In healthcare system Implementing Team-Based Learning for During Class are rules and manners of collaborative and vast information. It is interactive and dynamic process as compare to traditional method of teaching only giving knowledge.
During Class Implementing Team-Based Learning
Using Each Major Unit of Instruction
Units of instruction in TBL (each consisting of approximately 6–10 class hours) follow the activity sequence shown in Figure 2.1. As described in part one, each in class activity should be designed to build students’ understanding of course content and increase group cohesiveness via proper design and immediate feedback.
Ensuring Content Coverage
In TBL, the basic mechanism to ensure that students are exposed to course content is the Readiness Assurance Process (RAP). This process occurs five to seven times per course and constitutes the first set of in-class activities for each of the major instructional units identified through the backward design activity (see above). It also pro vides the foundation for individual and team accountability as one of the building blocks of TBL. The RAP has five major components:
(a) assigned readings
(b) individual tests
(c) group tests
(d) an appeals process
(e) instructor feedback
Each of the individual components is discussed in the following paragraphs.
Assigned Readings
Prior to the beginning of each major instructional unit, students are given reading and other assignments that should contain information on the concepts and ideas that must be understood to be able to solve the problem the instructor identified for this unit in the backward design activity . Students are to complete the assignments and come to the next class period prepared to take a test on the assigned materials.
Individual Test
The first in-class activity in each instructional unit is an individual RAT (IRAT) on the pre-class assignments. The IRATs typically consist of multiple-choice questions that, in combination, enable the instructor to assess whether students have a sound understanding of the key concepts from the readings. As a result, the IRAT questions should focus on foundational concepts (and avoid picky details) but be difficult enough to create discussion within the teams (Michaelsen et al., 2002, 2004 for information on how to create effective IRATs).
Team Test
When students have finished the IRAT, they turn in their answers (which should be scored during the team test) and immediately proceed to the third phase of the RAP, the group RAT (GRAT). During the third phase, students retake the same test, but this time the teams must agree on the answers to each test question and immediately check the correctness of their decision using an Immediate Feedback Assessment Technique (IF-AT) self-scoring answer sheet that provides real-time feed back for the team GRATs.
With the IF-AT answer sheets, students scratch off the covering of one of four (or five) boxes in search of a mark that indicates they have found the correct answer. If they find the mark on the first try, they receive full credit. If not, they continue scratching until they do find the mark, but their score is reduced with each unsuccessful scratch. This allows teams to receive partial credit for proximate knowledge .
In our judgment, the IF-AT answer sheets are the single best way to provide timely feedback on the group RATs (not the IRATs, otherwise, members would know the answers before the team test and discussion would be pointless). Getting truly immediate feedback from the IF-AT provides two key benefits to the teams.
- Truly immediate feedback enables members to quickly correct their misconceptions of the subject matter. Finding a star immediately confirms the validity of their choice, but finding a blank box lets them know they have more work to do.
- Truly immediate feedback creates a situation in which, with no input from the instructor, teams quickly learn how to work together effectively. In fact, IF-ATs virtually eliminate any possibility that one or two members might dominate team discussions.
Pushy members are only one scratch away from having to ‘‘eat crow,’’ and quiet members are one scratch away from being validated as a valuable source of information and two scratches away from being told that they need to speak up. The positive impact of the IF-AT on team development is nothing short of astounding.
In our judgment, using the IF-ATs with the GRATs is the single most powerful tool one can use to promote learning and cohesiveness in classroom learning teams. Anyone who is not using them already is missing a sure-fire way to increase their effectiveness at implementing TBL. The IF-AT forms can be ordered from the Web site http://www.epsteineducation .com.
When you order a set of forms, they come with different patterns of correct answers; this prevents students from simply memorizing the patterns. The teacher receives a key to find the correct answers on any given set of forms. Further, because they are only used for the team tests and can often be used for more than one GRAT, an initial order often covers the needs of several users and/or several years of use. Thus, the cost of the forms is quite reasonable.
Appeals
At this point in the RAP, students proceed to the fourth phase. This phase gives students the opportunity to refer to their assigned reading material and appeal any questions that were missed on the group test. That is, students are allowed to do a focused restudy of the assigned readings to challenge the teacher about their responses on specific items on the group test or about confusion created by either the quality of the questions or inadequacies of the preclass readings.
Discussion among group members is usually very animated while the students work together to build a case to support their appeals. The students must produce compelling evidence to convince the teacher to award credit for the answers they missed on the group test. Teachers listening to students argue the fine details of course material while writing team appeals report being convinced their students learn more from appealing answers they got wrong than from confirming the answers they got right. As an integral part of the RAP, this appeals exercise provides yet another review of the readings.
Instructor Feedback
The fifth and final part of the Readiness Assurance Process involves oral feedback from the instructor. This feedback comes immediately after the appeals process and allows the instructor to clear up any confusion students may have about any of the concepts presented in the readings. As a result, input from the instructor is typically limited to a brief, focused review of only the most challenging aspects of the pre-class reading assignment.
The RAP in Summary
The RAP allows instructors to virtually eliminate class time often wasted in covering material that students can learn on their own. Time is saved because the instructor’s input occurs after students have:
(a) individually studied the material
(b) taken an individual test focused on key concepts from the reading assignment
(c) retaken the same test as a member of a learning team
(d) completed a focused restudy of the most difficult concepts
A cursory review of team-test results illuminates for the instructor which concepts need additional attention so that he or she can correct students’ misunderstandings. In contrast to the concerns many instructors express about losing time to group work and not being able to cover as much content, many teachers report being able to cover more with the RAP than they can in a lecture.
Leveraging the motivational and instructional power of the Readiness Assurance Test leaves the class ample time for students to tackle the application-oriented assignments to develop students’ higher-level learning skills. Beyond its instructional power, the RAP is the backbone of TBL because of its effect on team development. The RAP is the single most powerful team development tool we have ever seen because it promotes team development in four specific areas.
First, starting early in the course (usually the first few class hours) the students are exposed to immediate and unambiguous feedback on individual and team performance. As a result, each member is explicitly accountable for his or her preclass preparation. Second, because team members work face to face, the impact of the interaction is immediate and personal. Third, since students have a strong vested interest in doing well as a group, they are motivated to engage in a high level of interaction.
Finally, cohesiveness continues to build during the final stage of the process, namely, when the instructor is presenting information. Groups become more cohesive because, unlike lectures, the content of the instructor’s comments is determined by the results of the RATs and is specifically aimed at providing value-added feedback to the teams.
Even though the impact of the RAP on student learning is limited primarily to ensuring that they have a solid exposure to the content, it is still an extremely valuable teaching/learning activity because it creates a feedback-rich learning environment. By encouraging pre-class preparation and intensive give-and-take interaction, this process also increases students’ ability to solve difficult problems.
Pre-class preparation and lively discussion build the intellectual competence of team members and enhance their ability and willingness to provide high-quality feedback to one another. This, in turn, dramatically reduces the teacher’s burden of providing feedback to individual students.
As a result, the RAP provides a practical way of ensuring that, even in large classes, students are exposed to a high volume of immediate feedback that, in some ways, can actually be better than having a one-on-one relationship between student and instructor.
Promoting Higher-Level Learning
The final stage in the TBL instructional activity sequence for each unit of instruction is using one or more assignments that provide students with the opportunity to deepen their understanding by using the concepts to solve some sort of a problem. As outlined above, good application-focused group assignments foster give-and-take discussions because they focus on decision making (not writing) and enable students to share their conclusions in a form that enables prompt cross-team comparisons and feedback.
Several examples of potential application-focused assignments that meet these criteria. In each case, the assignment requires teams to use course concepts to make a complex decision that can be represented in a simple form . As a result, because each of these assignments could be implemented so that teams could receive prompt and detailed peer feedback on the quality of their work, the assignments would also enhance learning and team development.
Learning is enhanced because students would be forced to reexamine and possibly modify their assumptions and/or interpretations of the facts, and the teams become more cohesive as they pull together in an attempt to defend their positions.
Encouraging the Development of Positive Team Norms
Learning teams will only be successful to the extent that individual member’s pre pare for and actually attend class. Fortunately, if students have ongoing feedback emphasizing the fact that preclass preparation and class attendance are critical to their team’s success, these norms will pretty much develop on their own. One very simple, yet effective, way to provide such feedback to the students is through the use of team folders.
The folders should contain an ongoing record of each member’s attendance, along with the individual and team scores on the RATs and other assignments (Michaelsen et al., 2002, 2004). The act of recording the scores and attendance data in the team folders is particularly helpful because it ensures that every team member knows how every other team member is doing.
Further, promoting a public awareness of the team scores fosters norms favoring individual preparation and regular attendance because doing so naturally focuses attention on the fact that there is always a positive relationship between individual preparation and attendance and team performance.
Near the End of the Term
Although TBL provides students with multiple opportunities for learning along the way, instructors can solidify and extend student understanding of course content and group process issues by using specific kinds of activities near the end of the term. These are activities that cause students to reflect on their experience during the past semester. Their reflecting is focused on several different areas. In most cases, these end-of-the-semester activities are aimed at reminding students of what they have learned about:
(a) course concepts
(b) the value of teams in tackling intellectual challenges
(c) the kinds of interaction that promote effective team work
(d) themselves.
Reinforcing Content Learning
One of the greatest benefits of using TBL is also a potential danger—particularly in health professions schools. Since so little class time is aimed at providing students with their initial exposure to course concepts, many fail to realize how much they have learned that will aid them in taking the board exams. In part, these results from the fact that, based on the reduced volume of lecture notes alone, many medical students are somewhat uneasy and some may actually feel that they have been cheated.
As a result, on an ongoing basis—and especially near the end of the course— instructors should make explicit connections between board and end-of-course exams and the RAT questions and application assignments. In addition, an effective way to reassure students is devoting a class period to a concept review. In its simplest form this involves:
(a) giving students an extensive list of the concepts from the course— especially those that are likely to appear on the board exam
(b) asking them to individually identify any concepts that they don’t recognize
(c) compare their conclusions in the teams
(d) review any concepts that teams identify as needing additional attention
Learning About the Value of Teams
Concerns about better students being burdened by less-motivated or less-able peers are commonplace with other group-based instructional approaches. TBL, however, enables instructors to provide students with compelling empirical evidence of the value of teams for tackling difficult intellectual challenges. For example, in taking individual and team RATs, students generally have the feeling that the teams are outperforming their own best member, but they are seldom aware of either the magnitude or the pervasiveness of the effect.
Near the end of each term, we create a transparency that shows five cumulative scores from the RATs for each team—the low, average, and high member score; the team score; and the difference between the highest member score and the team score (Michaelsen et al., 2002, 2004).
Most students are literally stunned when they see the pattern of scores for the entire class. In the past 20 years, over 99.95% of the teams have outperformed their own best member by an average of nearly 14%. In fact, in the majority of classes, the lowest team score in the class is higher than the single best individual score in the entire class (e.g., see Michaelsen et al., 1989).
Recognizing Effective Team Interaction
Over time, teams get better and better at ferreting out and using members’ intellectual resources in making decisions (e.g., Watson et al., 1991). However, unless instructors use an activity that prompts members to explicitly think about group process issues, they are likely to miss an important teaching opportunity. This is because most students, although pleased about the results, generally fail to recognize the changes in members’ behavior that have made the improvements possible.
We have used two different approaches for increasing students’ awareness of the relationship between group processes and group effectiveness. The aim of both approaches is to have students reflect on how and why members’ interaction patterns have changed as their team became more cohesive. One approach is an individual assignment that requires students to:
(a) review their previous observations about the group
(b) formulate a list of changes or events that made a difference
(c) share their lists with team members
(d) create a written analysis that addresses barriers to team effectiveness and keys to overcoming them
The other, and more effective approach, involves the same assignment but having students prepare along the way by keeping an ongoing log of observations about how their team has functioned (see Hernandez, 2002).
Learning About Themselves
One of the most important contributions of TBL is that it creates conditions that can enable students to learn a great deal about the way they interact with others. In large measure, this occurs because of the extensive and intensive interaction within the teams. Over time, two important things happen. One is that members really get to know each other’s strengths and weaknesses.
This makes them better at teaching each other because they can make increasingly accurate assumptions about what a given teammate finds difficult and how best to explain it to that person. The other is that, in the vast majority of teams, members develop such strong interpersonal relationships that they feel morally obligated to provide honest feedback to each other.
Although students learn a great deal about themselves along the way, the instructor can have a significant positive impact on many students’ understanding of themselves by using a well-designed peer evaluation process. In its simplest form, this involves formally collecting data from team members on how much and in what way they have contributed to each other’s learning and making the information (but not who provided it) available to individual students.
Some prefer collecting and feeding back peer evaluation data two or more times during the term (usually in conjunction with major team assignments). Others favor involving teams in developing peer evaluation criteria partway through the term but only collecting the peer evaluation data at the very end of the term. The biggest advantage of collecting and feeding back peer evaluation data along the way is that it gives students the opportunity to make changes. The disadvantage is that having students formally evaluate each other can measurably disrupt the team development process.
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