2020 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.