A multiyear analysis of team-based learning in a pharmacotherapeutics course

Impact of Collaborative Testing on Academic Performance in Pharmacy Education

OBJECTIVE

To determine the impact of 2-stage collaborative testing (CT) on academic performance of pharmacy students and to characterize pharmacy student perceptions of CT.

METHODS

Two-stage CT was piloted in a 2-course patient assessment sequence within a Doctor of Pharmacy program. Students were randomly allocated into 2 groups and further divided into teams of 4 to 5 students. Student teams alternated taking section examinations in a traditional 1-stage (individual) and 2-stage CT (individual then team) format to establish an experimental design. Near the end of each semester, students individually took a post-test to facilitate assessment of CT on academic performance. A 12-item, anonymous survey instrument assessed student perceptions of 2-stage CT. The group differences in academic performance and survey responses were analyzed statistically.

RESULTS

There were 128 students enrolled in the course sequence, 123 of whom met the inclusion criteria for assessment of academic performance and 100 of whom completed the survey (response rate = 83%). Generally, students performed better on post-test items initially assessed through 2-stage CT (retention marker) and on post-test items that were answered incorrectly under 2-stage CT conditions (learning marker). Approximately 9 in 10 survey respondents preferred 2-stage CT over traditional 1-stage individual testing, with an equivalent proportion reporting it helped them learn from their mistakes and retain what they learned. There was high-level agreement among respondents that 2-stage CT improved their ability to work as a team and think critically.

CONCLUSION

The implementation of 2-stage CT in a patient assessment course sequence was associated with improved learning and retention and was well-received by students.

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

Background

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

Methods

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

Results

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

Conclusion

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

Enhancing application and long-term retention of clinical knowledge using an extracurricular non-credit course

BACKGROUND AND PURPOSE

Curricular overload in doctor of pharmacy (PharmD) programs is necessitating innovative approaches to support student learning. The purpose of this study was to describe the design, delivery, and assessment of a non-credit extracurricular course that reinforced foundational concepts through the application of learning in case-based activities.

EDUCATIONAL ACTIVITY AND SETTING

A 14-week extracurricular course, designed using principles of spaced repetition and interleaving in the context of case-based exercises, was offered to third-year PharmD students. Content focused on Top 300 and over-the-counter medications, brown bag sessions/drug utilization review, and medication therapy management. Short-term course effectiveness was assessed through post-course focus groups. Longitudinal effectiveness was assessed nine months post-course using an online survey. Qualitative data were analyzed using a content analysis process with overarching themes identified. Clinical interventions identified in the post-course survey were analyzed descriptively.

FINDINGS

Twenty-four students completed the course and all assessments. Focus group themes were: (1) making connections to prior learning; (2) moving beyond memorizing facts; and (3) benefit from a low-stakes course. Students identified 162 course-linked clinical interventions during advanced pharmacy practice experiences (APPEs) in 16 different settings.

SUMMARY

Student learning can be enhanced through integration of evidence-based teaching strategies both within and across the curriculum. This can be accomplished not only through introduction of an extracurricular course but through modification of existing courses. Providing additional opportunities for reinforcing core clinical knowledge and applying clinical decision-making in a low-stakes environment was well-received by students and helped them make clinical interventions during APPEs.

Student Performance on Graded Versus Ungraded Readiness Assurance Tests in a Team-Based Learning Elective

Objective. Team-based learning is widely used in pharmacy education. In this context, students need to be incentivized to do preclass preparation, thus ensuring they are ready for team-based learning, via graded readiness assurance tests (RATs). The purpose of this study was to determine the effect of graded versus ungraded RATs on examination performance in an ambulatory care elective course for third-year student pharmacists.Methods. For the course offered in spring 2020 and 2021, a standard team-based learning framework was employed. In 2020 the RATs were graded and contributed to the overall course grade (graded RAT cohort), but in 2021 RAT grades did not contribute to the course grade (ungraded RAT cohort). For the ungraded RAT cohort, at the end of the course students completed an online anonymous survey regarding class preparation and perceived team accountability.Results. No significant difference was found between the graded RAT (n=47) and ungraded RAT cohorts (n=36) in the overall mean percentage score on individual RATs (76% vs 74%) and individual examinations (82% vs 80%). Most students (69%-91%) in the ungraded RAT cohort reported completing preclass preparation assignments. In the postcourse survey, 94% of students agreed or strongly agreed that RATs contributed to team members' learning, and 86% agreed or strongly agreed that they were proud of their ability to assist in the team's learning.Conclusion. Ungraded RATs did not significantly impact students' examination performance in an elective course. Removing the grading of this test, whereby grading promotes the performance approach to learning, may have shifted the students' motivation to the mastery approach in the context of preclass preparation. This challenges a widely held belief that grades are necessary incentives for preclass preparation within team-based learning.

A small‐group activity to enhance learning of cardiovascular drugs for health science students

This small‐group activity provides two cases in cardiovascular pharmacology to engage students in a medical or other health professions curriculum. The goal of this activity is to apply students' basic knowledge of physiology and pharmacology to clinical case scenarios. Students were provided with the cases 1 week in advance and were encouraged to use their lecture notes and/or other references of their choosing to answer as many of the questions as possible and prepare to discuss the answers with their classmates at the session. Facilitators were provided with detailed notes and a video that explain the answers and provide suggestions for engaging and challenging the students. For the 2021 academic year, 201 students (139 first‐year medical students and 62 second‐year pharmacy students) at UC San Diego participated in the small‐group activity. Eighteen facilitators were recruited to lead this 110‐min session. Students' performance was assessed on the final exam of their integrated cardiovascular physiology‐pharmacology course. Students achieved 84% (SD 17.54) on questions related to the small‐group session compared to 78% (SD 15.60) on other cardiovascular pharmacology questions not related to the activity. Student perceptions of the facilitators leading the small‐group activity were very positive (average of 4.7 on a 5‐point Likert Scale). Using this approach, we demonstrate that a small‐group activity with clinical scenarios helps students master the pharmacology content related to cardiovascular drugs. The small‐group activity included constructed response questions to foster conceptual understanding.

Drug development and the process of transitioning to team-based learning in a qualitative way

BACKGROUND AND PURPOSE

The North American Pharmacist Licensure Examination and the Pharmacy Curriculum Outcomes Assessment are two standardized tests that evaluate students' preparedness to progress into pharmacy practice. Pharmacy educators are responsible for ensuring individual learners are engaged in course material and take appropriate steps to succeed in meeting learning outcomes. Whenever a new pedagogy is adopted in a previously existing course, understanding the impact on learners is critical.

EDUCATIONAL ACTIVITY AND SETTING

Team-based learning (TBL) was implemented within a novel Drug Discovery and Development course to measure the impact in active participation and student performance within the second year of pharmacy school. Survey data was collected to gather pharmacy students' perspectives regarding the pedagogy change. Examination competency scores and active participation were tracked to measure student engagement.

FINDINGS

Survey results revealed students agreed or strongly agreed that Drug Discovery and Development was enjoyable when taught with a TBL model, created a conductive learning environment, and improved their perceived knowledge, communication skills, and confidence. Average attendance scores were > 90% in a TBL setting. No change in block exam competency scores were noted across the three academic cohorts.

SUMMARY

Students agreed that Drug Discovery and Development was enjoyable when taught using TBL, created a conductive learning environment, and improved their perceived knowledge, communication skills, and confidence. Additional research should be conducted to quantify student engagement and active attendance within similar courses. Similar styles of TBL implementation could be incorporated at other colleges of pharmacy to measure its potential benefits.

Comparing Active Learning to Team-Based Learning in Undergraduate Neuroscience

Team-based learning (TBL) is a special form of collaborative learning that involves the use of permanent working teams throughout the semester. In this highly structured and interactive teaching method, students perform preparatory activities outside of class to gain factual knowledge and understand basic concepts. In class, students collaborate with peers to apply content, analyze findings, and synthesize new ideas. To better understand the learning outcomes specific to TBL courses, we analyzed end-of-semester course evaluations from an undergraduate neuroscience course taught using either a moderate structure active learning or TBL format. Our analysis reveals that the TBL taught classes had significantly higher levels of self-reported learning in the areas of gaining, understanding, and synthesizing knowledge. We propose that these gains are driven by the TBL readiness assurance process and peer evaluations. Both of these structural components are expected to increase student accountability, motivation, and engagement with course content.

Determining Indicators of High-Quality Application Activities for Team-Based Learning

Objective. To determine the indicators of quality for application activities in pharmacy team-based learning (TBL). Methods. A modified Delphi process was conducted with pharmacy TBL experts. Twenty-three experts met the inclusion criteria, including having at least four years of TBL experience, designing at least eight TBL sessions, training others to use TBL, and authoring a peer-reviewed TBL pharmacy paper. In round 1, panelists responded to five open-ended questions about their successful TBL applications activities, including satisfaction with the activity and methods for creating positive student outcomes. In round 2, panelists indicated their level of agreement with the round 1 quality indicators using a four-point Likert rating. Consensus was set at 80% strongly agree/agree. In an open comment period, panelists provided suggestions to help expand the indicator descriptions. Indicators were verified based on TBL and the education literature. Results. Twenty panelists (87% of those eligible) responded in round 1 and 17 (85% participation) in round 2. Sixteen quality indicators were identified in round 1, with 14 achieving consensus in round 2. "Uses authentic pharmacy challenges or situations" (88% strongly agree/agree) and "incorporates or provides effective feedback to groups" (88% strongly agree/agree) met consensus. However, "has multiple right answers" (76% strongly agree/agree) and "incorporates elements from school specific emphases (eg, faith, underserved)" (53% strongly agree/agree) did not reach consensus. Conclusions. These indicators can assist faculty members in designing application activities to provide high-quality TBL exercises that promote deep thinking and engaged classroom discussion. The indicators could also guide faculty development and quality improvement efforts, such as peer review of application activities.

Assessing Students' Satisfaction with a Redesigned Pharmacology Course Series

Objective. To describe the revision of a pharmacology course series taught over three quarters within a Doctor of Pharmacy (PharmD) curriculum and assess changes in students' attitudes toward and performance after the revision. Methods. Based in part on students' dissatisfaction regarding a pharmacology course series, a course director was hired and tasked with teaching a major portion of the course content, rewriting course examinations, and facilitating active learning in the course series. Course evaluations and examination scores of students who completed the course series after the implementation of the redesigned curriculum (classes of 2015 and 2016) were assessed and compared with those of students who completed the course before the revisions were made (classes of 2013 and 2014). Results. Qualitative analysis of second-year pharmacy student evaluations identified a lack of integration and coordination within the pharmacology course sequence. Poor examination quality and the absence of active teaching methods were other frequently described shortcomings of the pharmacology curriculum. Course evaluations dramatically improved after shortcomings were addressed and students' performance in the subsequent therapeutics course also increased significantly. Conclusion. Adding additional structure to and oversight for a pharmacology course series by adding a course director improved student satisfaction with the course and improved performance in the subsequent therapeutics course. This study highlights the importance of a well-designed pharmacology curriculum for continued success in core courses in the PharmD curriculum.

Using a Novel Student-centered Teaching Method to Improve Pharmacy Student Learning

Objective. To improve students' learning and develop their learning skills in pharmacy education. Methods. A novel teaching method composed of Self-study, Test, Question and Discussion (STQD) sessions uses self-, peer-, co-learning, active learning, inductive teaching, and formative assessment to promote student-centered teaching in pharmacy education. STQD has been implemented within courses focusing on instrumental analysis and analytical chemistry. In a four-year study, qualitative and quantitative approaches were used to evaluate the effectiveness of STQD in facilitating students' learning. Results. Students positively evaluated their experience in STQD class with an overall mean and standard deviation of 4.35 (0.64) in a 5-point Likert scale, where a score of 1 is "strongly disagree" and a score of 5 is "strongly agree." The final examination results showed students' average score in an STQD class was higher than students' average score in a traditional class. Most students indicated that the STQD improved their learning ability, communication ability and facilitated their learning. Conclusion. The use of STQD in an integrated basic science curriculum has the potential to develop students' learning skills and improve their learning in pharmacy education.

Curricular Reform in Pharmacy Education Through the Lens of the Flexner Report of 1910

Abraham Flexner's 1910 report on medical education in the United States (US) and Canada propelled medical training forward into a contemporary renaissance. The report heralded many seismic changes that still resonate within medical and health professions education throughout the US. Today several factors are accelerating curricular reform within pharmacy education, including but not limited to accreditation standards, technologic advances, and student diversity. Despite the fact that Flexner's report is now over a century old, many of his observations and recommendations regarding education are as pertinent and timely today as they were in 1910. This commentary will discuss and reflect upon curricular reform in pharmacy education as it contrasts with some of the observations, findings, and recommendations of Flexner's 1910 report.

Student preparation time for traditional lecture versus team-based learning in a pharmacotherapy course

BACKGROUND AND PURPOSE

Determine how much time students spent preparing for traditional lecture versus team-based learning (TBL) for a pharmacotherapy course and determine if time spent in each pedagogy was within stated expectations for the course.

EDUCATIONAL ACTIVITY AND SETTING

Instructors used a combination of traditional lecture and TBL to deliver material. Before each lecture, instructors recorded the amount of time students spent preparing for each method using a one-question clicker-response survey.

FINDINGS

Instructors delivered 16 hours of TBL, 32 hours of traditional lecture, and eight hours of a mix of TBL and traditional lecture. The median of students completing the survey each week was 89. A large percentage of the class (40.9%) did not prepare for traditional lecture while only 3.4% did not prepare for TBL. About 61% of students spent between 30 min and two hours preparing for a two-hour TBL session and only 10% spent more than three hours preparing.

DISCUSSION AND SUMMARY

Results of this project show students spend little time preparing for traditional lectures without in-class accountability, which may give students the perception that TBL requires too much preparation time.

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

PURPOSE

Summarize the published literature on team-based learning (TBL) in health professions education (HPE) using the TBL conceptual framework to identify gaps that can guide future research Methods: PubMed, Web of Science, ERIC, and Google Scholar were searched through May 2016 for English-language articles regarding the use of TBL in HPE. Reviewers independently extracted data and coded for the seven elements in Michaelsen's Model of TBL.

RESULTS

A total of 118 articles met inclusion criteria. The number of articles published yearly on TBL has grown steadily, more than tripling between 2011 and 2016. Most studies (55; 47%) involved undergraduate medical students and took place in the US (72; 61%). The most commonly studied framework component was Teacher and Learner Attitudes (97; 82%). Other commonly studied elements included Learning Outcomes (85; 72%) and Team Characteristics (25; 21%). Contextual Factors affecting TBL was addressed in one study.

CONCLUSIONS

A substantial body of literature examines the effect that TBL has on traditional measures of achievement. However, many dimensions of TBL have not been well studied, including Teacher Decisions about TBL, Contextual Factors that affect TBL, Learners' Engagement, and Pattern of Engagement within Teams. Future research in these areas could determine the best use of TBL in HPE.

A Team-based Assignment to Integrate Basic Science and Pharmacotherapeutic Principles for Anticancer Agents

Objective. To implement and evaluate an active-learning, team-based assignment centered on anticancer agents for the integration of basic science and pharmacotherapeutic principles. Methods. Student teams were assigned a specific anticancer agent and were expected to answer a series of questions on the written section of the assignment, followed by a presentation to the class. Each assignment was assessed using a grading rubric that was mapped to the 2013 CAPE educational outcomes. Student perceptions of the assignment were assessed using a short survey. Results. Student cohort performance on the assignment was in the B range (83%) with a mean of 33.2 out of 40. Using the grading rubric, the 12 student cohorts performed particularly well under professionalism (Domain 4.4) that focuses on personal and professional development from CAPE 2013 with means >4 on a 1-5 scale. Student impressions of the assignment suggested that students believed the assignment had a positive effect on their learning and should be continued. Conclusion. The assignment provided a focused review of basic science and pharmacotherapeutic principles and enabled integration of concepts relating to the therapeutic application of anticancer agents, and management of anticancer agent mediated adverse effects. The assignment could contribute toward preparing students for the evolving role of the pharmacist in the management of cancer.

Comparison of long-term knowledge retention in lecture-based versus flipped team-based learning course delivery

OBJECTIVES

To determine whether team based learning (TBL) is superior to traditional lecture -based learning in confidence and knowledge retention one year later.

DESIGN

A survey was administered 17 months after a completion of a required over-the-counter /self-care (OTC) course to two different cohorts of students. The survey assessed confidence and knowledge related to OTC topics. The lecture group had a traditional lecture based classroom experience; the intervention group experienced a TBL format throughout the entire course.

ASSESSMENT

One hundred forty-seven students of 283 enrolled (51.9%) in the lecture group and 222 of 305 (72.8%) students in the TBL group participated in the knowledge assessment and survey. Demographic data including student grade point averages (GPA) and confidence were similar in both groups. Mean assessment scores (±SD) on OTC knowledge was significantly higher in the traditional lecture based group versus the TBL group; 62.9±19.3 vs. 54.9±15.7 (p=0.001).

CONCLUSION

Although TBL is thought to improve student engagement and mastery of material, after an initial implementation of TBL, knowledge retention in the long term appears to be lower than lecture based learning.

A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes

Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.

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.