2019 Meeting Posters – TBL/PBL

Poster Award Nominee
– “Describe What You See”: A Pilot Project in Converting Problem-Based Learning from Text to Videos in Preclinical Medical Student Psychiatry Education
Mary Steinmann and Sean Ferrell
University of Utah

PURPOSE Problem-Based Learning (PBL) is a commonly-utilized teaching method in preclinical medical student education.  PBL consists of cases that students work through in small groups with a faculty facilitator, who may or may not be a content expert.  At our institution, the cases are typically presented in text format with progressive disclosures as the case unfolds.  However, important psychiatric concepts, including mental status examination findings, are difficult to learn.  Video has been used widely in psychiatric teaching. In an effort to improve student engagement and understanding of observable psychiatric findings, we developed and piloted a series of progressive-disclosure cases that use videos of simulated psychiatric patient encounters to stimulate small group discussion and problem solving, facilitated by faculty who are not content experts.

METHODS Three progressive-disclosure video cases were developed to teach depression, psychosis, and peripartum mood disorders.  The videos employed psychiatric residents as actors to reduce cost and enhance authenticity.  The cases were piloted during weekly 1-hour PBL sessions in the second-year medical student Brain and Behavior course.  A separate facilitation guide was developed describing key teaching points of each case disclosure, and offering suggestions to help faculty who were not experts in behavioral health facilitate student discussion.  A 30-minute training session was held with faculty facilitators prior to each session to review the case and answer questions.  The activity was assessed on standard end-of-course evaluations.

RESULTS 120 second-year medical students participated in the pilot project.  Each case took approximately 1 hour for groups to complete.  92% of students on end-of-course evaluations reported that the videos used in PBL increased the authenticity of the cases.  91% of students reported that PBL sessions enhanced their learning of course content.

CONCLUSION Video-based PBL is an engaging method to teach psychiatric principles including mental status examination/observation, diagnosis, and treatment in preclinical psychiatric education.

501 – Transformation of Didactic Medical Content to Interactive Video Lectures (IVL) – Mass Production
Alice Akunyili, Hany Ibrahim, Kanee Lerwill, and Rodolfo Bonnin
Herbert Wertheim College of Medicine

PURPOSE Conversion of didactic lectures in the curriculum at Herbert Wertheim College of medicine into an innovative instructional method, Interactive Video Lectures (IVL), seeks to transform medical content into e-Learning options that apply learning science and data science to improve access to medical education, fit remote audiences and allows flexibility of content delivery and adaptive learning, or learner controlled content sequence.

METHODS The first step was to identify the utility of IVL within the larger framework of our curriculum, and garner support from key stakeholders. Our team of physician educators had a mandate from the administration, so the challenge was to secure the support and the resources from faculty, staff, and other key stakeholders. The second step was to assess the feasibility of transforming complex didactic content and determining which parts of the curriculum could be converted efficiently. The final step was to design a quality assessment and improvement process using a standardized rubric incorporated into a production process that can be scaled.

RESULTS  To achieve our objective of transforming didactic lectures to IVLs, we created a process aimed at efficiently developing and converting large amounts of medical content. In essence, we created an assembly line for IVLs. It is a production process in which elements of the IVL are added as the semi-produced IVL moves from one station to another in a specific sequence, until the IVL is fully produced. Each station has functions specific to the elements being incorporated. Quality checkpoints are positioned at different stations throughout the assembly.

CONCLUSION Aligning institutional objectives with production capability and subject matter expertise is a major challenge of e-Learning transformation in Medical Education. Creating an IVL assembly line allows for efficiency and quality checkpoints, and can be scaled up or down according to the purpose, resources, priorities, timeline and quality requirements.

Jennifer R. Amos , Jaya Yodh, Stephanie Ceman, Kashif Ahmad, and Kaustubh Bhalerao
Carle Illinois College of Medicine and University of Illinois at Urbana Champaign

PURPOSE Carle Illinois students start off their medical curriculum with a Foundational Elements course based on the NBME outline for ā€œFoundational Contentā€.  This course is meant to normalize and assess proficiency of students entering the program from many different backgrounds.  The course also aimed to compare learning from Team-based Learning (TBL) and National Board of Medical Examiners (NBME) style quizzes.

METHODS In a foundations course based on the NBME outline for ā€œFoundational Contentā€, both TBL and weekly quizzes using NBME style questions were used to assess student understanding of content across genetics, biochemistry, immunology, physiology, and cell biology. IRB was obtained and students consented to participate in the study.  The students participated in a weekly TBL, consisting of an individual readiness assessment test, group assessment and applications activity, based on pre-readings and lectures.  The students also participated in weekly quizzes formed using NBME style questions matched by course objectives and keywords from question bank. At the end of the course students took a NBME subject exam based on Foundations content and 29 students consented for sub-scores to be released for analysis.

RESULTS Scores for TBL and weekly quizzes were compared using a Pearson correlation by topic and by week.  Correlations for topics ranged from 0.20 to 0.50 and correlation for weekly performance was between 0.2 and 0.4 but overall average performance on quizzes and IRATs was 0.68.

CONCLUSION Well-written TBL IRATs can be indicative of student performance on high stakes exams in the same way that correlates with NBME style quiz indicators for student performance.

503 – Student Physical Therapist Use of Digital Textbooks and Electronic Media
Debbie Ingram
University of Tennessee at Chattanooga

Purpose: Digital textbooks have become an attractive option for students, faculty, and administrators (Daniel). Researchers have discovered several unique advantages to digital textbooks including features such as interactive learning modules, multimedia experiences, references, and resources for topics of interest (Keena). Staiger found that students enjoyed the search feature, as well as the ability to electronically highlight, bookmark, and annotate. Eno found that nursing students appreciated the lighter weight and significant reduction of paper. Rockinson et al. found that students who used digital textbooks for their courses ā€œhad significantly higher perceived learning and psychomotor learning.” Multiple authors have reported students prefer printed textbooks over digital. The purpose of our study was to identify the perceptions and use of digital textbooks and electronic media by doctoral physical therapist (DPT) students.

Methods: A 30 item survey instrument was created by the authors and distributed electronically using Qualtrics. The survey addressed use and preference of traditional books vs. digital texts. Students from 2 DPT programs in different regions of the country completed the survey.

Results: 125 DPT students completed the survey (48%). The majority (72%) were female. Most of the students owned devices capable of viewing digital texts (98%). 7% had previously purchased a digital textbook and 78% preferred to purchase printed texts. Students preferred digital textbooks for portability (83%), lower costs (72%), and easiest means to search subject matter (57%). Printed texts were thought to be easier to read (91%), less tiring on the eyes (95%), improved comprehension (86%), easier to remember material (88%), easier to use for exam preparation (83%), and more suited to some individual learning styles (86%).

Conclusions: The findings from our study mirror the findings of previous studies. It is important for DPT programs to be familiar with innovative new educational strategies such as digital textbooks and electronic media.

504 – Implementation of Team-Based Learning (TBL) in a Second Year Medical School Course: Does Prior Experience with TBL Improve Impact of this Pedagogy?
Gonzalo A. Carrasco, Matthew Gentile, Michelle L. Salvatore, Osvaldo J. Lopez, and Kathryn C. Behling
Cooper Medical School of Rowan University and Hackensack Meridian School of Medicine at Seton Hall University

PURPOSE: TBL has been used in several educational environments including medical education.  At our institution, we have shown that use of TBL in a first-year Infectious Diseases (ID) course resulted in improved final examination performance and fewer course failures.  Therefore, we decided to implement TBL in the second-year Womenā€™s Health (WH) course to improve acquisition of course content related to sexually transmitted infections (STI).   Here we examine how prior experience with TBL in the ID course affected TBL performance, approximately 12 months later, in the WH course.   

METHODS: The ID course has weekly TBL exercises that cover all the course material, while the WH course has one TBL that only covers a small portion of the course material (STI). Final examination and TBL individual readiness assurance test (iRAT) scores in the ID and WH courses from three classes of students (n=226) were obtained with Rowan institutional review board approval.  Statistical analyses were performed using IBM SPSS Statistics (IBM Corp., Armonk, NY).   R

ESULTS: As we previously reported in the ID course, WH iRAT scores were significantly correlated with WH final examination performance (r=0.33,p<0.001).  Additionally, individual student average iRAT scores in the ID course were highly correlated with ID (r=0.45,p<0.001) and WH (r=0.31,p<0.001) final examination scores, as well as with iRAT scores in the WH course (r=0.35,p<0.001).  Finally, WH iRAT scores were significantly higher than individual student average ID iRAT scores (9.19 vs. 7.40, p<0.0001).   

CONCLUSIONS: We have previously reported that TBL-iRAT scores are predictive of performance on summative course examinations of medical knowledge.  In this study, we found that TBL scores are also predictive of future performance in other courses. Interestingly, the current study also suggests that prior TBL experience likely contributes to better TBL performance, as measured by iRAT scores, in future courses.

Jaehwa Choi, Hye Young Yoon, and Robert McKallip
Mercer University School of Medicine

PURPOSE The SPICES model of educational strategies has been implemented for curriculum development by many institutions. It is a student-centered (versus teacher-centered), problem-based (versus information-gathering), integrated (versus discipline-based), community-based (versus hospital-based), elective (versus uniform), and systematic (versus apprenticeship-based) approach. To help studentsā€™ learning in basic medical sciences, a student-centered and integrated summer cardiology course named Summer Cardio Camp was developed.

METHODS In an organ-based basic medical science curriculum, cardiology is undoubtedly one of the most challenging topics. It is particularly challenging for those who have not had any foundational courses in physiology. Thus, the goal of Summer Cardio Camp was to guide students for self-directed preparatory learning in medical cardiology by providing asynchronous online mini-courses. First, an institutional subscription to a series of commercially available online lectures was made available to all students. Among over 100 hours of lectures in cardiovascular physiology, pharmacology, and pathology, a selected list of lectures that could fit in a 4-week self-studying program was prepared. Relevant readings of textbooks were provided to students as well for those who preferred to read than listen to the lectures.

RESULTS This course was offered not as a mandatory but as a non-credit earning, voluntary mini-course. Weekly assignments were given to the students. Faculty gave immediate feedback on their assignments. Studentsā€™ feedback from the course evaluation varied from enthusiastic to uninterested.

CONCLUSIONS In conclusion, a student-centered and integrated mini pilot course  which was not mandatory but self-directed with guidance by a teacher  was developed to aid students in learning cardiology. To enhance the effectiveness of self-directed learning, the timing and duration of the mini-course will be re-designed based on studentsā€™ feedback and their performance on the summative exam.

Amanda J. Chase, Daniel Griffin, and Patricia C Rose
Nova Southeastern University

PURPOSE: Team-based learning (TBL) has emerged in medical curricula as an educational method that promotes learning of the foundational and health sciences. Our curriculum begins with a fundamentals course which includes active learning and TBL sessions facilitated by content experts who design content around their discipline. The fundamentals course is followed by integrated systems courses. For the systems courses, we developed TBL sessions that emphasize synthesis of integrated content spanning several disciplines. This methodology involves a process referred to as scaffolding, whereby students learn foundational concepts in isolation during the fundamentals course and then synthesize these concepts in combination with multidisciplinary learning objectives in subsequent courses.

METHODS: Our TBL process follows traditional best practices established by the TBL Collaborative. To transform TBL sessions in our integrated systems courses we modify the content and delivery of each session, using interprofessional teams to achieve integration and higher order learning. To add to this, content is presented and assessed using clinical scenarios that integrate multidisciplinary learning objectives.

RESULTS: We present approaches and challenges to the transformation of discipline-based instruction into integrated TBL experiences. In addition, we present outcomes of assessment on learning objectives between the fundamentals and systems courses. To assess the impact of redesigned TBL, we describe results of a survey to assess the studentsā€™ perspective of engagement.

CONCLUSIONS: Our measured approach to introducing integrated TBL sessions exemplifies the scaffolding process by which learners develop stronger metacognitive skills when they are exposed to concepts in isolation prior to applying them in combination. Future directions include evaluating outcomes over several consecutive student cohorts.

Paige McDonald, Howard Straker, Jacqueline Barnett, and Gregory Weaver
George Washington University School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences – Physican Assistant Program, and Duke University School of Medicine Physician Assistant Program

PURPOSE Learning Health Systems (LHS), proposed as a model to integrate evidence for continuous quality improvement and learning, require connections between the healthcare education and delivery systems. Faculty leveraged blended learning in a Physician Assistant (PA) course sequence to connect the classroom and clinic for active learning. Through online technologies, we connected students in the classroom with clinicians from clinics with diverse patient populations to develop quality improvement projects addressing current disparity concerns within the clinical setting (C4Tech). This pilot seeks to understand if C4Tech can bridge the classroom/clinic divide for authentic learning and practice improvement.

METHODS Investigators adopted a case study approach to access the efficacy of the educational intervention. Multiple assignments-community/clinic profiles, VoiceThread presentations, and final Performance Improvement Continuing Medical Education (PICME) projects-were analyzed for overall and highest level of learning using Bloom’s Taxomony of learning domains. Final PICME projects were also analyzed for integration of course concepts, clinic knowledge, and evidence for practice improvement.

RESULTS Community profiles exhibited wide variation in overall and highest level of learning, with 5 out of 8 teams achieving ā€œapplyā€ as the highest level. VoiceThread presentations exhibited less variation in highest and overall level of learning, with 6 of 8 achieving ā€œevaluateā€ as the highest level. All 8 PICME projects achieved integration of course concepts, clinic, knowledge and evidence for practice.

CONCLUSION Application of the C4Tech model promotes high levels of learning and knowledge integration. It can also bridge the classroom and the clinic for active learning and quality improvement. Additional research is required to determine the factors that influence variation in the levels of learning achieve across clinic/student teams. Future applications of the model should consider the impact on quality metrics or patient outcomes as well as clinician learning.

Poster Award Nominee
– Evaluation of Premedical Module at Duke-NUS Medical School
Lee Cheng Jie Irene and Sarada Harichand Bulchand
Duke-NUS Medical School

PURPOSE: Duke-NUS medical school, a graduate entry medical school, the first in South East Asia, adopts Team-based learning (TBL) in delivering preclinical content. To recruit prospective MD students, we developed a Premedical Module using TBL as the main pedagogy to drive critical thinking and communication skills.  The module, runs for 16 weeks, and is offered to local undergraduate students across faculties. This abstract describes the project and its outcomes.

METHODS: The module has run for 7 years. A wide range of topics in biomedical science were delivered in TBL format together with team assignments and field trips. The course was facilitated by research fellows. Students who completed the module with outstanding performance were shortlisted as Premed Scholars. These individuals received clinical shadowing experience to gain insight into the roles of medical professionals in Duke-NUS. To evaluate the effectiveness of the Premedical module as a recruitment tool, we analyzed studentsā€™ reaction to the module, using thematic analysis on session evaluation reports, and also determined the application and acceptance rate to the MD programme.

RESULTS: 169 students took the module from 2010 to 2015. 91 students were selected as Premed Scholars. Common perceptions of the module included an enriching exposure to different aspects of cutting edge medical research, and a positive learning experience through TBL which gave an insight into the unique pedagogy used at Duke-NUS. On average, in each academic year, 24% of Premedical modules takers applied, and among those who applied an average of 72% were accepted to the MD programme. Among the Premed Scholars, on average 50% applied and 78% were accepted to the MD Programme.

CONCLUSION: The Premed module provides an opportunity to attract high quality candidates. Experiencing the same teaching pedagogy of the MD programme, and routine engagement with the medical school facilitates quality applicants and entrants to the MD programme.  

510 – Optimization of small group learning
Mark Best, Anthony Pappas, Mark Coty, and Swapan Nath
Lake Erie College of Osteopathic Medicine Bradenton and TCU and UNTHSC School of Medicine

PURPOSE Currently medical education strategies and processes have incorporated or focused on active learning (including collaborative learning) for knowledge acquisition for practice, education program objectives (including teamwork, interpersonal and communication skills and professionalism), and outcome measures (including national board scores, formative assessments by educators). Continuous improvement of our ability to impact self-regulated learning, clinical reasoning, medical knowledge, professionalism, and teamwork skills is necessary.  Improving educational quality/effectiveness, increasing educational efficiency, and increasing student and facilitator satisfaction are the goals of this synthesis.

METHODS This synthesis is based on neurobiology of learning, cognitive psychology theories (e.g. metacognition, transdisciplinary thinking, cognitive integration), process management methods, quality improvement techniques, and implementation science. We use Google Scholar, ERIC, and MEDLINE for our literature search. Inclusion criteria key words are: team-based learning, problem-based learning, case-based learning, case-based collaborative learning, cognitive load theory, integrating basic sciences and clinical content and experiences, learning environment, memory, encoding and retrieval, sensory processing, experiential learning, reward and reinforcement, implementation science. Exclusion criteria is non-English publications.

RESULTS A critical synthesis of small-group instructional designs for active learning, including team-based learning (TBL), problem-based learning (PBL), case-based learning (CBL), & case-based collaborative learning  (CBCL), describes the structure, constraints, processes, and outcomes, and compares and contrasts these strategies. We simplify an optimal design and processes to increase cognitive knowledge and experiential knowledge in the learning environment.

CONCLUSION This review provides educators with a summary of what works well for small-group instructional designs, within the time constraints and other limited resources, to assist them in operationalizing the optimal studentsā€™ educational experience for the needs of their patients, or community.

Surya Khadilkar and Lynn Cialdella-Kam
Case Western Reserve School of Medicine

PURPOSE: Currently, limited curriculum time is dedicated to nutritional content and many medical students lack confidence in applying their nutritional knowledge to a clinical context. A team-based learning exercise (TBL) was implemented in the Case Western Reserve School of Medicine (CWRU SOM) curriculum during the preclinical nutrition, gastroenterology and biochemistry block to increase nutritional knowledge and confidence. We investigated if TBL is an effective modality to educate students on the fundamentals of nutrition and increase retention of this information.

METHODS The TBL exercise was implemented into the required preclinical curriculum for first year medical students. In order to evaluate the efficacy of the team-based learning session, an optional posttest was administered both to students who received the intervention and to a randomly selected medical student cohort that did not participate in the educational intervention, and their results were compared.

RESULTS The TBL has been implemented in for current the first year medical students. In 2018, 18 first year students and 14 second year students (total n = 31, yr. 1-2) completed the posttest survey out of a possible 50 randomly selected students in each year level respectively. Based on student evaluations of the TBL faculty, students indicated that: 1) have valued the the TBL exercise as an educational modality  and 2) enjoyed the input from the facilitators.

CONCLUSION A lack of basic understanding in nutritional counseling motivated us to seek out a new opportunity to incorporate more nutritional content into the curriculum. The intervention appears to have a positive influence on studentsā€™ confidence in nutritional knowledge. Further steps include interventions to test the retention or change in both knowledge and confidence.