Team-Based Learning Promotes Self-Reflection and Creates Lifelong Learners

by Austin Simmons, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

During the first two years of any healthcare provider’s schooling, students often find themselves navigating their curriculum and trying to remember all of the little details that are thrown their way. Most students don’t engage in much self-reflection during this period due to workload demands. Then comes the third and fourth years of school. This is when students try to piece it all together and decipher what they know and what they will need to work on as they transition from student to independent practitioner. I believe team-based learning prepares students to transition from dependent learners to lifelong learners and promotes self-reflection.

Team-based learning is built on the constructivist theory which states that learners process new material and integrate it with existing understandings in order to form a new cognitive structure that is unique to them.¹ Hrynchak and Batty wrote about team-based learning and provide an analysis of how constructivist theory plays a role in student development. Essentially, the professor is a facilitator for learning.  The students encounter inconsistencies between their preconceptions and new experiences.  In team-based learning, the focus is on relevant problems and accompanied by group interactions, and this often leads to reflection.² They go on to explain that team-based learning can be used in large classes that are divided into smaller groups.  The goal should be to maximize the diversity within the teams.² Let’s take a look at the framework team-based learning uses to promote self-reflection and build lifelong learners.

Classically, the design of team-based learning is a three-step process that involves student preparation, readiness testing, and application-focused exercises.³ Now, how does this framework promote learning and increase student self-awareness? Let me draw from my own experience.  At my pharmacy school, we had a class called case studies. The intent of this class was for the students to prepare before the class session and use prior knowledge.  We would then engage in collaborative work discussing a patient case in our assigned small group. Then after our small group discussion, the classroom as a whole would come together and the professor would facilitate a conversation by asking each small group questions related to the patient case. The instructor would also encourage the entire class to openly respond to these questions. It was during these interactions, in our teams and the entire class, that we’d encounter inconsistencies between our preconceptions and the perspectives of our instructor as well as other students.² Doing so, in theory, prompts each student to reflect on his/her own understanding of the material. But what are the individual processes or parts that make team-based learning work and what are the important takeaways for a student and instructor?

From my own experience, I found that the immediate feedback from my classmates and the instructor allowed me a way to rapidly assess how well I understood the material. Our class was a 3-hour session which included the time for our small group discussion. If we discussing a case about a patient with diabetes, I might ask myself: what do the blood glucose data mean?  What are the blood glucose goals for the patient? I would rapidly assess and begin self-reflection by asking myself if I needed to review more about the treatment of diabetes. The immediate feedback is a big part of what makes team-based learning work and vital to increasing self-reflection.⁴

I believe it is important to keep in mind that all aspects of the team-based learning framework must be implemented and the intentional guidance provided by an instructor is essential.⁵ Martirosov and Moser found that a student’s understanding and performance were significantly reduced in the absence of appropriate guidance.⁵  To maximize learning, the instructor must ask probing questions. For example, a patient case about diabetes helped promote self-reflection by getting students to think through the data and recommend starting a medication, perhaps an angiotensin receptor blocker (ARB). Then the instructor would ask questions about why they think the patient should receive an ARB instead of an ACE inhibitor. By prodding the students to explain their choices, it forces them to reflect on that choice and critically examine the thought process. An instructor is the glue that prompts high-level cognitive processing and pulls forth the student’s previous knowledge.  In this way, team-based learning helps students put the pieces together.

Team-based learning is an excellent instructional strategy that many curriculums have used. Team-based learning requires students to engage in reflection because it frequently challenges their preconceived understanding of the material and, in turn, promotes life-long learning.  With guidance from the instructor, students must defend their choices, and this helps them “put it all together.” I firmly believe team-based learning helps students develop lifelong learning skills and helps them become excellent healthcare practitioners.

References:

1. Moon J. A Handbook of Reflective and Experiential Learning. 1st ed. Hoboken: Taylor and Francis; 2004.
2. Hrynchak P, Batty H. The educational theory basis of team-based learning. Medical Teacher [Internet]. 2012 [cited 2020 Nov 3];34(10):796-801.
3. Overview - Team-Based Learning Collaborative [Internet]. Team-Based Learning Collaborative. 2020 [cited 2020 Nov 3].
4. Whittaker A. Effects of Team-Based Learning on Self-Regulated Online Learning. International Journal of Nursing Education Scholarship [Internet]. 2015 [cited 2020 Nov 4];12(1):45-54.
5. Martirosov A, Moser L. How Team-Based Learning Can Promote the Development of Metacognitive Awareness and Monitoring. American Journal of Pharmaceutical Education [Internet]. 2020;84(11): Article 848112.