Ruth E. Levine

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.

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.

Anxiety symptoms during pregnancy and postpartum.

This cross-sectional study compared the distribution of anxiety symptoms among pregnant, non-pregnant, and postpartum women of lower socioeconomic status. Participants were 807 women who were pregnant (24–36 weeks), postpartum (2–8 weeks), or not pregnant. Anxiety and depressive symptoms were assessed by the state-trait anxiety index and the Beck depression inventory, respectively. English and Spanish versions of the instrument were available. Group differences in anxiety were evaluated using analysis of variance. Multivariate regression was performed to evaluate differences in anxiety while controlling for marital status, education, race/ethnicity, employment, cohabitation, income, parity, history of depression/anxiety, and depressive symptoms. Anxiety scores were lower among postpartum women relative to pregnant and non-pregnant women (both P < 0.001), who did not differ (P = 0.99). After controlling for depressive symptoms and patient characteristics, anxiety remained lowest among postpartum women. Additionally, history of depression/anxiety and depressive symptoms were significant predictors of anxiety in the multivariate analysis. Comparatively low anxiety and depressive symptoms were observed among women who were 2–8 weeks postpartum. Anxiety symptoms that occur postpartum may not appear until later in the postpartum period.

Evaluating the quality of learning-team processes in medical education: Development and validation of a new measure

Background Measurement of the quality of team processes in medical education, particularly in classroom-based teaching settings, has been limited by a lack of measurement instruments. Therefore, the purpose of this study was to develop and test an instrument to measure the quality of team interactions. Method The authors created 30 items and reduced these to 18 items using factor analysis. They distributed the scale to 309 second-year medical students (RR = 95%) in a course that used teams and measured internal consistency, validity, and differences in scores between teams. Results Cronbach’s alpha for the scale was 0.97. Team ratings were variable, with a mean score of 95.7 (SD 8.5) out of 108. Team Performance Scale (TPS) scores correlated inversely with the spread of peer evaluation scores (r = −0.38, P = .003). Differences between teams were statistically significant (P < .001, &eegr;2 = 0.33). Conclusions The TPS was short, had evidence of reliability and validity, and exhibited the capacity to distinguish between teams. This instrument can provide a measure of the quality of team interactions. More work is needed to provide further evidence of validity and generalizability.

Team cohesiveness, team size and team performance in team-based learning teams

The purpose of this study was to explore the relationships among variables associated with teams in team‐based learning (TBL) settings and team outcomes.

Is transferring an educational innovation actually a process of transformation

Recent debates question the extent to which adopting an educational innovation requires compromise between the innovation’s original design and the adoption site’s context. Through compromises, the innovation’s fundamental principles may be transferred, transformed, or abandoned. This paper analyzes such compromises during the piloting of Team-Based Learning (TBL). We ask: When is the process of transferring an innovation actually a process of transformation? This study is an autoethnography of our research team’s implementation process. Autoethnographies are personalized accounts where authors draw on their own experiences to extend understanding of a particular topic. To conduct this autoethnography, we used an in-depth, interactive interview with the piloting clinician educator. In the analysis of TBL’s fundamental principles, some aspects of the principles transferred easily, while others were transformed. Analysis raised concerns that the transformations threatened the foundational principles of TBL. While an educational innovation’s techniques may seem to be surface structures, they are realizations of deeper fundamental principles. The fundamental principles are themselves realizations of the innovation’s foundational philosophy. When techniques and/or principles are modified to a context, it is important to analyze if the modifications continue to uphold the innovation’s philosophy.

Team-based learning for psychiatry residents: a mixed methods study

BackgroundTeam-based learning (TBL) is an effective teaching method for medical students. It improves knowledge acquisition and has benefits regarding learner engagement and teamwork skills. In medical education it is predominately used with undergraduates but has potential benefits for training clinicians. The aims of this study were to examine the impact of TBL in a sample of psychiatrists in terms of classroom engagement, attitudes towards teamwork, learner views and experiences of TBL.MethodsForty-four psychiatry residents participated in an Addictions Psychiatry TBL module. Mixed-methods were used for evaluation. Self-rated measures of classroom engagement (Classroom Engagement Survey, CES) were compared with conventional lectures, and attitudes regarding the value of teams (Value of Teams Scale, VTS) were compared before and after the module. Independent t-tests were used to compare ‘lecture’ CES scores with TBL CES scores and pre and post scores for the VTS. Feedback questionnaires were completed. Interviews were conducted with a subset of residents and transcripts analysed using thematic analysis.ResultsTwenty-eight residents completed post-course measures (response rate 63.6%). Seven participants volunteered for qualitative interviews–one from each team. There was a significant difference in the mean CES score lectures compared to TBL (p < 0.001) but no difference was found in mean VTS score pre and post for either subscale (p = 0.519; p = 0.809). All items on the feedback questionnaire were positively rated except two regarding session preparation. The qualitative analysis generated seven themes under four domains: ‘Learning in teams’, ‘Impact on the individual learner’, ‘Relationship with the teacher’ and ‘Efficiency and effectiveness of the learning process’.ConclusionsIn this group of residents, TBL significantly improved learner-rated classroom engagement and seemed to promote interactivity between learners. TBL was generally well-received, although required learners to prepare for class which was difficult for some. TBL did not change these clinicians’ views about teamwork.

How we implemented team-based learning for postgraduate doctors

Abstract Background: Team-based learning (TBL) has been shown to improve knowledge, teamwork and interactivity in medical school settings. There are fewer reports of its use with postgraduate doctors. We report on our experience of using TBL with residents. What we did: We converted a didactic module of lectures into a TBL module for 44 psychiatry residents. This involved training faculty, orientating residents, writing TBL materials, delivering and evaluating the module. On the basis of the positive evaluations we aim to introduce more TBL. Conclusions: TBL can be successfully introduced into a residency training programme. Tips for implementation include: involve a TBL expert and provide experiential training for faculty; hold an orientation session for residents; and provide individual and team incentives to reinforce pre-class preparation and promote engagement with TBL. Avoid underestimating the effort involved in converting lecture-based teaching into TBL and do not assign excessive pre-session assignments.

Psychiatry Clerkship Students’ Preparation, Reflection, and Results on the NBME Psychiatry Subject Exam

ObjectivePsychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE).MethodsClerkship students from six U.S. medical schools who had recently completed their psychiatry clerkship and PSE were surveyed regarding reading material use, teaching methods encountered, and other relevant resources which may have influenced their PSE scores.ResultsThe most frequently used PSE preparation material was a “step-or-prep” book, followed by practice questions, handouts and assigned texts. No single preparation material type or combination proved significantly different in influencing PSE scores. The didactic methods used in clerkships did differ significantly in their influence on PSE scores. Students in the top quartile used slightly more books and different combinations of books than students in the bottom quartile.ConclusionStudents exhibited several trends in their preparation for the PSE. The most striking findings were the heavy student reliance on step-or-prep books over other learning resources and that step-or-prep books did not demonstrate significance as a superior preparation resource for the PSE. These trends in third-year psychiatric rotations have important implications for medical student education.

Fitting the Means to the Ends: One School’s Experience with Quantitative and Qualitative Methods in Curriculum Evaluation During Curriculum Change1

Abstract Curriculum evaluation plays an important role in substantive curriculum change. The experience of the University of Texas Medical Branch (UTMB) with evaluation processes developed for the new Integrated Medical Curriculum (IMC) illustrates how evaluation methods may be chosen to match the goals of the curriculum evaluation process. Quantitative data such as ratings of courses or scores on external exams are useful for comparing courses or assessing whether standards have been met. Qualitative data such as students’ comments about aspects of courses are useful for eliciting explanations of observed phenomena and describing relationships between curriculum features and outcomes. The curriculum evaluation process designed for the IMC used both types of evaluation methods in a complementary fashion. Quantitative and qualitative methods have been used for formative evaluation of the new IMC courses. They are now being incorporated into processes to judge the IMC against its goals and objectives.