2017 Meeting Posters – TBL/PBL

701 – Is Student Participation Influenced by Incentive Structures? A Comparison of Case-Based and Team-Based Learning.
Kathryn C. Behling, Gonzalo A. Carrasco, Michael E. DiSanto, Susan M. Perlis, and Osvaldo J. Lopez
Cooper Medical School of Rowan University

PURPOSE: Student engagement is essential to the effectiveness of active learning activities (ALAs), but the effect of engagement on educational outcomes has not been thoroughly studied. At our institution we use two different ALAs, Team-Based Learning (TBL) and Case-Based Learning (CBL), which have different incentive structures for participation. We have previously reported improved learning of course content after implementation of TBL exercises in a first year Infectious Disease course. Here, we study how student participation correlates with incentive structures in the two different ALAs used in our school.

METHODS: Student participation in TBL and CBL exercises, occurring during a first year, medical school Microbiology course, was recorded. Twenty-four students were assigned to 3 CBL groups (with 8 students per group) and 4 TBL teams (with 6 students per team). Student participation was quantified and correlated with performance on individual readiness assurance tests (iRATs) and group readiness assurance tests (gRATs).

RESULTS: As expected iRAT and gRAT scores are positively correlated (r2=0.424,p <0.01) in this study. We did not detect any significant differences (p>0.05) between males and females in percent participation in TBL or iRAT/gRAT scores. Unlike males, there was a highly positive correlation in the percentage time of participation amongst individual CBL sessions (r2=0.699-0.867,p <0.01) in female participants. Similar correlation was detected between individual TBL sessions (r2=0.678,p <0.05) only in female participants. Preliminary data suggest no correlation between percentage time of participation in TBL and iRAT scores, suggesting that preparedness does not necessarily correlate with participation.

CONCLUSIONS: Our preliminary data suggests that student participation in CBL or TBL may be independent of incentive structures inherent to different ALAs. We anticipate that future data from the final examinations in the Microbiology and Infectious Diseases courses will provide a more comprehensive view of the role of participation in ALAs with different incentive structures.


703 – Group Discussion Participation in Team-Based Learning Correlates With Performance During a Pre-Medical Microbiology Course for Students Underrepresented in Medicine
Christine M. Collins, Gonzalo A. Carrasco, and Osvaldo J. Lopez
Cooper Medical School of Rowan University

PURPOSE: The PULSE (Premedical Urban Leadership Summer Enrichment) Program at Cooper Medical School is designed for students from underrepresented (URM) groups in medicine. A four-week microbiology course was developed for these students, consisting of daily lectures, small group study sessions, and five graded Team-Based Learning (TBL) exercises. We recently reported that TBL exercises improve student’s critical thinking and knowledge of course content in this microbiology course. As a continuation of our studies, we now investigate how the degree of preparation for TBL relates to participation in group discussion and overall exam grades.

METHODS: Student’s individual time percentage of participation was quantified and correlated with: (1) grades of individual TBL (iRAT and gRAT); (2) a test given at the course onset (pre-test); (3) and final examination (post-test).

RESULTS: In our overall analysis we found a significant (p <0.05) correlation between: (1) iRAT scores and student’s time percentage of participation (r2=0.434, p <0.01); (2) time percentage of participation and degree of course improvement measured as grade difference between pre- and post-test (r2=0.4088, p <0.01);(3) post-test scores and time percentage of participation (r2=0.511, p <0.01); (4) iRAT and gRAT (r2=0.3454, p <0.01); and (5) iRAT and post-test scores (r2=0.373, p <0.01). Subgroup analysis to examine possible differences between female (n=23) and male (n=10) participation showed a significant positive interaction in female students between: (1) iRAT scores and time percentage of participation (r2=0.468, p <0.05); (2) post-test scores and time percentage of participation (r2=0.612, p <0.01); and (3) pre- and post-test scores (r2=0.498, p <0.05). No significant interactions were detected in male students.

CONCLUSIONS: Our data suggest that student participation (particularly female students) in TBL correlates with student preparation due to the immediate accountability that occurs during gRAT discussion. We hypothesize that affirmation of a correct response positively reinforces the student’s self-confidence which prompts them to increase their participation.


705 – Impact of Team-Based Learning Implementation to an Established Flipped-Classroom Model at a New Osteopathic Medical School
Mark J. Hernandez, Audrey A. Vasauskas, James Lyons, and Philip Reynolds
Alabama College of Osteopathic Medicine

PURPOSE: The Alabama College of Osteopathic Medicine (ACOM), a medical school that opened its doors in 2013 with the purpose of abating the local and national physician shortage, will graduate its first class in 2017. During the third year of existence, Team Based Learning (TBL) was implemented to complement our systems-based curriculum. To assess the outcome of this implementation we compared the COMSAE Phase I, a comprehensive osteopathic medical self-assessment examination administered in osteopathic medical schools which we administer in the end of fall semester, before and after the implementation of TBL.

METHODS: Aggregate data was made available for each class by the National Board of Osteopathic Medical Examiners (NBOME), and data was analyzed using GraphPad Prism statistical software version 7.0. Comparisons between the 2014 class (pre-TBL) and 2015 class (TBL) were performed by using a multiple t-test analysis. Differences between the classes were considered significant when P <0.05.

RESULTS: We analyzed the first semester of Year 2 medical students at ACOM for years 2014 (no TBL) and 2015 (with TBL). This term semester includes the cardiovascular, respiratory, and renal systems courses. Our results indicate the TBL curricular implementation resulted in more successful outcomes as measured by COMSAE scores.

CONCLUSION: The changes in the curriculum with the addition of TBL, resulted in an increased number of high grades (As and Bs) and decreased lower grades (Cs). The maximum score showed a significant increase (P <0.05) after implementation of TBL into the curriculum, and the minimum score post-TBL adoption indicated an increasing trend as well.


707 – OBSERVATION, OBSERVATION, OBSERVATION! ANOMALIES SEEN AND LEARNED FROM A PROSECTED CADAVER
Penprapa S. Klinkhachorn and Cody L. Mullens
West Virginia University

PURPOSE: Here, we share and discuss unique anomalies seen in a prosected cadaver, when observed very carefully and knowledgably. They include some rare anatomical variations and pathological conditions, which are rarely appreciated and perhaps unheard of with all of these variants in a single cadaver.

METHODS: The specimen was an 87-year-old male and was a muscular construction worker. The cadaver died of coronary disease and hyperlipidemia, with other co-morbid conditions including chronic kidney disease, type 2 diabetes, and Alzheimer’s disease.

RESULTS and DISCUSSION: Several interesting anomalies were observed during the prosection, and each was appreciated, measured, and photographed. A literature review was performed for each anatomical variant in order to determine each of their prevalence. They include a coracobrachialis muscle variation involving the median nerve and brachial vasculature, which had potential functional impact and surgical awareness. The second variation appreciated was a flat, transverse muscle in the extensor retinaculum of the right forearm, with hardly any literature reference. Thirdly, an ulnar nerve palsy was found below his right wrist. Atrophy was noticed in the hand’s intrinsic musculature innervated by this nerve. Fourth, a sizeable cyst was found along the cadaver’s left infraspinatus tendon with a smaller cyst found on the right side. Further inspection of the shoulder musculoskeletal anatomy demonstrated damage to the articular surfaces and synovial fluid leakage beyond the joint capsule.

CONCLUSION: This cadaver is an example of the importance of careful attention to detail when prosecting and dissecting specimens. Not only is this cadaver unique in a number of its variations but it also can be a useful clinical teaching tool for students to appreciate and compare normal and abnormal human cadaveric anatomy.


709 – Participation In Group Discussion In Team-Based Learning Exercises Correlates With Preparation In Female But Not Male Medical Students
Swar Vimawala, Kathryn C. Behling, Gonzalo A. Carrasco, and Osvaldo J. Lopez
Cooper Medical School of Rowan University

PURPOSE: We have previously demonstrated that Team-Based Learning (TBL) increases student success in our Infectious Diseases course at Cooper Medical School of Rowan University. Participation during group discussion in TBL exercises is essential to the effectiveness of this learning strategy. Factors contributing to student participation include preparation, personality traits, and comfort with group learning strategies. We hypothesize that better prepared students will have higher individual readiness assessment test (iRAT) scores and consequently, will speak more during group discussion.

METHODS: Eight groups of 6-7 students (n=49) were recorded during four TBL sessions during the four-week Infectious Diseases course. On-topic, individual, verbal participation was quantified and converted to percentages of time spoken within each group. These data were compared with iRAT and group readiness assessment test (gRAT) scores.

RESULTS: Overall data analysis demonstrated a significant positive interaction between iRAT scores and student participation (r2= 0.280, p <0.01), and between iRAT and gRAT scores (r2= 0.404, p <0.01). Subgroup analysis to examine possible differences between female and male participation showed a significant positive interaction between iRAT scores and student participation (r2= 0.265, p <0.01), and between iRAT and gRAT scores (r2= 0.350, p <0.01) in female students. In male students, we only found a positive interaction between iRAT and gRAT scores (r2= 0.506, p <0.01). Notably, male participation in group discussion was significantly higher than female participation (21.15% vs. 13.79%, p <0.01).

CONCLUSION: Our data suggest that student participation in TBL correlates with student preparation as measured by iRAT performance, and teams with better prepared students achieve higher gRAT scores. Although female students in our study participated less in group discussion, their percentage of participation is better correlated with their preparation, suggesting that their involvement in group discussion is related to their confidence in their knowledge of the subject discussed.


711 – Using Small Case-Based Learning Groups as a Setting for Teaching Medical Students How to Provide and Receive Peer Feedback
Emily Bird, Robert H. Carnahan, Neil Osheroff, Cathy C. Pettepher, and William B. Cutrer
Vanderbilt University Medical Center

Providing and receiving feedback is an integral part of the life of a physician. Feedback comes in many forms in the workplace; it may come formally through a structured supervisory relationship or informally through work relationships with peers or other healthcare professionals. In addition to receiving feedback, physicians routinely provide feedback to those with whom they collaborate with in order to provide the best patient care.¬†To better prepare medical students for the next step in their career, they need to be carefully, concretely, and intentionally taught how to provide useful peer feedback, as this is not an innate skill. Case-based learning environments represent a unique opportunity to teach feedback skills.¬†Students build a cohesive learning environment in this facilitated small group setting as they meet multiple times a week throughout the one-year pre-clerkship phase to work through the provided cases. Along their journey, students gain an intimate understanding of their peers’ strengths and weaknesses. They also become invested in achieving group success and learn through their own experience that a well-functioning team will accomplish considerably more than an individual will on their own.¬†We have developed a structured framework aimed at¬†improving the skills of trainees at both¬†giving and receiving face-to-face feedback from their peers. This method guides both the facilitator and the students through preparation, execution, and reflection upon the feedback process.