Adapting Team-Based Learning for Medical Education: A Case Study with Scalable and Resource-Efficient Implementation

Abstract

Purpose Team-based learning (TBL) is a structured collaborative learning strategy where students are able to apply conceptual knowledge in small groups through a sequence of activities comprised of preparation, individual readiness assurance testing, teamwork, and team readiness assurance testing, typically followed by an application exercise. TBL has been gaining popularity in many education institutions and programs across the world and in the USA. This study marks the beginning of implementing TBL as a major active learning modality at Texas Tech University Health Sciences Center School of Medicine. Through this initiative, we present TBL as a versatile and adaptable method to improve students’ learning and examination outcomes. Methods TBL sessions are conducted in three steps: pre-class preparation, in-class readiness assurance testing, and application-focused exercise. The present study used a modified or abbreviated format, consisting of pre-class preparation and in-class individual readiness assurance test (iRAT) and team readiness assurance test (tRAT) followed by immediate feedback. A Pilot Phase was used to engage early-adopter faculty and optimize session parameters, and an Implementation Phase was used for one organ system, with both phases in the pre-clerkship curriculum and a class size of 180 students. During the Pilot Phase, student participation was voluntary, whereas in the Implementation Phase, participation counted towards a selective session attendance requirement. Therefore, student numbers were significantly smaller during the Pilot Phase supporting gradual optimization of session organization. Results iRAT, tRAT, and summative end of organ system section National Board of Medical Examiners (NBME) scores were analyzed. We find that participation in an increasing number of TBLs was associated with increased iRAT scores and a decreased performance gap between highest and lowest performers, where the increase in the scores of lowest performers was more substantial than the increase in the scores of highest performers. NBME score analysis showed that TBL participation increased examination performance by an average of 2.4% per TBL session attended. Conclusions We present an implementation strategy for TBL sessions using a two-phased approach. Our process implementation provides a clear roadmap for other health professions or medical schools to implement TBL format sessions in their specific educational context. Importantly, the unique, abbreviated TBL format presented here facilitates implementation and adaptation. Observed learning strategies during tRAT that have been demonstrated to be effective include elaboration, dual coding, specific examples, interleaving, and retrieval practices. Overall, the results indicate a positive impact of TBL participation on final summative exam scores.