2020 Poster and Oral Presentation Abstracts – Innovations

301 – Escape from the ordinary: Introducing First Year Medical Students to Blood, Lymphatics, and Inflammation Using an “Escape Room” Approach
Devin Cook, Rylan Russell, Leslie Ziegler, Abby Geis
Arkansas College of Osteopathic Medicine

The Arkansas College of Osteopathic Medicine (ARCOM) aims to teach students in a way that they can integrate basic science coursework into their clinical education and medical practice. This is largely accomplished by using team-based learning (TBL) modules. TBL provides interactive settings where peers can work together to solve medical cases applying these basic science principles. However, medical students at ARCOM tire of the group application process, and they frequently rush to complete problems rather than engage in high order learning through discussion and team work. In an attempt to revive student enthusiasm for team work, ARCOM faculty coupled competition to a TBL module designed to reinforce learning of immunology, blood, lymphatics, and inflammation. This work describes a game-like “escape room” approach to the TBL application process amongst first year medical students. We diverged from TBL by reducing the use of multiple-choice questions in favor of open-ended questions, a design with both an advantage—reinforcing student recall with their application of concepts—and a disadvantage—requiring several faculty members for group facilitation. Nonetheless, we show highly favorable survey data from participants on their perception of the activity. We also compare some outcome data—performance on relevant exam items—from a cohort that had no escape room activity (2017) with the cohort that experienced the escape room activity (2018).

302 -The Feedback Clinic: the TBL Practice of the Academic Health Center
Carrie Bailey, Kathie Forney
Oregon Health & Science University

Inspired by the health and science university students transitioning into the role of practitioner, this poster focuses on TBL feedback messages, timing, and forms. Non-cognitive factors, such as consistent, supportive, motivational communication that focus on students’ individual readiness and attitudes, are equally as important as cognitive factors, as are development of positive relationships between learners and instructors in teams. Constructive approaches used in clinical practice can motivate learners from being individual to team-oriented; seeing evaluation as an internal process of intrinsic motivation that drives a professional life, and a method for facing challenges rather than hiding weaknesses for a learning practice that thrives.

Clinical medical practice informs the idea of holistic balance of individualized feedback for TBL. Clinical practitioners engage in evidence-based collaborative conversations with active reflection, using it to improve one’s practice. A specific method used in this training is the R2C2 Model, which employs a 4-part pattern for feedback starting with a rapport and relationship building, followed by reactions to feedback and exploration of the feedback’s content, finalized with coaching for change (Sargeant et al., 2018). The R2C2 model exemplifies a developmental and team-based approach. Given the multiple dimensions in a system, feedback loops are more effective through reciprocal partnerships formed through a trusted network. To address changes in higher education, individual feedback should be customized and unique. Systems-based clinical practice illustrate one way to grow productive feedback loops in a dynamic TBL system.

303 – TBL approach to session-level integration of basic & clinical concepts for clinical reasoning in psychiatry
Dan Blunk, Tanis Hogg, Diana Pettit, Damaris Rosado, Dale Quest
Texas Tech University Health Sciences Center El Paso

BACKGROUND: Worked Case Examples sessions, which challenge students to work through unfolding real or realistic clinical case studies are guided by a written explanation of clinical experts diagnostic reasoning at each branch point of a scheme inductive algorithm. Economic and logistical drivers have motivated pilot demonstrations of formats for transitioning worked case example sessions from small group tutorials to TBL-inspired approaches. Limited availability of clinical faculty to facilitate frequent expert-guided small-group clinical case activities made TBL a viable option.

DESCRIPTION: Prior to expending resources to implement large scale curricular change, we firmly established that the need for change was (1) sufficiently important, (2) impacts a large number of people (students, faculty, and staff), and (3) will persist or worsen if not appropriately addressed. By managing change through the preliminary development, implementation and assessment of TBL-formatted pilots, we were able to establish the effectiveness of this instructional method as a practical, scalable, powerful, and cost-effective alternative to more resource intensive small-group approaches. Collaborators have been especially successful in developing worked case examples for the psychiatric component of the Mind & Human Development unit to case-based TBL-styled integration of basic sciences with scheme-inductive clinical diagnostic reasoning sessions using a four clinical concepts framework. Colleagues are likewise piloting conversion of the Endocrine Unit to asynchronous learning modules offered in advance of case-based TBL-styled sessions integrating basic sciences with scheme-inductive clinical diagnostic reasoning.

RESULTS: Higher performing student scores on the summative unit examinations were not significantly different than summative scores from the previous year. However, summative exam scores from students in the lower quartile improved significantly, justifying the economic advantage of transitioning to TBL.

CONCLUSION: Based on the outcomes of this study, our institution plans to launch a full-scale implementation of TBL-formatted diagnostic reasoning exercises in our clinical presentation-based pre-clerkship curriculum within the next 2 years.

304 – A simple methodology to distribute teaching material to in a multimodal curriculum in a consistent and reproducible manner
Boris Boyanovsky, Jody Takemoto
California Health Sciences University

Background: The diverse methods of content delivery at an institution may represent a challenge to distribute various topics to the most appropriate teaching modalities. Moreover, in different modules, teaching material may be distributed using criteria that significantly vary among faculty facilitating the courses. Introducing so many variables along the curriculum may result in students’ confusion and lower achievement of learning outcomes. Clear organization, rationale and continuity between different teaching modalities are necessary.

Hypothesis: Business and educational models adapted and applied sequentially and systematically to curricular development can consistently improve the distribution of course material in an institution using multiple modalities of instruction, which may be assessed through learners’ knowledge, skills, and mindset outcomes.

Aim & Research Question: To establish a method providing general guidance to assess and distribute course material content to appropriate learning and teaching modality, across a course with different instructional modalities. What is a reliable method to distribute course materials in a multimodal curriculum with appropriate assessments?

Methodology: Adaptation of The Golden Circle, Backwards Design, and the Multimodal Model to a teaching course using various instructional methods to help adequately distribute the material among teaching modalities.

305 – Developing an Electronic Immediate Feedback Assessment Technique for the Learner
Cortny Williams
University of Western States

Electronic immediate feedback assessment techniques (eIF-ATs) have been developed on a variety of data management platforms to streamline data entry and allow facilitators to observe readiness assurance process (RAP) outcomes in real time. To extend the goal of immediate feedback to the learner, I have implemented an automated feedback response system to provide individualized feedback during the team readiness assurance tests (tRATs). The individualized feedback is provided when the team selects an incorrect answer. The feedback restates the learning objective for the tRAT item that highlights the learning goal of the item. In this way, learners can compare and validate their ideas against the restated learning outcome toward understanding the concept and selecting the correct answer. The automated feedback guides team discussions such that the mini lecture before an application exercise is not always necessary. Here I will report how the RAP can be administered on the Moodle learning management system, and I will document how individualized feedback can be delivered to the TBL team in an eIF-AT. Finally, I will explore student perspectives about the effectiveness of the automated feedback during the tRAT.

306 – Using systematic teaching reflections to improve implementation of Team-Based Learning in General Education courses
Phillip Carr, Julie M. Estis, Amanda Rees
University of South Alabama, Columbus State University

Team-Based Learning (TBL) has not been widely implemented in General Education courses, which is the portion of the undergraduate curriculum shared by all students. Faculty teaching these courses have reported feeling isolated in their practice of TBL, found that TBL resources in their disciplines were sparse, and indicated that special considerations are warranted when using TBL in General Education courses. Specifically, varying levels of student preparation for college, diversity of learners, and student push-back in General Education courses require thoughtful focus on module planning and facilitation. Systematic teaching reflections were implemented with two General Education faculty at different regionally-serving public institutions in the Southeastern United States to continuously improve the quality of instruction for students and the quality of the experience for the instructor. A facilitator created and distributed automated surveys each week of the semester, and the two instructors responded to five prompts (e.g., Provide an overview of how things went this past week; In teaching, what was your greatest challenge this week?). Then, the instructors and facilitator discussed similarities and differences in their responses and identified an area of focus for improvement during the next semester of the course. Several benefits of this approach emerged that apply broadly to other disciplines and TBL contexts. It shaped a discipline of reflective teaching practice that was beneficial to the participants. It provided an opportunity to reflect and make adjustments prior to the subsequent class meeting and led to the long-term improvement of TBL course materials, course structure, and facilitation. Systematic teaching reflections also created an opportunity for collaboration and shared practice, which is especially important for faculty implementing TBL in contextual isolation.

307 – Enhancing Student Engagement through Team-Based Learning: An attempt in Accounting course
Lei Wang
University of Bristol

Background: TBL motivates students to prepare before classes, and to be actively engaged in learning activities during classes. Consequently, this innovative pedagogical strategy has been implemented as a form of flipped classroom in several discipline. There have been numerous descriptive and explanatory studies on TBL, but high-quality experimental studies are still in demand. In addition, the universal processes of TBL need to be tailored based on the nature of the discipline, so experimental studies are desired to test the adaptability of TBL and to explore any adjustments required.

AIMS: The purpose of this research is to propose a course design for an undergraduate Accounting course using TBL approach, and to evaluate the feasibility and adaptability of TBL in Accounting education. This study intended to fill the gap of experimental studies in TBL, particularly in Accounting discipline.

METHODS: A first year undergraduate Accounting course Accounting and Finance in Context has been used in this research. There were 72 students enrolled in this course, and they have been allocated into teams made up of six students each. The course adopted the form of three-hours lec-torial, which students had a short mini lecture (around 20 minutes) followed by student led team working, and back to another short mini lecture.

RESULTS: This study provided a practical example on designing an Accounting course using TBL approach. Discussion on the adaptability of TBL explained that TBL is an effective way to enhance student engagement in Accounting education, but adjustments need to be considered when designing the course. It enables further investigation on how to implement the course design from operational level, also provides empirical evidence for future experimental studies testing the effectiveness of TBL on learning outcomes.

308 – TBL-based exams in a pre-clinical medical curriculum: A discussion of implementation and outcomes
Nicole T. Stringham, Jennifer M. Carbrey, J. Matthew Velkey
Duke University School of Medicine

Problem: In teaching basic- science courses, summative assessment is necessary, but is often viewed as just a fixed timepoint wherein learned material is used by students to answer exam questions and then is not revisited. Team Based Learning (iRA, gRA) principles, however, provide a framework for which to turn these assessments into valuable learning experiences and opportunities for knowledge construction.

Approach: In Fall of 2019, a 2-phase, Team-Based Assessment (TBA) format was introduced into the pre-clinical curriculum at Duke University Medical School. Specifically, bi-weekly TBAs were implemented into our integrated biomedical course that encompasses molecular and cellular science, physiology, anatomy, and histology, (Human Structure and Function). Exams included an individual exam portion (iRA), followed by a group exam (gRA) of identical questions, and culminated in a large group session, led by faculty, and consisting of time for clarification and Q&A. Observed outcomes of TBA implementation included higher exam score averages, student’s improved perceived-understanding of the course content, and student-utilization of immediate feedback in order to ensure memory consolidation of accurate information.

Limitations: Potential considerations in implementation of TBA format are psychosocial group dynamics in approaching a higher-stakes summative exam, students’ emotional reaction to incorrect answers, and potential feelings of shame arising from peer comparison. This focus session will provide a forum to, 1) discuss lessons learned during TBA implementation, 2) facilitate a dialogue aimed at gathering suggestions to overcome potential hurdles, and 3) consider thoughtful approaches to mitigating negative feelings toward group/collaborative examination.

309 – Use of TBL in a Pharmacy Residency Teaching Certificate Curriculum: Constructing Effective Assessment Questions
Diana Langworthy, Mallory Snyder, Heather Blue
University of Minnesota College of Pharmacy, M Health Fairview

Introduction: Most pharmacy residency teaching certificate programs offer content related to teaching and precepting. While foundational content is essential, practical application of teaching and learning concepts through use of TBL would contribute to higher level skill development to prepare residents for the autonomous experiential components of their certificate.

Aims: Our aims included the following: to implement a TBL workshop for constructing effective multiple choice questions (MCQs); to role model the effective use of TBL for future pharmacy educators.

Methods: A novel TBL workshop was developed and focused on creating MCQs. Teams were comprised of 3-4 learners and the readiness assessment tests (individual and team) focused on good MCQ practices.  The application activity was composed of two parts. Part I engaged teams in critiquing existing MCQs. Part II asked teams to develop well-constructed case-based MCQs for a set of objectives.

Results: In the 2017-2018 and 2018-2019 years, there were 13 and 15 participants, respectively.  Residents were surveyed post-workshop to evaluate perceived achievement of learning. Overall, 17 out of 25 residents (68%) responded to the post-workshop survey. All 17 survey respondents (100%) either agreed or strongly agreed that, after participation in the workshop, they are able to critique an MCQ, develop well-constructed case-based MCQs, and construct assessment questions that link to class objectives. Common themes that emerged from the comments included an appreciation for collaborative team learning, an appreciation for the difficulty of writing good MCQs, and a desire for more clearly worded application activity questions.

Conclusions: A TBL activity on developing good MCQs resulted in pharmacy residents perceiving that they are able to develop and critique MCQs and link them to content objectives.  Future enhancement of this workshop through clarifying the application activity and implementing a pre- and post-workshop assessment may further describe the effectiveness of using TBL to develop our future educators.

310 – From Thin Air: Creating a University Wide, Student Led IPE TeamSTEPPS Simulation Curriculum
Sarkis Kouyoumjian
Wayne State University School of Medicine

Purpose: To create an open and respectful environment for Interprofessional healthcare students to learn team communication and team skills. To establish a foundation for a university wide longitudinal IPE learning initiative that allows students to learn these skills from day one of their professional career.

Background: Interprofessional Education (IPE) initiatives have long lasting effects on increasing health care students positive attitudes and skillful utility of IP collaborative practice in turn enhancing patient safety and quality of care. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a communication framework that has been effectively utilized as the basis oil IPE initiatives.

Methods: A collaborative of 15 students and key faculty from different professional schools including Nursing, Pharmacy, Physician Assistant and Medical School served as a core operating team. 2 full day Team STEPPS master training was given to the team as a pilot program. Students then participated in an Interprofessional simulation focusing on communication and team skills.

Results: As a result of this student run initiative, a relationship has developed between the professional schools. In addition, the school of social work and physical therapy have become partners. A steering committee has been established to create IP activities at Wayne State University. As a result a 2 credit communication and simulation course has been established that all students will take.

Conclusion: A student run initiative in IPE utilizing a Team STEPPS simulation has led to a university wide collaborative simulation and course.

311 – Global Training with Online Team-Based Learning
Brian O’Dwyer

Background: CognaLearn is an early stage company with a 15-person team spread across Singapore, Philippines, United States, and Africa. In September 2018, CognaLearn conducted its inaugural Employee Engagement survey. Following which the company identified communication skills as an area where it wanted to enhance the performance of its team.   However, the company did not have the resources to organize in-person team-building activities or trips. CognaLearn is a software company that developed the www.intedashboard.com team-based learning software platform. As a result, the company decided to implement a series of internal training sessions using team-based learning.

Method: The company organized a series of internal training workshops for shops using Zoom web conferencing and www.intedashboard.com to align and improve the current communication practices. Topics included “SMART Goals Planning”, “Caring for your Colleagues – Understanding Mental Health First Aid”, “Overcoming Communication Challenges using Active Listening” and “Mentor using the GROW Model”. In March and August 2019, the company conducted follow up employee surveys.

Results: The results of the survey indicated that employees who ‘Strongly Agree or Agree’ with ‘I look forward to going to work’ rose from 15% to 86%; employees who ‘Strongly Agree or Agree’ with ‘I am satisfied with my work-life balance’ rose from 79% to 93%; when asked ‘How often do you feel burnt-out by work?” employees who chose ‘Hardly Ever / Occasionally” rose from 77% to 93%; and when asked to rate the effectiveness of communication between different clusters of colleagues, effectiveness of communication with supervisor rose from 87% to 100%; effectiveness of communication with teammates rose from 85% to 100%; and effectiveness of Communication with senior management rose from 84% to 93%.

Conclusion: We conclude that online TBL can be effective for global training in a scalable, cost effective, and time-saving method that overcame geographical boundaries. However, the sample size for this pilot is small and may not be generalizable to other environments. More work can be done in this area in the future.

Disclosures: Brian O’Dwyer is the Commercial Founder of and has a financial interest in CognaLearn. CognaLearn is the company that developed InteDashboard™ www.intedashboard.com which is TBL software developed in collaboration with Duke-US Medical School; InteDashboard™ is one of the technology tools described in the previously mentioned whitepaper and will be used to implement the TBL methodology during the workshop.

312 – Team-Based Learning Across the Curriculum (TBL-AC): Promoting diversity and inclusiveness throughout TBL-based professional programs
Suzanne Clark, Jeremey Hughes, Parto Khansari, Leanne Coyne, David G. Fuentes
California Northstate University College of Pharmacy – Elk Grove, California Health Sciences University College of Pharmacy – Clovis, Stony Brook University, California Health Sciences University College of Osteopathic Medicine

Introduction: Several healthcare programs were recently established with TBL across the curriculum (TBL-AC). In TBL-AC, most didactic courses are taught using TBL. Advantages of TBL-AC include broader student, faculty and administrative buy-in to TBL, regular college-wide TBL training, and effective initial exposure to TBL during student and faculty orientation. Also, there is ongoing mentoring and support for faculty and students through frequent assessment and feedbacks. In addition, TBL-AC programs can promote diversity and inclusiveness through several mechanisms.

Background: In contrast to traditional lecture-based courses, where students usually sit with friends and there are few incentives to interact with others, TBL provides structure and encourages students to work with teammates from a range of backgrounds. TBL-AC takes this one step further, via cycles of team formation each semester, as well as through consistency in student and faculty expectations.

Diversity promotion: In TBL-AC, new teams are formed each semester, so students have many different teammates across the program. Teams can be intentionally planned to incorporate different underrepresented groups, disabilities, gender identities, language/cultural backgrounds, generations, and academic skills. The offices responsible for forming teams can access a wide range of sources to form diverse teams, including admissions and matriculation documents, as well as in-program performance and characteristics. This provides students with multiple opportunities to learn with, and about, each other. In addition, students matriculate with the expectation of a range of different teammates, as this aspect of TBL-AC can be explained during the interview. Finally, the different courses teams take together can allow students from different backgrounds to shine in various settings.

Conclusion: Through personal experience, teammates can gain an appreciation of the strengths that diverse teammates bring to problem solving. Experiences and processes from three different TBL-AC programs will be reviewed.

Reinvigorating Readiness Material for All Learners Through Technology and Creativity
Maya Leiva, California Health Sciences University
Oral Abstract 

Many educators utilizing TBL continually struggle with students adequately preparing for class. While iRATs and tRATs are intended to incentivize studying, all too often students skim the surface or are able to skate by if they’re good test takers. The struggle becomes even more burdensome for students with specific learning disabilities, attention deficit, and ESL students. There are a number of factors why students eschew readiness material until the very last hour before class or cram before exams; the material is too complex, long, dry, tedious, presented in a 2 dimensional handout, they don’t feel as though they are experiencing learning, or they require a more layered or scaffolded approach to topics.

In an attempt to incentivize students and level the playing field for more vulnerable students to prepare more thoroughly before class, I have employed several techniques to incorporate technology and interactive learning throughout their modules as well as adjusting the stakes around iRATs. I will share some of my practices, provide information regarding the efficacy of these practices in the classroom, student receptivity and feedback. My hope is to empower all of us as educators to consider various the methods we can deliver to help keep a “”flipped classroom”” active for students who may lack motivation or require a more dynamic approach to learning.”

Threshold Concepts-Based TBL
Suzan Kamel-ElSayed | James Grogan, PhD | Stephen Loftus, OUWB School of Medicine | OUWB School of Medicine | OUWB School of Medicine
Oral Abstracts 

The purpose of this presentation is to introduce participants to threshold concepts and how they can be used to improve educational programs. Many students struggle because of information overload. Threshold concepts help us to address the problems of curriculum overload and cognitive load. Threshold concepts have characteristics of being troublesome, transformative, integrative, bounded and irreversible. Identification of threshold concepts in different disciplines can be used as a foundation for designing an effective and powerful TBL session. This is because threshold concepts are those ideas that learners often find difficult but must understand in order to progress in understanding. TBL is an ideal environment for learners to articulate their understanding or misunderstanding of these key ideas and help each other work toward mastery of threshold concepts. This is because threshold theory recognizes the importance of liminality which is the need for many students to spend time working through difficult concepts before fully understanding them. On another level, threshold concepts can enhance teachers ability to integrate across disciplines, especially those from humanities, social and biomedical sciences. TBL session and application exercises, in particular, provide an ideal opportunity for students to engage with threshold concepts critically to solve complex problems. One limitation is that preparatory work of faculty is needed to collaboratively identify threshold concepts in their courses.

TRIPLE with TIPEL: Bridging the Curricular Divide Between Classroom and Practice Across Professions
Robin Risling | Jennifer L. Styron | Ronald A. Styron Jr., University of New England | Eastern Virginia Medical School | University of South Alabama
Oral Abstract 

Background: Historically, health professions’ curriculum is delivered in two phases: a didactic component focused on in-classroom instruction and a clinical component focused on experiential learning. Team Based Learning (TBL) is an evidence-based methodology usually housed in the didactic phase of health professional learning while Interprofessional Education (IPE) is commonly a part of the clinical phases. To prepare students for IPE and team-based patient-centered care, it is best to introduce IPE in the didactic stage. However, teaching IPE in the didactic phase of the curriculum and expecting students to retain the knowledge in the clinical phase is challenging. This is further complicated by teaching across professions at varying levels of training.

Description: The TIPEL model employs a combination of three unique strategies to deliver a core set of objectives using the methodology of TBL, IPE, and Experiential Learning in the didactic phase of training across professions. The TIPEL experience demonstrates how didactic and clinical student learning objectives were carefully synced, performed, and measured through an interprofessional experiential learning experience that took place during the didactic phase. The event occurred at a health and wellness clinic in a day shelter servicing individuals who are homeless.

Results: Students agreed that the TIPEL model helped apply core competencies and that they were better prepared because of the TIPEL strategy. Students demonstrated higher RAT scores across IPEC competencies when they worked in teams.

Conclusions: Classroom instruction often loses its momentum by the time the student gets to the clinical phase of education. The TIPEL model provides a unique way to overcome this barrier by simultaneously delivering classroom typical instruction using TBL and incorporating IPE competency mastery in an experiential service learning experience during the didactic phase of education.

Combining the Elements of Team-Based and Project-Based Learning in an Undergraduate Rehabilitation Sciences Course to Increase Student Engagement and Improve Outcomes
Laurie A. Schroder, East Tennessee State University
Oral Abstract 

Undergraduate education that produces graduates who meet the qualifications of graduate programs, the workforce, and society demand an awareness of the expectations that those graduates will participate successfully in creative, problem-solving, interdisciplinary teams. While team-based learning (TBL) has emerged as a promising means of meeting some of the challenges of this proposition, it does not fit every educational situation, and improved learning outcomes have not always resulted from what is a preparation-intensive instructional method.

Project-based learning (PjBL), which offers an opportunity for students to engage creatively in problem-solving teams, has strengths that complement TBL, and combining the two methods has the potential to result in improved outcomes in both affective and cognitive domains. For example, cited limitations of PjBL include the tendency for social loafing, which may be offset by inclusion of the peer grading component of TBL; the creative focus on final projects in PjBL is reported to distract instructors and students from achievement of learning objectives, which may be countered with the cyclical unit structure of TBL; and, while the intensive preparation of multiple real-world activities for TBL is often a barrier to its implementation, this can be lessened by the client-driven project construction of PjBL.

Combining these instructional methods resulted in a positive student response and improved engagement with material and peers for a pilot course in a newly designed rehabilitation science course within a new program at East Tennessee State University. My research reflected that the design of the course resulted in high levels of student attendance, retention, and perceived self- and team-efficacy, and achievement of learning outcomes.

Scaling Up: Implementing TBL in a Statewide, Multi-site, Workforce Training Program
Crystal Turner | Liz Winter, University of Pittsburgh
Oral Abstract 

This oral focus session will tell the story of implementing TBL™ in a multi-site, statewide training program serving the public child welfare workforce in the United States.

Background: The Pennsylvania Child Welfare Resource Center (CWRC) at the University of Pittsburgh, School of Social Work serves the public child welfare system in Pennsylvania by designing and delivering training, transfer of learning, research and evaluation, and other services.  The CWRC partners with state government (the Office of Children Youth and Families), 67 local government (county) child welfare agencies, and many contracted instructors who deliver training curricula to thousands of child welfare professionals each year.  In 2018, the CWRC committed to the adoption of TBL™ as its primary teaching and learning method. The first CWRC training series selected for revision was the state mandated certification training series for newly hired public child welfare professionals with approximately 750-1000 enrolled annually. The 124-hour series, Foundations of Pennsylvania Child Welfare Practice: Building Competence, Confidence, and Compassion, (Foundations), was developed and piloted in late 2018 and early 2019, and fully launched statewide in July 2019.

Implementation of TBL™: This session will tell the story of how CWRC implemented  TBL™ statewide into a child welfare training environment by convincing their stakeholders of the advantages of the TBL™, incorporating TBL™ design in its curriculum development processes, re-training over eighty new and existing instructors on TBL™ facilitation methods, and changing the culture and structure of curriculum delivery to its stakeholders. The successes and challenges that CWRC experienced throughout this endeavor will serve as an example for any organization or institution seeking to incorporate TBL™ in a training environment.

The activities of the Pennsylvania Child Welfare Resource Center are made possible through grant funds from the Pennsylvania Department of Human Services to the University of Pittsburgh.

From ‘hands off’ to ‘hands on’: Introducing experiential learning into the TBL course builds student confidence for 4S assignments.
Irina Dedova | Angela Li | Michelle Moscova, School of Medical Sciences, University of New South Wales (Sydney, Australia)
Oral Abstract 

Description of the problem or issue:  Students often find anatomy assessment difficult as many focus primarily on memorising the content that often is perceived as excessive, difficult and irrelevant to future occupations. Since the introduction of the TBL pedagogy into a Head, Neck and Back Anatomy course (UNSW, Sydney) for Medical Science students in 2017, the outcomes and student satisfaction have improved significantly. However, there was still high anxiety in the team assessments with students feeling under-prepared for the task. Student felt difficulty in visualising anatomical structures, relating structure to function and felt apprehensive towards problem-solving due to low confidence and fear of failure.

Proposed solutions or approaches: To close the gap between the theory and practical application of knowledge, we introduced experiential learning pedagogy into the TBL-based course. We have developed ‘hands on’ team learning activity that utilised 3D-printed vertebrae that were used to investigate and model factors contributing to stability and mobility of the vertebral column. This was followed by a team reflection on factors important for spine stability. This provided students with concrete learning experience that in TBL settings facilitated reflective observation, active experimentation and conceptualisation. The activity was delivered as preparation for a 4S TBL team assignment focused on applying this knowledge to evaluate a probability of back pain development in several real-life case scenarios. We hypothesised that experiential ‘pre-learning’ activity increased student confidence. Team reflection helped to relate TBL assignment to a previous experience and promoted engagement motivation. This subsequently improved overall performance (both, individual and team) and decreased anxiety associated with assignment.

Limitations: Although combining the TBL and ‘learning by doing’ principles in the anatomy course delivery and assessment appears to facilitate a positive change, more detailed analysis of the causative links and effectiveness of experiential learning in the TBL setting is required.

Is truth better than fiction? : Using fairy tales to teach peer evaluation skills
Michelle Moscova, UNSW Sydney, Australia
Oral Abstract 

Description of the problem or issue: Peer evaluation can be an opportunity to teach students giving effective and constructive feedback. While many academics use specifically designed sessions to teach peer evaluation skills and model effective feedback, students often have poor engagement with these sessions and are reluctant to provide formative feedback to their peers. They often do not want their team mates to know if they are unhappy with their performance, as they fear retaliation during summative peer evaluation at the end of the course. This leads to student reluctance to engage in formative evaluations and results in missed opportunities to practice providing effective feedback.

Proposed solutions or approaches: We introduced a new approach to teaching peer evaluation skills in our 10-week TBL course that teaches Head, Neck and Back anatomy elective to third year medical science students at the University of New South Wales, Sydney, Australia. The aim was to address problems with poor engagement with peer-evaluation and student reluctance to practice giving feedback. We gave students a choice to either perform a formative evaluation of their actual peers or fictional fantasy characters Snow White, Shrek and Donkey – we then compared the quality of feedback given by the students. Students who chose to evaluate the fantasy characters were more engaged in the process and provided better quality feedback compared to students who chose to evaluate their peers during formative workshop. We theorise that this may be due to the task being less threatening and having greater familiarity with the fantasy characters than with their teammates at that point of the course.

Limitations: The overall experience of using fantasy characters in the peer-evaluation workshop was positive and produced more constructive feedback. However, as the students had a choice, self-selection bias could not be ruled out.

Challenges to develop TBL modules that integrates 5 basic disciplines in the first year of a Medical School.
Fernanda Teresa de Lima, MD, PhD | Thomaz Augusto Alves da Rocha e Silva, PhD | Welbert Oliveira Pereira, PhD, School of Medicine, Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, Brazil
Oral Abstract

BACKGROUND: An integrated curriculum presupposes approximation of various disciplines into meaningful associations to focus upon broader areas. Team Based Learning (TBL) seems to be a suitable method for such approach. Our institution delivers almost all instruction in the first four years through active learning, mainly TBL. In two 20-week courses, during the first two semesters, covering Cell Biology, Molecular Biology, Biochemistry, Biophysics and Genetics, 10-16 TBLs were performed, and many challenges were faced when developing modules for the first year of a Medical School.

AIM: Describe our experience in developing integrated TBL modules and how we approached these challenges.

METHODS: Teaching plans, syllabus, pre-class and in-class materials from seven semesters (February 2016 to July 2019) were reviewed, and faculty was interviewed to provide understanding of challenges and how they overcame them.

RESULTS: There were 5-7 TBL modules during first semester and 5-9, on the second. At each semester, at least one new TBL module was developed, totalizing 37 different modules. Development of objectives, content and appropriate application exercises integrating the different subjects, followed by lack of pre-class material in appropriate volume and difficult level were the main challenges. Literature search from the standpoint of disciplines in isolation to later find common ground, exploration of student’s early clinical experiences, clinical-research partnership and multidisciplinary discussion rounds provided clarification of objectives and ideas for exercises. Feedback from faculty from clinical years also ensured vertical integration between basic and clinical sciences. Creative pre-class videos and materials, using clippings and excerpts of different texts were developed. Reading guidelines are carefully prepared, often in the form of questions, to ensure that the student understands what goals to achieve when reading the material

CONCLUSION: Developing TBL modules integrating 5 basic disciplines and clinical sciences in the first year of a medical school brought many challenges. Careful and creative preparation and team work were essential to overcome them.

Involving Patients/Standardized Patients in TBL
Wendy Madigosky | Michelle Colarelli | Lisha Bustos | Elshimaa Basha, University of Colorado Anschutz Medical Campus
Oral Abstract  

Healthcare professional students apply their learning with patients and standardized patients (actors trained to portray patients in a standardized fashion).  Does it work to involve patients and standardized patient in TBL?   At the University of Colorado Anschutz Medical Campus, patients and standardized patients are involved in two different ways within a TBL-based interprofessional education course for dental, medical, nursing, pharmacy, physical therapy, and physician assistant students.

Patients/Family Advocates help to teach in a session about ‘Patient Engagement’ in health care at the individual, system and societal level.  Advocates have 3 roles: 1) represent the patient/family voice and role in health care and health professions education, 2) be a resource to student teams as they determine the best strategy to engage a patient/family at the individual level during their application exercises, 3) provide feedback and encouragement to student teams during report outs and inter-team discussion.   In effect, they join the facilitator as being a visiting ‘guide on the side’ with authentic expertise in this content area.  Standardized Patients portray challenging patients/providers as part of the application exercises during our ‘Advocacy and Assertion’ session.   In this session, teams are required to speak up in scenarios that otherwise might result in patient harm.  Standardized Patients enable teams to demonstrate their skills and communication approaches during the application exercise report out, and also provide feedback during the inter-team discussion.

In this presentation, we will describe how to recruit, train and involve Patients/Family Advocates as well as Standardized Patients in traditional TBL sessions.  We will also share feedback from students, faculty, patients and standardized patients based on engaging them in TBL sessions, and future directions.

“Surviving” TBL team development: an Evidence-Based Practice course with a novel, Survivor-themed, team building scavenger hunt
Diana Langworthy | Tiana Luczak | Sarah Brown, University of Minnesota College of Pharmacy
Oral Abstract 

Introduction: Building functional and cohesive teams is an essential component of creating a successful TBL environment and fostering high-level intra-team discussion.  Our aim was to increase students’ autonomy and responsibility for self-learning by setting team and faculty expectations in a collaborative, lively manner prior to the TBL sessions. Our secondary aim was to assess the students’ understanding of biomedical study designs and skill level in literature searching.

Methods: We piloted a novel team building activity at the start of an Evidence Based Practice course in the third year doctorate of pharmacy (P3) curriculum at the University of Minnesota College of Pharmacy. This course was structured to utilize TBL in five class sessions. The themed scavenger hunt was inspired by the American television show Survivor™ and focused on TBL teams working competitively to find their evidence-based practice themed team names (e.g., The P-Values) through a virtual scavenger hunt using literature searching techniques in PubMed. After finding their team names within the literature, they designed a team flag that included written expectations for fellow team members and faculty for the semester. The activity concluded with a debriefing on the relationship between expectation setting and team development.

Results: Throughout the activity, students were highly engaged and motivated to work collaboratively with overwhelmingly positive attitudes. Common themes that students identified for expectations of each other included being respectful, an active listener, inclusive, and accountable. Student’s expectations of faculty had similar themes and included being flexible, respectful, understanding, and providing clear communication.

Conclusion: This novel scavenger hunt is an innovative TBL technique that fostered high student engagement and team collaboration. The activity served as a positive and fun method of introducing evidence-based practice concepts and helped students build a solid foundation of unity and understanding through self-determined expectations for a semester of TBL.

Team-based learning, academic accommodations, and universal design for learning: Considerations in course construction and delivery
Jen Wrye | Liz Gerard, North Island College
Oral Abstract 

In this focus session, we examine the relationship between universal design for learning (UDL) and team-based learning (TBL). Universal design for learning holds that environments must dismantle irrelevant barriers to be accessible to the greatest number of people possible. UDL assumes every class has significant learner variability and that educators can foster success with good quality curriculum and instruction that offers flexibility in the ways students access material, engage with it, and show what they have learned.

By contrast, TBL is a structured approach to course design and delivery. It is organized to make students accountable to their classmates by teaching, and learning with, others. Teams use course concepts to solve relevant problems, which “focuses student learning, provides traction in the learning process, induces team cohesion, and stimulates general student enthusiasm” (Roberson & Franchini, 2014: 275). We contend that some students (e.g. those with diverse needs in relation to mental health issues, neurodiversity, perceptual differences, etc.) may experience barriers in TBL courses. Therefore, while the team-based learning structure has offers many students powerful and engaging learning experiences, it also raises questions about inclusion and accessibility.

This session considers some of those questions and comes from the experience of redesigning five undergraduate Sociology courses using TBL in a community college. We will outline some tensions between principles of UDL and TBL, as well as opportunities for addressing them. Most notably, we will explain some of the ways practitioners can maintain the TBL configuration while also minimizing barriers for students with unique needs.

A Perfect Medley: Designing Team-Based Learning Application Activities Using Resources from the National Center for Case Study Teaching in Science
Sandra Westmoreland, The University of Texas at Arlington
Oral Abstract 

Introduction and Background Information: Using Team-Based Learning (TBL) in our classrooms is a natural fit for teachers who wish to encourage teamwork and to develop critical thinking skills in their students. However, sometimes designing the application activities for TBL seems challenging. How do we create application activities that are aligned with our student learning objectives, relevant, and both challenging and age appropriate for our students? Team-Based Learning can form a “perfect medley”” with the case studies and teaching resources that are available at the National Center for Case Study Teaching in Science (NCCSTS) case collection website. The mission of the National Center for Case Study Teaching in Science at the University at Buffalo is to “”promote the development and dissemination of materials and practices for case teaching in the sciences”(http://sciencecases.lib.buffalo.edu). The website provides access to a collection of over 800 peer-reviewed science case studies which are organized for keyword search by subject, educational level (middle school, high school, college, and professional),and date of publication.

Method: The author has reviewed over 100 case studies from the NCCSTS website and has adapted many of them to use as application activities in successful TBL modules for Principles of Biology (majors freshman college biology) on such diverse topics as osmosis, cell structure, mitosis, photosynthesis, cellular respiration, and Mendelian genetics.

Results: This presentation will detail the steps used by the author to select and adapt case studies from the NCCSTS collection for use as TBL application activities. In addition, the author will provide a model lesson, including the case, a team decision worksheet, and evaluation rubric,demonstrating alignment with TBL teaching principles.

An Innovative Approach to Accommodate Different Learning Needs in Medical Histology course
Lu Xu | Andrew Wang | Danielle Krakosky | Angela Sultan, Department of Structural and Cellular Biology, Tulane Medical School
Oral Abstract 

Background:Medical Histology teaching has changed drastically over the last decade from traditional microscopy to virtual microscopy. In this digital age, the way that students learn has changed as well. Many students prefer independent study and preparation over traditional mandatory lectures and laboratory sessions. However, due to the hands-on nature of Histology lab, not all the students were able to learn how to recognize tissues by themselves. We sought to develop an approach that would accommodate students’ different learning needs without compromising the practical elements of Histology.

Description:Tulane Histology course has transitioned to team-based learning (TBL) in the 2018-2019 school year. The preparation materials for TBL were provided online including the Histology lab guide. Students can choose to do the Histology lab independently at home. Option lab sessions associated with TBL preparation materials were offered to the students who preferred learning under faculty supervision. A survey was administered to 191 students from 2018-2019 who experienced the TBL with optional lab approach.

Results:Student satisfaction was significantly higher after implementing TBL with optional lab approach (p< 0.05; 3.79 > 3.34). Most students reported the new method to be helpful for their Histology learning. With the same number of faculty involved in the Histology lab, the approach led to an increase of a faculty to student ratio.  Faculty reported an improved quality of discussion with students and less time spent in the optional lab compared with the traditional laboratory teaching.

Conclusion: Using an innovative approach of combining TBL with an optional lab, we manage to accommodate students with different learning needs, maximize students’ learning efficiency, increase the faculty to student ratio during the contact time, improve the interaction between faculty and students, decrease faculty total time spent in the lab and increase faculty satisfaction.

Thoughtful Design of Application Exercises Using Principles of Backward Design: A Round Table Exercise
Kajal Madeka | Holly Bender, Instructional Design Consultant | Iowa State University
Oral Abstract

Are you excited about implementing TBL in your classrooms, but struggle with creating effective application exercises? Do you grapple with questions like “How do I create an exercise that addresses the significant problem I have identified? How do I effectively execute the “4S’s”? How do I ensure that they are prepared to solve the problem?” Join instructional designer, Kajal Madeka and veterinary pathology professor, Holly Bender in a round table discussion where they will share with you a methodology based on principles of Grant P. Wiggin’s “”backward design”” and Dee Fink’s Creating Significant Learning Experiences. This simplified step-by-step process has helped members of the 250 member Iowa State University TBL Faculty Learning Community learn how to design effective application exercises. This method will gently guide you through the process of design with a series of questions and answers, “”mining your brain”” as you build. Whether you like an approach using technology or a paper backup– stop by and give the method a try.

Aligning Online Self-learning Pre-work Activities with RATs and Exams Improved Student Satisfaction with TBL Substantially in University Geology and Geophysics Courses
Stuart Clark, UNSW Sydney
Oral Abstract 

Feedback provides a platform for students to correct course towards the learning outcomes of the course. However, feedback is usually understood as an instructor activity directed at students. A number of papers have shown that student participation in the feedback process leads to more effective learner. Two courses were taught over three years in different formats:

1) in 2017, the course were taught with lectures and tutorials utilising instructor feedback only

2) In 2018, the courses were adapted to TBL with pre-work readings derived from the lecture materials

3) IN 2019, the TBL course was refined with online pre-work that used self-directed feedback aligned to the readiness assurance testing (RAT) phase of the course.

In 2017, the feedback provided was for summative quizzes (together worth 50% of the course assessment) and therefore it was difficult to see how the feedback could be actionable by students and lead to improvement. In 2018, feedback was provided after the RAT process, but because of the summative nature of the RATs, students found these stressful and it was difficult to anticipate in advance which elements of the pre-work to prepare in detail on. In 2019, pre-work quizzes that quizzed the same topics as the RATs were developed. This allowed students to self-regulate their learning and refer back to the other pre-work materials to better understand concepts that would be examined in the RAT.

Since the questions were not identical, but very similar, memorising responses from the pre-quiz would not help, but using the quiz to build understanding and ask the right questions from the online forums to clarify concepts meant that students were highly engaged with the course material before coming to class.

The ability to self-regulate their learning in 2019 through the use of practice quizzes probably led to better results in similar RATs in 2018. In addition, while students satisfaction in 2018 was mixed about TBL, in 2019, the student satisfaction was significantly better than the 2017 results as well as compared to courses across the Faculty. In 2019, students preferred the TBL components of the course assessment and also the majority of students felt that the instructors were very effective or better.

Integrating the basic and clinical science pharmacy curricula using a multi-disciplinary TBL facilitation team.
Luma Munjy, Chapman University School of Pharmacy
Oral Abstract 

Introduction: Traditional pharmacy curricula employ a single-instructor approach to teaching therapeutic topics. This approach often fails to connect the basic sciences with patient care delivery. The present study assessed the benefits of team-based learning (TBL) with a multi-disciplinary team consisting of a medicinal chemist, pharmacologist and clinical pharmacist to deliver an integrated pulmonary therapeutics course to student pharmacists.

Background: Chapman University School of Pharmacy utilizes TBL for delivering both basic science and clinical pharmacy courses. Study authors designed a 6-week pulmonary disease module that utilized a multi-disciplinary team to design and deliver course content. The multi-disciplinary team co-designed all pre-work, individual readiness assessments, and an integrated patient case activity. The TBL module was rehearsed prior to delivery to ensure that each instructor was prepared to seamlessly integrate their topic into the co-facilitated discussion. Learners were subsequently completed a 5-question survey regarding the effectiveness of the course.

Results: A total of 47 students participated in the post-course survey. A four-point Likert scale from strongly agree to strongly disagree was used to assess students’ opinions regarding the multi-instructor approach. Of the 47 students who participated in the survey, 89.59% strongly agreed or agreed that the multi-disciplinary approach demonstrated the importance of linking basic science knowledge to clinical practice. A total 87.5% strongly agreed or agreed that they were able to increase their retention of course material and develop a deeper understanding of subject material. Additionally, 91.67% strongly agreed or agreed that this approach stimulated critical thinking skills.

Conclusion: A multi-disciplinary TBL approach provides a platform by which academicians from various backgrounds may build connections between the basic sciences and clinical practice within the pharmacy curriculum. Future studies will assess the outcomes of a multi-facilitator TBL approach on student performance on clinical exams.

Implementing a Team-of-the-Month Award to Recognize and Incentivize Effective Teamwork
Suzanne Clark, BS Pharm, PhD | Tarnjit Kaur, BS, California Northstate University College of Pharmacy, Elk Grove CA
Oral Abstract 

Introduction: TBL teamwork can be facilitated by helping teams progress smoothly through the stages of forming, storming, norming and performing.  Although students may not come to a TBL class with effective teamwork skills, these can be learned and practiced, with appropriate guidance.  This can include providing education on characteristics of effective teams, reinforcement of effective teamwork strategies, opportunities for self-reflection, and regular feedback.  Similarly, good teamwork can be incentivized through acknowledgment and recognition.

Aim: To promote and recognize effective teamwork, we have developed a Team-of-the-Month award open to teams from all classes across our curriculum.

Methods:  A set of criteria listing effective teamwork skills are provided to all students in the College of Pharmacy PharmD program.  Criteria include smooth team transitions (forming through performing), team accountability to members (and members to teams), responsible collaborations, mentorship, professionalism, and patience.  Teams are required to reflect on qualities that make/made their team excellent and to discuss how their team exemplifies up to three criteria from a list.  They can also propose their own criteria, to allow for creative reflection by teams.  At our program, advanced students have been on up to 6 different TBL teams by the time they complete their three didactic years.  Students have expressed an interest being allowed to nominate a previous team, instead of being limited to current teams.  Accordingly, students can nominate any team on which they have been a member.  This is important, for as students progress through the program they have more experience with effective teamwork and may better recognize effective teamwork, in retrospect.

Outcomes: Nominations are scored using a set of criteria including standard assessments (word count, deadline, number of criteria addressed directly) and compelling narrative.  Winning teams are acknowledged at a College-wide meeting, where they read their narrative and are photographed for website acknowledgment.