TEAM BASED LEARNING: AN ACTIVE LEARNING STRATEGY

FOR ALL LEVELS OF LEARNERS

APPD/COMSEP 2013 April 13, 2013

Facilitators

•  Priya Garg-Tufts University

•  Dorene Balmer- Baylor

•  Andrew Mutnick- Columbia University

•  Julia Aquino-Tufts University

•  Linda Tewksbury- NYU

Drs. Aquino, Balmer, Garg, Mutnick and Tewksbury

have nothing to disclose

Objectives •  Identify the essential elements of team based

learning

•  Identify tools used in TBL to create an interactive learning environment

•  Participate in a TBL session

•  Review the evidence related to TBL

•  Develop an implementation plan for home

TBL Overview

Active Learning E

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Engagement with others about content Borrowed from Boyd Richards, 2010

TEAM-BASED LEARNING: ONE OF SEVERAL “C-TYPE” ACTIVE LEARNING STRATEGIES

Strategies to promote active learning

Team-based Learning

Problem-Based Learning

Case Discussions Think-pair share

What is TBL?

•  An instructional strategy designed to transform small groups into teams and impact learning through: •  Ensuring preparation and provoking motivation •  Replacing passive with active learning •  Enhancing group problem solving skills •  Maintaining optimal results even when student:faculty ratio

is high

Transformation

4 Essential Principles of TBL

Ø  1 - Groups must be properly formed and managed

Ø  2 - Students must be made accountable for their individual and group work

Ø  3 - Group assignments must promote both learning and team development, and

Ø  4 - Students must have frequent and timely feedback.

When these principles are in place, groups of students evolve into cohesive learning teams.

Team-based learning sequences learning experiences:

3. APPLICATION Learners solve and defend increasingly complex problems through INTRA- and INTER-group discussions

2. READINESS ASSURANCE: Learners demonstrate (individually and in small groups) readiness to use desired knowledge

1. PREPARATION: Learners acquire desired knowledge

TBL Structure

Phase 1

•  Preparation • Compels teacher to have clear learning

objectives • Readings linked to those objectives • Assigned readings to be completed prior to class

Phase 2

•  Readiness Assurance •  Individual (IRAT)

•  10-15 MCQs •  Group (GRAT)

•  Repeat IRAT with Team •  Immediate Feedback

•  Challenges/Appeals/Clarifications

Immediate Feedback Readiness Phase

• Come to a group consensus answer for each question

• Scratch off the corresponding block – look for the STAR

• Scoring system

Readiness Assurance

•  Encourages individual and group learner accountability

•  Impresses outperformance of group over individual efforts

•  Promotes teamwork and effective communication

Phase 3

• Application •  Novel cases that stress core course/session concepts •  Simultaneous reporting – Immediate Feedback

Immediate Feedback Application Phase

A B D E

Applications

•  Develop critical, clinical reasoning skills

•  Continue to hone adaptive teamwork skills

•  Appreciate the ambiguity and variability of practice

•  Cogently express challenges to accepted practice

TBL in action

Get to work!

•  Can you recognize this picture?

Team Formation

TBL Learning Objectives

TBL session timeline Phase 1

•  1st video clip (3 min)

Phase 2

•  Individual RAT (5 min)

•  Group RAT (10 min)

•  Review answers (Appeals process) (5 min)

Phase 3

•  2nd video clip (4 min)

•  Application Exercise (5 min)

•  Reporting back (5 min)

Preparation Phase

Readiness Assurance

Application Phase

Designing Readiness Assurance Test (RAT)

•  Keep it brief

•  Focused on key concepts (distinguish from application)

•  Questions clear (don’t get caught in semantics) with clear choices

•  Consider 1-2 controversial questions

Designing application exercise

Four S’s •  Significant

•  Important to clerkship •  Consider using real cases

•  Same •  All teams working on same problem

•  Specific •  Narrow questions à deeper analysis •  Addresses application, not factual recall

•  Simultaneous report •  Fosters healthy competition •  Prevents boredom

Group Reflection

TBL Across the Continuum of Medical Education

Peds Clerkship- Columbia University

•  4 sessions, each 1-2 hrs long since January 2011

•  Facility:

•  Topics •  Fever, Common Infections, GI (Emergencies, Vomiting, Diarrhea, Constipation),

Renal (Hematuria and Proteinuria)

•  Facilitator: •  Clerkship Director

•  Specialists +/- (ID, GI, Nephrology)

•  Evaluation: ~7% of total grade •  50% IRAT

•  50% GRAT

Residency Program Tufts Medical Center

•  Monthly sessions, each 1hr long since July 2011

•  Facility: Residency Conference Room

•  Topics

•  American Board of Pediatrics Board Certification Content

•  Question Development

•  AAP PREP Series

•  Facilitator:

•  3rd year resident on teaching resident rotation

•  Residency Director

•  Evaluation: Based on attendance, scores reviewed semi annually

Faculty Development Workshop

Phase Three: Application

Group problem solving Report out and Discussion

Phase Two: Readiness Assurance

Individual readiness quiz Group readiness quiz Appeals and Discussion

Phase One: Pre-reading

Participants asked to peruse article, Qualitative Research in Medical Education

Questions

Any Evidence?

•  Growing body of evidence in medical education

•  Different learner groups

•  Different levels of outcome

Academic Performance

•  The Impact of Team-Based Learning on Medical Students’ Academic Performance. Koles, et al (2010) Acad Med •  Students scored higher on preclinical exam

questions related to course content taught through TBL suggesting that TBL enhances mastery of course content.

•  Students in the lowest academic quartile showed the greatest gains and may benefit more than highest quartile students from the TBL strategy.

Confidence & Behavior Change

•  Applying team-based learning in primary care residency programs to increase patient alcohol screens and brief interventions. Shellenberger et al (2009) Acad Med •  Residents reported high levels of confidence

in alcohol screening/intervention after 3 TBL booster sessions .

•  The number of residents reporting alcohol screening/intervention behaviors increased over the 4 month training period.

Gain (or loss) based on comparing the score of each team to the score of its own BEST member.

Gain (or loss) based on comparing the score of each team to the score of its own BEST member.

Our Performance

Columbia TBL Performance Data

Tufts TBL Performance Data Topic Individual Avg

Performance Score

Group Avg Performance Score

IBD/GI Disorders 55% 75% Puberty and Short Staure

80% 80%

Toxicology 60% 100% Inborn Errors of Metabolism

68% 85%

Genetic syndromes 78% 85%

Immunology 74% 100% Nephrotic and Nephritic Syndrome

75% 85%

Meningitis 66% 90% Hematuria 71% 80% Opthamology 80% 100% Urology 85% 95% AVERAGE 72% 89%

Baylor Workshop Evaluation

1 2 3 4 5 6 7

Overall Education Event Specific TBL Session

Low High

Questions

Implementation : small group exercise

Successful curriculum

Obtain “stakeholder”

support

Determine topics

Establish question

development process

Design evaluation

process

Determine facilities logistics

Build an instructor pool

Feedback

THANK YOU!!

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