TBL in Medical EducationGetting Beyond Covering

Content

Small Group Learning in a Large Group Setting

Edward E. McKee Central Michigan University College of Medicine With Slides from Sandra Cook, , Dean ParmeleeAnd Ruth Levine, UTMB.

Case #1A 24 year old medical student presents with a complaint of feeling overwhelmed in preparation for an exam in three days, feels isolated from peers (all of whom study individually), finds lectures boring, and small groups not helpful except when the “answers” are given right away.

Case #2A 46 year old associate professor of medicine presents with complaint of exasperation in teaching clinical pharmacology because the students, though bright enough, never seem to come prepared and ready to be challenged.

Case #3

A 51 year old professor and course director complains of fatigue from having to beg clinical faculty to teach small groups. She develops migraine when they either fail to show up or fail to follow the script for what to teach. Some even give their groups answers to exam questions!

Case #4A “39” year old associate dean for med ed presents with complaint of too many complaints from faculty about students not coming to lecture and not being prepared for small group discussions. Even she feels that this ‘millennial generation’ wants to be spoon-fed and that many of the faculty have given up trying to become inspiring teachers.

Pre-work Active Learning

Homework

Wishful Thinking:

Pre-workPassive Lecture

REALITY:

StudyStudy

TRADITIONAL

Before During After

Before During After

Exam

Exam

Lecture StudyPre-work

Traditional Reality:

Team Problem Solving

ReviewVideo-tapedLecture/Text/PowerPoint

Before During After

Principle: When forming teams, you want to ensure equal distribution of resources and maximize participation of all membersOperationalized:

Aim to identify important resources available to individuals and equally distribute those individualsThe teacher forms the teams – not students5-7 individuals per team

R. Levine

First Need to Form Teams…

Components of TBLSequence of Learning

R. Levine

Read the lecture notes pages 51 – 69 and 87-91.. View the Lecture recording (Camtasia ) online for

Lectures 2 and 3 (Mendelian Inheritance and Population Genetics) ; or,

View PowerPoints 2-3 on Mendelian Inheritance.and Population Genetics

Reference in Genetics in Medicine 7th ED. Chapter 7, and Pages 192-199.

IUSM-SB Genetics Module:To Adequately Prepare for this TBL Session you must:

1. To explain the modes of inheritance of the most common genetic diseases. 2. To be able to write and interpret pedigree information from a patient

history and to determine the most likely mode of inheritance. 3. To be able to calculate carrier frequency and allele frequency in defined

populations given the incidence of an inherited disorder in that defined population. 4. To be able to integrate pedigree risk and population risk in calculating overall risk to any member of a pedigree. 5. To be able to identify and demonstrate when and how to use conditional

probability in a risk calculation. 6. To demonstrate the role of fitness and selection in determining the likelihood of new mutations for a particular disorder. 7. To be able to use the Binomial theorem to calculate multiple probabilities

in families. For example what is the probability that a heterozygous couple for Cystic Fibrosis alleles will have 2 affected children in a family of 5 children?

IUSM-SB Genetics Module: Objectives

Components of TBLSequence of Learning

R. Levine

IRAT

GRAT

Basic questions to:1. Determine individual preparedness2. Introduce basic information that must

be understood for the application3. Provide assessment that basic

information is understood. Typically 10 multiple choice questions (15

minutes). Our students take the IRAT online with the benefit of immediate instructor item analysis.

Scantrons work well, but item analysis not immediately available.

IRAT

• Students take the IRAT as a team.• This exercise is usually fairly easy for

the class. (15 minutes).• Good opportunity to use IF AT cards.

Teams answer all of the questions at one time.

• Discussion focuses only on questions that were difficult as assessed by item analysis of IRAT scores and a scan of IF -AT cards. (http://www.epsteineducation.com/home/order/default.aspx )

GRAT

ComponentsSequence of Learning

R. Levine

• Significant problem• Same Problem• Single Best Answer

– Teams must discuss the choices and arrive at a consensus best answer. (Generates good intra-team teaching and discussion.)

• Simultaneous reporting – All teams report their answer at the same

time. Lettered cards can be used or Audience response systems can be used. A team member must then justify their team’s answer. Robust inter-team discussions often follow when teams have selected different answers.

The “Four S’s” of TBL*

Questions must be challenging, but there should be a clear best answer.

Question should generate good team discussion.

The application must be perceived as productive. Students should feel that the exercise helped them learn the material.

Teams are allowed to challenge questions, but they must document the reasons for their challenge and/or re-write the question to make it better.

Application

The two finalists in the world arm-wrestling championships at Petaluma, California, are well-matched. Upper body muscle mass, insensitivity to pain, motivation, and experience are identical between the two. Vito, a Las Vegas bookie, slips you the results of each competitor’s physical exam and ‘asks’ you to predict the winner. What is most likely to determine the eventual winner?A. Maximum cardiac outputB. Mitochondrial content of the exercising

musclesC. Muscle glycogen contentD. Oxygen carrying capacity of the bloodE. Phosphocreatine levels in the muscles

Example Application Muliple Choice Question: Muscle Physiology

Example Application Short Answer Question:

A patient with the following symptoms has been admitted to ER. What imaging test would you order first?

Write your response on the whiteboard

A 16 year old girl named Jane has come to your office for counseling following a positive pregnancy test. She informs you that her maternal grandfather has a bleeding disorder and regularly has been injected with a protein called Factor VIII. Jane has 2 younger brothers that are in good health. Jane’s mother Judy is 39 years old and is also 3 months pregnant. Jane’s father Al is 60 years old and is in excellent health. Jane confides in you that the father of the baby is her first cousin Bill, who is 26 years old and talked her into a sexual liaison when she was “a little tipsy” from wine that was provided by Bill.

List and describe all of the genetic and ethical issues that should be discussed during the counseling session. Place your teams answers on the easel paper provided. All teams post their answers at the same time.

Then, have each team choose the response that they think is best (not including their own). (Simultaneously displayed.) Teams describe and defend their own answer as well as defend their choice for the best response.  

Example Application Gallery Walk Question:

Peer Evaluation in Team Based Learning

Peer evaluation is an important component of TBL, helping to assure that students are accountable to each other. Regular TBL exercises provide an excellent basis for students to practice, refine, and assess their peers on basic competencies: communication, life-long learning, self awareness, ethical and moral reasoning, problem solving, and professionalism. With some training and an appropriate peer evaluation instrument, students can obtain quality feedback from their peers on the degree to which they are mastering these competencies. This can be a significant added bonus of using TBL.

Students Like It!

Scores represent experience with TBLs in Biochemistry at IUSM-SB

Comparison of Psychiatry and Ob/Gyn NBME Performance

35th

49th

66th 69th

50th

60th

42nd42nd 46th

52nd

58th

72nd

0

0.2

0.4

0.6

0.8

1

NB

ME

perc

entil

e sc

ore

2003 2004 2005 2006 2007 2008

Ob/gyn began TBL in Class of 2006

Psych began TBL in Class of 2004

2008 scores represent 1st half of the year

Team-Based Learning: A Transformative Use of Small Groups (2002) L. K. Michaelsen, A. B. Knight, and L. D. Fink,

Pareger Publishing, Westport, Ct. Team-Based Learning for Health Professions

Education Michaelsen, et. al 2008, Stylus Publishing,

Sterling VA Team Based Learning Collaborative http://www.teambasedlearning.org

• MedEdPortal https://www.mededportal.org// • Twelve Tips for doing effective Team-Base

Learning (2010)• D. Parmelee and L. Michaelsen Medical Teacher

32:118-122.

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