Boyd F. Richards

Team-based learning at ten medical schools: two years later

Purpose  In 2003, we described initial use of team‐based learning (TBL) at 10 medical schools. The purpose of the present study was to review progress and understand factors affecting the use of TBL at these schools during the subsequent 2 years.

An initial experience with "team learning" in medical education.

Team learning is an approach to large-group teaching that combines the strengths of small-group interactive learning with teacher-driven content delivery. Team learning has been used successfully in professional disciplines other than medicine. The authors describe a field test of team learning in the setting of an internal medicine residency noontime lecture in the spring of 2000 at Baylor College of Medicine. They surveyed residents on their attitudes toward the usefulness of the lecture content before and after the session and surveyed them on their engagement in learning. Residents reported their engagement as high and demonstrated favorable changes in their attitudes about the usefulness of the lecture content to their daily medical practice. The authors describe their adaptation of the team-learning approach and conclude that team learning may be a useful new pedagogic tool in medical education.

Advancing educators and education by defining the components and evidence associated with educational scholarship

Objective  This study aimed to establish documentation standards for medical education activities, beyond educational research, for academic promotion consistent with principles of excellence and scholarship.

Perspective: Guidelines for Reporting Team-Based Learning Activities in the Medical and Health Sciences Education Literature

Medical and health sciences educators are increasingly employing team-based learning (TBL) in their teaching activities. TBL is a comprehensive strategy for developing and using self-managed learning teams that has created a fertile area for medical education scholarship. However, because this method can be implemented in a variety of ways, published reports about TBL may be difficult to understand, critique, replicate, or compare unless authors fully describe their interventions. The authors of this article offer a conceptual model and propose a set of guidelines for standardizing the way that the results of TBL implementations are reported and critiqued. They identify and articulate the seven core design elements that underlie the TBL method and relate them to educational principles that maximize student engagement and learning within teams. The guidelines underscore important principles relevant to many forms of small-group learning. The authors suggest that following these guidelines when writing articles about TBL implementations should help standardize descriptive information in the medical and health sciences education literature about the essential aspects of TBL activities and allow authors and reviewers to successfully replicate TBL implementations and draw meaningful conclusions about observed outcomes.

A Comparison of In-Class Learner Engagement Across Lecture, Problem-Based Learning, and Team Learning Using the STROBE Classroom Observation Tool

Background: Having recently introduced team learning into the preclinical medical curriculum, evidence of the relative impact of this instructional method on in-class learner engagement was sought. Purpose: To compare patterns of engagement behaviors among learners in class sessions across 3 distinct instructional methods: lecture, problem-based learning (PBL), and team learning. Methods: Trained observers used the STROBE classroom observation tool to measure learner engagement in 7 lecture, 4 PBL, and 3 team learning classrooms over a 12-month period. Proportions of different types of engagement behaviors were compared using chi-square. Results: In PBL and team learning, the amount of learner-to-learner engagement was similar and much greater than in lecture, where most engagement was of the learner-to-instructor and self-engagement types. Also, learner-to-instructor engagement appeared greater in team learning than in PBL. Conclusions: Observed engagement behaviors confirm the potential of team learning to foster engagement similar to PBL, but with greater faculty input.

Team Learning in Medical Education: Initial Experiences at Ten Institutions

Purpose. In the midst of curricular reforms that frequently call for reducing lectures and increasing small-group teaching, there is a crisis in faculty time for teaching. This paper describes the initial experiences of ten institutions with team learning (TL), a teaching method which fosters small-group learning in a large-class setting. Method. After initial pilot studies at one institution, nine additional institutions implemented TL in one or more courses. Results. Within 18 months, TL has been used in 40 courses (from .5% to 100% of the time) and all ten institutions will increase its use next year. Conclusions. We surmise that this relatively rapid spread of TL into the medical curriculum is due to the sound pedagogy and efficiency of TL as well as the modest financial resources and support we have provided to partner institutions.

The Academy Movement: A Structural Approach to Reinvigorating the Educational Mission

Despite its fundamental importance, the educational mission of most medical schools receives far less recognition and support than do the missions of research and patient care. This disparity is based, in part, on the predominance of discipline-based departments, which focus on the more sustainable enterprises of research and patient care. Where departmental teaching is emphasized, it tends to center on trainees directly associated with the department—leaving medical students unsupported. The authors argue that the ongoing erosion of the educational mission will never be reversed unless there are changes in the underlying structure of medical schools. Academies of medical educators are developing at a number of medical schools to advance the school-wide mission of education. The authors describe and compare key features of such organizations at eight medical schools, identified through an informal survey of the Society of Directors of Research in Medical Education, along with direct contacts with specific schools. Although these entities are relatively new, initial assessments suggest that they have already had a major impact on the recognition of teaching efforts by the faculty, fueled curricular reform, promoted educational scholarship, and garnered new resources to support teaching. The academy movement, as a structural approach to change, shows promise for reinvigorating the educational mission of academic medicine.

Factors Influencing Implementation of Team-Based Learning in Health Sciences Education

Background Limited studies have looked at factors that lead to successful implementation of team-based learning (TBL). The purpose of this study was to identify contextual factors associated with implementation of TBL with a larger pool of individuals. Method The authors administered a questionnaire who had implemented TBL via the Web to participants who attended TBL workshops; 297 of 594 responded. We used the constant comparative method to analyze responses. Results Analysis revealed five factors important to successful implementation of TBL: buy-in, expertise, resources, time, and course characteristics, with 60%, 38%, 37%, 36%, and 16% of respondents identifying each factor, respectively. Conclusions When health science faculty and administrators implement TBL or other educational innovations, they must have buy-in, ensure adequate time and resources, develop needed expertise, and determine best fit within a course. Although these results are specific to TBL, they are consistent with models of dissemination and have implications for other educational innovations.

COMMENTARY: Drawing Conclusions from the Team-Learning Literature in Health-Sciences Education: A Commentary

We believe that team learning has much to offer teachers and learners across the continuum of education in health sciences institutions (i.e., allied health, nursing, graduate and medical school courses, and resident and continuing medical education conferences). We are not surprised that interest in the method, also known as team-based learning (TBL), particularly outside of the health sciences literature, continues to increase as evidence about its positive impact on learning accumulates in the literature through presentations1,2 and publications,3–6 including the article by George Dunaway7 published in this issue. The diffusion of team learning into health sciences education has grown steadily in the past 4 years, encouraged by a loosely formed “community of team-learning scholars” (e.g., deans, course directors, instructors, and educational consultants from multiple institutions) supported by grants from the Fund for Improvement of Post-Secondary Education (FIPSE) to Baylor College of Medicine.8 This collaborative has indirectly influenced the implementation, evaluation, and dissemination of numerous trials of the method.9 Sharing of team-learning experiences and outcomes through formal and informal means is an important part of a much needed process to investigate how the potential of team-learning can most effectively be realized across the diversity of settings in the profession. Published studies,3–7 including those in Teaching and Learning in Medicine,4,6,7 have set a strong precedent for the merit and worth of these dissemination activities. Hunt et al.,4 one of the earliest published reports of the use of team learning in the health sciences, describes a 7-week course after which 2nd-year medical students demonstrated proficiency in critical appraisal of the medical literature. Levine et al.,6 a more recent work, reports how progressively more use of team learning in a 4-week psychiatry clerkship lectureship series for medical students significantly improved students performance on the end-of-clerkship National Board of Medical Examiners shelf exam. Dunaway,7 in this issue, describes a 2-week endocrine module in a pharmacology course for 9 graduate students, which led to achievement of course objectives and high student and instructor satisfaction.

Validation Of An Observation Instrument For Measuring Student Engagement In Health Professions Settings

Documenting student engagement has received increased emphasis in medical schools, as teaching strategies are changing to include more student-to-student interactions. The purpose of this study was to develop and evaluate a measure of student engagement completed by independent observers that would not interfere with student learning time. Data from 3,182 observations completed by nine observers in 32 educational classroom settings with 23 different instructors were used to evaluate the interobserver reliability and gather validity evidence for our observational instrument, named the STROBE. Results indicated that interobserver agreement was good to excellent when observations were conducted simultaneously on randomly selected students in the same classroom (84% average agreement and 0.79 average kappa coefficient) and when observations were conducted on different randomly selected students (79% average agreement). Results also provided strong evidence for validity. Overall, findings indicate that the STROBE demonstrates promise for educational research and evaluation by documenting student engagement in medical education settings.