Team-based learning in large enrollment classes

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.

Interactive audio human organ model combined with team-based learning improves the motivation and performance of nursing students in learning anatomy and physiology

Among the basic medical sciences, anatomy and physiology (anatomy & physiology) is a fundamental subject for students majoring in nursing. Due to its diversity and difficulty, nursing students experience stress when studying it. Previous graduates generally presented lower achievements in anatomy & physiology than in other nursing-related subjects in the National Council Licensure Examination-Registered Nurse, indicating that anatomy & physiology education requires improvement. Accordingly, we examined the impact of innovative teaching on students' motivation and performance when learning anatomy & physiology through a quasi-experimental pre-/post-test design. For innovative teaching, we used the novel interactive audio human organ model, followed by team-based learning. The participants were 200 lower-grade students in the nursing department of a junior college in Taiwan, divided into two groups receiving innovative teaching (experimental group) or traditional teaching (control group). Questionnaire surveys were administered, and the collected data were statistically analyzed. The innovative teaching in anatomy & physiology improved learning motivation, especially in terms of affect, executive volition, and learning performance. The essential components of learning motivation, such as value, expectation, affect, and executive volition, were positively correlated with the reaction levels of learning performance. Regarding the improvement in academic performance, the experimental group performed significantly better than the control group. The use of innovative teaching in class enhances students' learning motivation and learning performance when studying anatomy & physiology. Interactive teaching aids enhance the enjoyment of learning anatomy & physiology while facilitating in-depth exploration of the human organs and systems.

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.

LecturePlus: a learner-centered teaching method to promote deep learning

A new teaching format, the LecturePlus, was formulated as a lecture followed by small-group learning activities. This study assessed the effectiveness of LecturePlus in medical education. An interventional study was conducted among final-year medical students, with 74 students in the experimental group and 96 students in the control group. Each LecturePlus lasted ∼1 h and was conducted with 12-18 students. A LecturePlus session comprised of a lecture followed by small-group problem-solving exercises. The exercises were clinical cases with open-ended short-answer questions. Students were divided into groups of three (triads) for these exercises. A faculty tutor assisted the small groups as needed. Closure was achieved through a discussion moderated by the tutor. Learning outcomes were assessed via the National Board of Medical Examiners (NBME) subject scores and compared with those of the preceding academic year. An additional multiple-choice question (MCQ) test was administered before and after the clerkship. The MCQ test showed improvement in knowledge application (P < 0.001, partial eta squared = 0.42). There was a statistically significant improvement in adjusted NBME scores among female students (74.8 vs. 71.8; P = 0.017) but not among male students. An anonymous written questionnaire survey showed high ratings for LecturePlus (95% selecting yes or partly yes to overall satisfaction). LecturePlus is an instructional strategy that integrates a lecture with learning activities. It can be scaled to large class sizes facilitated by one teacher. By combining didactic teaching with problem-solving, this new instructional strategy may foster application of knowledge.NEW & NOTEWORTHY We developed a new structured teaching format, the LecturePlus, to promote deep learning. A LecturePlus session consists of a brief lecture, followed by small-group problem-solving exercises, ending with a closing discussion moderated by the teacher. During the small-group exercises, students were divided into groups of three (triads) and given case-based problems. One faculty tutor supervised the entire session. LecturePlus resulted in improved learning outcomes and was rated highly by medical students.

A metacognitive confidence calibration (MCC) tool to help medical students scaffold diagnostic reasoning in decision-making during high-fidelity patient simulations

The purpose of this study was to 1) help novice students scaffold problem-solving and engage safely in the deliberate practice of diagnostic reasoning and medical decision-making in real time; 2) assess how accurately students gather and apply data in medical reasoning and treatment during high-fidelity patient simulations (HFPSs); 3) identify students' scientific misconceptions related to the case; 4) promote student metacognitive processing, self-assessment, and self-efficacy; and 5) facilitate the explicit calibration of student confidence in deliberate reasoning with patient outcomes. In a mixed-method design, a metacognitive calibration self-assessing (MCC) survey tool was applied to HFPS (n = 80, 20 teams of 6 medical students) and semistructured interviews were conducted with faculty (n = 5). When scored by faculty with a rubric, the mean student accuracy ranged from 23% to 74%, whereas their self-assessment of confidence ranged from 71% to 86%. This result revealed overconfidence bias in novice students regarding the correctness of their wrong responses. The most common misconception identified was inverting cause and effect: metabolic acidosis was pointed to as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus. The most common treatment error was overtreatment, with unnecessary added medication. Interviews with faculty suggested that the MCC tool improved the team process by slowing students down, requiring them to think through their answers, and that overall the tool improved their critical thinking. This study demonstrated the feasibility of using a metacognitive confidence calibration tool to assist novice students in learning safely to make deliberate diagnostic reasoning and decisions on patient care in real time during complex simulations while observing objectively their levels of psychological confidence against patient outcomes.NEW & NOTEWORTHY This study demonstrates the feasibility of a metacognitive confidence calibration tool (MCC) to assess and promote novices in the learning of diagnostic reasoning and treatment decisions on patient care in real time during high-fidelity patient simulations while comparing confidence and accuracy data and identifying students' scientific misconceptions. Results revealed the presence of overconfidence bias, overtreatment, and the misconception of metabolic acidosis as the cause of the patient's problems rather than a consequence of untreated diabetes mellitus.

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

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

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.

Improving team dynamics for project based learning in pharmacy: A multimodal approach

BACKGROUND AND PURPOSE

Students taking a research elective with project-based course components have shown aversion to group activities. We aimed to minimize group participation hesitancy and give students autonomy in choice of team formation approach in order to examine the effects of team formation approaches on successful team dynamics.

EDUCATIONAL ACTIVITY AND SETTING

Learners chose either a student self-selected (SS) or an instructor randomized (IR) team formation approach for two activities (a brief intervention role-play and a review of reviews research symposia presentation). Group development for the different team approaches was studied using the Tuckman model. Using this model, team dynamics was evaluated over five stages of group development: forming, norming, storming, performing, and adjourning. Student reports for each of the phases were evaluated using a project evaluation rubric. For the adjourning phase we used an open-ended survey embedded in the course learning management system. Free text answers from open-ended questions were analyzed for themes related to team dynamics concepts.

FINDINGS

Students rated their satisfaction with team performance higher for SS than for IR teams. In terms of individual learning and satisfaction with individual's roles and tasks, they indicated greater satisfaction with the IR approach.

SUMMARY

Team formation methods impacted group dynamics and individual attitudes with favorable team dynamics leading to better individual task and overall team performance. Higher team performance corresponds to higher grades for group projects and for courses with group projects, favorable team dynamics could impact students' evaluation of the course.

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.

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.

Combined effect of different teaching strategies on student performance in a large-enrollment undergraduate health sciences course

Students' course performance is fundamental for any institution to carry out its academic mission. Often, in-class disengagement and lack of after-class course support in large-enrollment classes trigger academic problems for students. This leads to poor exam performance and an increased rate of final letter grade of a D or F or student withdrawal (DFW), an indicator of students' poor academic success. Changing teaching strategies by using interventions that incorporate student-student interaction and student-faculty interaction may offer the opportunity to improve course performance. In this retrospective study, we examined the effect of changing teaching strategies on student course performance of 5,553 students enrolled in an undergraduate health sciences course over a span of 20 semesters. Three different interventions namely 1) daily low-stake in-class quizzes, 2) team-based learning, and 3) after-class review sessions were incorporated as teaching strategies. To assess the combined effect of these strategies' students' performance in the intervention period (12 semesters) was compared with control period (8 semesters). Student performance in the course was measured by exam grades; overall score; percentage of students receiving letter grades and A, B, C; and DFW rates. The data indicated that in the intervention period, exam scores increased by 6.6%, overall course score increased by 6.2%, percentage of students receiving letter grade A/B increased by 21.3%, percentage of students receiving letter grade C decreased by 6.9%, and the DFW rates decreased by 14.5%. Overall, changing teaching strategies through incorporation of these interventions improved students' performance in the course.

Evaluation of Team-Based Learning to Increase Nurses' Knowledge of the Ventricular Assist Device

Ventricular assist devices (VAD) are used to extend life expectancy for patients with advanced heart failure. Approximately 102 hospitals nationwide have a VAD program, but the majority implant only a small number of devices each year. This low-volume and high-acuity patient population can create concerns for maintaining nursing knowledge skill levels. Nursing staff from a step-down telemetry floor in a large urban hospital completed an Individual Readiness Assessment Test to assess their knowledge and accuracy in the care of mechanical circulatory support patients using the Immediate Feedback Assessment Technique. The nurses were then assigned to small groups and worked as a team to complete the same test known as the Group Readiness Assessment Test. Study results suggest that team-based learning was effective in increasing knowledge of mechanical circulatory support. [J Contin Educ Nurs. 2021;52(1):13-20.].

Effective Large Group Teaching for General Surgery

Large group settings display no signs of disappearing. Most surgeons charged with this education have received no formal training. Lecturing remains the most common method of educating large groups. Even though factors required for an excellent lecture are known, their inconsistent application results in variation of effectiveness. Long-standing principles of rhetoric and recent advances in neuroscience, cognitive science, learning models, and teaching theory play a role in achieving effectiveness. This article makes recommendations for creating and delivering lectures, including active learning opportunities and modern innovations in information technology supporting teaching methods. Effective lecturing skills are acquired by persistent deliberate practice.

Knowledge of and attitudes to occupational and sports medicine among medical students in Zagreb, Croatia

Occupational and sports medicine (OSM) education is poorly represented in Croatian university undergraduate medical curricula. Zagreb University medical students are required to take OSM classes for a week on their final year of studies. The classes are organised around team-based learning (TBL). Given that students who attend TBL classes have significantly higher exam scores than students who take lectures ex cathedra, the aim of this study was to assess students’ knowledge and attitudes immediately after TBL OSM classes. This cross-sectional study included 162 final-year Zagreb University School of Medicine students taking TBL classes in OSM in the academic year of 2019/2020. They were recruited from 30 September 2019 to 4 March 2020. Participants filled in a 20-item questionnaire compiled by the authors and adapted to the Croatian legislation. Their answers demonstrated positive attitude toward OSM classes and negative attitude toward occupational medicine practice and OSM specialty. They showed moderate interest only for the job of sports physician. Even though they showed sufficient knowledge of OSM immediately after the course was completed, they were moderately satisfied with their knowledge. Our findings call for rethinking the practical aspects of teaching OSM classes in order to promote OSM practice among medical students or at least raise awareness about the importance of prevention of numerous work or sport-related disorders.

Team-based, problem-solving exercises using studies of diarrhea and oral rehydration encourage students to integrate knowledge of systems physiology

We describe an inquiry activity that aims to develop students' ability to interpret findings that span whole body systems and so encourage the integration of knowledge. The scenario we choose was the physiological challenge posed by diarrhea and the physiological mechanisms that underpin oral rehydration therapy. Before the staff-facilitated inquiry activity, students engage with an online information resource and complete a formative, but mandatory, prelaboratory quiz. These tasks encourage students to develop some mastery of the relevant physiology before the timetabled inquiry activity. The 3-h inquiry activity is driven by a paper workbook containing data from published studies, mainly from veterinary physiology, of the various consequences of diarrhea. Figures from published data are arranged so that, initially, the impact of dehydration on a single system (the cardiovascular system) could be appreciated. Integration with other systems (respiratory and renal systems) is then introduced progressively through the activity. The exercise is designed as a team-based inquiry activity that emphasizes the value of discussion to identify appropriate features for interpretation of the data. Students are obliged to complete a postlaboratory quiz within 5 days of the inquiry activity, serving to consolidate the students' learning and provide staff with feedback on the attainment of intended learning outcomes. Marks from formative pre- and postlaboratory quizzes typically have a median mark in excess of 80% (pass mark is 50%), and qualitative feedback suggests that the majority of students recognized the value of the activity, despite simultaneously reporting that it was intellectually demanding.

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.

Implementation of flipped classroom combined with case- and team-based learning in residency training

The core problem of Chinese resident doctor training is that medical educators present content in an attractive teaching mode to make students more motivated to learn and improve their clinical thinking ability, humanistic care, and practical ability. The traditional classroom mode of teaching cannot meet the needs of modern medical education. The purpose of this study is to explore the benefits and challenges of the flipped classroom (FC) combined with case- and team-based learning (FC-CTBL) for residency training. In this study, 60 junior surgical residents of Xiangya Medical College were enrolled. "Diabetic foot" was selected as the content of this study. Residents were divided into an FC-CTBL group and an FC group. FC-CTBL and FC were compared on the basis of residents' feedback questionnaires, residents' learning burden, test scores from a pre-quiz, and objective structured clinical examinations (OSCE). Residents were more satisfied with the FC-CTBL model compared with FC. In the FC-CTBL group, more participants said that the course improved their teamwork skills, analytical skills and their confidence in tackling unfamiliar problems. Residents in the FC-CTBL group also spent significantly less time preparing for class and performed better in the OSCE than those in the FC group. FC-CTBL stimulates residents' learning motivation, decreases their workload, improves their performance in the OSCE and may help to enhance clinical thinking and teamwork skills. The FC-CTBL approach is a good option for residency training.

Impact of readiness assurance process and faculty feedback on individual application exercises: a model for continuous assessment in physiology

This study is aimed at the implementation of a continuous assessment model in physiology for a large-enrollment classroom with 250 students. The readiness assurance process (RAP) and immediate feedback elements from team-based learning (TBL) methodology were adopted to test their ability to guide students to solve applications exercises individually. Three continuous assessments in physiology (CAPs) were conducted with the RAP to include individual (iRAT) and group readiness assurance tests (gRAT). Immediate feedback was provided with faculty-student discussion (FSD), and the individual application exercises (iAE) were designed to be answered individually. Each CAP was subjected to three types of experimental manipulation in subgroups created out of 250 students. The intervention began with iRAT for all three subgroups. The sequence of iRAT, gRAT, FSD, and iAE varied between subgroups within a CAP. In a cross-over study design, each subgroup of students was subjected to all three intervention types over three CAPs. The subgroup completing iAE after RAP and FSD showed higher scores than the subgroup with RAP alone. One hundred eight-two students (82.35% response rate; 101 women and 81 men) responded to the questionnaire. The majority of students (87.4%) felt that doing iRAT and gRAT at the beginning helped them to solve iAE better. Most of the students (86.8%) responded that they received useful feedback and clarification during the discussion with the teacher after the gRAT. In conclusion, the administration of iRAT first followed by gRAT and immediate feedback from faculty seem to be beneficial to prepare students to tackle application-based exercises.

Engaging Pharmacy Students in Interactive Life-Based Situations as the Basis for Teaching a Biochemistry Course

Objectives

Undergraduate pharmacy students have neither sufficient training on analyzing the role of biochemistry in actual-life situations nor on its effect on both health and disease. Therefore, we conducted this study to link the biochemistry course with actual-life situations and to encourage students to search for biochemistry answers for the health problems they face.

Methods

Students were randomized into different groups of three to five students. Every week, a group was asked to search the Internet for the most prevalent disease in their area associated with the biochemistry title studied. The group was asked to have an open discussion was their colleagues about a hot topic in life that is related to this subject. Finally, the group was asked to dig into social media for a current event that grabbed their attention in relation to this subject and write a short paragraph beyond the details. This scenario was repeated weekly using different student groups. The students’ opinion was collected before the conduction of the course and the end of the semester.

Results

The post-course questionnaire showed good improvement in the students’ ability to communicate effectively, conduct independent work, participate in active discussion, and solve problems. Overall, the students’ satisfaction was significantly elevated.

Conclusions

We have promoted a method to engage undergraduate students in linking biochemistry theories with real-life situations instead of just memorizing them. The new method improves the students' perception of biochemistry courses. Finally, it provides a promise of a new active learning strategy for undergraduate pharmacy students, which can be used widely to motivate students.

Designing Cases for Case-Based Immunology Teaching in Large Medical School Classes

Case-based, interactive sessions for small groups (in a large medical school class of 150 students) reinforces basic immunology concepts by including clinical scenarios that stimulate student learning and consolidate critical concepts. Careful design of cases (designing backwards from the key concepts) leads students through successively more complicated and linked group-work questions. This paper details why cases are effective learning tools, how to design an effective case, how to ask appropriate questions and how to help students apply basic immunology concepts to a case. Each group work session is facilitated and followed by a question and answer presentation by faculty, where student groups are directly asked to answer the questions and also challenged with “bonus questions” not presented with the original case. This allows students to “put together” immunology information into a “story” that they can tell and prevents student frustration by summarizing the results at the end of each case. Case design is carefully discussed including clinical relevancy and accuracy, how to write questions that do not give away the answers, how to emphasize mechanistic questions that allow students to “clinically explain as a physician” the immunological basis for the answers. Additionally, students better understand the role of immunity in both normal and disease states. A case-based approach promotes student learning by re-emphasizing basic concepts in the context of the case and promotes better students understanding of critical immunological concepts.

Are Two Teachers Better than One? Team Teaching in TBL

Teaching the medical sciences using team-based learning (TBL) is a complex task, which requires knowledge of both the subject matter and pedagogy. To deal with these increased demands on the teacher, a strategy where every TBL session is co-taught by a Content Expert and a Facilitator was implemented. Twelve classroom sessions focusing on the interaction between these groups of teachers and their contribution in class were observed. There are quantitative and qualitative differences in the nature of the questions that they ask. The findings provide insight into how effective TBL sessions arise from complementary questioning strategies from these parties.

Using Modified Team-Based Learning to Teach Antimicrobial Stewardship to Medical Students: One Institution's Approach

Educational interventions are a critical feature of antimicrobial stewardship programs. Most of these interventions target practicing physicians whose prescribing habits are usually difficult to influence. Consequently, there has been increasing interest in familiarizing early learners with the principles of antimicrobial stewardship. However, there is limited data regarding the utility of active learning interventions, such as team-based learning (TBL), for this purpose. In this article, we report the results of a post-course survey eliciting the opinions of the 168 second year medical students who completed the first implementation of a modified TBL course on antimicrobial stewardship. The course consisted of two 120-min modules, each of which guided participant students through most of the characteristic stages of TBL. The post-course survey was analyzed using qualitative and quantitative methodologies. In general, students found the readiness assurance testing, application activity, and team dynamics of TBL effective and the webcasts, used for pre-class preparation, ineffective. This study offers a first glimpse into the attitudes of pre-clinical medical students toward TBL as a strategy for introducing antimicrobial stewardship. It can serve as a roadmap for educators contemplating the implementation of a similar program at their institution and as a launching pad for research on the effects of this type of intervention on physician prescribing habits.

Integration of Microbiology, Pharmacology, Immunology, and Infectious Disease Using Active Teaching and Self-Directed Learning

In an era of decreasing basic science curriculum at medical schools, we sought to re-imagine how to optimally deliver three core basic science disciplines (microbiology, pharmacology, and immunology) together with infectious disease in a 5-week course. This course, developed as part of a new 1-year pre-clinical basic science curriculum at the recently established Dell Medical School (DMS) at the University of Texas at Austin, featured a fully integrated curriculum in which the majority of the sessions were team-taught. This course, in line with the goals and missions of DMS, presented material using primarily self-directed and active learning approaches. Here, we describe the format and content of the course. We present our strategy and rationale for selecting these particular learning modalities and topics for pre-class and in-class coverage, using educational and cognitive psychology literature as a guide. We also discuss how, based on feedback from both student evaluations and performance data, the course evolved over the first two iterations.

Collaborative active learning: bioimpedance and anthropometry in higher education

Research in the health sciences devotes much attention to overweight and obesity and, consequently, to body composition. In recent years, traditional body measures have been questioned as efficient variables in health sciences due to the fact that they cannot give information about body fat mass. Our aim is to teach how to analyze body composition through anthropometry and bioelectrical impedance analysis to our "Physiology of Vegetative and Reproductive Functions" students, who are studying for their degree in Biology. We proposed project-oriented-learning to promote collaborative interactions among students. Fifty-two students voluntarily formed five groups; they worked with the concepts of basal metabolic rate and body composition from a theoretical point of view and later transformed these concepts into a practical perspective by preparing a manuscript in groups with objectives proposed by our teaching team. In this research, we show a collaborative educational scenario for university students in which students are tutored from a constructivist perspective to promote social interactions, resulting in new knowledge acquisition.

Multistation exercises: a combination of problem-based learning and team-based learning instructional design for large-enrollment classes

To introduce active learning session for a large group of 250 students, we combined the strengths of problem-based learning and team-based learning to promote a structured active learning strategy with less faculty involvement. For the implementation of this strategy, a case on anemia was selected based on the module already covered in classes. Structured exercises were preplanned on six different concepts that a student should possess for solving the problem. The large group of 250 students was divided into groups of 41 or 42 each. The groups were facilitated by one faculty member for one structured exercise. At the station, the group of 41 or 42 was further broken down into 6 smaller groups comprising 7 students each. After completion of the exercise, students cycled to the next exercise station facilitated by another faculty member. The case was solved in a plenary session. The effectiveness of the method was assessed by comparing the academic performance of the group with other similar groups from the previous year. The intervention group performed significantly better than the nonintervention group on the related item. Quartile subanalysis found that the effect was present in the performance of average and higher quartile groups, but not in the lower quartile group.

Sourcebook update: intestinal smooth muscle contractility and autonomic control

This laboratory practical requires first-year students to anticipate the effects of drugs active at cholinergic and adrenergic receptors on gut motility in order to design experiments during an authentic inquiry exercise. Rather than specifying a strict sequence of drug additions that aim to provide ideal demonstrations of pharmacological and physiological antagonism, I have instead designed switches into the drugs provided and set students, working in small teams, the task of identifying the switched drugs, an inquiry activity. To extend the teamwork aspect, laboratory reports were submitted by the student teams rather than individual students. Staff observed that discussions within the teams were stimulated by the inquiry-led nature of the practical. The quality of the laboratory reports submitted by teams were substantially improved over the individual reports submitted in previous years. (Students previously worked in teams, but simply followed a list of prescribed experiments and wrote individual reports.) Although, in conversation, teams of students had an improved understanding of the regulation of gut motility by the parasympathetic and sympathetic divisions of the autonomic nervous system and could readily distinguish between pharmacological and functional antagonism, no attempt was made to evaluate learning because the revision was triggered by the observed effect of a technical error and was not otherwise planned. It is likely that laboratory practicals, in general, would benefit from inclusion of inquiry.

Work station learning activities: a flexible and scalable instrument for integrating across basic subjects in biomedical education

BACKGROUND

Establishing innovative teaching programs in biomedical education involves dealing with several national and supra-national (i.e. European) regulations as well as with new pedagogical and demographic demands. We aimed to develop and validate a suitable instrument to integrate activities across preclinical years in all Health Science Degrees while meeting requirements of national quality agencies.

METHODS

The new approach was conceived at two different levels: first, we identified potentially integrative units from different fields according to national learning goals established for each preclinical year (national quality agency regulations). Secondly, we implemented a new instrument that combines active methodologies in Work Station Learning Activities (WSLA), using clinical scenarios as a guiding common thread to instruct students from an integrated perspective. We evaluated students' perception through a Likert-type survey of a total of 118 students enrolled in the first year of the Bachelor's Degree in Medicine.

RESULTS

Our model of integrated activities through WSLA is feasible, scalable and manageable with large groups of students and a minimum number of instructors, two major limitations in many medical schools. Students' perception of WSLA was positive in overall terms. Seventy nine percent of participants stated that WSLA sessions were more useful than non-integrated activities. Eighty three percent confirmed that the WSLA methodology was effective at integrating concepts covered by different subjects.

CONCLUSIONS

The WSLA approach is a flexible and scalable instrument for moving towards integrated curricula, and it can be successfully adapted to teach basic subjects in preclinical years of Health Science degrees. WSLA can be applied to large groups of students in a variety of contexts or environments using clinical cases as connecting threads.

How do the Institutes on Teaching and Learning (ITLs) nurture the members of the Physiology Educators Community of Practice (PECOP)?

Do you teach physiology? Do you use best practices when you teach physiology? Have you ever thought about conducting educational research? Do you need collaborators to help with ideas for educational research or to expand your research populations? The American Physiological Society (APS) Teaching Section has developed a biennial Institute on Teaching and Learning (ITL) through the APS Conference Program to address these issues. The first institute was held in June 2014, and the second institute was held in June 2016. A Physiology Education Community of Practice (PECOP) was created to help connect the institute participants and other physiology educators and to share evidence-based teaching in physiology at all education levels. The 2018 APS ITL will be the next meeting to learn best practices, to share ideas with colleagues, and to find collaborators in improving the teaching of physiology for students. The meeting will include workshops modeling best practices, plenary talks about hot new issues in physiology and science education, and poster sessions and informal meals to discuss interests with colleagues. Even if one's primary responsibility is bench research or administration, the training from the institute will improve efficiency and effectiveness when teaching. The two prior ITLs (2014 and 2016) were highly evaluated by educators of both undergraduate and professional students who spent a week together emphasizing improvement in their teaching. This paper reports the outcomes of the 2016 ITL and encourages participation in the upcoming ITL in Madison, WI, June 18-22, 2018. Watch the APS Conference site for more information about the 2018 ITL (http://www.the-aps.org/mm/Conferences/APS-Conferences).

Group Problem Solving in Class Improves Undergraduate Learning

Developing methods for improving student learning is a long-standing goal in undergraduate science education. However, the extent to which students working on problems in small groups versus individually results in improved learning among undergraduate science students has not been evaluated in a randomized controlled trial. We have performed such a trial with 80 students in an undergraduate biochemistry class, in which students were randomized to either learning in groups or learning individually. All students participated in the same class, which consisted of a lecture with periodic breaks for students to solve problems using an audience response system. Students in the individual learning condition answered these questions on their own, but students in the group-based learning condition answered these questions in an assigned group of four students. At the end of the class, all students then took the same exam as individuals. The exam had two types of questions-recall questions, in which students had to simply recall information provided to them, and predict questions, in which students had to apply their new knowledge to a new context. Students in the individual and group-based learning conditions performed similarly well on recall questions. However, students who had been in the group-based learning condition performed significantly better as individuals on the predict questions. This suggests that learning in groups may be more effective than individual learning for undergraduate science students, particularly for applying their knowledge to new contexts; this highlights the potential need for pedagogical approaches in undergraduate science courses that incorporate learning in groups.