Posters

These TBL related posters were presented during the 4th Annual National Conference in Team-Based Learning™ in Medical & Health Sciences Education hosted by Wright State University Boonshoft School of Medicine, June 2005.

Introduction of Team Learning to First Year Medical Students - The Adjunctive Use of WebCT

 

Author:
Lindsay Davidson

Affiliation:
Assistant Professor, School of Medicine, Faculty of Health Sciences, Queen's University

Purpose:
A pilot Team Learning initiative was introduced into the Queen's University First year Medicine "Musculoskeletal Course" in January 2005. This instructional method (Michaelsen, Knight and Fink, 2002) aims to develop high performance learning teams and serves to "enhance the quality of student learning".

Methods:
In addition to this in-class intervention, WebCT was used to provide electronic self-study modules, case summaries that prefaced in class assignments, as well as individual quizzes. The goal was to promote independent learning and pre-class preparation. In a transitional context such as this, where the student culture remains largely dominated by a classroom "passive didactic" model, the availability of adjunctive electronic resources was used to ease the transformation of the overall pedagogical framework of the course.

Results:
Almost all students completed the required web-based tests. While most students appreciated the opportunity for self-testing, there was concern about marks being assigned to the electronic quizzes. Some students perceived that testing was occurring prior to formal teaching. Over the course of one month (18 instructional days), there was an average of 35 website hits per student indicating regular use of the Course website, however negative student feedback revolved around logistical issues with WebCT. Anecdotal Faculty feedback suggested an increased level of student preparation for both TBL and didactic sessions, evidenced by less basic questions (e.g vocabulary, background concepts) and more interactive classroom discussion.

Conclusion:
A well designed, user-friendly website can be used to help introduce a more learner-centered curriculum that includes TBL. Student preparation can include a variety of independent electronic learning modalities including self-directed modules, case summaries and quizzes that incorporate feedback. Future directions include the use of private team discussion threads to facilitate peer learning in an asynchronous fashion and build upon classroom exercises.

Submitted by:
Lindsay Davidson
School of Medicine, Faculty of Health Sciences
Queen's University

Integrating Legal, Ethical and Practice Aspects in a Team-Based Learning Session

 

Authors:
Hettie Till M.Sc., M.Med.Ed., D.Ed.; Allan Freedman B.A., L.L.B.; Glynn Till D.C., D.Hom., F.C.C.S.; Stuart Kinsinger B.Sc., D.C., F.C.C.S.

Affiliation:
Canadian Memorial Chiropractic College

Purpose:
To use Team-Based Learning™ to assist preclinical students to better realise that certain actions or decisions that they might take in practice could have serious ethical or legal implications.

Methods:
The faculty member responsible for teaching Jurisprudence to our 3rd Year students developed the scenario which was a composite taken from his actual client files and embellished by the other team members to include ethical and practice issues and questions. Although the session was used to apply previously learnt material, the students were also given extra pre-reading. The session was offered by the whole team to a class of 156 students.

Results:
The session went well and a lot of discussion was generated both in the groups and between groups. The students felt it was of particular benefit to have faculty from different courses present at the same time. Both qualitative and quantitative student evaluations of the session gave positive results with the students enjoying the group interaction to solve "real life" problems as well as the immediate feedback from the faculty. They indicated that they preferred learning some course material on their own in preparation for an applied session and that more emphasis should be placed on actual cases and scenarios in the teaching of ethics. A hundred percent agreed that a solid foundation in some aspects of law is important for successful clinical practice.

Conclusion:
The positive outcome of this session has led to a number of other faculty members expressing interest in including TBL in their courses.

Submitted by:
Hettie Till
Canadian Memorial Chiropractic College

A Preliminary Report Comparing Traditional Teaching and Team-Based Learning™ Strategy in Medical Anatomy Course

 

Authors and Affiliations:
N.S. Vasan, * D.V.M., Ph.D. and D.O. DeFouw, * Ph.D. Department of Cell Biology and Molecular Medicine; B.K. Holland, Ph.D. Department of Preventive Medicine and Community Health, New Jersey Medical School, and *Members of UMDNJ- Stuart D. Cook, M.D. Master Educators' Guild, Newark, NJ.

Purpose:
At our school, anatomy was taught traditionally with lectures (40%) and cadaver dissection of (60%). Assessments include three unit (cadaver oriented practical and didactic) and final NBME subject exams. Under the new curriculum initiated in August 2004 all basic anatomy lectures were cut in favor of implementing active student-centered teaching. To maintain course content and effective teaching, we piloted a modified TBL strategy to promote active learning.

Methods:
170 students were divided into teams of 8. Each team received serial assignments on basic anatomy, embryology and clinical correlations. Weekly, teams discussed the assignments using cadavers, radiographs, skeletons and models. For each unit exam students received individual grades, and the teams then discussed without team grading, the questions for deeper understanding.

Results:
The 2004 class averages for unit exams 1, 2 and 3 were 77, 81 and 80 %. This is approximately 5-7 % higher than scores from 2002 and 2003. Using the traditional curriculum, in 2002 and 2003, NBME exam results were below the national average (lower on 6/8 topic areas in 2002, p=0.145; lower on 8/8 topic areas in 2003, p=0.004). In 2004, with the introduction of TBL, NJMS scores shifted upward in 8/8 topic areas (p=0.004). Scores now exceeded national figures in 6/8 topic areas, much better than performance in either 2002 (p<0.05) or 2003 (p=0.01).

Conclusion:
We found that TBL is effective, efficient and appealing to both students and faculty.

Support:
Supported in part by the Department of Cell Biology and Molecular Medicine, and Master Educator's Guild.

Submitted by:
Nagaswami Vasan D.V.M., Ph.D.
New Jersey Medical School

Team-Based Learning™: An Effective Method for Teaching Pharmacology?

 

Authors:
Amy L. Wilson-Delfosse1 and Daniel. R. Wolpaw2,3

Affiliation:
Departments of 1Pharmacology and 2Medicine, CASE School of Medicine, CASE Western Reserve University, Cleveland, OH and 3Cleveland VA Medical Center

Purpose: Team-Based Learning™ was introduced into the first year CASE School of Medicine pharmacology curriculum in an attempt to: 1) increase student satisfaction with regard to their experience learning fundamental principles of pharmacology, 2) promote self-directed learning and 3) improve students' ability to apply and retain fundamental principles of pharmacology.

Methods:
A Team-Based Learning™ approach was introduced into the first year, Fundamentals of Therapeutic Agents subject committee. Specifically, half of the class studied pharmacodynamic principles by means of a traditional small group approach, while the other half of the class was exposed to the same cases and principles utilizing a team learning approach. This study is being evaluated utilizing: 1) surveys to evaluate student perception of their learning experiences and self-reporting of their preparation for the sessions and 2) multiple choice exam questions administered during the interim exam and one year later to assess mastery of concepts, ability to apply to complex situations and retention.

Results:
There are no differences with regard to student perceptions or exam performance when the Team-Based Learning™ approach is compared to the current small group conference approach.

Conclusions:
Team learning is an effective approach to use for the teaching of pharmacodynamic principles of pharmacology. From the perspective of student perception and knowledge acquisition, however, advantages to a team learning approach are not clear.

Submitted by:
Amy Wilson-Delfosse
Pharmacology and Medicine
CASE School of Medicine
CASE Western Reserve University

Pathology Laboratory Content Taught Using a Team Based Learning Approach

 

Authors:
Sidney S.Murphree, William B. Lockwood

Affiliations:
Department of Pathology, University of Louisville School of Medicine, Louisville, Kentucky, USA

Purpose:
Team-learning was used to teach pathology laboratory content to second year medical students. We attempted to see whether case based Pathology laboratory content could be adequately covered in a large group (LG) setting when a team based learning (TBL) approach was combined with independent study of electronic media, and structured group work. We hoped to reduce the manpower needed for this content while increasing student performance and student satisfaction

Methods:
Cases from a "textbook companion" CD were assigned for review and discussion by small groups [6-7 students per group]. These cases were then covered in TBL sessions run by two or three faculty [generally content experts] in a large auditorium. Sessions included individual and group quizzes, post quiz discussions, analysis of gross and microscopic images and other pathology content. Student feedback instruments, instructor and student perceptions, student performance [Pathology Shelf Exam and USMLE Step 1 Exam] were used to evaluate instructional materials, student opinions, cost-benefit, and student performance.

Results:
The team learning approach received positive evaluations from students and faculty with a positive trending in student performance (Shelf score and Step 1 pass rate) and an 80% decrease in the faculty required. Students felt they benefited from working in stable groups and also appreciated their access to content experts. Students thought TBL helped them integrate difficult pathology content.

Conclusions:
Team based learning can be used to deliver case based pathology laboratory content to a LG with increased student satisfaction, decreased manpower requirements, and an increase in student performance.

Submitted by:
Sidney S Murphree
Department of Pathology
University of Louisville School of Medicine

Team-Based Learning™ in a Community Health Practicum for BS/MD Students

 

Author: Terry H. Albanese, Ph.D.

Affiliation:
Northeastern Ohio Universities College of Medicine

Purpose:
Team-Based Learning™ was introduced as a teaching modality for NEOUCOM's BS/MD Community Health Practicum in the summer of 2004. In this 8-week course BS/MD students work in groups to investigate and offer solutions for an identified community health problem. The course had previously been conducted with lectures and Problem-Based Learning; Team-Based Learning™ was instituted to replace lectures as a method for teaching students how to apply the material from the text to their community health problem.

Methods:
Faculty members who teach in the Practicum participated in a faculty development session about Team-Based Learning™ prior to the beginning of the course. The course director developed TBL readiness assurance tests and application activities based on the course textbook. Other faculty members provided input and assisted in developing the TBL application activities. The objective of the TBL activities was to guide the students in applying the text material, consistent with what they would be expected to do for the community health problem they were addressing in PBL.

Results:
Evaluation of the piloting of TBL included student mid-course and final course evaluations as well as faculty evaluations, both formal and informal. Overall results indicated that TBL was a positive teaching and learning experience, however, refinement of the TBL application activities was a primary recommendation.

Conclusions:
TBL will be continued in the 2005 Community Health Practicum. Additional faculty development will be provided and application activities will be revised. Evaluation will be expanded to compare classroom engagement and learning outcomes for TBL and lecture.

Submitted by:
Terry H. Albanese, Ph.D.
Northeastern Ohio Universities College of Medicine

Using Team Learning to Teach the Operations of the Health Care System to First Year Medical Students

 

Author:
Dan Mayer, MD

Affiliation:
Professor of Emergency Medicine, Theme Leader of Evidence Based Health Care, Albany Medical College

Purpose:
Curricular change at Albany Medical College has been ongoing for 12 years. A hallmark of this change has been the introduction of a longitudinal Pass-Fail course, Evidence Based Health Care, to teach students how to become lifelong learners and how the health care system works.

Methods:
Incorporating active teaching strategies into a Pass-Fail course within a traditionally graded curriculum for a class of 130 students every year is an educational challenge. Currently the course uses large group teaching settings with a student to teacher ratios of 24 to 1. Team Learning (TL) was instituted to foster active learning, self-study, advance preparation, and team communication among students in the large groups. In the first year class, students learn the principles of the operation of the health care system including the structure of various practice models and skills relating to provision of cost-effective and evidence-based patient-centered care. The curriculum of this portion of the course will be given in the poster.

Results: TL has led to a subjective enhancement of student engagement in class. The students use these opportunities to acquire and practice competencies involving content knowledge, communications, and problem solving. An overview of the course will be given and handouts will demonstrate the RATs and Application Exercises.

Conclusions:
TL has been successfully used to improve the conduct of a course teaching the structure and function of the health care system. There are no current outcome measures and we have relied on subjective faculty feedback suggesting improved student participation and retention of the material.

Submitted by:
Dan Mayer, MD
Department of Medical Education
Albany Medical College

Using Team Learning to Teach Evidence Based Medicine to First and Second Year Medical Students

 

Author: Dan Mayer, MD

Affiliation:
Professor of Emergency Medicine, Theme Leader of Evidence Based Health Care, Albany Medical College

Purpose:
Curricular change at Albany Medical College has been ongoing for 12 years. A hallmark of this change has been the introduction of a longitudinal Pass-Fail course, Evidence Based Health Care, to teach students how to become lifelong learners and how the health care system works.

Methods:
Incorporating active teaching strategies into a Pass-Fail course within a traditionally graded curriculum for a class of 130 students every year is an educational challenge. Currently the course uses large group teaching settings with a student to teacher ratios of 24 to 1. Team Learning (TL) was instituted to foster active learning, self-study, advance preparation, and team communication among students in the large groups. In the first and second year class, students learn skills and principles of EBM including critical appraisal of the medical literature and principles of medical decision-making. The curriculum of this portion of the course will be given in the poster.

Results:
TL has led to a subjective enhancement of student engagement in class. The students use these opportunities to acquire and practice competencies involving content knowledge, communications, and problem solving. An overview of the course will be given and handouts will demonstrate the RATs and Application Exercises.

Conclusions:
TL has been successfully used to improve the conduct of a course teaching the basic concepts and skills of EBM. There are no current outcome measures and we have relied on subjective faculty feedback suggesting improved student participation and retention of the material.

Submitted by:
Dan Mayer, MD
Department of Medical Education
Albany Medical College

Adapting Team-Based Learning™ to a Sim-Man Experience in Teaching the Physiology of Chest Pain to First year Medical Students

 

Authors:
Michael Petty, PhD*; Michael Soulsby, PhD; Jehad Albataineh, MD; Blake Norris, MD; James Pasley, PhD

Affiliation:
University of Arkansas for Medical Sciences (UAMS) College of Medicine

Purpose:
Student understanding is enhanced by inclusion of simulation in curriculum, yet real understanding depends upon student preparation as well. Team learning was used to ensure adequate preparation, as well as to reinforce complex concepts presented during the use of simulation.

Method:
Sim-Man was introduced into the physiology curriculum during the 2003-2004 academic year. Team Learning was added in 2004-2005 to enhance the experience and encourage preparation prior to the simulator. Students were assigned to 14 groups of 10 students based upon last name. An individual readiness assurance test (RAT) was given to the students prior to the simulation to assess their knowledge of heart physiology. At the simulator, individual groups arrived at 20 minute intervals and the group RAT given. Basic science faculty then responded to questions that arose from the RAT to correct any misconceptions. Students then participated in the simulation concerning heart physiology and chest pain. The next day, an application question based upon the experience was introduced by a cardiologist and student interactions observed.

Results:
Students were very active in the debriefing session between the group RAT and the Sim-Man experience. The application phase question was too complex for the students so most interaction was cardiologist to students rather than inter-group.

Conclusion:
The greatest surprises were teachable moments that occurred between group RAT and Sim-Man experience. The interaction was not planned, but occurred naturally with all groups. The application question requires refinement to make it more appropriate for 1st year students.

Submitted by:
Michael Petty, Assist. Prof.
Office of Educational Development
University of Arkansas for Medical Sciences (UAMS) College of Medicine

Development of a Laboratory/Conference Using a Human Simulator, a V-Tel System and a Team-Based Learning™ Approach

 

Authors:
William Zehring ,Ph.D., Mordechai Bermann, MD., Claire B. O'Connell, MPH, PA-C, Stephen P. McKenzie, MS, PA-C, Matthew A. McQuillan, MS, PA-, C Carol J.Sadley Med, PA-C, Jill Reichman, MPH, PA-C, William J. Hamilton. and Nancy R. Stevenson, Ph.D.

Affiliation:
UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway NJ, 08854

Purpose:
Combining Team-Based Learning™ methodology with new technologies to develop interesting and innovative teaching formats that stimulate student learning.

Method:
Existing scripted patient presentations involving cardiovascular and pulmonary systems were adapted to include use of the patient simulator in real time. Simulator data was transferred from the hospital to the classroom via a videoconferencing system. Team-Based Learning™ methodologies were employed to direct student discussion of the cases. The 2 sessions were held 1 month apart. This project involved 46 PA students enrolled in the Medical Physiology course; the rest of the class, 150 MD students, were the controls and handled the cases in traditional paper-based small groups. At the end of the semester, the PA student's exam scores will be compared with that of the controls to see if there is any objective change in student learning related to these conferences.

Initial Results:
After each session, questionnaires were completed. Questions were answered on a 1 to 5 scale [least to most positive]. The average evaluation of both conferences was 3 or better and the responses to the second were slightly better than the first. In the second, 75 - 85% of the class rated the effect of Team-Based Learning™ on factors related to individual learning and engagement in the learning process as 4 or 5.

Conclusions:
This initial application of team-based-learning methodologies to physiology teaching was successfully received by both students and faculty, and has spurred interest in applying TBL in other areas of our curriculum.

Submitted by:
Nancy R. Stevenson, Ph.D.
UMDNJ-Robert Wood Johnson Medical School

Group Assignments Based on Learning Style

 

Author:
John W. Pelley

Affiliation:
Texas Tech University HSC

Purpose:
Group assignment methods attempt to maximize heterogeneity in order to accelerate the development of group cohesion. Heterogeneity based on learning style can strengthen the development of problem solving skills.

Methods:
Preferred learning style based on Myers-Briggs personality types are determined prior to group assignments. The class is first sorted into either the extravert group or the introvert group. Extraverts and introverts are in turn each sorted into sensing and intuitive preference groups. Student assignments into seven member TBL groups are made by distribution from each of the four groups with a minimum of two extraverts or introverts per group and a minimum of two sensing or intuitive types per group.

Results:
Extraverts energize group discussion; their preference for processing information out loud helps to initiate dialogue. Introverts bring depth of reasoning; their preference for processing information more thoroughly before discussion brings more complete thinking to the group. Intuitive types tend to point out patterns and relationships and sensing types are more alert to important details. As group cohesion develops each "type" develops thinking skills of their opposite, e.g. sensing types develop intuitive skills. By understanding their own thinking, each student develops a trust for other ways of thinking; eventually they develop this thinking in themselves. Trust between students is an absolute requirement for cohesive problem solving.

Conclusion:
Students with different learning style preferences bring a balance in thinking skills to a group. This is most effective if they know about this in advance.

Submitted by:
John W. Pelley
Texas Tech University HSC

Team Learning in PA Education

 

Authors:
VF Schneider, P Haidet, PA Kelly, C Seidel, N Searle, B Richards
Affiliation: Baylor College of Medicine

Purpose:
To improve students' critical evaluation skills in physical diagnosis through use of a new instructional technique, Team Learning, while maintaining didactic knowledge and hands-on examination skill acquisition.


Methods: Team Learning (TL) is an instructional method in which students working in small groups apply course content through problem solving exercises. TL was used during 10-months of a year-long physical diagnosis course in the first-year curriculum. A major goal of the course was to teach students to interpret history and physical exam results to formulate a differential diagnosis of presenting symptoms. Since PAs practice as part of a PA-Physician team, they must be able to present concise summations of patient evaluations. This requires the ability to integrate and analyze data. Helping students acquire these critical evaluation skills are essential in PA education. In prior attempts to encourage content application through case discussions in a lecture-hall setting, the majority of students were more passive than desired in the learning process. Problem-based learning was considered as a means to increase active learning and to provide opportunities for practicing analytic skills, but was not implemented due to faculty resource constraints. We believed that Team Learning would provide an opportunity to fully engage students in problem-solving, better prepare them for rotations, and build teamwork skills, but without the resource demands of problem-based learning.
Consistent with Team Learning principles, permanent small groups were established at the outset of the course. Course objectives were organized into teaching modules according to presenting symptoms. Learning objectives were then taught by repeating a three-phase process for each unit. First, students independently studied pre-assigned readings. Next, individual students and small groups completed readiness assurance tests in class. The instructor provided immediate feedback by scoring and returning tests during the session, answering questions, and providing brief supplemental teaching as needed. This readiness assurance process was designed to hold students accountable for and demonstrate mastery of the material and to enable the instructor to clarify any misconceptions. Finally, students applied what they had learned to real-world situations through intra- and inter-group problem-solving discussions. These steps shift the responsibility of learning to the student while retaining the important role of the instructor as content expert. The instructor spends the majority of class time helping learners enhance their application skills, typically the richest and most difficult part of the learning process.

Results:
Outcomes were compared to the prior year lecture-based course. Quantitative evaluations using an observational instrument developed at Baylor indicated significantly greater levels of student engagement using Team Learning (p<.001). Didactic examinations indicated equivalent mastery of core knowledge. Qualitative evaluation, based on student evaluation and instructor observation, indicated high enthusiasm for learning and significant improvement in problem-solving skills. Evaluation using self-efficacy measures indicated greater student confidence in differential diagnosis skills. Data collection is in progress to determine if clinical preceptors also observe changes in student performance.

Conclusion:
As a result of this successful pilot, the use of Team Learning in the Physical Diagnosis course continues and expansion into other courses is planned.

Submitted by:
Virginia Schneider
Baylor College of Medicine

A Conceptual Model for Teaching and Research on Team Learning

 

Authors:
Paul Haidet MD MPH, Boyd Richards PhD

Affiliation:
Baylor College of Medicine

Background:
To date, most evaluation and research efforts about Team Learning in medical education focus mainly on either educational outcomes (knowledge acquisition, student attitudes, etc) or processes (engagement, student experiences, etc). These studies have demonstrated a diversity of results, generally showing that TL leads to high levels of engagement and sometimes enhanced learning outcomes. Much of this work has relied on a general conceptualization of education, that is, better teaching leads to better outcomes. However, the central focus of team process in TL suggests that a more specific conceptual model is needed to guide research and teaching decisions about Team Learning. We propose a potential conceptual model here.

The Model:

the model for Team Learning in Medical Education

In this model, the central focus is the team process itself. The model suggests that those teams that develop high quality organizational and communicative processes will achieve high quality learning outcomes, both as a team and as individuals. The model also suggests that decisions made by the teacher (e.g., whether to have a readiness assurance process, whether to grade application activities, etc) can impact the quality of team processes and ultimately affect learning outcomes. For simplicity, we have omitted other elements of the model (e.g., student attitudes, etc).

Implications for Teaching and Research:
The model provides direction for teaching and research on Team Learning. A central initial task is the development of reliable and valid measures of Quality of Team Processes and Educational Outcomes. Thinking about the conceptual model while designing a course and its evaluation can help educational scholars to systematically examine particular aspects of Team Learning (e.g., RATs, structure of application activities, facilitation skills, peer review, etc). Such studies will help to develop the body of knowledge and experience about Team Learning in medical education.

Submitted by:
Paul Haidet
Baylor College of Medicine