In healthcare system Team-Based Learning in Health Professions Education is a source of collaborative and vast information. It is interactive and dynamic process as compare to traditional method of teaching only giving knowledge.
Health Professions Education and Team-Based Learning
Educators in the health professions know that students must acquire an enormous amount of information, demonstrate that they know the information by scoring well on multiple-choice exams, and then use the information in their evaluation and treatment approaches with clinical problems.
So many of our curricula are designed to cover the content deemed essential for the discipline, and although curricula may have components that require the student to demonstrate integration of content elements in problem-solving exercises, it is rare that application of knowledge is the cornerstone of a curriculum’s design.
Requiring graduates of professional education/training programs to demonstrate that they have the attitudes and skills to function in the health care setting is considered under the category of professional competencies, and all disciplines have defined these with outcome measures. Unfortunately, there is still a divide in which the student/trainee must first demonstrate knowledge of facts and concepts before showing any ability to integrate this information by solving problems through the exercise of judgment or clinical reasoning.
And, although all health professional training programs have professional competencies for communication, interpersonal skills, and teamwork, they struggle with how to incorporate meaningful learning opportunities for these competencies and to find methods for documenting achievement. Over 40 years ago, at McMaster University in Ontario, Canada, problem-based learning (PBL) was developed for the medical school curriculum, and many schools adopted this strategy as a way to help health care professionals develop skills working in groups to solve clinical case problems.
Wide incorporation of the strategy did not occur because of the faculty resources required (each small group requires a facilitator) and, in so many settings, both students and faculty prefer to use the lecture format for classroom teaching. With a lecture format, the time commitment is not significant for the faculty, students do not have to prepare seriously, and there is no expectation for interpersonal interaction between faculty and student or student and student.
PBL addressed many of the professional competencies, but the lecture format, preferred by students emerging from pre-health undergraduate programs, has held sway. Larry Michaelsen, as professor of business at the University of Oklahoma in the late 1970s, developed a large-class strategy that dramatically changed the dynamics in the lecture hall for his course in management.
At the first session, he assigned students to teams, informed them that he would not lecture and that they would learn the content of the course on their own and in teams, and that they would be applying what they learned at every class session. His role was to tell them what content they needed to master, create challenging problems for them to solve, and probe their reasoning for how they came to their conclusions.
Some students felt cheated that they were not being ‘‘taught,’’ but they quickly discovered that they were learning more in a lecture where all the students were questioning, debating, teaching one another, and even arguing! Michaelsen spent the next several years refining the principles of TBL, as they could be applied to any subject matter that involved problem solving. For many years, he traveled to universities and colleges doing faculty development workshops on his strategy.
Many who attended taught undergraduate science classes of students who were pre-health professionals and they saw TBL as a way to get them engaged in classroom problem solving. Others thought that the strategy deviated too far from traditional pedantic paradigm and that the pre-health professions students would have a hard readjustment when they went to the graduate level. Starting in 2001, with an award by the U.S.
Department of Education’s Fund for the Improvement of Postsecondary Education (FIPSE) to Baylor Medical College to increase TBL in medical education, and with the publication of Team-Based Learning: A Transformative Use of Small Groups (Michaelsen, Knight, & Fink, 2002) and later revised and republished as
Team-Based Learning: A Transformative Use of Small Groups in College Teaching (Michaelsen, Knight, & Fink, 2004), faculty in medical, nursing, physician assistant, dental, and veterinary schools became interested in this strategy through workshops, peer-reviewed publications, and a changing health care education environment that wanted its professionals to be better at teamwork.
Faculty at more than fifty health professions schools have tried out TBL, and there have been over 20 publications on its use with health professions education in peer reviewed journals since the beginning of the FIPSE program. No professional degree program has adopted the strategy as the cornerstone of its curriculum, but some have used it increasingly in courses, and faculty interest continues to grow.
Since so many courses in the health professions are taught by several faculty in the attempt to provide integration of science disciplines (anatomy, physiology, biochemistry), it requires one or two very determined faculty members to develop and deliver the TBL modules, sometimes stretching their comfort level with the course content.
However, when several faculties from different disciplines start working together on creating TBL modules, the benefit for the students can be great, since they must integrate the content from these disciplines to be successful. For example, an anatomist, a biochemist, and a physiologist could collaborate to develop a group application on Vitamin D.
A case of rickets is selected and questions designed that require the students to demonstrate their knowledge of the anatomy and histology of bones, the formation and structure of Vitamin D, the physiology of bone formation, and how to apply this knowledge to solving complex problems on the diagnosis, treatment, and prevention of rickets. This group application then becomes the focus for a defined portion of the course’s content related to normal and abnormal bone formation and structure.
The faculty determines the depth of knowledge necessary to answer the group application questions, and assigns readings or other activities (histology lab, interpretation of bone density studies, question sets in biochemistry) that must be done before class. At the end of the exercise, the faculty will know how well the students have mastered the material and can address any important gaps in knowledge or application of the knowledge.
Clearly, this process of faculty collaboration to design and deliver an effective TBL module is more challenging and time consuming than putting the requisite lectures together to cover the content. And, the faculty must know how the student clinicians (dental, medical students) solve problems at their stage of education so that they can tailor the difficulty and complexity of the questions.
Students in a program designed to produce research scientists will need to have not only very complex questions, but also ones that require considerable creativity to answer and defend. Faculty hesitation to incorporate TBL in a course, or convert the course to TBL, is understandable, but we feel that for professional students to be engaged fully, challenged intellectually, and have the opportunity to develop interpersonal and teamwork skills, the TBL strategy holds the greatest promise in curriculum development. Student engagement is the hallmark of TBL.
As experienced educators know, student engagement with content is correlated with both student satisfaction and student achievement, especially when the subject matter is difficult. The well designed TBL module, used in a class where teams have been properly created, generates remarkable interactions between students and the faculty instructor.
There is no comparison between what one sees and hears in such a class and a lecture format class. Furthermore, the longer teams work together with appropriately challenging TBL modules, the more they appreciate being given progressively difficult problems to solve. What is it about the TBL strategy that guarantees student engagement? It is all about accountability and learning about judgment.
Accountability In Team Based Learning
It is part of the structure of TBL. Students learn quickly that their grades as individuals in the course are derived from how well they prepare for TBL sessions (individual Readiness Assurance Test), how well they relate to their team members and contribute to their team’s productivity (peer evaluation), how well they as team members can demonstrate their collective preparation (group Readiness Assurance Test), and how well they collaborate as team members to apply their knowledge to solve difficult problems (group application exercise).
Although all of these grade incentives for accountability motivate the students to work hard, they become less important as teams work together over time. Members of established learning teams report that they prepare thoroughly and contribute all they can in the sessions because they want their team to be successful. The lecture format can never generate the level of engagement with content that comes from students using their cognition and their affect through the TBL process.
Judgment In Team Based Learning
Kenneth A. Bruffee (1978), defined judgment as ‘‘decision making, discrimination, evaluation, analysis, synthesis, establishing or recognizing conceptual frames of reference, and defining facts within them’’ (p. 450). Health professionals become clinicians when they are given responsibility to care for others. In addition to a host of personal characteristics, such as a passion to provide service to others, the clinician must have this judgment skill set to make decisions.
The structure of TBL requires the individual and the team to judge and make decisions, and when the instructor facilitates well, both individuals and teams must explain how they arrived at their decisions and why they excluded other considerations. The entire process of dialogue and debate within teams and between teams teaches students about judgment, and, as they practice the skill set for judgment, they engage deeply with the content.
Many of us would consider judgment to be the foundation of sound clinical reasoning. As one reads the remaining coming topics, one will discover that TBL holds much promise to transform the way health professions education and its related science disciplines are taught and learned. The strategy’s inherent approach to accountability, judgment, and the mastery of content for the purpose of applying it in the classroom supports the values and competencies that prepare the student for a future as a professional. Furthermore:
- It is suitable for large classes held in lecture halls.
- It engages students fully during class time.
- Students come to class on time and they come prepared.
- One faculty member can conduct an entire session.
- Several professional competencies can be addressed (communication, interpersonal skills, teamwork skills, including giving and receiving peer feedback, knowledge acquisition, and applying knowledge to real case problems).
- Academic achievement on end-of-course exams is the same or better than with traditional lecture format.
- It offers students opportunities to develop clinical reasoning skills in the context of a supportive and engaged group of peers.
- It contributes to the development of a learning community for a class.
Because of the burgeoning interest in understanding better how future clinicians develop their clinical reasoning, reviews critical thinking in the context of TBL. For a relatively new educational strategy to grow in acceptance and use, its outcomes must be published in the peer-reviewed literature; therefore, three scholars have written about what they feel are the scholarship priorities for TBL.
Part two, ‘‘Voices of Experience,’’ is by contributors who have taken the plunge and started using TBL in their classes. Not always have they followed the rules for how to do it; sometimes, they have discovered some variations that work well in their particular setting. Several faculty at my institution, the Boonshoft School of Medicine at Wright State University, began to use TBL in our preclinical curriculum in 2002.
Within one year, all of our preclinical, basic medical science courses were incorporating TBL as important components of the course work. Over the next four years, faculty learned more about how to do it well, and we created a culture that supported it. Student evaluations of TBL have become uniformly excellent and faculty who use it would never go back to the previous small-group teaching. We continue to expand its use in our curriculum and to learn how to generate the best learning for our students.
Read More:
https://nurseseducator.com/high-fidelity-simulation-use-in-nursing-education/
First NCLEX Exam Center In Pakistan From Lahore (Mall of Lahore) to the Global Nursing
Categories of Journals: W, X, Y and Z Category Journal In Nursing Education
AI in Healthcare Content Creation: A Double-Edged Sword and Scary
Social Links:
https://www.facebook.com/nurseseducator/
https://www.instagram.com/nurseseducator/