IAMSE – Publications Committee MSE Article Review

The Publications Committee provides another review of an article in Medical Science Educator (MSE).  This month’s publication by Roman, B., Hayden, C. & Parmelee, D. (Wright State University Boonshoft School of Medicine), entitled “The Effectiveness of Engaged Learning: 8 Years of TBL in Internal Medicine and Psychiatry Clerkships”, used the paired t-test to compare two TBL clerkships and three teacher-centered clerkships on the basis of NBME test performance. The original research article is cited in Medical Science Educator, September 2017, Volume 27, Issue 3, pp 475-479 and can be located online at http://bit.ly/2DxBeQc. Team-based learning (TBL) was devised by Dr. Larry Michaelsen et al. at the University of Oklahoma in the early 1970s for courses in business school to allow class time for students to master problems in small groups and eliminate lectures. In each TBL session there is an advanced preparation assignment (individual pre-work), both independent and group readiness assurance tests consisting of 5-20 multiple choice questions, termed IRAT and GRAT respectively, and “team-based” clarification and application exercises that relate one or more problems with specific choices.  Although TBL has been demonstrated to improve academic scores in pre-clinical medical school courses, including anatomy, molecular and cell biology, etc., there are few studies on the use of TBL in the clinical curriculum. In the above cited Roman et al. manuscript TBL was incorporated into both the internal medicine and psychiatry clinical clerkships during the third year of medical school.  Whether the TBL system caused an improvement in final NBME subject exam scores for each clerkship, when compared to “teacher-centered clerkships”, was investigated over a period of 8 years. The results provide evidence that students enrolled in the two TBL clerkships produced higher scores than the traditional teacher-centered modalities, when compared to the norm of national scores on the respective NBME standardized exam over a period of 8 years. The authors conclude that a TBL curriculum at their institution provided a sustained improvement over teacher-centered clerkships.