By Dean Parmelee, M.D., Associate Dean for Academic Affairs, Boonshoft School of Medicine, Wright State University
First, a short survey. Do you agree or disagree with the following statements?
- Students should always come to class prepared.
- Students can learn much from one another, often more than what I teach.
- The best use of my time is challenging students to think and problem-solve in the classroom.
- I get excited in the classroom when students debate/argue with each other over a question I pose.
- I mostly want students to be able to apply what they learn in my course 2-3 years from now.
- A noisy classroom, with students engaged in tackling problems, inspires me.
If you agree with most or all of the above, you owe it to yourself to check out Team-Based Learning" (TBL). This instructional strategy developed by Professor Larry Michaelsen, a business professor now at the University of Central Missouri, is used at many medical, nursing, pharmacy, veterinary, and allied health professions schools in the United States and around the world. Faculty who use TBL assign students to heterogeneous groups, ensure preclass preparation through a "readiness assurance process" that occurs at the beginning of each class, create assignments that encourage collaboration and active learning, and establish a system of assessment that rewards both individual preparation and teamwork. Because each student's preparation and participation impact the performance of the group, students pull their own weight and mentor each other so that the group is as productive as possible.
Since 2001, when health professions educators began to learn about TBL through a grant to Baylor College of Medicine from the U.S. Department of Education, dozens of peer-reviewed articles have been published demonstrating its effectiveness for academic and professional competencies outcomes. The Team-Based Learning Collaborative, with both
national and international membership, has evolved to promote its further development and use across secondary and higher
In 2002, two of our medical school course director faculty here at Wright State University attended a four-day workshop through the initial U.S. Department of Education grant and proceeded to completely redesign their respective courses using TBL extensively. Within a couple of years, all of our preclinical courses incorporated the strategy in varying amounts, and now more than half of our clinical clerkships have abolished didactic lectures and are using TBL exclusively in parallel with the clinic and hospital patient-care learning. In large part, students have
played a role in its growth at our institution by sharing their critiques of TBL and our other formats of instruction, and making it clear that they learn more and remain engaged when the material is presented in the TBL module format. Essentially all of our faculty who have learned how to develop and use TBL correctly would never go back to small-group exercises that lack accountability and require so many faculty facilitators or so many lectures to "˜cover' units of study. Ten years of student evaluations of all of our learning activities in each course have consistently rated TBL highly.
I attribute the success of TBL at my institution to the faculty here who said "this is for us," and embraced the idea that
the classroom should be a place where students solve problems rather than act as receptacles for information. In other words, our
institutional decision to adopt an active learning instructional strategy has been faculty-led with student guidance and administrative support. It has not been "˜top down.' Furthermore, several faculty have seized upon the scholarship opportunities inherent in a newly adopted instructional strategy and have conducted some very compelling and now published studies.
Why should other health professions educators consider TBL? It works well in any discipline where the goal is for the
learner to be progressively challenged with the kinds of problems that he or she will face in the workplace. Bear in mind, when I use
the word "˜problems,' I include the multifaceted complexities of clinical practice (whether in medicine, dentistry, pharmacy, or nursing) AND the kinds of interpersonal and team conflicts that are increasingly inherent in any clinical setting. Through well-constructed and -conducted TBL modules, students learn to think more deeply about a problem, solicit and incorporate input from peers, and make specific choices including critical decisions. In addition, they learn about their own strengths and limitations in any subject domain as well as how they contribute or detract from a team's productivity. All health professions schools face the same challenges in "˜covering' interminable amounts of content while hoping that the key concepts can someday be applied at the bedside or, in a dental setting, the chairside. I have no doubt that when TBL is done right, the "˜content coverage' focus becomes secondary to designing patient problem cases and questions that ensure that the student can apply the content in meaningful ways.
What are the challenges in adopting TBL within a curriculum or using it to replace much of a curriculum? This is really the subject of a whole workshop on curricular change! However, going back to the set of questions I pose at the beginning, if you are an educator who truly wants your students to be able to apply at a later date what they have learned in your class (not just do well on the MCQ exam or the dental boards), then you need to learn more about TBL and give it a try. At first it will be a difficult transition, because you will have to ask yourself frequently, "What is it I want them to do with this information?" rather than list what you want them to know. Crafting questions that make students think deeply about a subject is our toughest job and why we're paid the big bucks!
I invite you to explore the Team-Based Learning Collaborative website, read some of the peer-reviewed publications posted there, and attend a workshop on TBL at one of the national health science education meetings. TBL is a viable active learning strategy for dental education, one with great promise to enrich the academic achievements and professional competencies of those in the pipeline for practice, but it does require faculty to think differently about how learning occurs
best. The TBL Collaborative welcomes your inquiries and participation.