Virginia Schneider

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.

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.

Rapid Detection of Microorganisms in Blood Cultures of Newborn Infants Utilizing an Automated Blood Culture System

Background. Neonatal sepsis is a low incidence, high-risk disease with many sepsis work-ups performed to detect a single case. Seventy-two hours of antibiotic therapy have been traditionally recommended pending negative culture results. Improved culture media and new technology integrated into blood culture systems could shorten incubation time required to detect positive culture results. This would then change the length of antibiotic therapy in the management of the newborn infant with suspected sepsis. In addition, previous data supporting the 72-hour recommendation were retrospectively acquired, utilized nonautomated systems, and reported in an era with a different population of microorganisms cultured in special care nurseries. Objective. Evaluate the time of incubation to detect positive blood cultures from newborn infants with suspected sepsis using a computer-assisted, automated blood culture system, ESP (Trek Diagnostic Systems, Inc, Westlake, OH). Design. Prospective, observational study. Patients and Setting. All positive blood culture results that were obtained from term and preterm newborn infants born from November 1993 through June 1997 at a publicly funded hospital with over 6000 live births per year. Methods. As positive blood culture results were identified, data were prospectively obtained from the patients medical record. The computer algorithm in the automated blood culture system determined the time to positivity. Time to positivity was determined for blood cultures obtained before the initiation antimicrobial therapy and compared with those cultures obtained after beginning therapy. Time to positivity was also evaluated for clinically important Gram-positive and Gram-negative bacteria and yeast. Results. Four hundred fifty-five positive blood culture results were obtained from 222 patients. Gram-positive organisms accounted for 80% (366/455) of the positive culture results, Gram-negative organisms accounted for 11% (48/455), and yeast for 9% (41/455). Virtually all cultures growing clinically significant Gram-positive and Gram-negative organisms were positive by 24 to 36 hours of incubation. Cultures growing Staphylococcus epidermidis were virtually all positive after 36 to 48 hours of incubation. Of cultures growing yeast, 88% (36/41) were positive by 48 hours of incubation. There was no difference in time to positivity in pretherapy or posttherpay obtained positive blood cultures. Prenatally administered antibiotics did not affect time to positivity in positive cultures drawn on the first day of life. In a selected group of microorganisms that are the frequent cause of bacteremia in term infants, 97% and 99% of cultures were positive by 24 to 36 hours of incubation when only pretherapy cultures are evaluated. Conclusions. The ESP blood culture system identified 77%, 89% and 94% of all microorganisms at 24, 36, and 48 hours of incubation in aerobic cultures obtained from both term and preterm infants. Introduction of antimicrobial therapy did not affect time to positivity. Reducing duration of antibiotic therapy to 24 to 36 hours should be considered in term, asymptomatic newborn infants undergoing evaluation for suspected sepsis for maternal indications. Confirmation of similar rapidity of detection using other blood culture systems should be undertaken.

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.

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.

Multicultural Sensitivity of Physician Assistant Students After Instituting Cultural Competence Instruction

Purpose: To evaluate the impact of two cultural competence interventions in a physician assistant (PA) program. Methods: An intensive Spanish language (ISL) course and a longitudinal course in cultural competency (CC) were implemented and assessed using the Multicultural Sensitivity Scale (MSS) at three time points. Differences were analyzed between and within groups. Results: Three groups (totaling 74 students) participated in ISL, CC, or ISL and CC; and a nonintervention group of 37 was used for comparison. At baseline and after preclinical coursework, no differences were found between the groups. After clinical rotations, differences were noted between the CC and comparison groups (p=.010). Notably, MSS scores of the CC group significantly increased (p<.001) throughout the study. Conclusions: A cultural competence curriculum seems to be associated with increases in cultural competence for some students. Cultural competence education of health professionals has evolved since the start of this study. More research is needed to determine the factors (eg, dosage and course format) that may have the greatest influence on increasing student cultural competence.

CURRENT EPIDEMIOLOGY AND LABORATORY EVALUATION OF CONGENITAL SYPHILIS IN AN URBAN POPULATION |[dagger]| 1658

Among urban, parturient women in the US, the rate of positive serologic tests for syphilis is 2%-6%. The purpose of this study was to review the epidemiology of syphilis in our perinatal population and to determine if results of the routine laboratory evaluation affected infant treatment. Our publicly funded hospital delivered 12,922 infants in 1992 and 1993: 82% Hispanic, 13% black. Universal screening at delivery identified a positive MHA-TP in 345 women (2.2%). Medical records were reviewed for maternal history, demographic data, and infants hospital course. Blacks had higher odds of positive serology vs Hispanics (odds ratio=11.3, 95% CI 8.8-14.3). Seropositive mothers with no treatment, undocumented treatment, partial treatment, or evidence of reinfection were considered untreated. Evaluations for congenital syphilis included a physical examination; complete blood count(CBC); platelet count; ALT, AST, and direct bilirubin; urinalysis; RPR and MHA-TP; cerebrospinal fluid (CSF) cell count, protein, and VDRL; and long bone radiographs. Table