1. Team Based Learning Session Maj Dave Honeycutt Capt Matthew Hawks Capt Frederick Nielson Nellis Family Medicine Residency, Las Vegas, NV

2. Objectives for this session O Identify teaching situations and topics ideal for Team Based Learning (TBL) O Design and implement your own individual/team readiness assurance tests (iRAT and tRAT) O Learn how to guide your own TBL session

3. The reality of Powerpoint O Different formats for learning O Active learning vs. lecture O Jeopardy style game O Watch video, ask for responses O Novel: Team Based Learning Prince M. Khan MN1.

4. Team Based Learning “A special form of collaborative learning using a specific sequence of individual work, group work and immediate feedback to create a motivational framework in which students increasingly hold each other accountable for coming to class prepared and contributing to discussion.”

5. Team Based Learning O In practice: O Students responsible for reading prior to session O Individual readiness assessment O 5 to 15 multiple choice questions O Team readiness assessment- same questions, but with one answer sheet for team O Time for discussion and appeals O Application of learning to cases, following the tRAT O Significantly reduces teacher time in front of group Haidet P.

6. Team Based Learning

7. TBL scoresheets O Classic TBL scoresheets

8. Nellis FMR implementation O No scorecards O Logistics O Cost O Ability to have multiple correct answers www.epsteineducation.com

9. Nellis FMR implementation O Four topics covered O Hypertension O Hyperlipidemia O Type 2 diabetes mellitus O Preventive medicine O One topic a week, two lunchtime lectures O First day: iRAT and tRAT O Second day: patient cases and application

10. Examples of questions Good TBL questions draw knowledge from the material Glycemic control targets include the following O Hgb A1c O Fasting blood sugar O Pre-prandial blood sugar O Post-prandial blood sugar O C-peptide levels

11. Examples of questions According to the AACE, this is the goal A1c for T2DM patients (select all that apply) O A1c<7% in younger, healthy individuals at low risk for hypoglycemia O A1c<8% in older patients at risk for hypoglycemia O A1c<6.5% in the majority of patients, modifying for hypoglycemia risk and other adverse outcomes O Allow the patient to determine their own A1c goal through informed discussion

12. Nellis FMR implementation O Beginning and end of rotation quizzes O Covered all four topics O Results O TBL resulted in improvement in retained knowledge in all four topics O One preventive medicine question discarded

13. Preventive Medicine 1. Selects appropriate cancer screening in asymptomatic adults 2. Identifies patients meeting screening criteria for common diseases (chlamydia, diabetes, AAA, depression)

14. Hypertension 1. Initiates anti-hypertensive therapy with an appropriate first-line agent based on gender and race 2. Establishes correct blood pressure target for patients with T2DM 3. Modifies blood pressure to correct target for patients over 60 without CKD

15. Hyperlipidemia 1. Evaluates patients for benefit from statin therapy based on risk factors 2. Discerns accurately between varying statin intensities (low, moderate, high)

16. Type 2 Diabetes Mellitus 1. Sets optimal therapy control target (Hgb A1c) for patients on oral therapy and low hypoglycemic risk 2. Adds insulin therapy appropriately for uncontrolled diabetes based on history, prior drug therapy, and current A1c

17. Medical student feedback O “helped me learn the guidelines much better than I would have on my own” O “Allowed for personal and group learning. Encouraged clinical application of learning with cases” O “Things to improve: make sure we get readings the week before they are due”

18. Our Experience O Enjoyable activity for learners O Enjoyable for instructor O Prepare ahead of time: readings, questions O Relaxed environment O Can be completed without scorecards O Results in significant learning

19. References O Prince M. Does Active Learning Work? A Review of the Research. J Engr. Education, 93(3), 233-231 (2004). O Khan MN1, Telmesani A, Alkhotani A, Elzouki A, Edrees B, Alsulimani MH. Comparison of jeopardy game format versus traditional lecture format as a teaching methodology in medical education. Saudi Med J. 2011 Nov;32(11):1172-6. O Haidet P et al. A Controlled Trial of Active Versus Passive Learning Strategies in a Large Group Setting. Advances in Health Sciences Education, 03-2004, Volume 9, Issue 1, pp 15-27Issue 1, pp 15-27 O Michel N, Cater JJ, Varela O. Active Versus Passive Teaching Styles: An Empirical Study of Student Learning Outcomes. Human Recourse Development Quarterly, vol. 20, no. 4, Winter 2009. O Runshe DD. Best Practices in College Teaching, Creating an Active Learning Environment (powerpoint presentation). Content Downloaded on 4 September 2014 from: http://www.google.com/url?url=http://www.innovativeeducators.org/v/vspfiles/IEfiles/a ctivelearning2010.ppt&rct=j&frm=1&q=&esrc=s&sa=U&ei=DmkIVOPbEIiSgwSL04DYBQ &ved=0CB4QFjAE&sig2=TCVUdqSdWgMOvYSLzuXLpQ&usg=AFQjCNHfjAL- XF7PTqtyVh6SD01R1WByHQ O What Is Active Learning? University of Minnesota. Center for Teaching and Learning. Office of Human Resources. Content Downloaded on 4 September 2014 from: http://www1.umn.edu/ohr/teachlearn/tutorials/active/what/ O Sibley S, Spiridonoff S. Team based learning. University of British Columbia.