ANNUAL FEATURE: IN PROGRESS: REPORTS OF NEW APPROACHES IN MEDICAL EDUCATION: CURRICULUM: Preclinical Education
Objective: Problem-based learning (PBL) is promoted in medical education because it fosters active learning and group skills. However, the student-centered, faculty-intensive attributes of PBL often present practical limitations (e.g., faculty time). Our objective was to try out an instructional method, team learning (TL), to achieve levels of active learning and group skills similar to PBL but in a lecture setting with a single instructor.
Description: TL combines out-of-class study with in-class, small-group problem solving.1 At the outset of a TL session, students take a pre-test individually and then together in assigned groups. These graded tests ensure that the students are prepared. After the pre-test, groups solve identical application problems and defend their answers to the class. The instructor facilitates discussion, clarifies misinformation, and helps the students reach the desired outcomes.
We used TL in a medical physiology course where PBL was impractical. The course was lecture-based with weekly small-group conferences, led by student teaching assistants. Despite directions to do otherwise, the conferences became mini-lectures rather than opportunities for active learning. Also, students migrated to groups with the “better” teaching assistants, creating marked imbalances in group sizes. To obtain the desired level of small-group, active learning, we replaced the conferences with TL.
We randomly assigned the class of 200 first-year medical and allied health students to groups of eight. During TL sessions, the groups sat in assigned areas of the lecture hall. Individuals completed a graded pre-test via the Internet prior to a session and again in their groups at the beginning of the session. After the pre-test, the groups solved and defended application questions through intragroup and then intergroup discussion. To facilitate desired “constructive controversy”2 within and between groups, the instructor used problems with no obvious right answer and required the groups to report their solutions simultaneously. After various groups had defended or refuted their responses, the instructor summarized key principles and explained the reasoning for the most correct response.
For example, in a session on respiratory physiology, the pre-test contained ten multiple-choice questions about pulmonary mechanics and circulation. The application question required students to recommend how paramedics should position a man with a gunshot wound to the left chest causing a pneumothorax and bleeding into the thoracic cavity. This question elicited lively intra- and intergroup discussion, using principles of pulmonary mechanics and circulation, about the merits of possible positions (lying on the right side, left side, back, etc.).
Discussion: Information from student focus groups indicated a favorable response to TL. Also, the graded pre-tests appeared to motivate the students to keep up. Informal observations by faculty revealed a high level of student engagement. Formal observations and written surveys are pending. The five faculty who individually conducted the sessions have also responded favorably. They were impressed by the students' interchanges and levels of reasoning. Nevertheless, most reported having difficulty developing appropriate application questions because of uncertainty about whether the questions would generate the desired level of controversy.
We conclude that TL fosters meaningful active learning in small groups using a single faculty instructor in a lecture hall. We have obtained funding to test the feasibility of TL in other settings.
1. Michaelsen LK, Fink LD, Knight A. Designing effective group activities: lessons for classroom teaching and faculty development. In: DeZure D (ed). To Improve the Academy: Resources for Faculty, Instructional, and Organizational Development. Stillwater, OK: New Forums Press, 1997.
2. Johnson DW, Johnson RT, Smith KA. Constructive controversy. Change. 2000;32:29–37.
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