Innovation – Engaging HS Students in Health Sciences Using a Modified TBL: A Medical Student Driven Experience in a Community Pipeline Program
Samuel H. Lai, Lakshmi Ramachandra, Nathan Whelham, Ai Yamasaki, Neil Hughes, Bonny L. Dickinson, Maria L. Sheakley, and Cheryl A. Dickson
Background: The Early Introduction to Health Careers (EIHC) program is an innovative and longitudinal educational pipeline program that aims to reduce health disparities. The program is the first partnership program between the Kalamazoo Public School System and Western Michigan University Homer Stryker MD School of Medicine. The EIHC program arose out of the need for graduate and professional schools to establish evidence-based STEM programs to increase the diversity of the biomedical workforce. Studies show that an increase in training and graduation of diverse students from health professions schools reduces healthcare disparities. Pipeline programs are an effective strategy to address educational achievement gaps, diversify the health professions, and increase the number of underrepresented minorities in the healthcare field.
Description: A highlight of this program was the development of an innovative strategy to create a medical student-driven collaborative learning experience for high school learners. Using a modified TBL approach to introduce high school (HS) learners to health science topics in a small group learning environment, medical students led effective team building exercises, facilitated hands-on small and large group activities, and developed mentor-mentee relationships. Rather than utilizing the typical large group and small group model with one central facilitator, EIHC placed medical student facilitators in each of the small groups of high school students. The medical student served as the expert for the content, thereby allowing increased engagement, higher rigor and a deeper understanding of the content.
Results: EIHC is a novel program for engaging HS students in medical science through a pipeline program. HS students engaged in discussion of various health topics, and along with medical student facilitators, developed mentorship relationships during the program. By utilizing this table facilitator and team-building model, students were able to delve into higher level discussions on content and build cross-curricular connections in health and medicine. By incorporating hands-on activities, students were able to connect content knowledge with relevant cases. Establishing EIHC, however, also had a number of challenges, including recruiting adequate number of inaugural students to utilize the program’s full potential and coordinating both HS students’ and medical students’ schedules for maximal attendance.
Conclusion: EIHC is a valuable program in providing hands-on experience and appropriate overview of the healthcare and STEM field. It is a transformative learning experience for both HS students as well as medical students and provides an opportunity for the medical school to be involved with the Kalamazoo community.
Scholarship – Medical Students’ Approaches to Preparing for TBL
Amy Lin, Paul Koles, Janet Riddle, and Ilene Harris
Background: Much of the Team-based learning (TBL) literature in medical education has focused on outcomes, such as student performance on exams, student satisfaction with TBL, and student perspectives about working in teams. Although students clearly learn content from the TBL process as measured by performance on exams, little is known about how students learn in TBL. This study explores medical students’ perspectives about how they learn in TBL, particularly during the preparation phase.
Methods: Twenty (20) first- (M1) and second- (M2) year medical students (10 M1s and 10 M2s) were recruited for the study. In the context of semi-structured focus groups, students first wrote their responses to open-ended questions and then discussed their perspectives (four focus groups of five M1 or five M2 students each) that were audiorecorded. Qualitative analysis of comments from the worksheets and transcripts of the focus groups was performed using the constant comparative method associated with grounded theory. Two of the authors analyzed the data independently and came to consensus on the thematic analysis.
Results: Major themes relate to: approaches to preparation; factors that influence student preparation; resources used for preparation; and factors that influence resources used. Students used several strategies for preparation: assessing the preparatory materials in relation to what they thought might be tested on the IRAT and the course exam; reviewing learning objectives; preparing notes; and using resources in addition to assigned preparatory materials. Factors that influence student preparation included: relevance of preparatory materials; expectations set for their preparation; and the integration of TBL in the course. Resources students used to prepare included assigned materials, learning objectives, lecture notes and powerpoints, and others.
Conclusion: Students’ approach to TBL preparation is generally what we expect: they use learning objectives, assigned preparatory materials and other course materials to learn key concepts that may be tested on the IRAT and course exam. In turn, comments about problems in implementation, which suggest opportunities for improvement, focus on: the quality and clarity of learning objectives, the relevance of preparatory materials, and poor integration of TBL into some courses.
Scholarship – Does Team Cohesiveness Impact Student Performance in a Team-Based Learning Setting?
Foy D. Mills, Jr., Ph.D., Kelsey L. Powers, L. A. Wolfskill, Ph.D., Shyam S. Nair, Ph.D., and Danhong Chen, Ph.D.
Background: Social and motivational forces comprising team cohesion have been shown to be a correlate, and possibly a determinant, of team performance (Beal, et al., 2003). Though teamwork skills can be developed in multiple venues, Team-Based Learning (TBL) is a pedagogical method encouraging structured collaboration among students. So, does structured collaboration (i.e., TBL) encourage team cohesiveness and contribute to improved student performance?
Description: Team cohesiveness in this study was defined as improvement in the average team peer evaluation score from mid-semester (formative) to semester’s end (summative). Formative and summative peer evaluation scores were collected over five semesters from a lower-division course, Principles of Agricultural Economics. Multiple linear regression was used to analyze the influence of mean and standard deviation (STDEV) of student GPAs used to form teams, formative evaluations, and the difference between formative and summative evaluations, on team score earned (i.e., performance).
Evaluation: Preliminary analysis indicated a quadratic relationship between team mean GPA and team performance. Therefore, the squared standard deviation of GPA was included as an explanatory variable. The mean of student GPAs used to form teams had significant impact on team performance (p<0.10). However, the STDEV and SQSTDEV of student GPAs were non-significant. The mean formative evaluation score was positively and significantly associated with team score (p<0.01). Yet, team cohesiveness as defined in this study was non-significant. A surprising finding was students enrolled in the fall semester performed significantly better than students enrolled in the spring (p<0.05).
Conclusions: Instructors must balance average team GPA across all teams to minimize the risk of impacting team performance. Yet, the degree of difference in student academic capability from team to team did not impact team performance. Though the measure of team cohesiveness as defined in the study was non-significant, a team’s function/dysfunction by mid-term has implications on final team score.
Scholarship – Influence of Targeted Instruction Post-RAT on Individual and Team Performance in a Team-Based Learning Course
L. A. Wolfskill, Ph.D., Foy D. Mills, Jr., Ph.D., Shyam S. Nair, Ph.D., Danhong Chen, Ph.D., and Kelsey L. Powers
Background: A key tenet of Team-Based Learning (TBL) is for the instructor to identify concepts that students failed to understand in individual preparation before class, using results from the individual Readiness Assessment Test (iRAT) and the same test taken by the team (tRAT). Subsequently, instructional efforts can focus on filling the gaps in knowledge and understanding that emerge from the results of the two RATs. Studies have shown that tRAT scores are consistently higher than iRAT scores. However, there is limited information regarding the impact of post-RAT instruction on hourly exam performance taken as individuals (iExam) and teams (tExam) when the instructor focuses on misunderstood concepts, rather than all concepts in the instructional unit.
Description: Grade data was collected from eight semesters of a lower-division Principles of Agricultural Economics course taught using TBL (~110 teams). Two-sample Student’s t-tests assuming unequal variance compared iRAT vs. iExam scores, tRAT vs. tExam scores, and the difference between RAT and Exam improvements in scores.
Evaluation: Average individual and team scores on iExams and tExams were each significantly higher than those earned on iRATs and tRATs, respectively (p<0.0001). Simultaneously, STDEV decreased pre to post for both RATs and Exams. The post-instruction difference (tExam-iExam) was significantly greater (p<0.0001) compared to pre-instruction difference (tRAT-iRAT).
Conclusions: The iExam scores improved over iRAT scores, indicating that post-RAT instruction was effective in clearing up misunderstood concepts. The tExam scores also improved over tRAT scores. A decline in student-to-student and team-to-team differences implies that lower performing students improved more than higher scoring students. From these results, instructors focusing their classroom efforts on addressing misunderstood concepts, rather than all concepts in an instructional unit, had an overall positive impact on students’ grades. Finally, based on the relationship between tRAT-iRAT and tExam-iExam scores, the TBL process positively contributes to student learning.
Fundamentals – Lessons Learned From Implementing TBL and How to Avoid Learning Them the Hard Way
Christopher Smoley and Christopher Petrie
The introduction of the any method of flipped classroom design can be a very intimidating and daunting task. Utilization of Team Based Learning (TBL) is no different than any other pedigological method in this respect; even more so when you are undertaking this task with limited on-site support available and with a student body accustomed to traditional lecture-style course heavy on rote memorization. The authors attempted to introduce TBL under these circumstances and came away with several important lessons learned. The most important lesson is that it is possible to succeed in implementing TBL under these circumstances, even for relative novices. During the session, the authors will share their experiences and help others develop strategies to use during their own implementation to avoid or at least reduce similar hurdles, frustrations, and difficulties that occur when first implementing TBL into their classrooms. Topics that will be emphasized include: grading and weighting the sub-components of a TBL model, getting student buy-in, chunking the course into TBL modules, ‘right-sizing’ TBL modules and the associated pre-work assignments, team formation, peer evaluation tools, developing TBL consistency throughout the institution, replacing answer cards with whiteboards, multiple-choice versus gallery-walk applications, making a mini-lecture for after the IRAT and TRAT, and any other topics that participants bring to the discussion. With the lessons shared, participants should feel more empowered to take the plunge on designing and implementing TBL in their own courses. Even with all these lessons, when you think that you have crafted a solid TBL module things can and will go wrong. These lessons will also equip participants to review and revise their TBL activities to make them more effective the next time.
Innovation – Team Based Learning to improve study results in Electrical Engineering
BACKGROUND: Within the study program of Electrical Engineering at the University of Twente, the communication part is always considered to be one of the most difficult subjects. Many students fail the test the first time. Typical passing rates of this course are around 40%. Attendance in the traditional classes is OK, but in the tutorial sessions only 20% of the students show up. We were looking for a didactic method to increase student participation and give a boost on the passing rates.
DESCRIPTION: The traditional lectures were replaces by a Team Based Learning (TBL) format. It uses the Readiness Assurance Process (RAP) to ensure preparation of the participants for the application exercise. Is consists the Individual RAP, Team RAP (both closed book), and a discussion afterwards facilitated and led by the instructor. We continued with the application exercise consisting of communication systems problems. The preparation of the students was completely flipped. The students had access to a blackboard site with all kinds of information about the lectures (videos explaining the content, handouts, worked out problems etc.)
The communication course is a second year bachelor course in the EE program with a total of 55 students participating.
RESULTS: The TBL sessions were very successful. The participation of the classes was almost 100%. Most students reported the TBL method was more effective, fun to do and it really improved both active participation as well as deeper learning.
At the end of the course a regular written exam was taken, so no changes here. The passing rate of the course increased from 40% to 74%.
CONCLUSION: The TBL approach proved to be very successful in the communication course in the EE program. In the next academic year we will use the TBL approach in more courses.
Innovation – Mapping out TBL Professional Development: Identifying Instructor Competency Domains
Amanda Rees and Cynthia G. Campbell
Team based learning (TBL) was originally designed by professor Larry Michaelsen for his graduate business courses in 1979 (Sibley & Osterfichuk, 2014). Subsequently, TBL has seen global expansion, with application largely in graduate and professional health sciences and medical schools. As a flipped classroom pedagogy, “TBL challenges both learners and teachers to adopt a new paradigm of education, and some find this challenge difficult” (Haidet, Kubitz & McCormack, 2014, 311). Our own experiences with implementing TBL in geography and psychology courses has led us to think more deeply about these challenges, and to ask what competencies (knowledge, skills, and behaviors) should TBL practitioners develop to make the most of TBL in a diverse context of students, courses, disciplines, and institutions.
Institutional cultures vary and educators early in their career and across different disciplines may experience varying levels of support for implementing TBL and developing advanced competencies as practitioners. Likewise, particular disciplines and courses may pose unique challenges for executing TBL. Students’ educational experiences and capabilities, and their level of understanding and openness to the social construction of knowledge can also influence the need for additional competencies.
While many instructor competencies are embedded in the TBL principles and structure, we believe these competencies deserve additional attention as instructors seek to develop their own skills and advance student learning. These competencies include: awareness of institutional acceptance of TBL, tolerance of individual risk-taking; supporting effective team management; addressing student motivation and resistance; using learning outcomes to drive content and assessment; scaffolding intra and inter-team discussions; developing effective feedback to teams; and, supporting inclusion and diversity. We believe that new and experienced TBL practitioners alike can better support their pedagogical practice and advance the learning of their students through focusing their professional development on these various competencies.
Scholarship – An Exploration of the Growth and Development of Student Collaboration Networks in a TBL Capstone Course
OP McCubbins, Thomas H. Paulsen, and Ryan Anderson
BACKGROUND: The capstone course framework touts collaboration and teamwork as an expected student outcome. Team-Based Learning (TBL) also espouses an increase in teamwork and collaboration. The Farm Management and Operations (AGEDS 450) course at Iowa State University was designed around the capstone course framework and TBL principles. The researchers sought to explore the growth and development of collaboration networks throughout a semester in a TBL capstone course.
DESCRIPTION: AGEDS 450 is a unique capstone course that challenges students to fully manage a typical Midwestern farm. Students are tasked with making all decisions involved in the farming enterprise by applying their previously learned content knowledge. The course was recently restructured to integrate TBL principles with the capstone course framework for agriculture. To examine the espoused benefit of increased collaboration, a social network analysis (SNA) instrument was utilized. SNA is a useful method of exploring relationships between actors in various settings. In this particular instance, the actors were the students, while the specific relationship between actors we were interested in was their collaborative efforts. Data were collected at the beginning, midpoint, and end of a 16-week semester in order to track the development and/or growth of the collaboration networks. Data were translated into sociograms for each team to visualize collaboration.
RESULTS: The development and growth of collaboration networks in the TBL formatted capstone course increased significantly over the semester. The sociograms showed a more inclusive and cohesive network of collaboration. The average increase in the density of collaborative relationships over the entire semester was 37%. The networks becoming denser illustrate the notion that TBL aids in the development of cohesive teams.
CONCLUSION: Continued exploration of collaboration networks is warranted. TBL will continue to be utilized in an effort to increase the development of teamwork and collaborative skills.
Scholarship – Developing Consensus on Quality Indicators in TBL Application Activities in Pharmacy
Kristin Janke, Peter Clapp, Robert Bechtol, Stephanie James, Gardner Lepp, Rebecca Moote, and Nicole Rupnow
Background: A primary goal in TBL is to move beyond content coverage and ensure that students have the opportunity to practice solving the kinds of problems they will face in the future. In-class Application Activities (AAs) are crucial, but some AAs meet with more success than others.
Description: A 3-round, online Delphi project with pharmacy TBL experts was conducted, in order to identify indicators of quality AAs and explore any profession specific indicators in designing AAs for pharmacy students. Expert panelists were recruited from a list of corresponding authors from peer reviewed TBL literature in pharmacy education, with a goal of identifing15-20 experts to serve on the panel. Round 1 consisted of open ended questions to probe aspects of AA design that indicated quality (e.g. What differentiates stronger AAs?). Round 2 grouped responses for agreement rating and comment by the panelists. Consensus was set prospectively. Round 3 allowed rating and comment on revised indicators not meeting consensus in Round 2. To assist in verifying and validating the results of the panel’s work, the TBL literature was consulted.
Results: This project is being completed in early fall 2016 with the support of a TBLC grant. A list of quality indicators in the design of AAs and the degree of consensus on those indicators will be available for presentation.
Conclusion: Expert opinion was used to identify quality indicators for AAs used within pharmacy education. These indicators can be used to examine interventions to increase quality, such as the effects of training, checklists, and peer review. Furthermore, knowing the quality indicators for AAs is a prerequisite for doing controlled studies on the impact of the application phase on the success of TBL.
Innovation – Live TBL: The Power of Real Patients in Team-Based Learning
Bonny Dickinson, Wendy Lackey, and Maria Sheakley
BACKGROUND: Real patients, standardized patients, and patient substitutes (e.g., mannequins) have been widely used in health science curricula to teach clinical skills (e.g., physical examination) and interpersonal skills (e.g., communication skills). To our knowledge, these instructional techniques have not been extensively used in the setting of TBL. Here, we describe how to develop TBL modules that involve real patients and discuss the general strengths of this approach and the challenges encountered.
DESCRIPTION: Our institution delivers a significant amount of instruction using TBL, most of which follow the conventional TBL model of multiple-choice questions embedded in a “paper-based” clinical application. To increase learner engagement, we developed an approach to involve real patients in TBL. This approach is powerful, because it combines two high-impact educational strategies: the use of real patients and TBL. An additional strength of our approach was to involve a team of basic and clinical science faculty in the design of the TBL to create an integrated and multidisciplinary application exercise focused on pathophysiology, clinical decision making, disparities in health literacy, effective patient communication, medical ethics, empathy, and patient-centered medicine.
RESULTS: Live TBL is a novel, innovative, and effective instructional strategy that brings real patients into the educational setting. While rewarding, it is also labor intensive and presents with several challenges, including potential ethical issues, possible negative psychological impacts on students and patients, the need for informed consent and institutional review board review, reliance on patients that must be educated and prepared for the classroom experience, and the time and expertise to video record and edit patient narratives.
CONCLUSION: Patient narratives are powerful; lived experiences offer unique, authentic, and transformative learning experiences for students and provide a catalyst for connecting basic and clinical science concepts to real-world clinical situations.