Enhancing a Medical Student Clerkship with Team-Based Learning Matthew N. Goldenberg, M.D., Kristina Money, M.D. and Derrick Hamaoka, M.D. Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD  Team-based learning (TBL) is an instructional strategy that has been increasingly used over the past decade in a number of educational venues including medical schools.  TBL places particular value on cooperation between student team members and on using class time for active, applied learning.  One medical school implemented TBL in its psychiatry clerkship and published data indicating improved student satisfaction and superior standardized exam performance.  At our institution, the didactic portion of the psychiatry clerkship had been conducted in a lecture-based format with little prescribed active student participation. Students traditionally rated the lectures as fair, and some cited a desire for more participatory learning.  In order to increase student participation in and satisfaction with the didactic portion of our psychiatry clerkship, we have transitioned from the lecture-based format to a TBL format to teach core topics in clinical psychiatry. PRE-CLASS ASSIGNMENTS RATIONALEINSTRUCTIONAL PROCESS Pre-class Assignment Individual Readiness Assurance Test (IRAT) Group Readiness Assurance Test (GRAT) Challenges Application Exercise(s) FUTURE DIRECTIONS Patient Voices Series TopicsApplication Exercise Orientation Interviewing and Assessment Psychiatric Emergencies Mental Status Examination Videos Case-based Exercise: Suicide Risk Assessment Week 1 Mood Disorders Adjustment Disorders Bereavement Mood Disorders Map Case-based Exercise: Choosing an antidepressant Week 2 Med/Psych Interface: Cognitive Disorders Eating Disorders Somatoform Disorders 3Ds (Dementia, Delirium, Depression) Card Sort (from SLU) Case-based Exercise: Somatoform Disorders Case-based Exercise: Decisional Capacity Week 3 PTSD Anxiety Disorders Substance Use Disorders Sleep Disorders Substance Disorder Card Sort Case-based Exercise: Combat Stress Control Case-based Exercise: Anxiety Disorders Week 4 Psychotic Disorders Violence Biology of Mental Illness Evidence-Based Exercise: Managing Agitated Behavior Antipsychotic Effects Card Sort Week 5 Childhood Disorders Personality Disorders Defense Mechanisms Case-based Exercise: Personality Disorders (from UTMB) CURRICULUM  Weekly Quizzes based on reading assignments.  10-questions, multiple-choice format.  Students take quiz individually first, then take same quiz as a team.  10 minutes for IRAT, 10 minutes for GRAT.  Teams get instant feedback via scratch-off answer sheet.  Teams may challenge answers via written appeals process.  Results:  minute activities  Teams work together to solve problems, accomplish tasks  Various Formats: Multiple-choice questions, card sorts, product generation  Open book, ungraded  Examples: Mood Disorders Map  Goal: Distinguish phenomenologies of various mood disorders from each other  Activity: Each team is given a poster and several colored markers and is asked to draw a “mood graph,” plotting the symptom and time course of various mood disorders or related phenomena (e.g. major depressive disorder, dysthymia, bipolar disorder I and II, schizoaffective disorder, bereavement, adjustment disorder). Mood is on the y-axis (in quality), and time is on the x-axis (in years). Words or illustrations can be added to graph to differentiate some of the syndromes. Suicide Risk Assessment  Goal: Identify static and dynamic risk and protective factors for suicide in clinical cases. Discuss rationale for clinical decision-making (including hospitalization) of suicidal patients.  Each team is given a written case of a patient who presents with depressive symptoms and passive suicidal ideation. From the case history, they develop lists of risk and protective factors and present their lists to the class for comments/critiques.  Each team is then given a series of five clinical vignettes of suicidal patients. They must list three concerning features of each presentation, and rank order the cases in terms of acuity/severity and need for hospitalization.  Cull evaluations of the clerkship to determine student satisfaction with TBL-based instruction.  Examine NBME Psychiatry exam scores to determine any trends since implementation of curriculum.  Use peer feedback in overall clerkship evaluation narrative.  Publish and otherwise disseminate teaching materials including both readiness assurance tests and application exercises.  Modify existing quizzes and exercises as needed and continue to develop other educational tools.  Incorporate TBL into other educational endeavors at institution, especially with curriculum reform efforts. REFERENCES/ACKNOWLEDGEMENTS  Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Eds. Larry K. Michaelsen, Dean X. Parmelee, Kathryn K. McMahon, Ruth E. Levine, (2007).  Levine, Ruth et al. “Transforming a Clinical Clerkship with Team Learning,” Teaching and Learning in Medicine, 16(3), , (2004).  Special thanks to the Team-Based Learning Collaborative and particularly to Ruth Levine, M.D. at UTMB for inspiring the incorporation of TBL into the psychiatry curriculum at USUHS. READINESS ASSURANCE APPLICATION EXERCISES