Team Based Learning

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Team Based Learning

• Sidney S. Murphree, M.D.

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Medical Schools Currently Using Team Learning In
Pathology

• Sebastion Alston
• Mercer, Macon Georgia
• Paul Biddinger, M.D.
• Cincinnati, Ohio
• George Breaux, M.D.
• Meharry Medical College, Nashville, Tennessee
• John H. Holliman, M.D.
• University of Oklahoma
• Paul Koles, M.D.
• Wright State, Dayton Ohio
• Sidney S. Murphree, M.D.
• University of Louisville, Louisville KY

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Why I Tried Team Based Learning

• Resource Problems
• Small Number of Quality Faculty
• Student Dissatisfaction
• Small Group Experiences Highly Varied
• Mandate to Decrease the Lecture Based Components
  of the Course
• Sense that TBL had some unique advantages and
  efficiencies

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Team Based Learning

• Small groups working independently on similar
  problems quiz questions
• Sessions led by a small number (1 - 3) of expert
  faculty
• Many of the benefits of faculty-led small group
  discussions
• Efficiency of high student-faculty ratios
  (1501) plus the effectiveness of having a
  content expert to guide all the involved groups
  in discussions / questions

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GOAL

• Goal to facilitate understanding of the
  laboratory content for the sophomore pathology
  course

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TBL Overview

• Small-groups working independently
• TL consists of repeating sequences of 3 phases1)
  Preparation - learners study independently
  outside of class to master identified
  objectives2) Readiness Assurance - individual
  learners complete a multiple-choice exam to
  assure their readiness to apply knowledge3)
  Application of Course Concepts - groups complete
  in-class assignments that promote collaboration
  allows identification of learning deficiencies

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Phase 1

• learners study independently outside of class to
  master identified objectives

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Phase 2

• individual learners complete a multiple-choice
  exam to assure their readiness to apply Phase 1
  knowledge.
• groups of 6-7 learners then re-take this exam and
  turn in their consensus answers for immediate
  scoring and posting
• discussion of answers and problems

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TBL Ideal

• At designated times, all groups simultaneously
  share their groups' answers with the entire class
  for easy comparison and immediate feedback.
• Create an energetic total-class discussion with
  groups asking questions, defending answers, and
  consolidating / expanding knowledge

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Phase 3

• Groups assignments promote collaboration, use of
  Phase 1 and 2 knowledge
• Teacher helps to consolidate learning, Identify
  and fill knowledge gaps

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Team learning phases as proposed by L.K.
Michaelsen in a business school model
Post Test - Group
DiscussionQ A
Group PreTest
DiscussionQ A
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Elements of Team Based Learning
Student preparation Readiness Assessment Group
Activities
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Structure of Team Learning

• 1) Individual and group accountability
• 2) Opportunity for interaction within groups and
  between groups
• 3) Motivation to learn, ask questions, engage in
  discussion.
• 4) Students teach each other

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Team Based Learning

• TBL stresses the importance of a priori,
  out-of-class learning self-study based on
  clear learning objectives and well defined study
  materials.
• It emphasizes the importance of holding learners
  accountable for attending the TL session prepared
  to participate, and provides guidelines for
  designing group learning tasks to maximize
  participation.

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Team Based Learning at Univ. of Louisville

• Two hours per week designated for self-study
  prior to live session (usually the day before)
• Two hour live sessions in auditorium
• Usually once a week

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Team Based Learning

• Cases assigned / scheduled to coincide with
  concurrent lecture topics
• Cases assigned from UTSW / Robbins CD
• Learning objectives
• Cases
• Images
• Assigned reading
• Embedded questions

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Environment and Organization

• Class divided into 20 teams 6 to 7 students
  on each team
• Teams created using blinded class rank data from
  year one
• highest rank students evenly divided between
  groups
• lowest ranking students divided among the groups

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Environment and Organization

• Alternative student information we did not use...
  
• M / F
• Myers-Briggs data personality type
• Ethnic groups / Racial characteristics

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Contribution Of Different Types To Team Learning

• All types benefit from the strengths of the other
  types in the group.
• Extraverts energize the group introverts give it
  depth of thought.
• Sensing types hear intuitive thought and develop
  their own intuitive skills.
• Intuitive types are reminded of all those details
  that they tend to overlook.
• Feeling types develop the logical organization
  that comes from thinking skills.

John Pelley, Texas Tech
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Environment and Organization

• Students sit grouped in large auditorium
• students sat together in assigned groups
• groups separated by one or two rows
• Faculty leadership
• Janice Wooldridge-Ware and Tassie Deppert

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Environment and Organization

• Quizzes Pretest and Posttest prepared ahead
  of time
• Multiple choice
• Image based
• Post Quiz Discussion with Q and A

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Environment and Organization

• Images projected on large screen in auditorium
• Large cards to identify groups
• READY CARDS

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CONTENT

• Four to 6 cases from CD assigned per week
• Cases usually from a single organ system / topic
• Students were assigned
• learning objectives
• reading
• case histories
• images
• embedded questions

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FORMAT

• INDIVIDUAL PRETEST IRAT
• GROUP PRETEST GRAT
• REVIEW OF PRE-TEST AND LARGE GROUP DISCUSSION
  WITH QUESTIONS AND ANSWERS
• GROUP POST-TEST
• REVIEW OF POST-TEST AND LARGE GROUP DISCUSSION
  WITH QUESTIONS AND ANSWERS

15 MIN
15 MIN
30 MIN
15 MIN
30 MIN
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FORMAT

• Individual PRETEST IRAT
• one test and one answer sheet for each student
• graded individually
• no discussion within the group
• GROUP PRETEST
• exact same test
• group discussion
• answers submitted and graded for the group

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FORMAT

• PRETEST
• 4 to 6 questions
• most questions image based
• most questions were double jump basic
  information pertaining to the cases assigned

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Eosinophils Plasma Cells Macrophages
Eosinophils Plasma Cells Macrophages
8. Mixed Inflammatory Infiltrate - High
Power This image is an area of inflammation
showing eosinophils, plasma cells, and
macrophages. Can you identify each of these
cells? Use the feature box after attempting to
find the cells. Under what conditions are
eosinophils prominent in the inflammatory
infiltrate? Answer What are the contents of
eosinophil granules? Answer What are the
factors/products secreted by activated
macrophages? Answer
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Double Jump Question

• A characteristic protein product made by the
  cells shown circled in black are...
• A) antibiotics
• B) antibodies
• C) leukotrienes
• D) complement precursors
• E) myeloperoxidase components
• F) fibrin split products

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FORMAT

• REVIEW OF PRETEST AND LARGE GROUP DISCUSSION
• questions posed to individual groups
• spokesperson answers for group
• follow-up questions open ended, challenging,
  engaging
• respectful interchange of questions and answers

VERY IMPORTANT TO CREATING THE ADDED VALUE
ASSOCIATED WITH TBL SESIONS
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FORMAT

• POST TEST / Group Activity
• Usually case based
• Different type of questions
• Required deeper knowledge of details, assigned
  reading, learning objectives
• synthesis questions best
• new problems / cases that can be solved based on
  the cases they have already worked through

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ADDED VALUE

• Most students felt they learned most of the basic
  knowledge and concepts relevant to the cases on
  the CD ... during self study.
• Prior small group sessions failed because there
  was ... no added value

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ADDED VALUE of TBL Sessions

• help the student understand major concepts of the
  CD cases that they may have missed in self study
  identify their knowledge gaps
• reinforce concepts / facts learned well
• help the student synthesize knowledge obtained
  from diverse sources putting it all together
  
• provide new knowledge, new challenges
  intellectual challenge
• create excitement for the content make
  learning fun
• motivate regular study of critical content pace
  learning

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ADDED VALUE

• The questions faculty developed to guide post
  quiz discussions were the most important and most
  easily identified source of ADDED VALUE
  associated with the TBL sessions.
• Quality of the questions developed for the TBL
  quizzes were also important.

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How To Make Our TBL Sessions Work

• Prepare high quality PRE-TEST AND POST-TEST
  questions that focus on the main points of the
  cases assigned.
• The ideal questions should include both an
  element of disease / image recognition and an
  associated point. double jump...

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How To Make Our TBL sessions Work

• Avoid a rote recitation of the images, captions,
  and questions already in the CD
• Make answering students questions a priority
• Be ready to answer questions that might arise
  from the images, captions, and questions already
  on the CD

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How To Make Our TBL sessions Work

• Carefully create additional questions that can be
  used to guide the REVIEW/ DISCUSSION sessions
  that follow the PRE-TEST AND POST-TEST
• Use the images, captions, and questions already
  on the CD to generate additional questions that
  will spark a deeper level of learning or a deeper
  level of understanding.

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Why Team Learning

• Maintained Student Satisfaction and Student
  Performance.
• Faculty Manpower decreased by a factor of 10
• 700 to 800 in class man hours with small groups
  (plus preparation time)
• 80 Hours (2 faculty X 16 sessions X 2 hrs per
  session plus prep time)
• Students build learning teams and learn from each
  other

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Summary

• Efficient and Effective Non-Lecture Format
• 700 to 800 hours Faculty time to 80 hours
• High Energy Large Group Sessions with Many of the
  Benefits of Small Group Interaction
• High Student Satisfaction
• Faculty Satisfaction

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Medical Schools Currently Using Team Learning In
Pathology

• Sebastion Alston
• Mercer, Macon Georgia
• Paul Biddinger, M.D.
• Cincinnati, Ohio
• George Breaux, M.D.
• Meharry Medical College, Nashville, Tennessee
• John H. Holliman, M.D.
• University of Oklahoma
• Paul Koles, M.D.
• Wright State, Dayton Ohio
• Sidney S. Murphree, M.D.
• University of Louisville, Louisville KY

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TBL History

• Developed by Larry Michaelson at Univ. Oklahoma
  School of Business
• More than 1000 individual teams studied
• Adapted for medical education by Boyd Richards at
  Baylor School of Medicine
• Supported by FIPSE grant
• Consortium of medical schools