside team-based learning on pediatric clinical practice in Chinese medical students

BACKGROUND

Bedside teaching is a primary educational tool to improve the clinical practice of medical students. As a new medical pedagogical approach, team-based learning (TBL) is gradually being integrated into Chinese medical education programmes to promote clinical reasoning, knowledge application, teamwork and collaboration. The aim of this controlled study is to investigate the effects of TBL on pediatric bedside teaching in medical students.

METHODS

Thirty medical students in pediatric clinical practice were randomly assigned to an intervention and a control group. Students in the intervention group exposed bedside teaching activity with TBL while students in the control group received traditional bedside teaching. Teaching for the two groups was conducted biweekly, and the same clinical cases were selected for both groups with the same instructors. After six months of clinical practice, the differences of learning outcomes between the two groups were compared through assessments by computer-based case simulations (CCS) and mini-Clinical Evaluation Exercise (mini-CEX). Student feedback following completion of bedside teaching was collected by questionnaire.

RESULTS

The CCS scores in the intervention group were significantly higher than that in the control group (p < 0.05). The mini-CEX results showed that clinical judgment and counseling skills of the intervention group were higher than those in the control group (p < 0.01). Medical interviewing skills and overall clinical competence in the intervention group were better than those in the control group (p < 0.05). In the questionnaire survey, students in the intervention group believed that bedside teaching activity with TBL could promote active learning ability, improve counseling skills and strengthen teamwork.

CONCLUSIONS

Application of TBL in bedside teaching not only enhanced clinical practice skills among medical students but also improved their clinical reasoning and counseling skills.

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.

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.

Team-Based Learning Among Health Care Professionals: A Systematic Review

Introduced in the 1970s to meet the academic needs of a growing number of students with relatively stagnant faculty, team-based learning (TBL) has revolutionized the modern classroom structure. Contrary to the traditional didactic model where the teacher assumes the central role and students are passive listeners, TBL participants are actively involved in the learning process. Teachers act as facilitators while the TBL participants work in groups to solve problems through engagement with their peers. The objective of the article is to conduct a systematic review on team-based learning using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

The studies were searched in databases like PubMed®, Scopus®, Embase®, and PubMed Central® using appropriate keywords. Two authors screened the papers, and a third author resolved the conflicts. This was followed by a bibliographic review based on the references of the selected study and bias assessment using the Joanna Briggs Institute (JBI) critical appraisal tool.

The team-based learning model is increasingly being used by different institutions globally. TBL and traditional lecture-based teaching outcomes revealed that TBL participants performed better in academic, clinical, and communication domains. In addition, TBL enhanced learners' engagement, collaborative spirit, and satisfaction. Our study results are similar to the prior meta-analysis and systematic review. Nevertheless, this systematic review remains more comprehensive, up-to-date, and inclusive thus far.

Team-based learning is a pragmatic and superior approach to learning among health care professionals. It has resulted in better academic, clinical, and communication outcomes. This finding spans all the medical and allied professions studied in this systematic review.

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.

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.

Lessons learned: Assessing team creation by personality inventories in pharmacy students

BACKGROUND

Proper team formation is critical for team performance and dynamics in the setting of team-based learning (TBL). Faculty should stratify students to ensure an even allocation of learner resources; however, the ideal method of team creation for TBL in pharmacy education has yet to be determined. A study aimed to assess team formation stratified by personality strengths on student performance for graded team activities, peer evaluations, and student perceptions of team dynamics compared to randomization of teams the previous semester with the same cohort. This Live and Learn piece will describe lessons learned throughout this project and research considerations for future studies on TBL team creation.

IMPACT

The study design compared team stratification by strengths vs. randomization, which resulted in similar distribution of CliftonStrengths domains with a variation of two teams between the semesters. Due to homogeneity in student strengths and negligible difference in purposeful team creation by strengths vs. randomization, the study was limited in its methodology and findings.

RECOMMENDATIONS

Through the description of this experience, the authors have outlined suggestions for designing studies to explore team creation methods, specifically capturing preliminary data, including a control group, and recognizing the influence of randomization.

DISCUSSION

Future studies to identify the optimal method for team formation may include alternate stratification approaches and should be performed over multiple cohorts from varying institutions. It is equally plausible that randomization consistently generates teams with equitable resource distribution and team formation has no overall impact on TBL effectiveness.

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.

Peer review in team-based learning: influencing feedback literacy

BACKGROUND

Peer review in Team-based learning (TBL) exists for three key reasons: to promote reflection on individual behaviours; provide opportunities to develop professional skills; and prevent 'free riders' who fail to contribute effectively to team discussions. A well-developed process that engages students is needed. However, evidence suggests it remains a difficult task to effectively incorporate into TBL. The purpose of this study was to assess medical students' ability to provide written feedback to their peers in TBL, and to explore students' perception of the process, using the conceptual framework of Biggs '3P model'.

METHODS

Year 2 students (n = 255) participated in peer review twice during 2019. We evaluated the quality of feedback using a theoretically derived rubric, and undertook a qualitative analysis of focus group data to seek explanations for feedback behaviors.

RESULTS

Students demonstrated reasonable ability to provide positive feedback, but were less prepared to identify areas for improvement. Their ability did not improve over time, and was influenced by the perceived task difficulty; social discomfort; and sense of responsibility in providing written feedback.

CONCLUSIONS

To increase student engagement, we require a transparent process that incorporates verbal feedback and team discussion, with monitoring of outcomes by faculty and adequate training.

Effectiveness of a Team-Based Learning exercise in the learning outcomes of a medical pharmacology course: insight from struggling students

We have previously reported that multiple Team-Based Learning (TBL™) exercises in a 4-week pre-clinical medical school course improved final exam performance and significantly reduced the number of course failures. Here, we conducted a long-term study, with eight cohorts of first-year medical students, to determine whether the implementation of a single TBL individual readiness assessment test (iRAT) exercise in a 4-week medical school pharmacology course produces similar effects in overall course performance. We implemented a single TBL iRAT exercise that covered the subjects addressed during one week of the medical pharmacology course, with the four most recent cohorts of students matriculating at Cooper Medical School of Rowan University (n = 403). The first four cohorts matriculating at CMSRU did not participate in the TBL exercises (n = 266). Correlation of individual student TBL iRAT and final examination scores in the medical pharmacology course was compared to a second, unrelated first-year course (physiology) to control for variation in student performance between cohorts. We found that there was a significant moderate correlation between final examination and TBL iRAT scores (r = 0.49, p < 0.01, n = 403). Interestingly this moderate correlation was seen in students performing in the lower 25^th percentile on the course final examination (r = 0.41, p < 0.01, n = 101) and negligible in students performing in the upper 25^th percentile (r = 0.11, n = 101, p > 0.05). Implementation of the single TBL exercise also significantly reduced variance or range of student final examination performance compared to the group of the first four cohorts. These results suggest that implementation of a single TBL exercise, which covers only one week of content delivered in a 1-month medical pharmacology course, benefits first-year medical students by reducing the disparity in knowledge acquisition among them and providing a means to identify students who may struggle with course content.

Applying team-based learning in a transnational post registration bachelor of nursing program in Singapore

Background

Team-Based Learning (TBL) is growing in popularity as a method to create active learning within larger group lectures. It is facilitated through phases of individual work, teamwork with immediate feedback and an application exercise, to develop students’ understanding and assessment of conceptual knowledge. A single facilitator can manage many groups within larger lectures. The study aim was to evaluate the impact of TBL on the engagement, learning and satisfaction of students enrolled in a transnational post registration Bachelor of Nursing (BN) program in Singapore.

Methods

A cross-sectional design was employed. The TBL approach was delivered during lecture sessions within a post registration BN program delivered in a Higher Education Institution in Singapore. A sample of BN students was drawn from 305 students undertaking the program. An online anonymous university-delivered student evaluation of course (SEC) survey and an online anonymous survey using the Student Assessment Instrument, were used to collect quantitative and qualitative data. Survey participation was voluntary with informed consent protocols followed. Student performance in the course was also reviewed.

Results

Eighty-two students (27%) completed the SEC scoring a median of 4/5 for satisfaction, and 68 (22%) completed the online survey. As 93 was the neutral score for the survey, there was a moderately positive evaluation with an overall score of 108.5/155 for TBL in accountability for learning, TBL preference and satisfaction with TBL compared to traditional lecture approaches.

Conclusions

Implementation of TBL with this cohort demonstrated evidence of moderately positive engagement, learning and satisfaction when compared to traditional didactic lectures.

Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL)

BACKGROUND

Two established small-group learning paradigms in medical education include Case-based learning (CBL) and Team-based learning (TBL). Characteristics common to both pedagogies include the use of an authentic clinical case, active small-group learning, activation of existing knowledge and application of newly acquired knowledge. However, there are also variances between the two teaching methods, and a paucity of studies that consider how these approaches fit with curriculum design principles. In this paper we explore student and facilitator perceptions of the two teaching methods within a medical curriculum, using Experience based learning (ExBL) as a conceptual lens.

METHODS

A total of 34/255 (13%) Year 2 medical students completed four CBLs during the 2019 Renal and Urology teaching block, concurrent to their usual curriculum activities, which included weekly TBLs. Questionnaires were distributed to all students (n = 34) and CBL facilitators (n = 13). In addition, all students were invited to attend focus groups. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

In total, 23/34 (71%) of students and 11/13 (85%) of facilitators completed the questionnaires. Twelve students (35%) participated in focus groups. Findings indicate their experience in CBL to be positive, with many favourable aspects that built on and complemented their TBL experience that provided an emphasis on the basic sciences. The learning environment was enriched by the CBL framework that allowed application of knowledge to solve clinical problems within the small groups with consistent facilitator guidance and feedback, their capacity to focus discussion, and associated efficiencies in learning.

CONCLUSION

While the TBL model was integral in developing students' knowledge and understanding of basic science concepts, the CBL model was integral in developing students' clinical reasoning skills. The strengths of CBL relative to TBL included the development of authentic clinical reasoning skills and guided facilitation of small group discussion. Our findings suggest that delivery of a medical curriculum may be enhanced through increased vertical integration, applying TBL in earlier phases of the medical program where the focus is on basic science principles, with CBL becoming more relevant as students move towards clinical immersion.

The Use of Virtual Reality Echocardiography in Medical Education

Virtual reality (VR) is a relatively new technology that allows an individual to experience a virtual world. This new immersive video type may be of particular usefulness in procedure-based healthcare settings. We hypothesized that VR echocardiography was non-inferior to live demonstration. Our aim was to assess the usefulness of a VR echocardiographic approach in teaching echocardiography to pediatric trainees compared to live demonstration. This was a single center, cross-sectional observational design. We used a Garmin VIRB® 360 and a head-mount display to record live echocardiography exams in a pediatric population. An Oculus Go™ was used to view the 360° immersive/VR videos. Trainees responded to a written questionnaire afterwards. Fifteen trainees participated in the study, each of whom had previously seen echocardiography through live demonstration teaching. Eleven respondents had previous hands-on echocardiography experience. All 15 participants confirmed that VR echocardiography is a useful teaching tool with 87% (n = 13) rating it as good or very good on a 5-point Likert scale. When asked to compare VR to live demonstration, 67% (n = 10) rated VR echocardiography as the same or better than live demonstration. One of the participants reported a side effect, namely mild and self-resolving dizziness. VR echocardiography is a safe, inexpensive and practical way for trainees to learn echocardiography. The addition of VR echocardiography to the arsenal of teaching tools may enrich the learning experience for trainees.

Exploring the feasibility of using very short answer questions (VSAQs) in team-based learning (TBL)

BACKGROUND

Team-based learning (TBL) currently relies on single best answer questions (SBAQs) to provide immediate feedback. Very short answer questions (VSAQs) are a reliable and discriminatory alternative that encourage learners to use more authentic clinical reasoning strategies compared to SBAQs. However, the challenge of marking VSAQs has limited their integration into TBL; we therefore explored the feasibility of VSAQs within a TBL session.

METHODS

An online platform was developed to allow immediate marking of VSAQs during the TBL sessions. As part of the readiness assurance process, students completed VSAQs and SBAQs, which were marked in real time.

RESULTS

Instructors were able to mark all VSAQs during the individual readiness assurance test (iRAT), which facilitated the provision of immediate feedback during the team readiness assurance test (tRAT). The mean time to mark five VSAQs was 422 seconds (SD 73 seconds). For VSAQs, the number of attempts to reach the correct answer ranged from 1 to 38, compared to 1 to 4 for SBAQs. In total, 71.6% of students agreed that using VSAQs in TBL helped to emphasise group discussions.

DISCUSSION

The wide range of attempts at, and students' perspectives of VSAQs are suggestive of their positive impact on student discussion during TBL. We demonstrate how new technology allows VSAQs to be feasibly integrated into TBL with the potential to enrich group discussions.

A Novel Team-Based Learning Approach for an Internal Medicine Residency: Medication-Assisted Treatments for Substance Use Disorders

INTRODUCTION

It is estimated that approximately one-tenth of the US population suffers from substance use disorders (SUD), a problem that is compounded when one considers the impact that drug addiction could have on treatment outcomes for many other chronic diseases. Thus, addiction medicine has become an important component of many successful urban primary care practices and residencies across the country. Our program sought to improve the confidence of our residents in managing SUD by instituting a team-based learning (TBL) activity that focused on the diagnosis and medication-assisted treatment of these illnesses.

METHODS

The class of 80 internal medicine residents were divided into groups of approximately 16 residents, and during the TBL sessions further divided into teams of three to four. Each TBL session consisted of an individual readiness assurance test, a group discussion of the correct answers, and a PowerPoint-based team application activity. Surveys were conducted for each group to assess the residents' attitudes after completing the activity.

RESULTS

Of residents, 69 of 80 completed the survey. The response to the TBL exercise was overwhelmingly positive, with most residents in agreement that the activity increased their knowledge and confidence in diagnosing and treating patients with SUD.

DISCUSSION

Overall, this TBL activity was well received by the residents and subjectively increased their competence in managing patients with SUD. In addition, our modification to the traditional TBL format suggested that the theories and spirit behind TBL can be successfully adapted to meet the challenges and intricacies of internal medicine residency education.

Team-based learning student assessment instrument (TBL-SAI) for assessing students acceptance of TBL in a Saudi medical school. Psychometric analysis and differences by academic year

OBJECTIVES

To assess psychometric properties of team-based learning student assessment instrument (TBL-SAI) and TBL acceptance by student academic year.

METHODS

A cross-sectional study was conducted at College of Medicine, University of Bisha, Bisha, Saudi Arabia, between February and May 2018. Students (n=109) from second- to fourth-year were scored on TBL-SAI scale (33-items). Principal axis factoring with varimax rotation was conducted on the scale to identify the emerged factors. Cronbach's alpha, item-total correlation were used to check the reliability and validity of the instrument.

RESULTS

Cronbach's alpha for the total scale was 0.798. The means scores of TBL-SAI scale and each subscale was favorable. On factoring analysis, 27-items of revised TBL-SAI scale were retained and 7 factors emerged. Factor 1 stands for TBL satisfaction; factors 2, 4, 5, 6 stand for TBL versus lecture preference, factors 3 and 7 stand for TBL accountability.  The scale was positively correlated with each TBL favor subscale, ranged between 0.328 and 0.756. Year-4 students scored higher (p less than 0.001) on TBL-SAI compared to year-2 or year-3 students.

CONCLUSIONS

The revised TBL-SAI is valid and reliable tool to measure the favor of TBL. Longitudinal studies across all academic levels are recommended to provide a clearer picture of the students' acceptance rate of TBL.

Team-based learning replaces problem-based learning at a large medical school

ABSRACT

BACKGROUND: With increased student numbers in the Sydney Medical Program, and concerns regarding standardisation across cohorts, student satisfaction of the problem-based learning (PBL) model had decreased in recent years. In 2017, Team-based learning (TBL) replaced PBL in Years 1 and 2 of the medical program. This study sought to explore students' perceptions of their experience of TBL, and to consider resource implications.

METHODS

In 2017, Years 1 and 2 medical students (n = 625) participated in weekly TBL sessions, with approximately 60 students per class, consisting of 11 teams of five or six students. Each class was facilitated by a consultant, a basic scientist and a medical registrar. Prior to each class, students were given pre-work, and completed an online Individual Readiness Assurance Test (IRAT). During face-to-face class, students completed the Team Readiness Assurance Test (TRAT), and received feedback with clarification from facilitators, followed by clinical problem-solving activities. Student feedback was collected by questionnaire, using closed and open-ended items. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

In total, 232/275 (84%) Year 1 and 258/350 (74%) Year 2 students responded to the questionnaire. Students found positive aspects of TBL included the small group dynamics, intra- and inter-team discussions, interactions with facilitators, provision of clinical contexts by clinicians, and the readiness assurance process. Suggested improvements included: better alignment of pre-reading tasks, shorter class time, increased opportunity for clinical reasoning, and additional feedback on the mechanistic flowchart. Resource efficiencies were identified, such as a reduction in the number of teaching sessions and required facilitators, and the ability to provide each classroom with clinical expertise.

CONCLUSIONS

Our findings demonstrate that TBL, as a replacement for PBL in Years 1 and 2 of the medical curriculum, provided a standardised approach to small group learning on a large scale, and also provided resource efficiencies. Students perceived benefits related to the active learning strategy of TBL that encourage individual learning, consolidation of knowledge, retrieval practice, peer discussion and feedback. However, improvements are needed in terms of better alignment of pre-reading tasks with the TBL patient case, and greater facilitator interaction during the problem-solving activities. Additionally, consideration should be given to reducing class time, and providing TRAT scores.

Team-based learning: design, facilitation and participation

Team-based learning (TBL) provides an active, structured form of small group learning, that can be applied to large classes. Student accountability is achieved through the specific steps of TBL, including pre-class preparation, readiness assurance testing, problem-solving activities, and immediate feedback. Globally, a growing number of healthcare faculties have adopted TBL in a variety of combinations, across diverse settings and content areas. This paper provides a succinct overview of TBL and guidance for teachers towards successful design and implementation of TBL within health professional education. It also offers guidance for students participating in TBL. The paper is informed by both educational theory, and the extensive, seven year experience of the first and last authors in designing, implementing, facilitating and evaluating TBL at a large medical school.

Facilitating small group learning in the health professions

There is now good evidence that small group teaching provides a fruitful academic environment, which optimises learning, particularly in the healthcare setting, and especially when compared to lectures. An individual student's understanding of knowledge is increased when they are able to actively compare and build on their own understanding in conjunction with their peers. Small group teaching provides opportunities for learners to work collaboratively, and promotes team-building skills - skills that are essential to work within healthcare settings. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and tips to improve learner engagement when facilitating small groups.

Leadership in healthcare education

Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Planning, preparing and structuring a small group teaching session

A structured approach is critical to the success of any small group teaching session; preparation and planning are key elements in ensuring the session is systematic and effective. Learning activities guide and engage students towards the achievement of agreed learning outcomes. This paper introduces the central concepts of planning and preparing a small group teaching session. It provides an overview of key theoretical principles in lesson planning, delivery, and how to provide effective feedback in this setting.

Use of End-of-Class Quizzes to Promote Pharmacy Student Self-Reflection, Motivate Students to Improve Study Habits, and to Improve Performance on Summative Examinations

Underperforming students are often unaware of deficiencies requiring improvement until after poor performance on summative exams. The goal of the current study was to determine whether inclusion of individual end-of-class formative quizzes, which comprise of higher level Bloom's questions, could encourage students to reflect on and address deficiencies and improve academic performance. Ninety-seven out of 123 first-year pharmacy students (79%) enrolled in a Biochemistry and Cell & Molecular Biology course participated in a single-blinded, randomized, controlled, crossover study. Paired t-test analyses demonstrated that that implementation of individual end-of-class formative quizzes resulted in significantly higher summative exam scores for below average students (p = 0.029). Notably, inclusion of quizzes significantly improved performance on higher Bloom's questions for these students (p = 0.006). Analysis of surveys completed by students prior to summative exam indicate that the formative end-of-class quizzes helped students identify deficiencies (89%) and making them feel compelled to study more (83%) and attend review sessions (61%). Many students indicated that quizzes increased stress levels (45%). Our collective data indicate that quizzes can improve summative exam performance for below average first year pharmacy students, and improve self-reflection and student motivation to study. However, the impact on student stress levels should be considered.

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.

Factors That Determine the Perceived Effectiveness of Peer Feedback in Collaborative Learning: a Mixed Methods Design

INTRODUCTION

Peer assessment has been promoted as a valuable approach to formative assessment to support learning and peer professionalism. This mixed methods study employed a conceptual framework to explore the factors that enhance the perceived effectiveness of formative peer assessment in the context of team-based learning as a form of collaborative learning.

MATERIALS AND METHODS

The volume and quality of written peer comments of two medical school classes at three time points were analyzed. Focus groups were then conducted to clarify issues that appeared in the quantitative data and to explore other emerging dimensions.

RESULTS

There was a notable deficiency in both the volume and quality of the comments provided, with no improvement over time. Several factors were identified, including some that are logistical and operational and can be corrected easily, such as the timing of the assignments. Others that stood out as major substantive issues and/or limitations related to the students' conceptions of the purpose of the peer assessment and to their interpersonal variables.

DISCUSSION

There were social disincentives for students to provide constructive feedback to peers with whom a continuing working relationship is necessary. There was also an inconsistency between the quality of the peer feedback being typically shallow and lacking in substance, and students considering it beneficial.

CONCLUSION

The findings identify factors that need to be addressed in order to ensure the quality and effectiveness of formative peer assessment among medical students.

Student Characteristics Associated with Passing the Exam in Undergraduate Pharmacology Courses-a Cross-sectional Study in Six University Degree Programs

Adequate knowledge in pharmacology is crucial in many professions but a non-negligible proportion of students fail the exams and knowledge of underlying factors is largely lacking. This study was performed to evaluate to what extent various factors are related to student performance in pharmacology-related courses in higher education, linking administrative data to attendance at non-mandatory teaching sessions and questionnaire replies. A total of 596 students (median age: 22 years; 70% female) were included from eight courses which are part of either the medical, pharmacy, dentistry, nursing, or biomedical analyst degree programs at the Sahlgrenska Academy, Gothenburg, Sweden. In all, 380 (64%) students passed the regular program- and course-specific exam. Multivariate logistic regression analysis revealed that a high participation rate in non-mandatory teaching sessions, as well as a perceived great interest in pharmacology, was associated with students' passing of the exam; adjusted odds ratio (95% confidence interval): 1.30 (1.19 to 1.42; per 10 percentage unit increase in attendance) and 3.38 (1.86 to 6.12), respectively. Working for wages during the course weeks and pre-university grades used in the program application were significant factors in subgroups of students, negatively and positively associated with the exam results, respectively. Age, having Swedish as a second language, and time spent studying were only associated with the exam result in the univariate analyses. To conclude, both students and teachers can contribute significantly to successful education within pharmacology, students by participating in the teaching sessions and teachers by encouraging students to find the subject interesting.

A meta-analysis of students' readiness assurance test performance with team-based learning

BACKGROUND

Team-based learning (TBL) is increasingly being utilized across medical fields by engaging students in small group discussions. The readiness assurance test (RAT) is an essential feature that differentiates TBL from problem-based learning (PBL) activity sequences. No publication has discussed differences in the RAT in TBL in medical schools. The purpose of this meta-analysis study was to examine the performance of learners in terms of group RAT (GRAT) and individual RAT (IRAT) scores in TBL for students of healthcare professions.

METHODS

Databases, including PubMed and Cochrane were searched using several terms. We assessed the quality of included studies and conducted a meta-analysis.

RESULTS

In total, 11 studies with 1575 participants were identified. Quality assessment scores of these studies ranged 4 ~ 7. Mean GRAT scores were significantly higher than mean IRAT scores (standardized mean difference (SMD) = 2.027, 95% confidence interval (CI) = 1.657 ~ 2.486, p heterogeneity < 0.001). Although the test of subgroup differences was insignificant (p = 0.113), the nursing-only subgroup showed much better performance in the GRAT than the IRAT (SMD = 2.3CI: 95% CI = 2.0 ~ 2.6, I² = 48.77%) compared to the others subgroup which included students from different majors. The subgroup analysis explained the heterogeneity in the overall analysis. Because of inadequate information from these 11 studies, a meta-regression could not explore the source of heterogeneity in terms of the mean age, duration of the intervention, preparation time before the RAT, and previous TBL experienced by students.

CONCLUSIONS

Students achieved significantly higher scores for the GRAT than for the IRAT, especially the group which only included nursing students, which implies excellent collaboration in the group of nursing students.

Impact of a case-based collaborative learning curriculum on knowledge and learning preferences of dermatology residents

Objective

Case-based collaborative learning (CBCL) models that incorporate learner-guided content review, structured preparatory assessment, and interactive case-based classroom sessions have been shown to promote content mastery among medical students. However, limited research has explored the viability of CBCL in resident populations, particularly in dermatology. We therefore sought to investigate the impact of a CBCL curriculum covering complex medical dermatology topics on resident knowledge and learning preferences.

Methods

This prospective cohort study included dermatology and combined internal medicine-dermatology resident trainees of all levels (postgraduate years 2–5) in a single residency program in Boston, Massachusetts. Four CBCL sessions covering complex medical dermatology topics were delivered to program residents between March and April 2019. Preparatory material for each session included a 20-minute concept video and a multiple-choice readiness assessment. During the sessions, residents applied their nascent understanding to newly introduced clinical vignettes and cases covering the preassigned materials. To assess knowledge and learner preferences, 15-question surveys were administered before and immediately after curriculum delivery. Changes in knowledge and learner preferences were determined using Student t tests to compare means and χ² tests to compare proportions.

Results

Of the 30 residents, 29 (96.7%) completed the precurriculum survey and 17 (56.7%) completed the postcurriculum survey. Mean content scores improved significantly (p < .01) from presession (x̅ 5.70; σ 1.88) to postsession (x̅ 9.71; σ 1.88). The majority of respondents indicated a preference for future CBCL sessions, with learning preferences remaining stable over time.

Conclusion

In this single-center prospective cohort study, resident knowledge improved significantly after CBCL curriculum delivery. Most resident learners viewed the curriculum as worthwhile and preferred it to traditional lecture-based didactics. Collectively, our findings suggest that CBCL models can be feasibly implemented and durably convey complex content to resident learners.