Team Based Learning

							Team Based Learning

Sidney S. Murphree, M.D.
      Why We Chose to Use
      Team Based Learning

Overview of Team Based Learning as
       a Pedagogical Method

   Team Based Learning At The
      University of Louisville

     Team Based Learning at
        Other Institutions
Why We Chose to Use
Team Based Learning
 Sophomore Pathology Course

► Traditional   Pathology Department Based
  Course
► Lectures
► Laboratory
► Other Assignments
   Autopsy / Death Certificate
   Patient Centered Response
   Others
        Laboratory Component:
        prior to TBL intervention


► “Small”Groups of 12 to 15 students
► Groups Led By Preceptors
      Laboratory Component:
      prior to TBL intervention
► Case Based Small Group Discussion
► Cases on CD
     Saunders Companion CD
     Clinical History with some Laboratory
     Annotated Gross and Micro
     Some Embedded Questions
► Sessions   began with short quiz
                   Preceptors
► “Small” Groups of 12 to 15 students led by
  preceptors which included
    Pathology Faculty
     ►Anatomic   >> Clinical >>> Research Pathology
   Community Pathologists
   Pathology Residents
 Preceptors: Time committment
► Needed   12 Preceptors each week

►3   hours each week
   One hour prep session
   2 hours in lab with students

► 18  weeks
     [648 hours if they spent
      no additional time preparing]
                             Problems
►   Difficult to obtain and train preceptors on a weekly basis
    [Weekly One hour Prep sessions]

►   TREMENDOUS VARIATION IN
        Preceptor Preparation
        General Teaching Skills
        Small Group Teaching Skills
        Knowledge of Subject Matter
        Enthusiasm ….HIGHLY VARIABLE

►   Most preceptors
      not “subject experts”
      Average to poor small group instructors
                    Problems
► Persistent Student Complaints of variation in the
  quality of small group experience

► Typical   Small Group Approach
   Passive Mini-lecture
   Preceptor read summaries and captions provided in the
    cases
   No actual case discussion
   Few incentives for individual student preparation or
    group participation
                        Problems
►   Typical student comments from course evaluations …

     “ …lab was often a waste of time with no value added
    beyond the opportunity to ask the preceptor questions,
    which, if you were luck, they occasionally could answer”

      “ … many students in my group often went next door to
    the sessions run by Dr. XXXX, who ran a great small group
    and consistently generated enthusiasm about the content
    with challenging questions and lively discussion that took
    them beyond the material we had already studied for each
    lab…. I usually stayed behind in the group I was
    assigned… and felt cheated ”
           What We Wanted
► Active learning with active group discussion
► Wanted to keep the group dynamic
► Active discussion with an exchange of
  questions and ideas …
   between preceptor and group members
   students in a group
       ( students teaching students)
          What We Wanted
► Wanted all groups have real time access to
 subject experts and quality teachers
► Wanted students motivated to spend time /
 effort preparing for laboratory sessions
► Wanted students motivated to help each
 other learn
    Overview of Team Based
Learning as a Pedagogical Method
          Team Based Learning
► Larry   Michaelson >
   Business School
   Problem solving

► Multiplesmall groups solving the same
 problem simultaneously in a large lecture
 hall with guidance from a content expert.
         Basic Components of
         Team Based Learning
► Learning  objectives and assignments
  structure preclass preparation
► Students are assigned to specific small
  groups
► Instead of multiple small groups scattered in
  several small rooms, TBL sessions are
  conducted in a large lecture hall
► Small group members are clustered
  together and solve problems as a group
              Team Based Learning
                 TBL PHASES
INDEPENDENT STUDY and GROUP STUDY PRIOR TO SESSION
DRIVEN BY: WELL WRITTEN LEARNING OBJECTIVES,
           SPECIFIC STUDY ASSIGNMENTS

              INDIVIDUAL PRETEST



                     GROUP PRETEST




    During session           ADDITIONAL GROUP WORK
                              POST TEST PROBLEM SOLVING
           Team Based Learning
► Demands   Active Learning and
  Pre-Class Preparation

► Individual   Preparation DRIVEN BY…
     Well written learning objectives
     assigned reading
     assigned cases
     individual pretest
     PEER PRESSURE [group pretest]

► Independent Study Prior to Group Sessions is
  Encouraged and Rewarded
1
        Pre-Class Preparation / Individual Study

        Readiness Assurance Testing
    2
                                                   Same Short Multiple
         Individual PreTest
                                                   Choice Test
         Group Discussion / PreTest                    Taken Twice



                              Instructor Feedback


            Application of Concepts        Post Test
    3
                                           Group Activity
              Group Application Activity
                                           Small Group Assigment



                                Instructor Feedback
              The Teamwork TBL
 Small Groups of 6 to 7 Students
 Groups must be carefully constructed and
  maintained intact
 Group Process is Important
 Small Group Discussion during Class
     Group Pretest
     Post Test // Group Activity
   Individual student grades determined by team
    performance (group pretest) and personal
    performance (individual pretest)
            Efficient Use of
       Student and Faculty Time
        in Team Based Learning
► Single Preceptor for Session
► Groups Generate Questions >>
   Dealt with by Preceptor(s)
► Preceptor Generates Questions >> Questions by
  are heard and considered by all groups
► All Groups have Identical Experience /
   Identical Exposure/Access to Faculty
► Added Value
What is was like before
  team learning….

 Robbins CD LINK Cardiac Case 1
Team Based Learning At The
   University of Louisville
Pre-Class Preparation / Individual Study

     Companion CD

             - Learning Objectives
             - Case History
             - Annotated Images
             -   Guiding Questions




Two hours each week are set aside on the
student calendar for TBL preparation
         Pre-Class Preparation / Individual Study
1                 Companion CD Content              Annotated Images
                  Learning Objectives               Guiding Questions


        Readiness Assurance Testing
    2                                                  Same Short Multiple
         Individual PreTest
                                                       Choice Test
         Group Discussion / PreTest                        Taken Twice


           Instructor Feedback           Discussion of Pretest
                                         Question and Answer Exchange
                                          Instructor Questions
                                          Group Questions


    3          Post Test
                 Group Activity
                     MCQ based on Similar but different Cases


                    Additional Instructor Feedback
What a team learning session is
           like….

  …. TBL Discussion Powerpoint
 Results – Two Years Experience
► No  change in student performance
  (? improvement) on Pathology Shelf and
  NBME I.
► 10 fold decrease in faculty time devoted to
    “ laboratory content” [750 + hours vs 75 to 80 hours]
► Consistently Positive Response from
  Students and Faculty
 Pathology Team Based Learning
 Mercer  Medical School – Sebastian Alston
 Univ of Oklahoma       – John Holliman
 Wright State          – Paul Koles
 Meharry               – George Breaux
 Univ of Cincinnatti   – Paul Biddinger
 Other Medical Schools ??
              TBL in Medicine
► Full Spectrum of Courses in Basic and
  Clinical Sciences
► Integrated and non-integrated curricula
► Both Lecture and Laboratory

Medical Team Based Learning Cooperative

   www.tlcollaborative.org
      Why We Chose to Use
      Team Based Learning

Overview of Team Based Learning as
       a Pedagogical Method

   Team Based Learning At The
      University of Louisville

     Team Based Learning at
        Other Institutions
                  Conclusions
► Team  Based Learning is a new pedagogical
  approach that emphasizes Individual and
   Small Group Work
► Widely used in Pathology and Other
    Medical Disciplines
► Active learning
► Benefits of Small Group Dynamic
► Compared to “traditional faculty lead small group
  sessions” TBL…..
   Fewer Faculty resources needed (10 fold decrease)
   All groups exposed to content experts
                       Questions?




Bright Star Regulus near the Leo 1 Dwarf Galaxy

    Astronomy Picture of the Day at ….
     http://antwrp.gsfc.nasa.gov/apod/image/0606/leoregulus_croman_big.jpg