Perceptions and Attitudes of First-Year Medical Students on a Modified Team-Based Learning (TBL) Strategy in Anatomy

Automated grading of anatomical objective structured practical examinations using decision trees: An artificial intelligence approach

An Objective Structured Practical Examination (OSPE) is an effective and robust, but resource-intensive, means of evaluating anatomical knowledge. Since most OSPEs employ short answer or fill-in-the-blank style questions, the format requires many people familiar with the content to mark the examinations. However, the increasing prevalence of online delivery for anatomy and physiology courses could result in students losing the OSPE practice that they would receive in face-to-face learning sessions. The purpose of this study was to test the accuracy of Decision Trees (DTs) in marking OSPE questions as a first step to creating an intelligent, online OSPE tutoring system. The study used the results of the winter 2020 semester final OSPE from McMaster University's anatomy and physiology course in the Faculty of Health Sciences (HTHSCI 2FF3/2LL3/1D06) as the data set. Ninety percent of the data set was used in a 10-fold validation algorithm to train a DT for each of the 54 questions. Each DT was comprised of unique words that appeared in correct, student-written answers. The remaining 10% of the data set was marked by the generated DTs. When the answers marked by the DT were compared to the answers marked by staff and faculty, the DT achieved an average accuracy of 94.49% across all 54 questions. This suggests that machine learning algorithms such as DTs are a highly effective option for OSPE grading and are suitable for the development of an intelligent, online OSPE tutoring system.

Prospective comparative study on enhancing geometrical mental representation and anatomical learning in medical students through modeling clay as an assessment tool

While traditional anatomy education often emphasizes passive learning and rote memorization, it seldom employs constructivist theories that focus on active, hands-on experiences for effective learning. This study tests the hypothesis that tactile experiences with modeling clay enhance geometric mental representation more effectively than verbal descriptions. We examine the potential of clay modeling to reflect and evaluate students' mental representation of anatomical structures. Utilizing a prospective randomized, open, blind endpoint (PROBE) design, we engaged 36 participants divided into three groups: blind, visually impaired, and a control group. The primary outcome measure was the difference between post-touch score and pre-touch score, which gauged the efficacy of tactile intervention in enhancing the participants' capacity to mentally reconstruct a well-designed anatomical fiction structure. Scoring was executed using a double-blind double-evaluation methodology, positioning clay model reconstruction as both an objective reliable assessment and a pedagogical tool. The analysis demonstrated a pronounced improvement in mental representation of anatomical structures, particularly in spatial comprehension and detailed textural discernment, with the mean score soaring from 47.81 pre-touch to 85.09 post-touch. Distinct cognitive processing adaptations were evident across groups, with the blind group excelling in tactile acuity and the visually impaired group showing the most significant gains in spatial understanding post-intervention (Cohen's d = 2.74). The application of modeling clay as a tactile intervention tool can significantly improve the learning of anatomy among medical students. The study underscores the value of active, multisensory engagement and customized teaching strategies for effective anatomy education among this demographic.

Responding to the healthcare workforce shortage: A scoping review exploring anatomical pathologists' professional identities over time

Anatomical pathology (AP) is an anatomy-centric medical specialty devoted to tissue-based diagnosis of disease. The field faces a current and predicted workforce shortage, likely increasing diagnostic wait times and delaying patient access to urgent treatment. A lack of AP exposure is proposed to preclude recruitment to the field, as medical students are afforded only a limited understanding of who a pathologist is and what they do (their professional identity/PI and role). Anatomical sciences educators may be well placed to increase student understanding of anatomical pathologists' PI features, but until features of anatomical pathologists' PI are understood, recommendations for anatomy educators are premature. Thus, this scoping review asked: "What are the professional identity features of anatomical pathologists reported in the literature, and how have these changed over time?" A six-stage scoping review was performed. Medline and PubMed, Global Health, and Embase were used to identify relevant studies (n = 74). Team-based framework analysis identified that features of anatomical pathologists' professional identity encompass five overarching themes: professional practice, views about the role, training and education, personal implications, and technology. Technology was identified as an important theme of anatomical pathologists' PI, as it intersected with many other PI feature themes, including diagnosis and collaboration. This review found that pathologists may sometimes perceive professional competition with technology, such as artificial intelligence. These findings suggest unique opportunities for integrating AP-specific PI features into anatomy teaching, which may foster student interest in AP, and potentially increase recruitment into the field.

Implementation of Team-Based Learning for a Clinical Module of the Ethiopian Undergraduate Anesthesia Curriculum and Students' Perspectives: A Pilot Cross-Sectional Study

Introduction

Team-based learning (TBL) is an active learning strategy that gives students the opportunity to apply conceptual information through a series of tasks that incorporate individual effort, team collaboration, and immediate feedback. This study aimed to report baseline TBL implementation in a clinical module of a fourth-year competency-based undergraduate anesthesia curriculum and explore the perspectives of students.

Methods

In April 2023, 18 students participated in two TBL sessions over two weeks, and readiness assurance test results and post-TBL evaluations were analyzed. Week one TBL implementation scores were compared with week two, establishing a longitudinal analysis over two points in time. Students also participated in an online survey to assess their views on the advantages and design of TBL, their perceptions of its best and worst features, and their suggestions for its implementation.

Results

Of 18 students, 16 (89%) responded to the survey. Most students believed that TBL was an effective educational strategy but expressed concern about the amount of time required for TBL preparation and the need for student readiness. The individual readiness assurance test scores did not differ significantly between weeks 1 and 2 (mean difference [MD] = 0.39, P= 0.519, 95% CI: -0.824 to 1.60). However, the students' median [IQR] team readiness assurance test scores increased significantly from week one to week two, from 8 [2] to 10 [1] (p = 0.004). Peer evaluation scores also showed a significant increase in week 2 (MD = 2.4, P = 0.001, 95% CI: -3.760 to -0.996).

Conclusion

TBL was successfully implemented for a clinical module at Dilla University-Ethiopia for the first time. Students perceived it positively, but some criticized its preparation time, workload, and minimal facilitator engagement. We suggest convenient and flexible scheduling personalized for each student's needs when TBL is applied for clinical modules.

Student Engagement Using HoloLens Mixed-Reality Technology in Human Anatomy Laboratories for Osteopathic Medical Students: an Instructional Model

Mixed-reality technology is a powerful tool used in healthcare and medical education to engage students in life-like scenarios. This blend of virtual and augmented reality images incorporates virtual projections with the real environment to allow real-time observation and interaction [1]. While this immersive technology offers advantages over cadaver dissections, it creates new challenges to keeping students engaged [2, 3]. Student engagement improves students' commitment to learning, critical thinking, and motivation and results in successful course outcomes [4, 5]. This paper provides an activity model using the HoloLens mixed-reality technology to deliver human gross anatomy laboratory sessions to first-year osteopathic medical students. The activity was designed using Gagne's model for instructional design and team-based learning to create an active learning model, which targets the behavioral, emotional, and cognitive dimensions of student engagement [6, 7]: behavioral engagement through autonomy and time on task, emotional engagement through providing the guiding exploration and narrative flow to accompany students' visual experience, and cognitive engagement by incorporating team-based learning (TBL) and case-based learning (CBL). The instructional model also answers the call for a new type of virtual reality instructor and pedagogical strategy that addresses the unique challenges and increases student engagement with this new technology. The effectiveness of this classroom activity was assessed by observing students for indicators or behaviors of student engagement, which are discussed. Further studies are required to measure the extent to which these indicators were exhibited and compare student engagement with this mixed-reality to didactic cadaver-based laboratory sessions.

Application of team-based learning to ophthalmology in China

Objectives

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The impact of asynchronous online anatomy teaching and smaller learning groups in the anatomy laboratory on medical students' performance during the Covid-19 pandemic

Due to the Covid-19 pandemic, National Taiwan University anatomy teachers adopted asynchronous online video teaching and reduced the size of anatomy laboratory groups in April 2020. The aim of this study was to investigate the impact of these changes on medical students' learning. Before Covid-19, the performance of the 2019-2020 cohort was significantly better than that of the 2018-2019 cohort. However, the implementation of modified teaching strategies significantly lowered the laboratory midterm score of the 2019-2020 cohort in the second semester. Conversely, the final laboratory examination score of the 2019-2020 cohort was significantly higher than that of the 2018-2019 cohort. Through correlation analysis, lecture and laboratory examination scores were highly correlated. Additionally, the difference in lecture and laboratory z-scores between two cohorts, the Likert scale survey and free-text feedback of the 2019-2020 cohort, were conducted to show the impact of modified teaching strategies. There were several important findings in this study. First, the change in teaching strategies may temporarily negatively influence medical students to learn anatomy. Besides, analyzing the performance of laboratory assessments could be a complementary strategy to evaluate online assessments. Applying lecture examination scores to predict laboratory performance was a feasible way to identify students who may have difficulty in learning practical dissection. Finally, reducing group size together with reduced peer discussion may have a negative effect on learning cadaver dissection for students with low academic performance. These findings should be taken into consideration when anatomy teachers apply new teaching strategies in anatomy courses.

Comparison of Team-Based Learning Over Conventional Didactic Lecture Among Second-Year MBBS Students

Introduction

Team-based learning (TBL) is an active and structured learning process. This study was undertaken to develop interest among the students over the subject and to analyze the academic performance over routine conventional lecture method of teaching. This was a comparative study organized to know the effectiveness of TBL over conventional didactic lecture (CDL) and also to assess the student’s perception towards TBL.

Methods

This was an interventional study where second-year MBBS students took part. Students were divided into two groups and the same topic was discussed by using two different teaching-learning methods. Similar sessions were conducted with crossing over of groups for four different topics and assessments were done after each session simultaneously for both the groups and the results were analyzed.

Results

Assessment of each session has been counted and the mean marks with standard deviation have been tabulated for both groups A & B. The results were statistically significant for the TBL group. Students’ perception was also evaluated by using 5-point Likert scale for both the teaching methods, which revealed statistically significant score for TBL over CDL with the a p-value of 0.001.

Conclusion

Overall, TBL was a good teaching-learning method according to the students’ performance and perception. Interactive innovative and small-group sessions can be an effective tool to overcome the limitation of conventional method.

Efficacy of Video-Based Forearm Anatomy Model Instruction for a Virtual Education Environment

INTRODUCTION

As virtual education becomes more widespread, particularly considering the recent COVID-19 pandemic, studies that assess the impact of online teaching strategies are vital. Current anatomy curriculum at Paul L. Foster School of Medicine consists of self-taught PowerPoint material, clinical vignette-centered team-based learning (dry lab), and prosection-based instruction (wet lab). This study examined the impact of video-based muscle model (VBMM) instruction using a student-designed forearm muscle model on anatomy quiz scores and student perceptions of its effectiveness with regards to learning outcomes.

METHODS

Students divided into Group 1 (54 students) and Group 2 (53 students) were assessed prior to and following a 3.5-minute video on anterior forearm compartment musculature using the muscle model. Group 1 began by completing a pretest, then received VBMM instruction, and then completed a posttest prior to participating in the standard dry lab and 1 hour wet lab. Group 2 completed the wet lab, then received the pretest, VBMM instruction, and posttest prior to participating in the dry lab. Both groups took an identical five-question quiz covering locations and functions of various anterior forearm muscles each time.

RESULTS

Mean scores were higher than no formal intervention with exposure to VBMM instruction alone (0.73 points, P = .01), wet lab alone (0.88 points, P = .002), and wet lab plus VBMM instruction (1.35 points, P= <.001). No significant difference in scores was found between instruction with VBMM versus wet lab alone (P = 1.00), or between either instruction method alone compared to a combination of the two methods (P = .34, .09). Student survey opinions on the VBMM instruction method were positive.

CONCLUSION

VBMM instruction is comparable to prosection-based lab with regards to score outcomes and was well received by students as both an independent learning tool and as a supplement to cadaveric lab. When compared to either instruction method alone, the supplementation of VBMM with cadaveric prosection instruction was best. VBMM instruction may be valuable for institutions without access to cadaveric specimens, or those looking to supplement their current anatomy curriculum.

Promoting interprofessional student outcomes through the narrative of an opioid use disorder survivor

The inappropriate use of opioids is a national concern. Experts suggest a multifaceted, collaborative practice approach to reduce mortality rates in complex healthcare issues is effective. Before practice, students require education to address the development of interprofessional (IP) skills. The purpose of this mixed-methods cohort study was to identify changes in student self-perceived value of IP socialization skills and to explore student perceptions of IP engagement in the context of the opioid crisis, before and after a combined IP panel and focus group discussion using a healthcare professional's journey from addiction into recovery. Thirty-three pre-licensure healthcare students in Schools of Counseling, Nursing, Occupational Therapy, Pharmacy, and Physical Therapy assessed their IP experience using the Interprofessional Socialization and Valuing Scale (ISVS). The IP event included interactive discussions with a panel of healthcare providers, a pharmacist in recovery from opioid use disorder, and a local prescription drug awareness and prevention advocate. Significant differences occurred between pre and post ISVS scores in the perceived value of IP collaborative work. Results from the qualitative analysis revealed a need for student-driven self-reflection before the discussions evolved to address the perspectives of future practitioner, the patient, and the healthcare system. Creating a real-time, face-to-face interaction with a panel of healthcare practitioners, an opioid survivor in concert with a local prescription drug prevention advocate may be an effective means toward improving teaching IP value and progressing student outcomes toward IP skill attainment.

Team-based learning versus Traditional lecture-based learning: An investigation of students' perceptions and academic achievements

Objectives:

Evaluation of TBL from students’ perspective has been done extensively, but limited studies have analyzed the effect of TBL on students’ academic performance. Objectives of the present study were to assess students’ perceptions about team-based learning versus traditional lectures and then to compare with students’ grades in both TBL and lecture-based assessments.

Methods:

Cross-sectional descriptive study which included 147 dentistry students was conducted between March and June, 2020 at Qassim University, Saudi Arabia. A self-composed 10 item closed ended instrument was administered through electronic mail. One block from each academic year was selected randomly and organizers were requested to provide grades of students in both TBL and lecture-based exams. Grades from A to F were determined as achievement indicator and were compared statistically using Kruskal Wallis, Tuckey Posthoc and Chi-square tests.

Results:

A total of 120 students (81.6%) responded to the survey, and mean perception score was (3.29±0.94). Perceptions of students, regarding TBL as a learning strategy were comparatively superior as compared to the lectures. Students scored significantly higher grades in TBL exams (p<0.05) as compared to lecture-based assessments. Gender-wise analysis indicated that female students secured significantly higher grades in the TBL.

Conclusion:

We conclude that dentistry students perceived TBL as superior teaching and learning strategy compared to traditional lectures. Their perception was verified by their significant higher academic achievements in the assessments for the coursework taught by utilizing team-based learning strategy.

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION/CONCLUSIONS

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

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

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

Team-based learning pedagogy enhances the quality of Chinese pharmacy education: a systematic review and meta-analysis

BACKGROUND

Recent years have witnessed the wide application of team-based learning(TBL) pedagogy in Chinese pharmacy education. However, the relevant systematic review evaluating the effects of such new pedagogical approach has not been established. The present study was designed to examine systematically the effect of using TBL approach in pharmacy education in China.

METHODS

Six databases were searched from the inception to January 2019. The studies reporting the performance of pharmacy students in Chinese university or college receiving TBL pedagogy compared to those receiving traditional lecture-based learning (LBL) were enrolled to be analyzed. Scores of the objective theoretical test were considered as the primary outcome, and the results from questionnaires about the number of students who approved the effects of TBL pedagogy on improving their learning enthusiasm, self-study ability, thinking ability, and communication skills were considered as the secondary outcome. A meta-analysis was conducted following the guidelines of the Cochrane Reviewer's Handbook and the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement.

RESULTS

A total of 1271 students in 12 studies published from 2013 to 2018 were enrolled in present analysis. Compared with traditional LBL pedagogy, TBL pedagogy exhibited more effectiveness in developing the objective tests scores of pharmacy students from both universities (SMD = 1.69, 95% CI [1.10, 2.28], p < 0.00001) and colleges (SMD = 4.37, 95% CI [1.33, 7.40], p < 0.00001), and such pedagogy applied well in experiments-oriented courses (SMD = 2.14, 95% CI [0.86, 3.43], p < 0.00001) and theory-oriented courses (SMD = 2.77, 95% CI [1.41, 4.14], p < 0.00001). In addition, it developed students' learning enthusiasm, students' self-study ability, thinking ability, and enhanced students' communication skills.

CONCLUSIONS

TBL pedagogy has developed rapidly and applied widely in Chinese pharmacy education during the last decade. The results indicated that such novel pedagogy is compatible with the present situation of Chinese pharmacy education. And it could be considered as an effective method to enhance both the theoretical test scores and various abilities of Chinese pharmacy students.

Using the Jigsaw Method to Teach Abdominal Anatomy

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

Pre-Class Learning Methods for Flipped Classrooms

Objective. To review the types of pre-class learning modalities used in flipped classrooms (FC) and team-based learning (TBL) and determine best practices. Findings. Forty-eight articles were included. Reading materials or video lectures were used most often as the primary modality to deliver the pre-class learning. Students favored assignments that have clear objectives, provide guidance, are guided, and are brief. Summary. This study describes how pharmacy schools and colleges are implementing FC into their curricula and the types of pre-class learning that are being developed and assigned with the implementation. More research should be done in comparing the impact of different types of pre-class material on learning outcomes, such as knowledge retention. This is especially important in FC settings because the in-class learning and higher order activities are built upon having a good foundational knowledge, which comes from the pre-class learning.

Use of Real Patients and Patient-Simulation-Based Methodologies for Teaching Gastroenterology to Pre-Clinical Medical Students

In recent years, there has been an increasing focus on the need to integrate formal knowledge with clinical experience in the pre-clinical years since the initial years of medical education play an important role in shaping the attitudes of medical students towards medicine and support the development of clinical reasoning. In this study, we describe approaches that involve real patients and patient-simulation-based methodologies to teach gastroenterology to second year medical students. Our goals were to (i) demonstrate bio-psychosocial aspects of clinical practice, (ii) demonstrate commonality of gastrointestinal ailments, and (iii) help understand complex gastroenterology concepts. We used two main approaches including brief, pre-prepared questions and answers discussing with the patients in various sessions throughout the course and a two-hour session that included patient participation, patient simulation modalities with high fidelity mannequins, a lightening round of interactive cases, and a Patient Oriented Problem Solving (POPS) session. The approaches improved the effectiveness of the delivery of the content-heavy, fast-paced GI course and provided opportunities for the students to think about gastroenterology from both basic and clinical points of view. The approaches involved peer teaching, which supports knowledge acquisition and comprehension. Very positive feedback and overall engagement of students suggested that these approaches were well-received.

Meta-analysis on the effectiveness of team-based learning on medical education in China

BACKGROUND

Team-based learning (TBL) has been adopted as a new medical pedagogical approach in China. However, there are no studies or reviews summarizing the effectiveness of TBL on medical education. This study aims to obtain an overall estimation of the effectiveness of TBL on outcomes of theoretical teaching of medical education in China.

METHODS

We retrieved the studies from inception through December, 2015. Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Wanfang Database, Chinese Scientific Journal Database, PubMed, EMBASE and Cochrane Database were searched. The quality of included studies was assessed by the Newcastle-Ottawa scale. Standardized mean difference (SMD) was applied for the estimation of the pooled effects. Heterogeneity assumption was detected by I² statistics, and was further explored by meta-regression analysis.

RESULTS

A total of 13 articles including 1545 participants eventually entered into the meta-analysis. The quality scores of these studies ranged from 6 to 10. Altogether, TBL significantly increased students' theoretical examination scores when compared with lecture-based learning (LBL) (SMD = 2.46, 95% CI: 1.53-3.40). Additionally, TBL significantly increased students' learning attitude (SMD = 3.23, 95% CI: 2.27-4.20), and learning skill (SMD = 2.70, 95% CI: 1.33-4.07). The meta-regression results showed that randomization, education classification and gender diversity were the factors that caused heterogeneity.

CONCLUSIONS

TBL in theoretical teaching of medical education seems to be more effective than LBL in improving the knowledge, attitude and skill of students in China, providing evidence for the implement of TBL in medical education in China. The medical schools should implement TBL with the consideration on the practical teaching situations such as students' education level.

Team-Based Learning Experiences of Fourth-Year Pharmacy Students in a South African University

Objective. To determine fourth-year pharmacy students' learning experiences with team-based learning (TBL) at a South African university. Methods. A survey composed of biographical data and quantitative questions focusing on student learning experiences was sent to students. There were 183 (91.5%) students who completed the survey. Results. Students had a positive experience with TBL and found it valuable and more worthwhile than traditional lecture methods, regardless of their initial negative perception of TBL. Students enjoyed working in multi-cultural, mixed gender teams. Conclusion. TBL is an effective teaching strategy to simulate the reality of health professions where practitioners are required to work in a team. TBL should be offered in more courses in health professions curriculum in South Africa to strengthen and promote efficient health care delivery.

Team-based learning: assessing the impact on anatomy teaching in People's Republic of China

OBJECTIVES

In this study, the effects of team-based learning (TBL) method on the anatomy course for students in People's Republic of China were assessed.

METHODS

The students were randomly divided into the traditional lecture-based teaching group (traditional learning [TL] group, 99 students) and TBL teaching group (98 students). The TBL method required the students to prepare the assigned content in advance and discuss some specific topics in small groups. The test scores and questionnaire were applied to evaluate the effects of the two methods.

RESULTS

The students in TBL group had higher examination scores (81.70±8.53 vs 74.41±8.27, F[1,195] =124.6, p<0.01). The ratios of students with excellent (13.27% vs 9.09%, χ²[1] =4.00, p=0.041) and good scores (25.51% vs 16.16%, χ²[1] =4.85, p=0.027) were markedly increased in the TBL than the TL group, and the ratio of students who had just managed to pass was decreased (17.34% vs 32.33% in TL group, χ²[1] =5.91, p=0.015). The students in TBL group significantly achieved some improvement in mutual communication ability (χ²[1] =7.54, p=0.006), expression ability (χ²[1] =4.930, p=0.026), generalization capacity (χ²[1] =4.08, p=0.043), cooperative ability cultivation (χ²[1] =5.04, p=0.024), knowledge extension (χ²[1] =4.50, p=0.034), and enthusiasm mobilization (χ²[1] =4.27, p=0.039).

CONCLUSION

TBL could improve not only the test scores of the students, but also their study enthusiasm, initiative learning ability, communication ability, and team awareness.

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.

Team-based Learning Strategy in Biochemistry: Perceptions and Attitudes of Faculty and 1st-Year Medical Students

Background:

Team-based learning (TBL) strategy has been widely adapted by medical schools all over the world, but the reports regarding the perceptions and the attitudes of faculty and undergraduate medical students towards TBL approach have been conflicting.

Aim:

The study aimed to introduce TBL strategy in curriculum of Biochemistry after evaluating its effectiveness through perceptions and attitudes of faculty and 1^st-year medical students.

Materials and Methods:

One hundred and fifty students of first professional M.B.B.S and five faculty members participated in the study. Their responses regarding perceptions and attitudes towards TBL strategy were collected using structured questionnaires, focus group discussions, and in-depth interviews. Data were analyzed using Wilcoxon signed-rank test, paired sample t-test, and Mann–Whitney U-test.

Results:

Majority of the students expressed satisfaction with team approach and reported improvement in the academic scores, learning styles, and development of problem-solving, interpersonal, and professional skills. The faculty, however, recommended a modified TBL approach to benefit all sections of the students for the overall success of this intervention.

Conclusion:

TBL is an effective technique to enable the students to master the core concepts and develop professional and critical thinking skills; however, for the 1^st-year medical students, a modified TBL approach might be more appropriate for the effective outcomes.

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.

Social problem-solving in Chinese baccalaureate nursing students

OBJECTIVE

To describe social problem solving in Chinese baccalaureate nursing students.

METHODS

A descriptive cross-sectional study was conducted with a cluster sample of 681 Chinese baccalaureate nursing students. The Chinese version of the Social Problem-Solving scale was used. Descriptive analyses, independent t-test and one-way analysis of variance were applied to analyze the data.

FINDINGS

The final year nursing students presented the highest scores of positive social problem-solving skills. Students with experiences of self-directed and problem-based learning presented significantly higher scores in Positive Problem Orientation subscale. The group with Critical thinking training experience, however, displayed higher negative problem solving scores compared with nonexperience group.

CONCLUSIONS

Social problem solving abilities varied based upon teaching-learning strategies. Self-directed and problem-based learning may be recommended as effective way to improve social problem-solving ability.

Student perceptions of independent versus facilitated small group learning approaches to compressed medical anatomy education

The purpose of this study was to compare student perceptions regarding two, small group learning approaches to compressed (46.5 prosection-based laboratory hours), integrated anatomy education at the University of Ottawa medical program. In the facilitated active learning (FAL) approach, tutors engage students and are expected to enable and balance both active learning and progression through laboratory objectives. In contrast, the emphasized independent learning (EIL) approach stresses elements from the "flipped classroom" educational model: prelaboratory preparation, independent laboratory learning, and limited tutor involvement. Quantitative (Likert-style questions) and qualitative data (independent thematic analysis of open-ended commentary) from a survey of students who had completed the preclerkship curriculum identified strengths from the EIL (promoting student collaboration and communication) and FAL (successful progression through objectives) approaches. However, EIL led to student frustration related to a lack of direction and impaired completion of objectives, whereas active learning opportunities in FAL were highly variable and dependent on tutor teaching style. A "hidden curriculum" was also identified, where students (particularly EIL and clerkship students) commonly compared their compressed anatomy education or their anatomy learning environment with other approaches. Finally, while both groups highly regarded the efficiency of prosection-based learning and expressed value for cadaveric-based learning, student commentary noted that the lack of grade value dedicated to anatomy assessment limited student accountability. This study revealed critical insights into small group learning in compressed anatomy education, including the need to balance student active learning opportunities with appropriate direction and feedback (including assessment).

A Rapid Review of the Factors Affecting Healthcare Students' Satisfaction with Small-Group, Active Learning Methods

PHENOMENON: Problem-based learning (PBL) and other small-group, active learning methodologies have been widely adopted into undergraduate and postgraduate healthcare curricula across the world. Although much research has examined student perceptions of these innovative teaching pedagogies, there are still questions over which factors influence these views. This article aims to identify these key elements that affect healthcare student satisfaction with PBL and other small-group learning methods, including case-based and team-based learning.

APPROACH

A systematic rapid review method was used to identify high-quality original research papers from the healthcare education literature from between 2009 and 2014. All papers were critically appraised before inclusion in line with published guidelines. Narrative synthesis was achieved using an inductively developed, thematic framework approach.

FINDINGS

Fifty-four papers were included in the narrative synthesis. The evidence suggests that, despite an initial period of negative emotion and anxiety, the perspectives of healthcare students toward small-group, active learning methods are generally positive. The key factors influencing this satisfaction level include (a) the facilitator role, (b) tutorial structure, (c) individual student factors, (d) case authenticity, (e) increased feedback, (f) group harmony, and (g) resource availability. Insights: Student satisfaction is an important determinant of healthcare education quality, and the findings of this review may be of value in future curriculum design. The evidence described here suggests that an ideal curriculum may be based on an expert-led, hybrid PBL model.

Outcomes of Irish graduate entry medical student engagement with self-directed learning of clinical skills

BACKGROUND

Existing literature is mixed as to whether self-directed learning (SDL) delivers improvements in knowledge, skills or attitudes of medical students compared with traditional learning methods. This study aimed to determine whether there is an association between engagement in SDL and student performance in clinical examinations, the factors that influence student engagement with SDL in clinical skills, and student perceptions of SDL.

METHODS

A retrospective analysis of electronic records of student bookings of SDL sessions from 2008 to 2010 was performed for students in the pre-clinical years of an Irish Graduate Entry Medical programme to assess their level of engagement with SDL. The extent to which this engagement influenced their performance in subsequent summative examinations was evaluated. A cross-sectional survey of students across the four years of the programme was also conducted to determine student perceptions of SDL and the factors that affect engagement.

RESULTS

The level of engagement with SDL decreased over time from 95% of first years in 2008 to 49% of first years in 2010. There was no significant difference between the median exam performance for any clinical skills tested by level of engagement (none, one or more sessions) except for basic life support in first year (p =0.024). The main reason for engaging with SDL was to practice a clinical skill prior to assessment and the majority of respondents agreed that SDL sessions had improved their performance of the specific clinical skills being practised.

CONCLUSION

Students viewed SDL as an opportunity to practise skills prior to assessment but there were no significant differences in subsequent summative assessment by the level of engagement for most clinical skills.

Modified team-based learning strategy to improve human anatomy learning: A pilot study at the Universidad del Norte in Barranquilla, Colombia

As part of an institutional program sponsored by the Centre for Teaching Excellence at the Universidad del Norte, Barranquilla, Colombia, we developed an educational research study on two sessions of human anatomy in which we combined team-based learning (TBL) and the use of iPads. Study data included the TBL, assessments applied during the course, student's grades on mid-term examinations and students' perceptions of their experiences. Students reported a positive attitude toward the use of the TBL sessions, and the results showed a significant improvement in their learning between the first and second sessions. Significantly positive correlations (P < 0.05) were obtained between (a) the individual students' readiness test performance 1 and mid-term examination 1, (b) the individual readiness test performances from Session 1 to Session 2, and (c) the group readiness test performances from the first and second sessions. These results point to positive learning experiences for these students. Analyses of the students' reflections on their activities also pointed toward future challenges.

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

PURPOSE

Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers.

METHOD

The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S's [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines.

RESULTS

The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students.

CONCLUSIONS

In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program.

Is a Team-based Learning Approach to Anatomy Teaching Superior to Didactic Lecturing?

OBJECTIVES

Team-based learning (TBL) is used in the medical field to implement interactive learning in small groups. The learning of anatomy and its subsequent application requires the students to recall a great deal of factual content. The aims of this study were to evaluate the students' satisfaction, engagement and knowledge gain in anatomy through the medium of TBL in comparison to the traditional lecture method.

METHODS

This study, carried out from February to June 2012, included 30 physical therapy students of the Shiraz University of Medical Science, School of Rehabilitation Sciences. Classic TBL techniques were modified to cover lower limb anatomy topics in the first year of the physical therapy curriculum. Anatomy lectures were replaced with TBL, which required the preparation of assigned content, specific discussion topics, an individual self-assessment test (IRAT) and the analysis of discussion topics. The teams then subsequently retook the assessment test as a group (GRAT). The first eight weeks of the curriculum were taught using traditional didactic lecturing, while during the second eight weeks the modified TBL method was used. The students evaluated these sessions through a questionnaire. The impact of TBL on student engagement and educational achievement was determined using numerical data, including the IRAT, GRAT and final examination scores.

RESULTS

Students had a higher satisfaction rate with the TBL teaching according to the Likert scale. Additionally, higher scores were obtained in the TBL-based final examination in comparison to the lecture-based midterm exam.

CONCLUSION

The students' responses showed that the TBL technique could be used alone or in conjunction with traditional didactic lecturing in order to teach anatomy more effectively.