Letters to the Editor
To the Editor:
The recent Academic Medicine article by Morrison and colleagues1 makes a compelling case for the need for team skills in medical practice. The article also explains that both team skills and professional practice can be taught effectively by engaging learners directly and specifically in work-related decision-making tasks. In support of their case, the authors cite outcomes from crew resource management training (CRM) and Team Strategies and Tolls to Enhance Performance and Patient Safety (STEPPS). They further cite evidence from the K–12 student literature that small-group instruction facilitates content learning and conclude by calling for the increased use of instructional strategies that explicitly and repeatedly require students to work in teams and be assessed as teams, based on their ability to solve practice-related problems.
Unfortunately, the authors completely ignore the growing body of literature2–4 related to an existing educational strategy, team-based learning (TBL), that demonstrates the validity of every aspect of their call to action. Like CRM and STEPPS, TBL immerses learners in medical-practice-related decisions as a means of teaching practice-related content and team skills. Although TBL was originally developed more than 30 years ago for business school classes, more than 10 years of TBL use in a rapidly growing number of U.S. and international medical schools has produced a well-documented track record for improving learning, enhancing learners' attitudes about working in teams, and developing learners' interpersonal and team skills. Further, the teams in TBL, unlike groups in problem-based learning, do not require facilitators. As a result, TBL has proven to be effective with instructor–student ratios of up to 1:200, and it does not include any prior or concurrent training in team skills because its components support the development and use of such skills from the very first session.
Based on the evidence in higher education and medical education literature in which TBL has been fully implemented,5,6 we have no doubt that Dr. Flexner would be enthusiastic about medical students learning in teams from the first day in medical school. We encourage medical educators to continue to share their TBL modules through the AAMC's MedEdPORTAL and to publish their outcomes in Academic Medicine.
Dean Parmelee, MD
Associate dean for academic affairs, Wright State University Boonshoft School of Medicine, Dayton, Ohio; firstname.lastname@example.org.
Larry K. Michaelsen, PhD
Professor of management, University of Central Missouri, Warrensburg, Missouri.
1 Morrison G, Goldfarb S, Lanken PN. Team training of medical students in the 21st century: Would Flexner approve? Acad Med. 2010;85:254–259.
2 Shellenberger S, Seale JP, Harris DL, Johnson JA, Dodrill CL, Velasquez MM. Applying team-based learning in primary care residency programs to increase patient alcohol screenings and brief interventions. Acad Med. 2009;84:340–346.
3 Thompson BM, Levine RE, Kennedy F, et al. Evaluating the quality of learning-team processes in medical education: Development and validation of a new measure. Acad Med. 2009;84(10 suppl):S124–S127.
4 Nieder B, Parmelee D, Stolfi A, Hudes P. Team-based learning in a medical gross anatomy and embryology course. Clin Anat. 2004;18:56–63.
5 Michaelsen L, Parmelee D, McMahon K, Levine R, eds. Team-Based Learning in Health Professions Education. Sterling, Va: Styllus Publishing; 2007.
6 Parmelee D, Michaelsen L. Twelve tips for doing effective team-based learning (TBL). Med Teach. 2010;32:118–122.