2018 Meeting Posters – TBL/PBL

701 – Working Together: Assessing the benefits of Team Based Learning in the Context of a Medical Pathology Course
Dragan Jovanovic, Rob Kidnie, Jamin Graham, Ranjan Solanki, and Jam Khojasteh
Trinity School of Medicine (Saint Vincent and The Grenadines campus), Trinity School of Medicine, and Oklahoma State University

Purpose: Pathology is an integrative course difficult to learn. Compared to lecture-based learning, Team Based Learning (TBL) can help students to better develop problem solving skills and strong critical thinking. We compared individual exam results with TBL group exam results and evaluated students’ perception of TBL.

Methods: Students enrolled in Medical Pathology were evenly divided into teams of 6 based on their academic performance, gender, and ethnicity. The results of tests administered individually and to the TBL groups during the course were evaluated using the Mann-Whitney U statistical test for group differences. At the end of Term 4 and 5 and during clinical rotations, the same students were asked to complete a survey to assess their perception of TBL compared to traditional lecture (15 items, 5-point Likert-type scale, strongly agree to strongly disagree). t-Test and one-way analysis of variance (ANOVA) were used to analyze this data.

Results: In all testing TBL groups exam results were significantly higher compared with individual student exam results. The benefits of TBL were experienced by both stronger and weaker students. Descriptive statistics for three outcome measurements, learning environment, student interaction, and group structure, were presented by group (i.e., disaggregated by term, course grade and prior TBL experience). The one-way analysis of variance yielded significant results for group structure by term, indicating that Term 4 students were .25 points significantly (p < .05) higher than Term 5 students on the group structure construct.

Conclusion: TBL is a promising educational method and was effective at improving learning outcomes in a Medical Pathology course. TBL was well received by the students that participated in the study. Term 4 students who had more recently participated in TBL rated group structure significantly higher than Term 5 students, indicating that their perception was more positive than that of Term 5 students.

Helena Spartz, Huda Tawfik, Elena Wood, Thaddeus Carson, Anthony Payne, Matthew Tews, and Eric Zevallos
Medical College of Georgia

PURPOSE: The Core Entrustable Professional Activities for Entering Residency (CEPAERs) are observable activities (functions), requiring faculty supervision. Two major challenges arise when considering the implementation of milestones for CEPAERs in the pre-clerkship curriculum. First, finding time to add new activities to time strained curricula. Secondly, the increased demand on faculty; including faculty development, supervision of the activity, and assessment.

METHODS: Milestones were developed by identifying which functions students might reasonably be expected to perform, and could realistically be implemented, in the pre-clerkship curriculum. Rather than creating a new course to address CEPAERs, we looked for opportunities to implement milestones of CEPAERs within our pre-existing curriculum. Problem-based learning (PBL) provided the structure necessary to implement milestones of CEPAERs. The existing PBL structure provided curricular time with relative flexibility to incorporate CEPAERs activities, pre-existing faculty development sessions and guides, and faculty available to provide direct supervision and assessment within a small-group structure. CEPAERs are intended to represent the day-to-day work of a physician. PBL allows the implementation and practice of milestones of CEPAERs within the clinical context of patient cases. Existing cases provided repeated opportunities for students to practice milestones of CEPAERs. Modification and enhancement with standardized patients and task trainers allows coverage of more functions for each CEPAER.

RESULTS: We have identified opportunities to incorporate milestones for each CEPAER within the PBL curriculum. We are in the pre-implementation phase and are continuing to develop simple, practical assessment tools for each CEPAER milestone.

CONCLUSION: PBL provides much of the pre-existing structure for implementation of milestones of CEPAERs. Examples will be provided. By sharing our approach to integrating milestones of CEPAERs into PBL, we hope to encourage other faculty and institutions to explore a similar approach, thereby bypassing the challenges inherent in implementing new activities into a pre-existing curriculum.

Iuliia Zhuravlova and Joshua Zweigle
Trinity School of Medicine

PURPOSE: Traditional didactic lectures are an essential portion of most curricula, but this type of activity does not provide engagement of students into the active learning process. We have attempted to implement team based learning (TBL) in our school to develop interpersonal and group interaction skills in our students, and also to prepare them for the lifelong learning and to help them to master the key course concepts.

METHODS: The TBL session plans were posted at the students’ portal prior to the beginning of the semester. In the beginning of the semester the students were separated into the groups and were informed about the dates of upcoming session, the amount of the material that should be prepared/learned by a student prior to each session. The pre-reading assignment was given to the students.

A total of 50 students of term 2 were separated into teams of 5-6. After each TBL session the students were completing a survey with 10 questions, where they had to rate the session on the basis of the 5 point Likert-type scale. The responses were anonymous.

RESULTS: After the analysis of the surveys completed by students, it was identified that majority of the students (89%) were satisfied with the TBL session, responding 4 (agree) and 5 (strongly agree). 78% agreed that TBL sessions promoted long term retention of the material. 82% agreed that they have deeper knowledge of the topics covered in TBL sessions.

CONCLUSIONS: Due to the success of the conducted TBL sessions, we plan to increase their amount in Anatomy course as well as in the other courses. After collecting the data over several semesters we plan to analyse the impact of the sessions onto the students’ performance in the course.

Jaya Yodh, Olivia Coiado, Roberto Galvez, Kashif Ahmad, and Judith Rowen
Carle Illinois College of Medicine

PURPOSE: Carle Illinois College of Medicine is creating a new model for medical education that integrates engineering principles and technology into a case-driven, active learning curriculum.  This novel engineering-infused curriculum will enable the training of a new class of physician-innovators who will design and implement transformative approaches for healthcare delivery.  To attract students that can meet this challenge, the college is hosting a series of showcases that immerses prospective students in this approach. A key showcase component is a problem-based learning (PBL) module comprising a patient scenario that integrates engineering, medicine, and teamwork concepts.

METHODS: The PBL module was run in groups of four students by a facilitator. After presenting the case about an injured hiker, the students were given two tasks: The first task required students to identify symptoms and list possible medical injuries for the patient.  The second task required students to build a boat out of playing cards to transport the patient and other hikers (figurines) across a river to safety.  The boats were tested to see if they could remain afloat while fitting four figurines.  The facilitator ended the session by summarizing the learning objectives.

RESULTS: The outcome of the PBL was gauged via task completion and facilitator input.  All sessions achieved the final delivery goal of constructing and testing a boat that satisfied predetermined requirements. Facilitator feedback reflected a positive impact on students’ understanding of 1) how Carle Illinois PBL sessions will be facilitated, 2) the collaborative nature of student team-work and research required, and 3) how engineering concepts will be integrated into medical case scenarios.

CONCLUSION: Development of its showcase PBL is one way Carle Illinois College of Medicine is leading recruitment of a new class of medical students and inspiring them to revolutionize healthcare through designing engineering-based solutions to current and future medical problems.

Michelle Mark and Hilary Petersen
Case Western Reserve University School of Medicine and Case Western Reserve University School of Medicine Physician Assistant Program

PURPOSE: There is no published data on the efficacy of problem-based learning (PBL) in developing clinical reasoning skills (CRS) for Physician Assistant students. In this study, we investigated whether PBL is an effective process that develops CRS. Our secondary goal was to see if PBL is an equitable teaching method that supports struggling learners.

METHODS: A curriculum consisting of clinical cases covering common chief complaints (CCC) was created with the goal of developing differential diagnoses, diagnostic plans, and making a final diagnosis. First year students took a key features pretest, which is a validated measurement of CRS for CCC. After engaging in weekly facilitated cases, students took a posttest that was based on the same but unique CCC as the pretest. Pre- and posttest scores were analyzed by paired student t-test. To correlate improved CRS to students’ academic status, students were divided into three equal groups (low, middle, and high achieving) by cumulative GPA. Correlation was determined by single variable ANOVA and one-tailed T tests. The size of the effect was measured using Glass’s ?.

RESULTS: CRS for the class significantly improved from 53.9% to 65.5% (P=1.48E-09). The impact of academic status on CRS improvement was significant (P=0.023). CRS improved for the low, middle, and high achieving cohorts 11.9%, 15.1%, and 7.78% respectively. The low and middle achieving groups improved significantly more than the high achieving group (P=0.023 and P=0.011). There was no significant difference in CRS improvement between low and medium achieving students. The effect size was 2.1, 2.4, and .84 for low, middle, and high achieving students respectively.

CONCLUSION: This case-based PBL curriculum significantly improved CRS across all cohorts of students. However low and middle performing students benefitted the most, demonstrating the effectiveness of this curriculum to address the needs of low and middle achieving students.

706 – Strong Correlation Between Individual Performance in Team-Based Learning Exercises and Final Examinations in a Four-Week Infectious Diseases Course for First Year Medical Students
Osvaldo J. Lopez, Kathryn C. Behling, and Gonzalo A. Carrasco
Seton Hall-Hackensack Meridian School of Medicine and Cooper Medical School of Rowan University

Purpose: Team-Based Learning (TBL) improves student learning by enhancing engagement with course content. In TBL, preparation of relevant course-work during self-directed learning time is evaluated by the individual readiness assessment test (iRAT). We recently reported that student performance on iRATs is strongly correlated with final examination scores in an infectious diseases (ID) course (Medical Teacher 2017: doi:10.1080/0142159X.2017.1408899). As a continuation of our studies, we are now investigating how the degree of preparation for each individual TBL relates to student course performance.

Methods: Student’s iRAT scores in the 4 ID course TBLs were quantified and?correlated with final examination scores using Krushkal-Wallis One-Way ANOVA and Newman-Keul’s statistical methods.

Results: One hundred and sixty five students were enrolled in this two-year study. The average final examination and iRAT scores were 84.91(9.67) and 7.43(1.79) (average (standard deviation)). To investigate factors that contribute to successful academic performance, we studied iRAT performance in students performing in the upper, middle and lower 33rd percentile on the final examination. The final examination and iRAT scores were (average (standard deviation)): 92.24(2.02) and 7.95(1.54); 85.96(2.87) and 7.95(1.71); and 76.48(5.61) and 6.92(1.95) for each of these groups, respectively. In contrast to students in the lower 33rd percentile, students in the upper and middle 33rd percentile showed significant (p<0.01) weekly improvement in their iRAT scores during this four-week course.

Conclusions: This study strengthens the relation between iRAT performance and course success in the medical curriculum. Pre-class preparation is essential to facilitate learning in TBL. Our data suggest that more poorly performing students don’t prepare as well for TBL exercises over the four weeks of the course, which interferes with the efficacy of this learning method for these students and their TBL teammates. Changes in TBL incentive structure may provide tangible rewards for pre-class preparation in particular for struggling students.

707 – Developing and Assessing Self-Directed Learning and Leadership in Medical Education
Richard Van Eck, Patrick Carr, and Nancy Vogeltanz-Holm
University of North Dakota School of Medicine and Health Sciences

PURPOSE: The University of North Dakota School of Medicine (UND SMHS) recently adopted new competencies based on the Physician Competency Reference Set, including those focused on lifelong self-directed learning skills, professionalism, and personal and professional development. One way the UND SMHS curriculum promotes these outcomes is through our patient-centered learning (PCL): a form of problem-based learning in which groups of students take turns serving as group leaders for a total of 64-week-long patient cases during their first 2 years. However, competencies such as these are best assessed through observed behaviors that improve incrementally over time, suggesting the need for an observational assessment form and formative feedback and assessment over time.

METHODS: An observational form to measure these competencies was developed based on previous research, including work by Howard University’s Center for Excellence in Teaching, Learning, and Assessment (CETLA) and the work of D. M. Richter at the University of New Mexico. This form was then used to assess students and provide feedback during each PCL case. Students use this feedback to generate two goals to focus on in future PCL cases. By the 32nd case they lead (end of Year 1), students are expected to demonstrate full competency and are then able to lead future PCL groups independently.

RESULTS: Data from the first block (78 students, 10 groups, eight weeks) suggest the form is effective. Data from all four blocks will be available May 2018 and will be shared and discussed along with advice for adoption.

CONCLUSION: The method appears to be a successful means of promoting and documenting self-directed learning/group leadership skills, making it possible to shift the role of faculty from facilitator to mentor as student expertise continues to grow in Year 2.

Shane Menzies, James Corbin Ferguson, Rachel Reeves, Joshua Thompson, and Mark Hernandez

PURPOSE: Medical students are responsible for learning and integrating large amounts of information in a limited time. Student attention can wane during class due to lack of active engagement.  By using pre-recorded videos of clinical scenarios, our goal at ACOM is to implement strategies that capture students’ attention and help them integrate and retain basic and clinical knowledge.

METHODS: Scripted clinical scenarios were prepared and filmed into short video segments to be used during team-based learning (TBL) sessions.  These video segments were paused between scenes to challenge the students with clinical application questions. After the session and examination, the students were asked to complete an anonymous electronic survey with the aid of Qualtrics. The survey evaluated student engagement, how well the videos helped the students learn and remember clinical knowledge compared to written cases, and whether they prefer the video format over written cases.

RESULTS: There was a difference of opinion to the use of pre-recorded clinical scenarios between first and second year students. Our results suggest the first year students found the videos to be more helpful, but the second year students showed less interest and felt that the use of videos was not helpful.

CONCLUSION: Use of pre-recorded clinical scenarios during TBL can help improve the process of integration of the clinical sciences by medical students.  These results suggest a difference between the first and second year students.  To improve the experience for all the students with pre-recorded clinical scenarios during TBL, further feedback is necessary.