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Team Based Learning at LLU headache

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					Team-Based Learning at LLU


Jeff Cao, M.D.
CDS Summer Meeting, 2006
Team-based learning sessions

   TBL sessions
       Class of 170 students divided into 34
        groups of 5 students for the year
       17 groups with one laptop each meet in
        Pathology Teaching Laboratory
       Each laptop in connected to the Intranet
   Intranet connections provide
       Access to Blackboard for group quiz
       Access to server for Virtual Microscopy
Team-based learning sessions

   Based on previous week’s lectures
   Each group = 1.5 hours each week
   RAT (readiness assurance testing)
    quizzes given on Blackboard
       Pre-session individual quiz posted before
        weekend before TBL
       Group quiz of 6 questions at beginning
        of TBL session
Pre-session Individual Rat Quiz

   Quiz of 5 questions on BlackBoard
   20 minutes allowed for quiz
   Can be taken at any time up until 24
    hours before TBL session
   Based on page of vignettes
       12 (+ or -1) clinical vignettes
       Arranged in ascending ages of patients
I. A 55-year-old male suddenly complains of severe headache and
collapses during an argument with his wife. He has a history of poorly
controlled severe hypertension. Physical examination reveals a breathing
but unconscious patient who does not respond to pain and has a dilated
left pupil. MRI shows an irregular cystic area with liquid in the left
cerebral hemisphere.
I. A 55-year-old male suddenly complains of severe headache and
collapses during an argument with his wife. He has a history of poorly
controlled severe hypertension. Physical examination reveals a breathing
but unconscious patient who does not respond to pain and has a dilated
left pupil. MRI shows an irregular cystic area with fluid in the left cerebral
hemisphere. (Intra-cerebral bleed from rupture of penetrating artery)
Pre-session Individual Rat Quiz

   Students
       Must figure out best diagnosis(es) for
        each vignette before taking the quiz
       May use vignette sheet for notes about
        the condition that the vignette
        represents
       May use annotated vignette sheet during
        quiz
Pre-session Individual Rat Quiz

   BlackBoard immediately informs
    student of grade after the quiz is
    submitted (but not what questions
    missed or their correct answers)
TBL Session

   Entire session = 80 minutes
   10 minutes = Group Quiz
   30 to 40 minutes = group discussion
    of additional questions
   30 to 40 minutes = Interaction
    (interrogation, pertubation?) of
    groups by discussion leader
   Students put take from/put back into
    the storage cart their group’s laptop
TBL Session Group Rat Quiz

   Quiz of 6 questions on BlackBoard
   10 minutes allowed for quiz
   Based on same page of vignettes
   Immediately graded by BlackBoard
       Group provided with score as well as
        correct answer
TBL Session Group Rat Quiz

   When group finished with quiz
       Group posts group number on wall
       Group given additional, expanded
        questions for most of vignettes
I. A 55-year-old male suddenly complains of severe headache and collapses
during an argument with his wife. He has a history of poorly controlled
severe hypertension. Physical examination reveals a breathing but
unconscious patient who does not respond to pain and has a dilated left
pupil. MRI shows an irregular cystic area with fluid in the left cerebral
hemisphere. (Intra-cerebral bleed from rupture of penetrating artery
What is the most important cause of this condition?



What are the differences in cause and results of fusiform versus
sacular aneurysms



What is the cause of his neurological findings?
 TBL Session Group Discussion

1.   Groups asked if any questions about
     the group quiz or disagreements
     about its questions
2.   Discussion leader
        Walks from group to group and
        Asks additional or additional-additional
         questions
        The other groups are the judges if the
         group’s response is correct
I. A 55-year-old male suddenly complains of severe headache and collapses
during an argument with his wife. He has a history of poorly controlled
severe hypertension. Physical examination reveals a breathing but
unconscious patient who does not respond to pain and has a dilated left
pupil. MRI shows an irregular cystic area with fluid in the left cerebral
hemisphere. (Intra-cerebral bleed from rupture of penetrating artery
What is the most important cause of this condition? (Hypertension
which not only causes the final rupture but also accelerates the
arterial damage to cause the predisposing aneurysm.)
What are the differences in cause and results of fusiform versus
sacular aneurysms (Sacular or berry aneurysms [which bleed into
the SAS] result from a congenital defect in the media at the
bifurcation of cerebral arteries and look like a ballon. Fusiform
aneurysms [which bleed into the brain substance and sometimes
even into the SAS] result from diffuse damage from hypertension
and/or atherosclerosis to the small penetrating arteries which
causes the classic elongated, sausage-like dilations and predisposes
the arterial segment to rupture, particularly in the presence of
hypertension.)
What is the cause of his neurological findings? (Transtentorial
herniation of the left uncal gyrus with compression of the left 3rd
nerve)
TBL Session Group Discussion

   Disagreements resolved by
    discussion between groups !!!!
   (Usually issues resolved by sudden
    gasp by other groups)
Result of Survey at End of Fall

   Out of 170 students, 152 responses
    (the small pox eradication effect)
   12 questions
       11 questions = choose from degrees of
          Agree
          Disagree

       1 essay question
   Survey done after exam
    Question 3 Multiple Choice
 Preparing for and participating in the
  Team-Based Learning session was an
  effective use of my time.
Answers                  Percent
Strongly agree           47.4%
Somewhat agree           40.8%
Neutral                    5.9%
Somewhat disagree          3.3%
Strongly disagree          2.6%
    Question 4 Multiple Choice
 The issues discussed in the Team-Based
  Learning Sessions were appropriately
  represented in the Mid-Term Examination
  and made preparation for that examination
  considerably easier.
Answers                     Percent
Strongly agree              39.5%
Somewhat agree              48.0%
Neutral                     10.5%
Somewhat disagree             1.3%
Strongly disagree             0.7%
    Question 5 Multiple Choice
 Preparation for the Team-Based Learning
  Sessions took up so much of my time that
  my performance in other courses like Patho-
  physiology or Psychopathology suffered.
Answers                    Percent
Strongly agree               3.9%
Somewhat agree             21.1%
Neutral                    23.7%
Somewhat disagree          31.6%
Strongly disagree          19.7%
    Question 6 Multiple Choice
 Figuring out which disease(s) is (are)
  represented by the clinical vignettes on the
  answer sheet for Quiz # 1 is a useful study
  /preparation technique for the sessions and
  learning.
Answers                      Percent
Strongly agree               55.3%
Somewhat agree               34.9%
Neutral                        6.6%
Somewhat disagree              2.6%
Strongly disagree              0.7%
    Question 7 Multiple Choice
  How much did you prepare for the sessions
   in addition to figuring out which disease(s)
   is (are) most appropriate for each of the
   vignettes in the answer sheet?
Answers                             Percent
I did not even try and just winged it during
   the group session.                 0.7%
I just studied the images and their
   comments.                        10.5%
I studied mainly my lecture notes.10.5%
I studied both my lecture notes and the
   images with their comments.      78.3%
    Question 9 Multiple Choice
 All of the members of my group are now
  showing adequate preparation and doing
  their fair share in support my group.
Answers                       Percent
Strongly agree                63.8%
Somewhat agree                29.6%
Neutral                        4.6%
Somewhat disagree              0.7%
Strongly disagree              1.3%
    Question 10 Multiple Choice
 I am comfortable with students (even
  me) being asked questions in front of
  the rest of the class during the
  session.
Answers                   Percent
Strongly agree            18.4%
Somewhat agree            28.9%
Neutral                   15.8%
Somewhat disagree         23.0%
Strongly disagree         13.8%
    Question 12 Multiple Choice

   Please comment here to express
    what is negative, what is positive and
    what changes should be considered
    in the way the laboratory sessions
    are done (even if just to say, "Please
    get rid to Team-Based Learning").
The Good 1

“I found it useful in the fact that it
   kept me up to date with the
 course material, and helped me
  review the information as the
       course progressed. “
The Good 2

  “Team based learning is a good
   headstart in understanding &
 remembering the diseases. Also,
  it prepares (from my opinion)
students in studying for the exam
    & not just plainly memorizing
              concepts.”
 The Good 3

“I do get really nervous when Dr. Cao
   asks questions and I feel like all I
    know about the subject goes
  away...however, I think this is a
     good practice for "pimping"
 episodes we will encounter when
  we are in the hospital. So, which
    one outweighs the other? well...i
          guess we will see. ”
The Good 4

“I enjoyed Team-Based Learning... it
   gave me an incentive to study
 and the group quizzes helped me
  see things from a different point
     of view. That is, my group
   mates' comments and insights
            were helpful.”
    The Good 5

   “Positive- Forces study and is a
    way to check comprehension.
   Negative- Difficult to get anything
    out of it if you havent studied
    ahead of time. “
The Good 6
 “As a whole I think the TBL sessions are
  good. I think the group part is more
"productive" than the individual part; i
 found discussing the questions to be very
 benificial, and the fact that they are done
  in a groupe is motivation to study. The
part of the TBL sessions that is difficult
 for me personally is having to answer
  questions in front of the class, but i
    don't necessarily think that part
           should be taken out. “
The Bad 1

  “The fact that people read at
    different speeds is the only
    problem that I see working
together as a group. Some people
 might feel rushed. Others might
  be annoyed that not everyone
    reads quite as fast as they
   do. The individual quizes were
 great, and the most valuable aspect
          of our sessions. “
The Bad 2

 “It is really hard for me to be
crowded around a computer with
  5 other people trying to read
      questions carefully and
   completely. It is very helpful
  having hard-based copies of the
  questions for the 2 people on the
           edges to read.“
The Bad 3
   “indeed, "please get rid of team-based
  learning"... the time to prepare for the
quizes is substantial if one wants to do
    well and is disproportionate to how
   much the tbl labs are actually worth
     gradewise. Preparing for the quizes
    restricts the freedom i have to allocate
time to my courses in accordance with their
respective needs. i grasp the material no
   better than when i had stepped into
   the path lab, and i wouldn't come if i
                didn't have to.“
  The Bad 4

“TBL is a fine idea in of itself but put in
    the context of how long a day it
  makes wednesdays it has caused me
     to dread it. …. My time would
   better be spent diving into my
  notes and really learning instead
    of listening to what everyone
   else has learned. I vote for the
       TBL labs to be canceled.“
 The Bad 5
“I know this may not be the best idea, but I
    would've been more comfortable had I
          been in a group that I knew
   better. Things get intense and we do
  get worked up when two people think
   they know the answer and they both
  have different answers. Of course this
    is how it will be for the rest of our
    lives, so I guess it's good to try to
      figure out ways to resolve such
      matters and it would be nice if the
    instructor would acknowledge this and
  reassure the groups that this is also one of
                  the goals.“
Preceptor Response
    Preceptor Response

   Amazed at
       The amount and intensity of discussion
       Quality of thinking
       Evident previous preparation
       The lack of bored students
    Preceptor Response

   But felt like a lump on a log
       Students only rarely asked them for help
  Preceptor Response

Solution: Train preceptors to be
 Discussion Leaders
    Conclusions

   Team-based learning
       Works and most students find it
        rewarding
       Is easier and cheaper to do
       Results in test scores were the same as
        the previous year and may even be in
        the process of becoming better
         (careful, Jeff !!)

				
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