Using Team-Based Learning in Health Professions Education

by Carlos Logan Magana, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

Team-based learning (TBL) has been around since the 1980s.  This strategy has been used in academic settings to supplement education through peer collaboration whereby students work in smaller groups when in large classroom settings.  This teaching strategy has been used widely in health professions education. TBL helps student develop their communication skills while making the learning environment stimulating.  I believe TBL should be used in combination with other teaching methods to help augment student learning.  This can benefit students both academically and professionally.

TBL has four key components.  The instructor must carefully form and manage groups, give frequent feedback, create problem-solving activities, and engage students in a peer evaluation process.  TBL sessions are conducted during class time and but the precise sequence of activities can vary depending on the course topic. When entering the classroom, students take an individual knowledge assessment where they are quizzed on pre-readings.  This is followed by a team-based assessment where teams work together to establish a consensus on answers. The group test is followed by facilitator feedback where the questions are discussed, and the answers explained.  Following these assessments, the instructor provides problems or activities that students worked on for the majority of the in-class time.  Groups work together using their pooled knowledge. There is a final debriefing about these activities.  Finally, the instructor has some closing messages and summarizes the key concepts addressed in the activity.

A method that is similar to TBL, but has some important differences, is called problem-based learning (PBL).  PBL also involves small student groups but the sessions are led by a facilitator who guides the students through a case from beginning to end. The team aspect is similar to TBL but PBL is more resource-intensive because it requires a greater number of facilitators and the pace of the activity is driven by the facilitator.  This differs with TBL does not (typically) require multiple facilitators and gives the learners more control over the learning environment and pace. Thus TBL is a hybrid teaching and learning method that blends aspects of small group activities with large group presentations.

TBL has gained traction in health professions education perhaps because it enables students to develop their team interaction skills.  It is also a great way for learners to spend time with facilitators who are experts in their field which allows for current information to be taught. TBL is more structured than PBL. In TBL, students must be prepared for the class content. This method also allows learners to learn from their peers – to get different points of view.  This constant influx of new thoughts and viewpoints is helpful for the learner to grow outside of their own personal bubble and implement new ideas into their own knowledge.  Finally, facilitators learn from each other based on their experiences and from learners that they have worked with throughout the year.

A few studies have explored the impact of TBL on learning outcomes. One study evaluated the TBL method in the second year of the curriculum at the Boonshoft School of Medicine.  The study was conducted over two consecutive academic years (2003-2004) and (2004-2005).  This study looked at the exam scores of 2nd-year medical students which included courses consisting of topics that emphasized foundational knowledge such as physiology, pathology, and pharmacology.  Teaching methods of these courses included lectures, lab exercises, clinical case discussions, independent study modules, and TBL modules.  All courses determined the overall course grade using multiple-choice question examinations.  There were a total of 28 examinations, and the investigators divided scores into two subgroups as follows: designated TBL-related pathology-based questions (TR PBQs) and designated TBL-unrelated questions (TU PBQs).  Once data was collected data showed that student scores in the TR area had overall improved mean scores on examination questions compared to the TU scores.  Indeed, not only did the highest quartile students in the TR group perform better (89.3% and 85.5%), so did the lowest quartile students (77.5% and 69.6%).  This kind of analysis is important because it documents that the lower quartile of the class also had a significant improvement in their scores (not just the high-performing students).  Thus, TBL can benefit students who may be struggling in their classes. The study concluded that TBL helps enhance mastery of content.

Another study published in 2017 surveyed first-year medical students in the Sydney Medical Program.  In total 144 out of 169 students completed a questionnaire regarding both TBL and PBL methods in their courses.  Overall students preferred TBL, with 85% agreeing it helped to enhance peer learning experiences compared to 37% in the PBL group.  It is also noted that 93% agreed that their team members made adequate efforts in team discussions compared to 46% with PBL.  While these are just some examples of student satisfaction of TBL there are others regarding their fondness of the facilitators and team feedback in TBL over PBL as well as other perceived benefits such as knowledge gained and examination preparedness. 

Most literature supports the use of the TBL method in health professions education. While there are many teaching methods that could be used in any curriculum, some will be more effective than others depending on course content and the audience. TBL is helpful but it is not all-encompassing. Learning is complex and teaching should involve a variety of methods. It is also crucial to use subjective data such as learner feedback and satisfaction along with performance data such as examination scores.  TBL is a truly welcomed addition to the teaching methods available to faculty and should be considered when teaching clinical decision-making and problem-solving skills.

References

1. Burgess A, van Diggele C, Roberts C, and Mellis C. Team-Based Learning: Design, Facilitation and Participation. BMC Medical Educ 2020; 20: Article 461.
2. Koles P, Stolfi A, Borges N, Nelson S, and Parmelee D. The Impact of Team-Based Learning on Medical Studentsʼ Academic Performance. Academic Medicine 2010; 85(11): 1739-1745.
3. Burgess A, Bleasel J, Haq I, Roberts C, Garsia R, Robertson T, and Mellis, C. Team-based learning (TBL) in the medical curriculum: better than PBL?BMC Medical Educ 2017; 17(1): Article 243.