A comparison of in-class learner engagement across lecture, problem-based learning, and team learning using the STROBE classroom observation tool

Short-term cognitive learning outcomes in team-based learning: is the permanent team important?

Assigning students to work in permanent teams is a design principle in Team-based learning (TBL). It has been assumed that a stable team composition supports the emergence of collaborative problem-solving and learning: when students became more familiar with each other, they shared more information and resolved discrepancies together, which in turn stimulated knowledge acquisition and comprehension. However, this assumption had not been probed by a randomized controlled trial with performance assessment as an outcome. In an online course for second term medical students, 50% of the students were reassigned to new teams for each of the 24 problems to be solved during four classes, thus precluding familiarity. The learning outcome was assessed shortly after the third of four classes by a domain knowledge test. Whether TBL teams were permanent or temporary did not affect the score of a domain knowledge test. As expected, participation in online TBL improved the domain knowledge test results. Overall, the permanent team seems to be less important for cognitive learning outcomes than previously assumed, but this may depend on the specific educational setting. However, team familiarity may still be important for team decision-making. As clinical reasoning in the medical workplace often involves collaborating in changing teams, future research on TBL should focus on how to utilize this format to prepare medical students for decision-making and optimal learning outcomes under these conditions.

Description of Medical Students' Behavioral, Cognitive, and Psychological Engagement with Faculty Online Teaching Styles

Purpose

The teacher-student dyad is the heart of an institute. A teacher's instructional role significantly influences the student engagement that indirectly measures the institutional outcome. The online transition of medical education changed the milieu of medical education where a virtual link between teacher and student is the only hope for the learner to continue the learning. There were no studies on the relationship between student engagement and teaching styles during online medical education.

Patients and Methods

The present study was an online survey-based descriptive study on medical undergraduates from two universities in the United Arab Emirates. Google forms containing consent statements, teaching styles inventory in higher education (TSIHE), and online student engagement questionnaires were emailed to all medical students requesting to participate in the study. Completed survey questionnaires were analyzed descriptively for the degree of student online engagement, and a chi-square test was used to correlate the relation between faculty online instructional methods and students' engagement.

Results

A total of 423 of 927 students from two universities participated in the survey. There was no significant perception difference among the students from the two universities regarding their faculty online teaching styles. Thirty-three percent of students at first university and 41% of second university students showed engagement during online classes, which is statistically significant. However, the degree of students' disengagement from both universities was high compared to their engagement for online classes. Both university students' cognitive and behavioral engagement was moderate to strongly correlated with four domains of teaching style. Interestingly, there was no correlation between online faculty instructional methods and students' psychological engagement from both the universities.

Conclusion

The present study establishes the relationship between students' cognitive and behavioral engagement and teaching instructional practices. However, there is a need to develop robust evidence on students' psychological engagement and the influencing factors during online and blended contexts.

A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education

Problem-based learning (PBL) is an instructional approach used in medical education that is characterized by solving problems in small groups with tutor guidance. More than 50 years since PBL's inception, many questions remain to be addressed about its processes and learning outcomes. The purpose of the study was to examine the bibliometric characteristics of the 100 most cited articles on PBL in medical education and to identify landmark papers that have made significant contributions to PBL research. Results were systematically reviewed for citation frequency, publication year, journal, article type, article focus, authors, author collaboration, and country collaboration. The number of citations ranged from 81 to 3531 times cited with 31,041 total citations. The articles were contributed by 211 authors in 23 journals and most articles (68%) were published in Medical Education, Academic Medicine, and Medical Teacher. The majority of the articles (71%) originated from Netherlands, Canada, and the United States and six prolific authors were identified. Almost half of the articles are classified as empirical research. Article foci included theoretical foundations of PBL, curriculum design, learning outcomes and processes, tutors, assessment, guides to PBL implementation, commentaries, and student well-being. The strong author and country collaborations indicate continued global interest in the PBL instructional method, which is likely to remain an active topic of research as the evidence of its effectiveness over traditional instructional methods as well as its most impactful components is inconclusive.

Construct validity of a questionnaire for measuring student engagement in problem-based learning tutorials

BACKGROUND

Student engagement is student investment of time and energy in academic and non-academic experiences that include learning, teaching, research, governance, and community activities. Although previous studies provided some evidence of measuring student engagement in PBL tutorials, there are no existing quantitative studies in which cognitive, behavioral, and emotional engagement of students in PBL tutorials is measured. Therefore, this study aims to develop and examine the construct validity of a questionnaire for measuring cognitive, behavioral, and emotional engagement of students in PBL tutorials.

METHODS

A 15-item questionnaire was developed guided by a previously published conceptual framework of student engagement. Focus group discussion (n = 12) with medical education experts was then conducted and the questionnaire was piloted with medical students. The questionnaire was then distributed to year 2 and 3 medical students (n = 176) in problem-based tutorial groups at the end of an integrated course, where PBL is the main strategy of learning. The validity of the internal structure of the questionnaire was tested by confirmatory factor analysis using structural equation modeling assuming five different models. Predictive validity evidence of the questionnaire was studied by examining the correlations between students' engagement and academic achievement.

RESULTS

Confirmatory factor analysis indicates a good fit between the measurement and structural model of an 11-item questionnaire composed of a three-factor structure: behavioral engagement (3 items), emotional engagement (4 items), and cognitive engagement (4 items). Models in which the three latent factors were considered semi-independent provided the best fit. The construct reliabilities of behavioral, cognitive, and emotional factors were 0.82, 0.82, and 0.76, respectively. We failed however to find significant relationships between academic achievement and engagement.

CONCLUSIONS

We found a strong evidence to support the construct validity of a three-factor structure of student engagement in PBL tutorial questionnaire. Further studies are required to test the validity of this instrument in other educational settings. The predictive validity is another area needing further scrutiny.

Student engagement in health professions education: AMEE Guide No. 152

This guide aims to support our colleagues to have comprehensive understanding of student engagement in health professions education. Despite the universal agreement about the significance of student engagement, there is lack of uniformity in conceptualizing and operationalizing this emerging construct. We review the theoretical basis explaining student engagement from three main perspectives: behavioral, psychological, and socio-cultural. In addition, we propose a contemporary and comprehensive framework for the student engagement in higher education, which is applicable to health professions education contexts. Drawing from this framework, we explain the conceptualization of the construct and its preceding factors, mediators, dimensions, spheres, and outcomes of student engagement. The proposed framework introduces student 'engagement through partnerships' as a novel component compared with the existing models of student engagement in higher education. This way, we are proposing a mixed model that not only considers the student as a 'customer' but also as a 'partner' in education. Engagement of students through partnerships include four areas: (1) provision of the education program, (2) scholarly research, (3) governance and quality assurance, and (4) community activities. This guide will provide practical applications on how to improve student engagement in health professions education. Finally, we highlight the current gaps in areas of research in the student engagement literature and suggested plans for future directions.[Box: see text].

Measurement of student engagement in health professions education: a review of literature

Student engagement is a complex multidimensional construct that has attained great interest in health professions education (HPE). Definition and conceptualization of student engagement is an important step that should drive the development of the instruments for its measurement. We have recently proposed a comprehensive framework for student engagement in HPE with a definition of engagement as student investment of time and energy in academic and non-academic experiences that include learning, teaching, research, governance, and community activities. The dimensions of student engagement in this framework included the cognitive, affective, behavioral, agentic, and socio-cultural. Guided by the student engagement framework, this non-systematic review aims to identify, critically appraise, and summarize the existing methods for measuring student engagement in HPE. Extrapolating from higher education literature, we attempted to link the theoretical perspectives of student engagement with the published methods of its measurement in HPE context. In addition, we have described the different methods of measuring student engagement including self-report surveys, real time measures, direct observation, interviews/focus groups, and the use of multiple instruments. The span of engagement dimensions measured by self-report surveys ranges from one to five dimensions. However, measurement of agentic and sociocultural dimensions of engagement in HPE is still limited and further research is required. We have also reflected on the existing methods of measuring engagement of students as active partners in HPE. The review also describes the advantages, limitations, and psychometric properties of each method for measuring student engagement. We ended the review with a guiding conclusion on how to develop and select an instrument for measuring student engagement in HPE. Finally, we addressed the gaps in the literature about measuring engagement of HPE students and future research plans.

EFL learners' engagement in online learning context: development and validation of potential measurement inventory

Research has proved learner engagement is a strong predictor of academic achievement, especially in the online learning environment. The lack of any reliable and valid instrument to measure this construct in the context of online education made the researchers of the current study develop and validate a potential measurement inventory to assess EFL learners' engagement in the online learning environment. For this purpose, a comprehensive review of the related literature and careful investigation of the existing instruments were carried out to find the theoretical constructs for learner engagement which led to the development of a 56-item Likert scale questionnaire. The newly developed questionnaire was piloted with 560 female and male EFL university students selected based on nonprobability convenience sampling. The results of the factor analysis indicated the reduction of items to 48 loaded on three main components, namely behavioral engagement (15 items), emotional engagement (16 items), and cognitive engagement (17 items). The results also revealed that the newly developed questionnaire enjoyed a reliability index of 0.925. The findings of the current study will undoubtedly help teaching practitioners assess EFL learners' engagement in the online learning context and make principled decisions when it comes to learners' engagement.

Student engagement in undergraduate medical education: A scoping review

INTRODUCTION

Student engagement is defined as behavioural, cognitive and emotional aspects of students' academic experience in teaching, learning and research through interacting with other students, faculty and community. Despite the growing interest in the field of student engagement, medical education research in this area is still fragmented. This scoping review aims to contribute to the understanding of measurements, drivers and outcomes of medical student engagement.

METHODS

The authors searched MEDLINE, PubMed, ProQuest, SCOPUS, ERIC, Science Direct and EBESCO for English articles published from 1990 until October 2021. In addition, we hand-searched key medical education journals and references in recently published articles. Using specific selection criteria, two authors independently reviewed the articles for eligibility, followed by data extraction using both quantitative and qualitative analysis.

RESULTS

Of the 2136 retrieved articles, 51 studies were selected for the review, and 94% of them were published in the past 8 years. The prevailing measures of student engagement failed to cover the multidimensionality of the construct with more focus on the behavioural dimension. Quantitative methods represented two thirds of the studies with a higher frequency of cross-sectional designs and using self-reports. The identified drivers of medical students' engagement are directed mainly to modifying the context of the learning environment. These factors increased student engagement by fostering relevance of learning, positive student relationships with peers and faculty, and enhancing student agency, and sense of competence. Cognitive engagement appears to be a positive predictor of academic achievement, but the relationship with other dimensions of engagement is controversial.

CONCLUSIONS

Student engagement in undergraduate medical education is an important, yet under-researched construct. The research that does exist suggests engagement to be malleable, something that can be modified by different types of interventions taking into consideration the context of education and practice. Further research is required, however, to address the gaps identified in this review.

Perceptions and behaviors of learner engagement with virtual educational platforms

Background

The COVID-19 pandemic has increased utilization of educational technology for surgical education. Our aim was to determine attitudes and behaviors of surgical education champions towards virtual educational platforms and learner engagement.

Methods

An electronic survey was distributed to all Association of Surgical Education members addressing i) methods of engagement in virtual learning ii) ways to improve engagement and iii) what influences engagement. Stratified analysis was used to evaluate differences in responses by age, gender, level of training and specialty.

Results

154 ASE members completed the survey (13% response rate). 88% respondents accessed virtual learning events at home. Most (87%) had joined a virtual learning event and then participated in another activity. 1 in 5 who did this did so “always” or “often”. Female respondents were more likely than males to join audio and then participate in another activity (62.3% v 37.7%, p = 0.04).

Conclusions

Virtual platforms do not automatically translate into increased learner engagement. Careful design of educational strategies is essential to increase and maintain learner engagement when utilizing virtual surgical education.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

SUPPLEMENTARY INFORMATION

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

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.

Improving Medical Education: A Narrative Review

With the advancement in basic and clinical sciences, medical education is also constantly evolving. The Accreditation Council for Graduate Medical Education (ACGME) has endorsed six core competencies to improve teaching and learning. This narrative review was conducted after searching the article databases (PubMed, PubMed Central, Embase, and Scopus) about the core competencies such as medical knowledge (problem-based learning), interpersonal communication, patient care, professionalism, practice-based learning and improvement, and system-based care endorsed by ACGME. We included randomized and quasi-experimental trials, cohorts, and case-control studies in this narrative review. In a problem-based learning modality, a real-life scenario is allocated to a group of students. Studies have shown that it is more effectively demonstrated by a better post-test score, improved concentration, and application of knowledge. Interpersonal communication skills promote collaboration with interdisciplinary teams, work quality, and patient adherence to treatment. Professionalism is a human attribute that creates a pleasant work environment and is an essential trait that improves patients' adherence to treatment. In system-based care, patients are benefitted through a well-structured plan of care. Finally, in practice-based learning, medical trainees learn to systematically evaluate the pattern of care and practice the best modality to improve the overall patient care and physician satisfaction. These core competencies need to be incorporated into all levels of medical training.

Comparison of team-based learning vs. lecture-based teaching with small group discussion in a master's degree in nursing education course

BACKGROUND

The high student-to-faculty ratio is an obstacle in the reform of teaching methods in master's programmes of nursing education in China. Though Kim's study showed that team-based learning (TBL) can be implemented in high student-to-faculty ratio classes, it is still a challenge for students accustomed to the traditional didactic lecture (TDL) teaching method, and the lack of an inclusive design model has restricted the effective application of TBL.

OBJECTIVE

To compare the effect of TBL on postgraduate nursing students with lecture-based teaching with small group discussion (LBTWSGD) and to clarify key factors to promote the effective application of TBL.

METHODS

A quasi-experimental study design. We selected 27 unbiased participants in the applied LBTWSGD group and 48 participants in the applied TBL group and conducted questionnaire surveys at the last day of the course which lasted for 10 weeks. Students' self-directed learning ability was assessed by the Self-Directed Learning Instrument (SDLI), classroom engagement was assessed by the Self-Report of Engagement Measure (SREM), and students' evaluation of the teaching experience was assessed by the Student Evaluation of Teaching and Units (SETU). A difference analysis between the two groups was performed by the SETU. The mean and standard deviation of each tool were calculated and compared between the two groups.

RESULTS

The study determined that compared to LBTWSGD, TBL significantly improved students' self-directed learning (p < 0.01) and classroom engagement (p < 0.05). The scores for 6 of 9 items in the SETU were significantly higher in the TBL group than in the LBTWSGD group.

CONCLUSIONS

The TBL teaching method can effectively improve nursing students' self-learning ability and classroom engagement through effective teacher feedback, discussion, and communication. The same clear and definite reading assignments in TBL can help students obtain effective teacher feedback and form effective discussions and communication.

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.].

Team-Based Learning and Lecture-Based Learning: Comparison of Sudanese Medical Students' Performance

AIM

Students' performance in TBL compared to LBL needs to be evaluated. This study aimed to compare students' performance in team-based learning and traditional lectures.

METHODS

A total of 176 class 4 and 202 class 6 medical students from University of Bahri, Khartoum, Sudan, participated in the study during 2018. Experienced staff were selected to conduct the teaching and assessment of the two groups, using the standard team-based learning procedure (iRAT, gRAT and AppT) in the first topic and the lecture-based learning procedure in the second, within the same time limit for the two methods.

RESULTS

The two classes overall mean score has a significant 5.1 points difference (p<0.001; 95% CI: 3.5, 6.0). Separate analysis showed consistency of superiority of TBL to LBL in either gender. A remarkable difference was observed when we compared the two methods in class 6 separately from class 4. Class 6 mean score was high for both TBL and LBL (77.2 and 70.2, respectively), with a significant mean difference of 7.0 (p<0.001; 95% CI: 5.1, 8.9). In class 4, the score was lower for both methods (mean of 62.8 for TBL and 59.9 for LBL). The mean difference of 2.95 points was still significant (p<0.05; 95% CI: 0.46, 5.43). Separate multivariate linear regression for TBL and LBL showed no significant difference in performance of males and females in either method. Controlling for gender in TBL, class 4 had a mean of -14.26 points, (p<0.001; 95% CI: -12.54, -15.98) less than class 6. Similarly, in LBL, class 4 had a mean of -10.18 points (p<0.001, 95% CI: -7.02, -13.35), less than class 6.

CONCLUSION

Students' performance using team-based learning was superior to lecture-based learning, irrespective of students' gender, noticeable among senior students.

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

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

The Effective Use of Information Technology and Interactive Activities to Improve Learner Engagement

Student engagement in the learning process is the key to successful delivery of teaching and learning. Teachers face several challenges to engage learners in different disciplines, including computer science. This research conducts a review of BSc (Computer Science) programmes and introduces interactive activities to enhance learner engagement. The study was conducted using a repeated measure design involving 24 participants. The findings revealed that the use of technology, and collaborative and interactive activities in groups may positively influence learner engagement. The participants’ feedback before and after introduction of group tasks and interactive activities showed a significant (p < 0.001) and increasing trend in response to questions-related learner engagement. The participants agreed that their learning experience and engagement enhanced with the use of technology and interactive and collaborative activities.

A cluster quasi-randomized controlled trial of an interactive, monthly obstetric anesthesiology curriculum: impact on resident satisfaction and knowledge retention

BACKGROUND

Increasingly, evidence supports the use of educational paradigms that focus on teacher-learner interaction and learner engagement. We redesigned our monthly obstetric anesthesia resident didactics from a lecture-based curriculum to an interactive format including problem-based learning, case discussion, question/answer sessions, and simulation. We hypothesized that the new curriculum would improve resident satisfaction with the educational experience, satisfaction with the rotation, and knowledge retention.

METHODS

Fifty-three anesthesiology residents were prospectively recruited and quasi-randomized through an alternating-month pattern to attend either interactive sessions or traditional lectures. Residents completed a daily satisfaction survey about quality of teaching sessions and a comprehensive satisfaction survey at the conclusion of the rotation. Knowledge retention was assessed with a knowledge test completed on the final day. The primary outcome was daily satisfaction with the curriculum, and secondary outcomes included overall satisfaction with the curriculum, overall rotation satisfaction, and within-resident difference between pre- and post-knowledge test scores.

RESULTS

No differences were observed in daily resident satisfaction after interactive sessions vs traditional lectures. Furthermore, no differences were observed between the interactive sessions and traditional lecture groups in overall satisfaction with the curriculum, overall satisfaction with the entire rotation or within-resident difference between pre- and post-knowledge test scores.

CONCLUSIONS

Our study failed to demonstrate improvement in resident satisfaction or knowledge retention following implementation of an interactive curriculum on a month-long obstetric anesthesia rotation. Reasons may include misalignment of the intervention with measured study outcomes, lack of sensitivity of the survey tools, and inadequate training of faculty presenters.

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.

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

RATIONALE AND OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

CONCLUSION

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

Enhancement of Anatomical Education Using Augmented Reality: An Empirical Study of Body Painting

Students in undergraduate premedical anatomy courses may experience suboptimal and superficial learning experiences due to large class sizes, passive lecture styles, and difficult-to-master concepts. This study introduces an innovative, hands-on activity for human musculoskeletal system education with the aim of improving students' level of engagement and knowledge retention. In this study, a collaborative learning intervention using the REFLECT (augmented reality for learning clinical anatomy) system is presented. The system uses the augmented reality magic mirror paradigm to superimpose anatomical visualizations over the user's body in a large display, creating the impression that she sees the relevant anatomic illustrations inside her own body. The efficacy of this proposed system was evaluated in a large-scale controlled study, using a team-based muscle painting activity among undergraduate premedical students (n = 288) at the Johns Hopkins University. The baseline knowledge and post-intervention knowledge of the students were measured before and after the painting activity according to their assigned groups in the study. The results from knowledge tests and additional collected data demonstrate that the proposed interactive system enhanced learning of the musculoskeletal system with improved knowledge retention (F_(10,133)  = 3.14, P < 0.001), increased time on task (F_(1,275)  = 5.70, P < 0.01), and a high level of engagement (F_(9,273)  = 8.28, P < 0.0001). The proposed REFLECT system will be of benefit as a complementary anatomy learning tool for students.

Effect of Team-based Learning using Reflection Journal on Pregnancy Nursing Course for Nursing Students

PURPOSE

To examine the applicability of a team-based learning using reflection journal in Women's Health Nursing for nursing students.

METHODS

This study had a nonequivalent control group non-synchronized design. Participants were 140 third-year undergraduate nursing students who agreed to participate in this study. The experimental group (n=70) received twice team-based learning using reflection journal about pregnancy nursing course while the control group (n=70) received only team-based learning. Data were analyzed with descriptive statistics, χ2 test, Fisher's exact test, and independent t-test using SPSS 23.0 program.

RESULTS

Compared to the control group, the experimental group reported significant positive changes in critical thinking (t=2.03, p=.044). Problem-solving, self-leadership, or academic self-efficacy of nursing college students was not significantly different between the two groups.

CONCLUSION

Team-based learning using reflection journal is an effective teaching strategy to enhance critical thinking of nursing students.

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

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

Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change

REVIEW AIM

The aim of this study is to review the evidence in relation to the experiences and outcomes of students on nursing and/or midwifery higher education programmes, who experience team based learning.

REVIEW OBJECTIVES

To examine the relationship between team based learning and attainment for nursing and midwifery students in professional higher education. To examine the relationship between team based learning and student satisfaction for nurses and midwifery students in higher education. To identify and report examples of good practice in the implementation of team based learning in Nursing and Midwifery higher education.

DESIGN

A systematic Review of the literature was undertaken. The population were nurses and midwives studying on higher education pre and post registration professional programmes. The intervention was learning and teaching activities based on a team-based learning approach. Data sources included CINAHL and MEDLINE. ERIC and Index to Theses were also searched.

REVIEW METHODS

International research papers published in English between 2011 and 2017 that met the inclusion criteria were included in the study. Papers that met the criteria were subjected to quality appraisal and agreement amongst authors for inclusion in the review.

RESULTS

A total of sixteen papers were reviewed and four themes emerged for discussion. These were Student Engagement, Student Satisfaction, Attainment and Practice Development and Transformational Teaching and Learning.

CONCLUSIONS

There is a tentative, though growing body of evidence to support TBL as a strategy that can impact on student engagement, student satisfaction, attainment, practice development and transformative teaching and learning. The literature indicates that implementing TBL within the curriculum is not without challenge and requires a sustained and structured approach. Staff and students need to understand the processes involved, and why they should be adhered to, in the pursuit of enhanced student experiences and outcomes for nurses and midwives in Higher Education.

Comparison of lecture and team-based learning in medical ethics education

BACKGROUND

Medical education literature suggests that ethics education should be learner-centered and problem-based rather than theory-based. Team-based learning is an appropriate method for this suggestion. However, its effectiveness was not investigated enough in medical ethics education.

RESEARCH QUESTION

Is team-based learning effective in medical ethics education in terms of knowledge retention, in-class learner engagement, and learner reactions?

RESEARCH DESIGN

This was a prospective controlled follow-up study. We changed lecture with team-based learning method to teach four topics in a 2-week medical ethics clerkship, while the remaining topics were taught by lectures. For comparison, we formed team-based learning and lecture groups, in which the students and instructor are the same, but the topics and teaching methodologies are different. We determined in-class learner engagement by direct observation and student satisfaction by feedback forms. Student success for team-based learning and lecture topics in the end-of-clerkship exam and two retention tests performed 1 year and 2 years later were compared.

ETHICAL CONSIDERATIONS

Ethical approval for the study was granted by Akdeniz University Board of Ethics on Noninvasive Clinical Human Studies Ethics committee.

FINDINGS

Short-term knowledge retention did not differ; however, team-based learning was found superior to lecture at long-term retention tests. Student satisfaction was high with team-based learning and in-class engagement was better in team-based learning sessions.

DISCUSSION

Our results on learner engagement and satisfaction with team-based learning were similar to those of previous reports. However, knowledge retention results in our study were contrary to literature. The reason might be the fact that students prepared for the end-of-clerkship pass/fail exam (short term) regardless of the teaching method. But, at long-term retention tests, they did not prepare for the exam and answered the questions just using the knowledge retained in their memories.

CONCLUSION

Our findings suggest that team-based learning is a better alternative to lecture to teach ethics in medical education.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Understanding the early effects of team-based learning on student accountability and engagement using a three session TBL pilot

BACKGROUND AND PURPOSE

This study examined the early effects of a team based learning (TBL) pilot, including differences in student engagement with TBL compared to lectures, and student accountability, preferences, and satisfaction with TBL.

EDUCATIONAL ACTIVITY AND SETTING

Three TBL sessions were delivered in the nephrology section of pharmacotherapy and then students completed the team-based learning student assessment instrument (TBL-SAI), which assesses TBL relative to lecture on three subscales (i.e., student accountability, preferences, and satisfaction). Students also completed a modified engagement instrument for a lecture and again for a TBL session.

FINDINGS

All students (160) participated in the survey (100% response rate). When comparing TBL and lecture engagement, five of eight statements were statistically significantly different. In TBL, students reported the strongest agreement with statements related to contributions (i.e., contributing fair share [mean 3.97], contributing meaningfully [mean 3.96]). Using the TBL-SAI, the mean score for accountability (30.64) was higher than neutral (24) indicating a higher level of accountability with TBL. Student satisfaction with TBL was neutral (mean 26.62, neutral = 27).

DISCUSSION AND CONCLUSIONS

In a three-session pilot, TBL had positive effects on engagement and accountability. Early positive effects could aid programs in building and maintaining momentum with the TBL approach while working towards outcomes that may take longer to achieve, such as changes in professionalism or teamwork. Duration of exposure and perseverance through the transition to TBL may be important in developing preferences and satisfaction. This study provides insights to programs and instructors about student perceptions and attitudes as TBL is introduced.

Effects of additional team-based learning on students' clinical reasoning skills: a pilot study

Background

In the field of Neurology good clinical reasoning skills are essential for successful diagnosing and treatment. Team-based learning (TBL), an active learning and small group instructional strategy, is a promising method for fostering these skills. The aim of this pilot study was to examine the effects of a supplementary TBL-class on students’ clinical decision-making skills.

Methods

Fourth- and fifth-year medical students participated in this pilot study (static-group comparison design). The non-treatment group (n = 15) did not receive any additional training beyond regular teaching in the neurology course. The treatment group (n = 11) took part in a supplementary TBL-class optimized for teaching clinical reasoning in addition to the regular teaching in the neurology course. Clinical decision making skills were assessed using a key-feature problem examination. Factual and conceptual knowledge was assessed by a multiple-choice question examination.

Results

The TBL-group performed significantly better than the non-TBL-group (p = 0.026) in the key-feature problem examination. No significant differences between the results of the multiple-choice question examination of both groups were found.

Conclusions

In this pilot study participants of a supplementary TBL-class significantly improved clinical decision-making skills, indicating that TBL may be an appropriate method for teaching clinical decision making in neurology. Further research is needed for replication in larger groups and other clinical fields.

Teaching neurology to medical students with a simplified version of team-based learning

Objective:

To compare the effect of a simplified version of team-based learning (sTBL), an active learning/small group instructional strategy, with that of the traditionally used small group interactive seminars on the acquisition of knowledge and clinical reasoning (CR) skills.

Methods:

Third- and fourth-year medical students (n = 122) were randomly distributed into 2 groups. A crossover design was used in which 2 neurologic topics were taught by sTBL and 2 by small group interactive seminars. Knowledge was assessed with a multiple-choice question examination (MCQE), CR skills with a key feature problem examination (KFPE). Questionnaires were used for further methodologic evaluation.

Results:

No group differences were found in the MCQE results. sTBL instruction of the topic “acute altered mental status” was associated with a significantly better student performance in the KFPE (p = 0.008), with no differences in the other 3 topics covered. Although both teaching methods were highly rated by the students, a clear majority voted for sTBL as their preferred future teaching method.

Conclusions:

sTBL served as an equivalent alternative to small group interactive seminars for imparting knowledge and teaching CR skills, and was particularly advantageous for teaching CR in the setting of a complex neurologic topic. Furthermore, students reported a strong preference for the sTBL approach, making it a promising tool for effectively teaching neurology.

Nurses' perceptions of the impact of Team-Based Learning participation on learning style, team behaviours and clinical performance: An exploration of written reflections

Team-Based Learning (TBL) is a teaching strategy designed to promote problem solving, critical thinking and effective teamwork and communication skills; attributes essential for safe healthcare. The aim was to explore postgraduate student perceptions of the role of TBL in shaping learning style, team skills, and professional and clinical behaviours. An exploratory descriptive approach was selected. Critical care students were invited to provide consent for the use for research purposes of written reflections submitted for course work requirements. Reflections of whether and how TBL influenced their learning style, teamwork skills and professional behaviours during classroom learning and clinical practice were analysed for content and themes. Of 174 students, 159 participated. Analysis revealed three themes: Deep Learning, the adaptations students made to their learning that resulted in mastery of specialist knowledge; Confidence, in knowledge, problem solving and rationales for practice decisions; and Professional and Clinical Behaviours, including positive changes in their interactions with colleagues and patients described as patient advocacy, multidisciplinary communication skills and peer mentorship. TBL facilitated a virtuous cycle of feedback encouraging deep learning that increased confidence. Increased confidence improved deep learning that, in turn, led to the development of professional and clinical behaviours characteristic of high quality practice.

The effectiveness of TBL with real patients in neurology education in terms of knowledge retention, in-class engagement, and learner reactions

In our medical school, we changed from a lecture-based method to a team-based learning (TBL) method to teach "polyneuropathies" in the neurology clerkship starting from the 2014 to 2015 academic year. Real patients were used instead of written scenarios in TBL sessions. This study aimed to compare former lecture-based and the current TBL methods in terms of knowledge retention, in-class learner engagement, and learner reactions. First, we determined in-class engagement and satisfaction of the students for the lectures given in the 2013-2014 academic year. The following year, besides the same criteria, we also determined individual (IRAT) and group readiness test (GRAT) scores in the TBL group. End-of-clerkship exam scores for both groups were recorded. Additionally, opinions of patients about their experiences throughout the TBL process were determined. One year later (2015 for lecture and 2016 for TBL), both groups sat for an MCQ test to determine their knowledge retention levels. We found no difference between groups regarding end-of-clerkship exam scores. The mean knowledge retention test score of the TBL group was significantly higher than that of the lecture group (5.85 ± 1.74 vs. 3.28 ± 1.70). The differences between IRAT, GRAT, and retention test scores in the TBL group were significant. The mean student satisfaction score on a five-point scale was 3.01 ± 0.9 (median = 3) in the lecture group and 4.11 ± 1.1 (median = 4) in the TBL group. Our results seem encouraging for use of TBL performed with real patients in neurology education to achieve better long-term knowledge retention and higher in-class engagement and student satisfaction.

Assessment of first-year medical students' perceptions of teaching and learning through team-based learning sessions

Team-based learning (TBL) is an emerging teaching and learning strategy being employed in medical schools. The College of Medicine at Alfaisal University has adopted a TBL approach as an instructional method for first-year medical students. The aim of the present study was to describe the TBL method employed at Alfaisal University College of Medicine and to assess first-year medical students' perceptions of this learning modality for the anatomy- and physiology-based blocks/courses in organ systems form of curriculum. A five-point Likert scale questionnaire was structured based on Kirkpatrick's theory and assessed three major domains: reaction, learning, and behavior. Confirmatory factor analysis (CFA) and Cronbach's α-coefficient tests were used to assess the validity and reliability of the construct, respectively. CFA showed an adequate validity of the survey and Cronbach's α revealed an acceptable internal uniformity (0.69). A total of 185 respondents rated reaction, learning, and behavior toward introduction of TBL as 3.53 ± 1.01, 3.59 ± 1.12, and 3.57 ± 1.12, respectively. Excellent students rated TBL highly in all major domains compared with borderline students (reaction, behavior, and learning domains with P values of <0.049, <0.035, and <0.031, respectively). Students who had prior teamwork experience rated TBL higher in terms of their learning experience compared with those who were rarely involved in team work. This study demonstrated that Alfaisal University first-year medical students perceived TBL positively as a teaching and learning strategy for functional anatomy, and prior involvement in teamwork and academic performance correlates with higher ratings of TBL.

Students' Attitudes, Academic Performance and Preferences for Content Delivery in a Very Large Self-Care Course Redesign

Objective. To evaluate students' performance/attitudes toward a flipped team-based learning (TBL) format in a "very large" self-care course based on student content delivery preference. Design. Third-year students enrolled in the course were surveyed regarding elements of redesign and homework completion. Additionally, their performance and incoming grade point average were evaluated. Assessment. A survey was completed by 286 of 305 students. Nineteen percent of respondents preferred traditional content delivery, whereas 30% preferred flipped TBL, 48% preferred a mixed format, and 3% had no preference. The grades achieved in the course were: A (49%), B (48%), C (3%) and D (0%). The majority completed "all" or "most" of the homework, appreciated attributes of course redesign, felt home preparation and in-class activities engaged them, and reported improved communication/evaluation skills. Content delivery preference significantly affected attitudes. Conclusion. Students positively received a flipped team-based learning classroom format, especially those who preferred flipped TBL or mixed content delivery. A minority with preference for traditional teaching style did not enjoy the new format; however, their academic performance did not differ significantly from those who did.

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

BACKGROUND

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

AIMS

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

METHODS & PROCEDURES

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

OUTCOMES & RESULTS

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

CONCLUSIONS & IMPLICATIONS

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

Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching

BACKGROUND

Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education.

METHODS

Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests.

RESULTS

Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions.

CONCLUSIONS

We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

Factors Influencing Seminar Learning and Academic Achievement

Many veterinary curricula use seminars, interactive educational group formats in which some 25 students discuss questions and issues relating to course themes. To get indications on how to optimize the seminar learning process for students, we aimed to investigate relationships between factors that seem to be important for the seminar learning process, and to determine how these seminar factors account for differences in students' achievement scores. A 57-item seminar evaluation (USEME) questionnaire was administered to students right after they attended a seminar. In total, 80 seminars distributed over years 1, 2, and 3 of an undergraduate veterinary medicine curriculum were sampled and 988 questionnaires were handed in. Principal factor analysis (PFA) was conducted on 410 questionnaires to examine which items could be grouped together as indicators of the same factor, and to determine correlations between the derived factors. Multilevel regression analysis was performed to explore the effects of these seminar factors and students' prior achievement scores on students' achievement scores. Within the questionnaire, four factors were identified that influence the seminar learning process: teacher performance, seminar content, student preparation, and opportunities for interaction within seminars. Strong correlations were found between teacher performance, seminar content, and group interaction. Prior achievement scores and, to a much lesser extent, the seminar factor group interaction appeared to account for differences in students' achievement scores. The factors resulting from the present study and their relation to the method of assessment should be examined further, for example, in an experimental setup.

A pilot study of team learning on in-patient rounds

BACKGROUND

Medical trainees often do not receive structured teaching during in-patient rounds.

OBJECTIVE

To assess whether the addition of a collaborative team learning technique would improve the learning experience on a general medicine in-patient team.

METHODS

Eight learners participated in this pilot study. Learning teams consisted of internal medicine residents and third-year medical students on a general medicine in-patient rotation. The experimental curriculum covered four common topics: cardiac stress testing; syncope; pneumonia; and valvular heart disease. Sessions had the following format: (1) each learner answered five self-assessment questions using an immediate feedback technique; (2) learners were divided into groups of two or three to discuss their answers; (3) the teaching doctor led a discussion to clarify and summarise, and also distributed a handout delineating key learning points. Control sessions consisted of the usual teaching rounds. Learners were e-mailed a daily online survey asking them to rate the rounds and handouts on a Likert scale. Medical trainees often do not receive structured teaching during in-patient rounds

RESULTS

All of the learners rated the collaborative team learning intervention as either 'excellent' or 'very good'. Learners also indicated that they found the take-away handout valuable, and positive responses were also noted in the survey comments.

DISCUSSION

A novel collaborative team learning technique resulted in high ratings of teaching rounds by medical residents and medical students. Learners found the sessions engaging, high yield, and educationally valuable. This interactive discussion-based teaching method could be used to enhance the learning experience during teaching rounds on medical, surgical and subspecialty services.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of Team-Based Learning on short-term and long-term retention of factual knowledge

PURPOSE

We investigated the effect of Team-Based Learning (TBL) on long-term retention of knowledge in comparison to a traditional curriculum.

METHODS

As TBL was incorporated into our curriculum in the 2008-2009 academic year, students were compared with those who received the traditional curriculum the year prior. Students in both the groups completed multiple-choice knowledge test at four time points spanning two years. Test performance was compared at each time point to assess changes in knowledge retention as a function of time.

RESULTS

Baseline knowledge did not differ significantly between the TBL and control groups [51% versus 46%; t(84) = 0.91, p = 0.37, d = 0.20]. Performance improved after the course for both the groups, but was significantly higher in the TBL group [79% versus 59%; t(84) = 4.96, p = 0.000004, d = 0.95]. However, when assessed prior to the pediatrics clerkship, learning gains from TBL had largely disappeared and the small difference in performance was not significant [57% versus 51%; t(84) = 1.51, p = 0.14, d = 0.32].

CONCLUSION

Incorporating TBL into the pre-clinical pediatrics curriculum led to large gains in knowledge over the short-term, but these gains did not persist. Further research should focus on extending the impact of TBL on long-term knowledge retention.

Implementing a third-year emergency medicine medical student curriculum

BACKGROUND

Emergency medicine (EM) is commonly introduced in the fourth year of medical school because of a perceived need to have more experienced students in the complex and dynamic environment of the emergency department. However, there is no evidence supporting the optimal time or duration for an EM rotation, and a number of institutions offer third-year rotations.

OBJECTIVE

A recently published syllabus provides areas of knowledge, skills, and attitudes that third-year EM rotation directors can use to develop curricula. This article expands on that syllabus by providing a comprehensive curricular guide for the third-year medical student rotation with a focus on implementation.

DISCUSSION

Included are consensus-derived learning objectives, discussion of educational methods, considerations for implementation, and information on feedback and evaluation as proposed by the Clerkship Directors in Emergency Medicine Third-Year Curriculum Work Group. External validation results, derived from a survey of third-year rotation directors, are provided in the form of a content validity index for each content area.

CONCLUSIONS

This consensus-derived curricular guide can be used by faculty who are developing or revising a third-year EM medical student rotation and provide guidance for implementing this curriculum at their institution.

Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study

OBJECTIVE

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL).

RESEARCH METHODOLOGY/DESIGN

A descriptive pre and post interventional design was used. Study data were collected by surveys and observation.

SETTING

University postgraduate critical care nursing programme.

MAIN OUTCOME MEASURES

Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports).

RESULTS

Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing.

CONCLUSION

Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care.

Team-based learning exercise efficiently teaches brief intervention skills to medicine residents

BACKGROUND

Evaluations of substance use screening and brief intervention (SBI) curricula typically focus on learner attitudes and knowledge, although effects on clinical skills are of greater interest and utility. Moreover, these curricula often require large amounts of training time and teaching resources. This study examined whether a 3-hour SBI curriculum for internal medicine residents utilizing a team-based learning (TBL) format is effective for SBI skills as measured by a standardized patient (SP) assessment.

METHODS

A waitlist-controlled design was employed.

RESULTS

Twenty-four postgraduate year 2 (PGY-2) and PGY-3 residents participated in a SP assessment prior to the TBL session (waitlist control group) and 32 participated in a SP assessment after the TBL session (intervention group). The intervention residents demonstrated better brief intervention skills than waitlist control residents, but there were no differences between the groups in screening and assessment skills. Residents receiving the TBL curriculum prior to the SP assessment reported increased confidence in all SBI skills.

CONCLUSION

Findings indicate that a brief educational intervention can improve brief intervention skills. However, more intensive education may be needed to improve substance use screening and assessment.