Development and Implementation of a Team-Based Learning Module: An Academic Perspective
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Session presented on Friday, July 25, 2014: Team-based learning (TBL) was developed as a method of ensuring the benefits of small group teaching with large groups of 200+ students (Michaelsen, 2002). To implement TBL a course/module is divided into learning units each of which follows a specific sequence of activities: (i) out-of-class preparation; (ii) 'readiness assurance process' of individual and team testing, plus the opportunity for team appeals; and (iii) application activities in which teams work on problems (Parmelee & Michaelsen, 2010). Students are also required to provide feedback on each team member's contribution to team working. Teams of between 5-7 students are formed in advance in a way that ensures team diversity (e.g. by grade, nursing specialty). To implement TBL a significant amount of preparation is required by the academic team (Andersen, Strumpel, Fensom, & Andrews, 2011); plus a clear understanding of, and commitment to dialectical questioning to facilitate deep learning and foster student engagement (Lane, 2008). The aim of this presentation is to report the process and outcome of implementing TBL in a second year evidence-informed decision making (EIDM) module in a BSc Nursing programme in England. The focus will be on the development work required to implement TBL; and the perceived value of TBL as observed by the academic team. Student results will also be presented. The methods and results describing the student perspective have been presented elsewhere. Design A post-intervention evaluation involving structured interviews with members of the teaching team involved in both the development of the module and the implementation (n=8 excluding the author JM). Data Collection A planning log was kept by the module leader (JM) recording the timeframe and work required. Interview questions focused on the process around development and implementation, and the perceived value of TBL. Data Analysis A timeline reporting key deadlines and decisions was extracted from the planning log. The interviews were digitally recorded to aid documentation and interpretation, and Atlas.ti 6 was used to aid the information sorting process. Thematic analysis was used guided by the interview questions. Results (1) Planning for TBL Implementation In order to prepare the team for TBL which was new to all of us, the module leader engaged in several academic development activities: studied TBL literature (pedagogical and evaluation), participated in a workshop led by Larry Michaelsen the originator of TBL, joined the TBL Collaboration listserve, attended the TBL Collaboration annual conference. The preparatory work required for TBL implementation was undertaken over a nine month period led by the module leader. The key stages were as follows: (i) Preparation of the teaching team; (ii) division of the 257 students into five main groups, subdivided into a total of 44 teams of between five and six students.; (iii) structuring the module into four learning units and identifying/developing the learning resources for each unit; (iv) timetabling and room organisation; (v) development and review of test and application activity resources for each unit; (vi) preparation of team folders, student handbook, tutor notes, induction material etc. A sub-group from the academic team was formed to review the resources and materials developed which were then subsequently reviewed by the whole teaching team (n=10 including the module leader). Team meetings were organised to ensure all understood the TBL process, what was required, and to ensure parity in how the student groups were facilitated. A checklist documenting all actions and dates of approval was developed and maintained by the module leader. (2) Results from the Academic Team Interviews Perceptions of TBL Prior to Implementation All referred to previous difficulties associated with students not engaging with the subject material, nor undertaking required reading and therefore coming unprepared to taught sessions. There was deliberation about whether TBL would result in more engagement and consequently deeper learning. Whilst all made positive comments about using TBL despite none having had previous experience of the strategy, there was also a degree of apprehension. Facilitating the TBL Sessions One of the key features of TBL is the emphasis on using dialectical questioning to help develop learning and engage students. Whilst most of the academic team did not find this a problem, they did recognise the challenges associated with eliciting information and probing students to establish levels of knowledge and understanding, rather than 'providing' students with 'answers'. TBL and EIDM Most of the academic team felt that TBL helped address some of the challenges previously experienced when teaching EIDM such as students not preparing for sessions, and consequently not engaging with the subject; nor applying the concepts learned to a wider context. The multiple choice question tests were seen as beneficial because the students had to complete the preparatory work for each module unit in order to succeed. The team working processes were seen to help those struggling to understand the subject concepts; and also demonstrate the level of knowledge and understanding to those students able to explain concepts to others. The preparatory work and team-based discussions were considered to help students understand the language of EIDM through the level of engagement more readily than with more didactic methods. It was suggested that through the application activities TBL helped contextualise EIDM in clinical practice which was essential if students were to understand the centrality of EIDM to the provision of efficient and effective health care. General Perceptions of TBL The academic team thought that overall TBL worked well. The preparatory work meant that students had to take responsibility for their learning which as well as being beneficial for helping ensure the module learning outcomes were achieved, was also seen as aiding the development of lifelong learning skills especially around learning how to learn, working independently; and also effective team working which is integral to professional practice. The majority of the academic team indicated that the appeal process worked well and contributed to the students' learning, although one member of the team thought it was too much work for little benefit for the students. There was a mixed response to the application activities with some members of the team indicating they worked well and that the students engaged with this element; but three members of the team did not see the benefit of this part of the TBL process. A team review meeting scheduled halfway through the module indicated that this might be due to the fact that the dialectical questioning technique and facilitation processes were not being implemented as required to fully engage the students. By the end of the module, all members of the academic team indicated significant learning had taken place about the process and pedagogical value of TBL. Preparing for the sessions was seen as key to successful implementation, as was the effective use of dialectical questioning. Having two members of the team facilitating each large group was seen as advantageous and helped ensure smooth running of the sessions. Having a strong and engaged teaching team was highlighted as being essential to successful implementation by one member of the team. (3) Student Results The mean score for the individual tests was 52.64, and 82.67 for the team tests. The overall pass rate for the module was 89% which was 10% higher than the results for the EIDM module for the previous academic year; 20% scored over 70% and a further 39% between 60-69%. Perhaps of most interest, however, was the change in scores between the lowest quartile for the two modules. The lowest quartile was 56% for the TBL module (median 62%), compared with 40% for the non-TBL module (median 50%) completed in the previous year. Conclusions: There was significant effort required on the part of the module leader to prepare the team, as well as the resources and materials required prior to this first implementation of TBL. It was felt that a minimum of nine months should be allowed for this process for those new to TBL. However future implementation with the same module will not be so time consuming as the materials have been prepared and can be reused. The interviews with the academic team indicated that TBL was a successful strategy to use with EIDM, requiring students to be prepared for sessions resulting in greater student engagement, and deeper learning. Student results indicated higher attainment than in a previous year, with a significant shift in results towards higher grades. A testament to this successful implementation is the fact that TBL will continue to be used for the next academic year and is being considered for use with other modules. References Andersen, E., Strumpel, C., Fensom, I., & Andrews, W. (2011). Implementing team-based learning in large classes: Nurse educators' experiences. International Journal of Nursing Education Scholarship, 8(1), 1-16. Lane, D. (2008). Teaching skills for facilitating team-based learning. New Directions for Teaching and Learning, 116, 55-68. Michaelsen, L. (2002). Getting started with team-based learning. Team-Based Learning: A Transformative Use of Small Groups (pp. 27-51). Westport, CT.: Praeger Publisher. Parmelee, D., & Michaelsen, L. (2010). Twelve tips for doing effective Team-Based Learning (TBL). Medical Teacher, 32, 118-122.