Journal Club

Our sincerest thanks to Judy Rowen who kept this COMSEP activity alive and well. Judy was the senior editor for the Journal Club section with guest editorials by Robin Deterding.

Dunaway G.A. Adaptation of team learning to an introductory graduate pharmacology course. Teaching and Learning in Medicine 2005;17(1):56-62.

Kelly A.P, Haidet P, Schneider V, et al. A comparison of in-class learner engagement across lecture, problem-based learning and team learning using the STROBE classroom observation tool. Teaching and Learning in Medicine 2005; 17(2): 112-118.

Michaelsen, L, and Richards B. Drawing conclusions from the Team-Learning literature in health-sciences education: A commentary. Teaching and Learning in Medicine 2005;17(1):85-88.

Reviewed by Lindsey Lane, Jefferson Medical School

Two articles about Team-Learning (and a commentary) in consecutive issues of Teaching and Learning in Medicine caught my eye and gave an opportunity to bring this teaching methodology to the attention of COMSEP members.

The article by Dunaway describes his experiences using his version (see below for explanation) of Team -Learning for a small - 9 students - graduate pharmacology course. The accompanying commentary by Michaelsen and Richards provides interesting insight into the Team-Learning process.

Team-Learning has been increasingly adopted as a teaching method in the health-sciences in the last 4-5 years: large classes (up to 200) are divided into teams of no less than 5-7 learners and are provided with learning objectives, guides, resources etc.; students engage in self-directed learning; take individual readiness assurance test (RAST); each team practices solving problems using scratch off cards (like lottery tickets) that reveal correct answers - the Immediate Feedback Assessment Technique or IF-AT; and then each team solves problems/ assignments in class. There is a "3S's rule" for the class problem solving assignments: all teams solve the Same problem; each team makes a Specific choice of best answer (like an MCQ question); and each team Simultaneously reports the answer. Following presentation of team answers "constructive controversy" ensues moderated by the teacher who must be a content expert. Members of a team each receive the same grade based on correct answers to IF-ATs and class problem solving. There is also peer evaluation of each student by fellow team members. The RAST ensures that all students have a basic knowledge level and the "team/peer" evaluation ensures that no students are "loafers" who allow others to do the work!

Proponents of Team-Learning outline the educational advantages as 1) Promotes self-directed learning, 2) Increases individual participation, 3) Promotes teamwork, 4) Promotes problem solving and 5) Goals 1-4 can be achieved with a single teacher/faculty member. These educational advantages, with the exception of #5 are the same described for Problem Based Learning (PBL), however PBL requires individual leaders for each small group (a class of 200 would require approx. 20 faculty).

Dunaway's method deviates from "classic" Team-Learning by having small teams of 3 students - maybe not enough intellectual capacity to problem solve effectively; by not having RATS; by having the instructor deduct points if he felt a student was "slacking"; by using in-class lectures to present material; by having teams solve different problems; and by having teams present in narrative form sequentially. Despite this Dunaway's students reported that they enjoyed and felt the experience was educationally valuable by increasing their classroom involvement, preparation prior to class and insight into the material. However, on the only objective measure of student performance - a knowledge test- the grades were similar to other classes.

The conclusion to be drawn here is that, like PBL, not all Team-Learning is really Team-Learning! This means that care must be taken when interpreting outcomes reported in the literature. In addition we also have to recognize that teacher and student self-report of "outcomes" have poor reliability and validity compared to outcomes that objectively measure student behavior and performance.

The article in the next issue of TL&M by Kelly et al is last authored by Boyd Richards who is co-author of the commentary on Dunaway's article.

This article takes as its premise the theory that "active" learning provides advantages over "passive" learning. In active learning it is postulated, "a variety of cognitive processes and verbal and non-verbal behaviors occur simultaneously" leading to "increased assimilation and retention of content and concepts." As a marker for "active" learning the authors measured in-class learner engagement: learner with learner and learner with instructor during Team-Learning, PBL and traditional lecture.

Data were based on observations using the "strobe method" in which repeated 5-minute observations of "engagement" are made every 8-10 minutes during a class. Each 5-minute observation period consists of four 10-20 second observations of individual learners, overall class observation, instructor observation and a count of the number of questions asked by the instructor and the students. It is not surprising that the authors found that engagement in lecture was predominantly learner-instructor; in PBL learner-learner; and in Team-Learning was more balanced between the two. Although the authors refrain from drawing conclusions as to what type of engagement is "better" for students' learning they do point out that many faculty find PBL a difficult teaching method as they are unable to deliver didactic material or act as content experts. In contrast, Team-learning allows faculty to "teach" and may have a "broader appeal" for instructors.

At my institution, Jefferson Medical College, Team-Learning has been introduced in the microbiology course and is highly rated as a teaching/learning method; student grades on microbiology tests remain the same but we do not (yet) have any objective measures of student behavior or performance. Team Learning is certainly an educational area where more research needs to be done; are other schools using Team-Learning and do any COMSEP members have objective educational outcomes from this teaching method to share?

(Lindsey's review provides an important look at a "hot" and emerging educational process to deliver curriculum. What methods would you prefer as a learner - lecture, PBL, or team-based learning? Is your school using team-based learning in the clinical years? Could you use it in your clerkship? - Robin Deterding)