Editors’ Note: Every Tuesday this month we’ve been examining best practices to promote active learning in medical education. We’ve looked at the important role of physical space and learning and we’ve suggested ways large lectures can become highly interactive. Here we explore the vital importance that teams play in helping to apply knowledge to real-world scenarios.
by Pablo A. Joo, M.D.
What’s the best way to learn something new?
Research has shown repeatedly that the most effective way for people to learn a new concept or skill is to read about it and discuss it and then immediately apply their newly acquired knowledge to solve real-life problems Yet the “classic” lecture, with the teacher setting the agenda and issuing information from a lectern, is still commonly used in medical schools and often leaves students in passive roles.
The result: a teaching and learning disconnect.
Students don’t hop into the driver’s seat often enough to test-drive concepts. And we know from numerous studies that most of the information we “learn” in didactics is not retained in the long term. The Liaison Committee on Medical Education, which accredits medical schools in the U.S. and Canada, has been promoting more-active learning methods over static lectures.
One of these innovative instructional methods is called Team-Based Learning (TBL). It is relatively new to medicine, but for more than 30 years it has been used in business, law, social work and other disciplines of higher education. In 2009, I had the chance to see TBL up close during an intensive workshop sponsored by the Association of American Medical Colleges.
TBL is a form of group learning, but not all group learning is TBL. TBL is a specific instructional strategy to enhance learning in small or large classes up to as many as 200 students. In TBL, individual students prepare in advance for a session via readings or online modules and then answer readiness-assurance questions to assess what they have understood of the fundamental principles.
Students then work collectively in teams to solve basic concepts in class. The correct answers are revealed immediately using scratch cards. Teams then apply these basic concepts to complex and difficult issues they see in the real world, and share their rationale with the entire class. Both individual and team performance count toward each student’s grade, so there is strong motivation to work together.
TBL has been a part of the family medicine clerkship at Einstein since 2009. It has allowed students to go beyond the basics of clinical prevention and chronic disease management. Using TBL, students have learned to develop patient-centered medical plans, apply principles of quality improvement to patient panels and employ shared decision-making skills in discussing mammography with women with average breast cancer risk.
TBL utilizes theoretical and practical strategies to ensure that small groups work effectively and independently in classes with high student-faculty ratios. As a result, it is more efficient and practical than other small-group methods, such as problem-based learning, that require many faculty members to run sessions.
Although TBL consistently improves academic outcomes by shifting the instructional focus from knowledge transmission to knowledge application, it also addresses several professional competencies that cannot be achieved or evaluated through lecture-based instruction. TBL is rooted in social constructivist theory, which posits that people learn better when they work with others to build knowledge.
Furthermore, a valued professional competency for physicians is that they must function effectively in teams, and TBL enables students to work on their listening, teaching and negotiation skills. Team performance on TBL tests is often better than individual performance.
TBL can present challenges and culture change for both students and faculty. It requires a greater investment of student time as opposed to passive attendance at lectures. Students are also accountable to each other in being prepared and punctual for sessions, and effective communication with peers is critical for success.
For faculty, TBL requires mastery of multiple abilities such as writing quality test items, facilitation skills, flexibility to teach what the students want to discuss and avoiding any predisposition to lecture. The new medical education center at Einstein, currently under construction, will allow TBL to thrive in more clerkships and large courses. Future initiatives could also be used for interprofessional training, with medical, graduate, social work, physician assistant and nursing students working together in team-based learning sessions, which would enhance student communication and leadership competencies. Effective teamwork improves clinical outcomes and enhances safety for patients.