1. Team-Based Learning in Large Enrolment Classes Jonathan Kibble, PhD Christine Bellew, MD Lisa Barkley, MD University of Central Florida, College of Medicine

2. Disclosures 1. The authors have no financial or other conflicts of interest related to this lecture presentation. Lisa Barkley, MD Family Medicine Adolescent and Sports Medicine Christine Bellew, MD General Pediatrics Pediatric Nephrology Jonathan Kibble, PhD Physiology Assistant Dean for Medical Education 2. We are SME’s who are active TBL practitioners, we are not TBL “experts!”

3. Overview Jon UCF context Core features of TBL Christine Design considerations for an M2 renal pathophysiology capstone TBL Lisa Creating the right environment for TBL Student engagement and management of classroom processes All Questions and Panel Discussion

4. New Medical School – Expanding Class Sizes 2009 2010 2011 2012 2013 2014 2015.. 40 60 80 100 120 + IPE Small Class Dynamic Changed About Here

5. How Students Experience TBL Pre-class Study Individual Readiness Assurance Test Application of Course Concepts Group Readiness Assurance Test Group Formation TBL Orientation Peer Evaluation Phase I Phase II Phase III FEEDBACK OPPORTUNITIES: APPEALS FACULTY FACILITATION Michaelsen LK, Sweet M (2008). New Direct Teach Learn 116: 7-27; Parmelee D, Michaelsen LK, Cook S, Hudes PD (2012) Med Teach 34: e275-e287.

6. Theoretical and Evidence-Basis of TBL TBL = (Social) Constructivism Learner centered Teacher as guide Activities stimulate new mental frameworks building on prior knowledge Learning is active with authentic problems Focused reflection and feedback Peer learning and team skills strengthened Outcomes evidence ↑ Knowledge acquisition ↑ Weaker academic students ↑ Student participation ↑ Team performance ? Critical thinking Mixed student satisfaction! Hrynchak P, Batty H (2012). Med Teach 34: 796-801; Haidet P, Kubitz K, McCormack WT (2014). J Excell Coll Teach 25: 303-333; Burgess AW et al., (2014). Acad Med 89: 678-688; Fatmi M et al., (2013). Med Teach 35: e1608-e1624.

7. The 7 Core Elements of TBL Team formation process Readiness assurance process Immediate feedback methods In-class sequencing of learning activities “4 S applications” Grading incentive structures Peer review process Haidet P, et al. (2012) Acad Med 87: 292-299

8. “Renal TBL” session design: Background Faculty members Pediatric nephrologist Transition to from primarily clinical role to UME instructional role Adult nephrologist Experience in both GME and UME instruction Learning TBL from scratch University/program New medical school with evolving class size and curricular details Course M2 year Renal and GI systems module 3 blocks of material (renal, gastrointestinal, and hepatobiliary) Mixture of instructional methods used (lecture, small-group case discussions, self-learning modules, and TBL) Taught by multiple faculty members

9. The “Renal TBL”- Goals Application of material Review material Encourage keeping up Prevent “cramming” Correct misconceptions Develop critical thinking and clinical reasoning skills Accept a certain level of uncertainty Assessment TBL sessions meant to be a small fraction of the overall assessment

10. Renal TBL: Backwards design What did we what the students to be able to do? Begin by developing AFE that accomplishes goal Four S’s of TBL Significant problem Same problem Specific Choice Simultaneous reporting What will they need to know to do it? Base i/tRAT questions on the background content needed

11. Renal TBL: The AFE Develop Differential Diagnosis (free text – “gallery walk”) Develop Differential Diagnosis (free text – “gallery walk”) Limited H&P Clinical reasoning Correct misconceptions Clinical reasoning Correct misconceptions Select Further Work-up (MCQ – one better answer but no perfect answer) Select Further Work-up (MCQ – one better answer but no perfect answer) Clinical reasoning Make judgement calls Accept uncertainty Clinical reasoning Make judgement calls Accept uncertainty Results to further evaluation Choose Diagnosis (MCQ) Choose Diagnosis (MCQ) Choose Treatment (MCQ) Choose Treatment (MCQ) Case Wrap-up and closure Pair groups – 10 reasonable 20 groups – difficult to go thought Do not grade AFE “No right answer” – fight for “points” Goal Problem Solution

12. Creating the Right Environment

13. Setting the stage before class starts Create an orientation session Clearly discuss the rationale for using TBL and your goals for active learning Describe the roles for students and faculty and how the sessions will be conducted Discuss the grading schema

14. Other curricular activities It is helpful to look at the other courses that are occurring in the curriculum at the same time as your TBL Try to arrange activities so that they don’t overlap with major tests or assignments in the other classes Consider the time it will take to complete your readings or other pre- class assignments

15. Gaining student buy-in and engagement Allowing students to have a vote in the grading weights of TBL What should be graded? We have stopped grading AFE Appeals process that is fair and allows students to contribute Components of TBL builds in student accountability structures Individual (IRAT, peer evaluations) Group (GRAT, AFE activities)

16. Facilitating student discussions The process of simultaneous reporting of answers allows you to ask groups with a particular response to explain their rationale In general, don’t lecture or give your point of view too soon Wait for students to answer, rephrase and support comments and use open ended questions to keep the dialogue going Manage time to end the discussion and bring closure to the question

17. Managing conflict Contentious inter-team debate Disagreements with faculty about the right answer- use of appeals process Professionalism in disagreement- benefit of TBL process “I was able to learn about some of the practical considerations for handling difficult situations. Overall, this kind of take-away is what matters most”

18. Outcomes “The strength of this module was the opportunity to have active discussion in a forum of peers. This was very helpful for my morale, as it brought me closer to other students, and it taught many of us the skill of mindful discussions that are productive rather than abrasive.”

19. Questions/Discussion ?