2017 Abstracts – Scholarship

132 – Flash card, scratch card and computer-based testing for Team Based Learning in sociology
Soe Moe, Lwin Mie Aye, Mila Nu Nu Htay, Han Ni, Nan Nitra Than, Htoo Htoo Kyaw Soe, Sudipta Pal, Adinegara Lutfi Abas

Team based learning (TBL) comprises a quiz-style readiness assurance process (RAP) and the immediate feedback for the quizzes. Thus TBL suits the new generation of medical students who have grown up with electronic gadgets and games. TBL was used in sociology classes for medical students in the study institution. Four coloured flash cards representing the answer options, the scratch card for Immediate Feedback Assessment Testing  (IFAT) and the computer-based testing (CBT) in InteDashboard online system were used for immediate feedback to the students during RAP. After completion of the sociology course, medical students anonymously gave feedback regarding their experiences in sociology classes.

The medical students’ feedback were analysed to compare their attitudes towards using flash card, scratch card and CBT with InteDashboard. Also, the marginal cost, feasibility, and efficiency of using these three tools are also explored and compared. Scratch card was the most preferred method by the medical students followed by flash card and CBT for getting immediate feedback. Sixty percent of the students agreed to the statement that scratch card enhances group discussion. Ownership of the electronic gadgets is not significantly associated with positive attitudes towards different tools. Using flash cards cost 24 Malaysian ringgit (MR) for the whole course of sociology and using scratch cards cost 112.6 MR. There was no marginal cost for using trial CBT in InteDashboard.

Qualitative analysis revealed that students were so excited to scratch the card and know the answer thus they skipped thorough reading and discussion of the questions. Students mentioned expenditure for the battery and mobile data of their electronic gadgets during CBT.

Each immediate feedback tool has its advantages and disadvantages. Cost is not a hindering factor for giving immediate feedback to the students.


133 – Impact of Teamwork Skills Training on Teamwork Quality in Team-Based Learning (TBL) Setting
Jessica Ang, Preman Rajalingam, Yang Lishan, Chen Meiying

TBL is a structured approach to collaborative learning (Brame, 2014; St. Clair & Chihara, 2012). While the literature extolls the benefits of learning as a team (Lang, 2008), simply putting students in teams does not guarantee that they will be able to function and learn effectively together. Everyone has had a prior experience of having been in a dysfunctional team, which has led to resistance from some students and faculty towards collaborative learning. To address this, educational institutions have implemented interventions such as team counseling and workshops on teamwork, with the assumption that these can effectively improve teamwork quality. This study will examine whether teamwork in a TBL setting can be enhanced through teamwork training.

This is a non-randomised, controlled, before-and-after study, carried out in two cohorts of students. The survey instrument used is based on a validated teamwork quality survey (Weimar,2013). Teamwork skills training was conducted with the aim of improving the quality of teamwork during TBL. Data from surveys and focus group interviews on teamwork quality was collected and analysed, in order to ascertain the educational impact of teaching students teamwork skills.

A cohort with 9 months of TBL experience was compared to another which had just 1 week of TBL experience. Their pre- and post-intervention surveys were analysed to determine differences in the quality of teamwork. In answering our research question, our intermediary findings showed that for the older teams, “Mutual Support”, a factor of teamwork quality, significantly increased after the training. In addition, students in new TBL teams show a higher positive perception of their teamwork compared to students who had been in their teams for 9 months. With this data, this study can also examine if teamwork improves over time through TBL.

134 – Leadership Identity Development through Reflection and Feedback in Team-Based Learning (TBL) Medical Student Teams
Maryam Alizadeh, Azim Mirzazadeh, Dean X. Parmelee, Elizabeth Peyton, Leila Janani

Theory: Studies on leadership identity development and reflection with Team-Based Learning (TBL) as the instructional strategy in medical student education are rare. The Leadership Identity Development Model was used as the theoretical framework of this study.

Hypothesis: We assumed that reflection and feedback on the team leadership process would advance the progression through leadership identity development stages in medical students within the context of classes using TBL.

Method: This study is a quasi-experimental design with pretest-posttest control group. The pretest and posttest were reflection papers of medical students about their experience of leadership during their TBL sessions. Teams of five to seven students were formed by random sorting at the beginning of the academic year (Intervention group n = 20 teams, control group n = 19 teams). In intervention group the TBL strategy and a team based guided reflection and feedback on team leadership process were performed at the end of all TBL sessions, and with the other group, only TBL was used. The Stata 12 software (StataCorp 2011) was used for data preparation and analyses. Leadership Identity were analyzed both qualitatively and quantitatively (to control the differences in baseline). Chi-square, t-tests and linear regression analysis were performed.

Results: At baseline, most students in the intervention and control group were categorized in the awareness and exploration stage of leadership identity, 52 (51%) in the intervention and 55 (59%) in the control group (X2= 15.6, P= 0.003). In posttest, in the intervention group 36 (36%) were in Exploration, 33 (33%) in L-identified 20 (20%) in Leadership differentiated and 10(10%) in the Generativity, none of them were in the Awareness and Integration stage. In the control group 3(2%) were in Awareness, 56 (52%) in Exploration, 35(33%) in L-identified, 13 (12%) in Leadership differentiated and none of them in the Generativity and Integration stages. Our hypothesis that reflection and feedback on the team leadership process would advance the progression of stages of leadership identity development in medical students within TBL activities was supported by the data (X2= 18.6, P= 0.002). Mean (SE) of leadership identity in pretest in intervention group =1.93(0.08) and control group=2.36(0.1), P= 0.004. Mean (SE) in posttest in intervention group= 3.04 (0.09) and control group =2.54(0.07), P<0.001 and Adjusted P<0.00.

Conclusion: We found that reflection and feedback advances the progression in stages of leadership identity development. Although the TBL strategy itself could have an impact on leadership Identity development, this study demonstrates that when a reflection and feedback on leadership intervention are added, there is much greater impact.

135 – A Hybrid Approach: Effectiveness of an Interprofessional Patient Safety/Quality Care Team-Based Learning Simulation Experience on In-Training Healthcare Professionals
Wei-Hsin Lu

Purpose/Background: Teaching and learning patient safety requires demonstration of competencies such as teamwork, communication skills and recognition of systems error. The goal of this project was to design, develop and implement a learning exercise on patient safety and quality care concepts using team-based learning pedagogy with simulated application scenarios that allowed healthcare trainees to apply learned knowledge and skills.

Methods: A three-hour interprofessional patient safety training workshop was offered to Internal Medicine interns and undergraduate nursing students. The trainees were given pre-reading assignments related to patient safety concepts including patient teach back techniques prior to the workshop. During the workshop, the trainees were grouped into pre-determined interprofessional teams of 3-4 trainees. Each trainee first completed an Individual Readiness Assurance Test [IRAT] and then asked to complete the Team Readiness Assurance Test [TRAT] with his/her team members based on team consensus. The 10-question items on the IRAT and TRAT were identical for a total score of ten points each. Following the IRAT/TRAT exercise, the interprofessional teams went through a series of simulation cases (medication error, effective hand-offs, and patient education teach back) with the use of high fidelity simulation mannequins and standardized patients. Following each case, trainees receive immediate debriefing and feedback from multidisciplinary faculty members on teamwork and error prevention. Learning outcomes were evaluated using learning assurance assessments (IRAT/TRAT). Checklists were used to identify omissions in safety tasks during the simulated cases.

Results: A total of 76 trainees (26 Medicine interns and 50 nursing students) participated and twenty interprofessional teams were created. An independent samples t-test was conducted to compare the IRAT and TRAT scores. The TRAT scores (Mean=7.7, SD=1.8) were significantly higher than the IRAT scores [Mean=5.6, SD=1.7; t(94)=-4.9, p=.001]. Chi-square tests were used to compare the number of correct responses for each IRAT/TRAT question item. A significantly higher number of correct responses were selected on the TRAT compared to the IRAT on questions related to preventable adverse events, anchoring heuristic, and patient handoff concepts.

Conclusion: Our study demonstrates that a collaborative team-based learning interprofessional simulation is an effective method for teaching patient safety.

136 – Student Pre-Disposition Toward Pre-learning in Entrepreneurship Courses
Peter Balan, Greg Restall, Michele Clark

Background: So that students can benefit from the pre-learning process in TBL classes they must find ways to develop self-direction, as well as an appreciation for the necessary  learning steps needed to be successful (Dunlap & Grabinger 2003; Black et al. 2006). This research assessed students’ preferences of learning in multiple foundation entrepreneurship courses using TBL.

Methodology: In the first entrepreneurship classes using TBL, students were asked to reflect on what they personally considered to be the most important aspect of learning (Smith 2008); (1) learning information (including facts, principles, concepts), or (2) learning how to apply or use that information in new situations, or (3) learning how to learn (or to develop lifelong learning skills). They were also asked to identify which they could do effectively outside the classroom on their own, and which they considered could only be achieved in class, working with their classmates and the lecturer. In the following  class session, compiled results were presented and discussed with each class.

Results and Implications: In each class, a majority of students considered that the most important aspect of learning for them was either learning how to use information, or to develop lifelong learning skills. In most classes, a majority considered that they could most effectively learn information by themselves outside the classroom, and that the classroom was best used for learning how to apply or use information in new situations. This pattern was found to be significant and this has significant implications for students and educators. This presentation will show how students gain useful insights from this exercise, and how it assists them to build a disposition toward lifelong learning (Dunlap and Grabinger 2003), as well as to improve engagement (Jarvis et al. 2014).

137 – Facilitating Team Based Learning in Health Management Classes: Findings from Three Cases
Jitendra Singh

Team based learning, with its roots in business schools, is currently being used in many medical schools in US and globally. Team based learning in smaller groups enhances student engagement and creates a positive learning environment for students. Important components of this approach include, assigning students to smaller teams of 4-5 students, administration of multiple choice question tests to students to assess their readiness and preparation, and group involvement once a test has been completed followed by peer evaluation where team members evaluate other students on their team. Prior research suggests that inclusion of team based approach in class room environment promotes student learning and helps in developing skills that are highly valued by employers. Given the importance of team work, it is important to examine students’ attitudes and perceptions towards usage of team work in assignments and class room activities.

This project presents findings from three cases (on-campus, hybrid, and online classes) where team based approach was incorporated in different tasks and assignments throughout the semester. Results suggest that support from instructor and colleagues, peer evaluation,  and use of technology helped in creating positive learning environment when team based approach is used.

Approach used in classes (presented in poster) –

  1. Comprehensive Assessment of Team Member Effectiveness (CATME) tools for team formation and self and peer-evaluation.
  2. Inclusion of individual readiness assurance test (IRAT) in online, hybrid and on campus classes
  3. Inclusion of group readiness assurance test (GRAT), group discussions and projects in online, hybrid and on campus classes
  4. Final quantitative survey (in hybrid and on campus classes). Subscales on survey –
    1. Impact of team on Quality of Learning
    2. Satisfaction with Peer Evaluation
    3. Team Impact on Reasoning Ability
    4. Professional Development
    5. Instructor’s approach

Poster Award Nominee
– Does Deliberate Team Formation Affect Student Perceptions of Team Cohesion?
Peter Balan, Heidi A. Mennenga

BACKGROUND: Team-based learning (TBL) often utilizes a systematic, yet random, approach to team formation. This research study explored whether using deliberate team formation, using responses to the Team-Based Learning Student Assessment Instrument, affected student perceptions of team cohesion.

DESCRIPTION: During the first class session of a nursing research and evidence-based practice course, students were asked to complete a demographic sheet and the “Team-Based Learning Student Assessment Instrument” using the online survey tool, Qualtrics. After the initial class period, the instructor used this benchmark data and responses to specific items on the instrument to purposely form teams composed of 5-6 students for half the class. The remaining students were randomly assigned to teams composed of 5-6 students. Teams remained in place throughout the semester. During one of the final weeks of the semester, the students were asked to again complete a simple questionnaire exploring their perceptions of the cohesion in their own team.

RESULTS: There was a significant difference in perceptions of the level of team cohesion between the two groups of students, with students in the allocated teams reporting a higher level of team cohesion than the randomly-assigned teams. In addition, analysis of qualitative perceptions of team cohesion revealed differences in the importance of perceptions of team cohesion between the two student groups.

CONCLUSION: Deliberate team formation may impact student perceptions of both the level and nature of team cohesion. These findings have implications relating to the theory of team cohesion, and practical implications for instructors.


139 – An Examination of Student Perceptions Concerning Their Experience Working in Teams before and After a Team-Based Learning Capstone Course
OP McCubbins, Thomas H. Paulsen, Ryan Anderson

BACKGROUND: Traditional methods of instruction dominant the post-secondary landscape. Active learning strategies have shown great promise throughout all levels of education. Team-Based Learning (TBL), an active learning approach, challenges students to prepare before attending a class in order to spend more time actively applying content knowledge in solving real-world problems. TBL has been linked to an increase in student performance, engagement, and satisfaction. Previous research has shown initial hesitation from students as they may have had prior negative experiences while working with teams. As students are exposed to the TBL model, their perceptions of teamwork and the value they place on working with their peers begins to increase.

DESCRIPTION: The Farm Management and Operations capstone course at Iowa State is the only completely student managed farm in the US. Students manage 1,500 acres of cropped and custom-farmed land, as well as a 3,500 head, custom hog finishing operation. Students critically analyze the farms finances, make management and investment decisions, and perform much of the labor required. The course had been delivered the same way (lecture and lab) for several years. It was flipped to TBL format in the fall of 2014. This study sought to examine student perceptions concerning their attitudes and beliefs about learning, motivation to learn, and the development of critical thinking skills in a team-based setting. A pretest/posttest study was designed to determine if their perceptions changed after exposure to TBL.

RESULTS: Initial student perceptions were rooted in the middle. Many students felt that there was little value in working with their peers on course work or felt neutral about it. Comparing pretest results to posttest results, statistically significant positive increases across all three areas were discovered.

CONCLUSION: TBL has proven to be effective in alleviating student concerns about working with their peers. Further examination of TBL in agriculture is warranted.

Poster Award Nominee
– Student Engagement in a Team-Based Learning Capstone Course: A Comparison of What Students Do and What Instructors Value
OP McCubbins, Thomas H. Paulsen, Ryan Anderson

BACKGROUND: Engagement is a vital component to long-term student success. Student-centered teaching methods, such as Team-Based Learning, have been linked to increased student engagement. Student engagement is at risk when instructor expectations and student participation are misaligned. Student engagement is often measured at the institutional level, making it hard to pinpoint areas of strength or areas that need to improve. Few measures do exist to measure student engagement at the class level, which allows faculty members to make informed decisions for potential course delivery revisions.

DESCRIPTION: The Farm Management and Operations course at Iowa State was recently restructured to Team-Based Learning format. This new structure made it necessary to explore the value instructors placed on activities linked to student engagement, as well as student participation in specific activities in the course. The purpose of this study was to determine classroom level engagement by comparing student perceptions regarding participation in engagement-specific activities with the instructors’ perceived importance of those same activities. The Classroom Survey of Student Engagement was utilized to collect the student participation and instructor importance data. Data were examined utilizing a 2×2 quadrant analysis.

RESULTS: Congruence between student participation frequency and instructor importance was found between 73.7% of the educational activities, while discrepancies were found on 26.3% of educational activities. Overall, students who completed the TBL-structured capstone farm management course were physically and psychologically engaged in the learning environment.

CONCLUSION: TBL is an effective method for high levels of physical and psychological student engagement. It is recommended that TBL be implemented in other courses within Agricultural Education to examine its utility in other contexts.

141 – Implementation of Team Based Learning in Two Undergraduate-level Basic Sciences Courses in a Premedical Curriculum in the Middle East: Students’ Reception and Instructor’s Reflections.
Diego Lorenzetti

BACKGROUND: The premedical curriculum at the Weill Cornell Medicine in Qatar (WCM-Q) program is designed to fulfill the natural and physical sciences requirements prior to four year of medical curriculum. Here, I report on students’ reception of TBL in an Introductory Biology course as well as the Human Genetics course offered in year 1 and 2.

DESCRIPTION: The introductory class periods in both courses were spent explaining the structure and rationale of a TBL-based course, followed by a RAP session. In both the Biology and Human Genetic class, online surveys and/or end-of-semester course evaluations were used to gather the students’ feedback on the specific components of TBL.

RESULTS: In the Biology course the TBL format was generally well received by the students. Specifically, the majority of students thought the iRAT/tRAT assessments to be conducive to consistent study habits. Many also commented favorably on the teamwork aspect of both the tRAT and the in-class application activities. However, a few students found the appeal process unfair, since teams and not individuals were allowed to challenge questions in the tRAT quizzes.

In both courses, the students often perceived the self-directed components of TBL to be inadequate to achieve their desired grade. In the human genetics course in particular, many students found the level of the material too advanced to prepare adequately for the iRAT/tRAT assessments.

CONCLUSIONS: Explaining the TBL methodology’s rationale at the beginning of both the Biology and Human Genetics courses may help students become more receptive to the implementation of this active-learning strategy. However, a considerable number of students still maintained strong misgivings about TBL and would prefer instead a more traditional lecture-based approach. Similar reservations are often expressed in Western educational settings where TBL is used, and therefore may not be specific to the Middle East.

Poster Award Nominee
– TBL is superior to lecture in osteoporosis teaching – does learning preferences play a role?
Matthew Tan Zhen-wei, Ha Tam Cam, Phua Ghee Chee


  • To compare modified team-based learning (TBL) with lecture in teaching osteoporosis and calcium disorder to a group of Singhealth internal medicine (IM) residents
  • To compare the learning style preferences of the residents and their subjective response to intervention

Method: Two-group control group pretest-posttest design was used. The IM residents who participated in the study were randomized into control group (lecture) and novel intervention group (TBL). Baseline and 6 month post-intervention 10 question MCQ tests were administered to assess effectiveness of intervention. Survey was conducted on the learning style preference and response to intervention.

Results: 19 IM residents (8 lecture, 11 TBL) completed baseline and 6 months post-intervention MCQ tests. At baseline, lecture group scored average of 5.3 (SD 1.5) versus TBL group who scored average of 4.5 (SD 1.9). At 6 months, lecture group scored average of 3.9 (SD 2.1) versus TBL group who scored average of 6.0 (SD 1.7). In multivariable linear regression, given the same age, gender, year of graduation and residency year, the mean score was likely to improve by 28% in the TBL group compared to the lecture group (p=0.01). On a 5 point Likert scale comparing preference for lecture over small group teaching, lecture group did prefer lecture (median score 4/5) whereas TBL group was neutral (median score 3/5). And on a 5 point Likert scale if they agree that teaching prepared them well for exam, lecture group was neutral (median score 3/5) whereas TBL group was positive (median score 4/5).

Conclusion: TBL was superior to lecture in this pilot study in the teaching of osteoporosis in terms of knowledge improvement at 6 months. TBL group was neutral towards lecture or small group teaching whereas lecture group was in favour of lecture over small group teaching and it remains to be seen if subjective teaching preferences have any bearing on effectiveness of teaching intervention; whereas subjective responses on whether the teaching intervention prepared them well for exam seem to agree better with objective measures.


145 – Can Team-Based Learning Replace Simulation for Interprofessional Education
Gail Taylor Rice and Michael Moor

Background: Accrediting agencies are increasingly requiring faculty in the health professions to provide interdisciplinary and interprofessional (IPE) educational experiences for their students. This has been extremely difficult as we have assumed that, to be effective, this requires a multidisciplinary clinical experience using simulation and/or standardized patients. Our research question was, Is it possible to achieve IPE goals for health professional students without:

  • Challenging design of simulation experiences
  • Expensive (in terms of personnel, equipment, standardized patients) execution of small group experiences
  • Tremendous challenges of finding ways to schedule and gather students from many health profession disciplines to participate in these simulation experiences

Methods: Data were collected from four groups of students attending a graduate course in Collaborative Learning in Higher Education at Loma Linda University during the winter quarter of the years, 2013 through 2016. This intensive 5-week TBL course utilized high-stakes decision-making, team-testing, application exercises, and group presentations. Students were graduate students and faculty members representing physical therapy, nursing, basic sciences, dentistry, medicine, and public health. Qualitative data were obtained from all four years (N=68) and quantitative data were gathered from the last three years (N=38). Comments came from the Canvas course discussions and the responses to the end of the course survey form question, “Comment on how Collaborative TBL learning experience has affected your thinking about respect for other health professionals”.

Quantitative data were obtained from pre-course and post-course administration of the interdisciplinary Education Perception Scale (IEPS), originally developed by Luecht et al. (1990).

Results: We found statistically significant differences between the pre- and post-scores, indicating that the 5-week course had strongly affected attitudes toward other disciplines. Comments strongly supported this conclusion. The answer to our research question was, “Yes, it is possible to obtain important IPE goals through less complicated methods than simulation experiences for small groups of students from various health disciplines. A well-planned TBL course can provide these positive benefits.

Recommendations: Health professional education programs might find that they are able to meet goals of IPE through developing courses which have common core with other health professions that could be offered to multidisciplinary groups of students. These courses must be taught using a TBL approach in order to achieve the anticipated results.

This approach might be superior to the previously used approach to IPE education in the health professions, providing similar outcomes with major savings in terms of time and expense for health professional educators.”