1. Team Based Learning Faculty Development Program Office of Medical Education Boston University School of Medicine 2005

2. Learning Objectives : Define Team Based Learning (TBL) Describe the four essential principles of Team-Based Learning Identify the benefits of Team- Based Learning List the steps to implement Team-Based Learning in a course What is TBL? What makes TBL? How to do TBL? Why use TBL? By the end of this presentation, you will be able to:

3. Team Based Learning * Small groups of students interact as in-class teams to apply content to simple and complex problems with the feedback of the instructor as the content expert. Individual learns assigned teacher-specified content Pre-class Student teams apply teacher-specified content to problem-solving discussions In-class Students receive frequent and immediate feedback During class *Team Based Learning was developed in the 1970’s by Dr. Larry K. Michaelsen, a Professor of Management at the University of Oklahoma, who wanted to change the passive learning in his lectures into active learning by testing and assigning students to teams. What is TBL?

4. Team-Baased Learning Process What is TBL? Individual Work Small Group Discussion Total Class Discussion XX= Impact on Learning Phase 1 Preparation (Pre-class) Phase 2 Readiness Assurance (In-class) Phase 3 Application of Course Concepts Individual Study Individual Test Group Test Instructor Feedback Small Group Assignments Team Appeals

5. Phase 2: Readiness Assurance Test Procedures Individual Test Closed Book 3pts/question Answer both on test and answer sheet Answer sheet goes in Team folder Team Test Closed Book 3pts/question Place Team # on answer sheet Use score sheet for grading Appeals Open book Show evidence from reading Questions & Discussions Clarify issues What is TBL?

6. Phase 3: Application-Focused Assignment Groups apply the fundamental concepts of the unit to a problem (50% class time) to produce an answer, product or idea Examples –answer a multiple-choice question set of 3 for a case vignette –develop a treatment plan (essay) –justify your diagnosis –explain the difference –compile a list of manifestations What is TBL?

7. Team -Based Learning FAQs* 1.How much material can be covered in Team-Based Learning? The same or more material can be covered in TBL as in traditional lecture format. 2.What is the most important element in Team-Based Learning? Team-Based Learning, Student Preparation, Readiness Assessment and Group Activities are the elements of Team-Based Learning and are equally important. 3.Where in medical education has Team-Based Learning been used? Team-Based Learning has been used in large group pre-clinical classes and clinical classes for 3 rd and 4 th students and residents. 4.What is the role of the faculty in Team-Based Learning? As the content experts, Faculty plays an active role providing feedback to the students, introducing new material and challenging the students with new questions. *From Baylor College of Medicine, Team Learning in Medical Education, February 04 Workshops What is TBL?

8. Team-Based Learning Course Objectives By the end of the course, the student will be able to: Master the course subject matter Utilize the course concepts in thinking and problem-solving Develop interpersonal and group interaction skills Prepare for life-long learning *From Baylor College of Medicine, Team Learning in Medical Education, February 04 Workshops What is TBL? Purpose of Team-based learning Meets LCME guidelines Similar to lecturing

9. An Alternative to Lecturing Lecture Faculty identifies content to student in the syllabus and in lectures Pre- class: Student “might” study concepts In class: Student passively takes notes Student accountability: Student study notes for final exam Lecture Faculty identifies content to student in the syllabus and in lectures Pre- class: Student “might” study concepts In class: Student passively takes notes Student accountability: Student study notes for final exam Team Based Learning Faculty identifies content for pre-class assignments, the syllabus and group interaction Pre- class: Student “must” study concepts for test In class: Student is tested on concepts and actively joins Team to solve simple and complex concept applications Student accountability: Student pre-class work and tests, Team tests and work, and final exam Team Based Learning Faculty identifies content for pre-class assignments, the syllabus and group interaction Pre- class: Student “must” study concepts for test In class: Student is tested on concepts and actively joins Team to solve simple and complex concept applications Student accountability: Student pre-class work and tests, Team tests and work, and final exam What is TBL?

10. What is the TBL Difference*? LectureProblem-Based LearningTeam-Based Learning Key pointsInstructor provides content for student note-taking in a hall Student-directed learning in solving real world problems in small groups Instructor-directed content applied to real world problems by student teams in a lecture hall Teaching Methods Lecturer didactically provides content Facilitators give cases and students analyze facts to solve case Students prepare content before class. In class, they apply it in teams to solve problems OutcomesContent acquisition and conceptual understanding Problem-solving abilities, critical reasoning, content acquisition, understanding, effective communication and small group interaction Content acquisition, understanding, content application to solve problems, critical reasoning, effective communication, collaborative team work Instructor’s role Identifies learning objectives, prepares presentations and answers student questions Facilitates small group discussions and gives students feedback and guidance as needed Identifies learning objectives and content, prepares readiness tests, answers student questions and prepares application assignments for team work Student’s role Attend lecture, study notes, prepare for exam Identify learning issues, do independent out of class research, join group discussions Do independent out-of-class study, join team discussions, defend team solutions to class *Table excerpted from Baylor College of Medicine, Team Learning in Medical Education, September 2002 What is TBL?

11. Can You Differentiate Small Group Learning? Casual –After a 15-20 minute lecture, students pair with a neighbor and discuss a question and some share their answers with the class –Breaks up lecture and requires little advanced planning, but provides little significant learning Collaborative or Cooperative –Frequent use of structured student activities –Requires planning, but does not alter structure of course Transformation or Team-Based Learning –Individual students commit to team effort –Requires transformation of course, student groups into teams and quality of learning What is TBL?

12. 4 Essential Principles of TBL* No matter how you customize your TBL class, you must have these 4 principles or TBL will not work: 1.Properly formed and managed groups 2.Student accountability for pre-class preparation and team performance 3.Team assignments that promote learning, group interaction and team development 4.Frequent and immediate student feedback provided through RATS and application-focused team assignments What makes TBL? *From Michaelsen, Larry K. “Getting Started with Team Learning.”

13. Essential Element: Group Formation Group Cohesivesness Developed –Minimize barriers by avoiding previously established groups –Mix students to establish new groups from ground up Group Resources Distributed –Assets: life and work experiences, previous courses, etc. –Liabilities: no previous experience, limited fluency in English –Evenly distribute resources for learning teams to work effectively Group Size –Large enough to maximize resources (5-7 members) –Large enough to allow full participation of members Group Permanency –As groups become teams, communication is easier and helps learning –Teams members willing to challenge each other for success of team What makes TBL?

14. Essential Element: Student Accountability Pre-class Preparation –Readiness Assurance Test evaluates pre-class preparation –Individual preparation necessary for Group Test and Team work Contribution to Team –Peer assessment of each member’s team work –Performance of team to develop a product Grading –Individual’s preparation for work –Individual’s contribution to the group –Effectiveness of the group What makes TBL?

15. Essential Element: Team Assignments Appropriate Group Assignments –Require group interaction –Members make decisions and report in simple form Inappropriate Group Assignments –Results in problem with learning groups (free-riders, member conflict) –Requires members dividing the work and completing it individually for a complex output (e.g., lengthy document or oral presentation) –Limits interaction and difficult to compare performance of teams What makes TBL?

16. Essential Element: Frequent and Immediate Feedback Regular and timely student feedback on group performance by: 1.Readiness Assurance Tests (RATS) Informs students how effective their learning procedures are Pulls together group members since Group scores are public Informs group immediatelt when and how they failed to perform 2.Application-focused Team Assignments More difficult to evaluate than RATS due to higher level learning skills Needs right kind of Team output to evaluate Provide a process to give peer review What makes TBL?

17. Difference Between a Team and Group Team 2 or more people who interact on a common activity Individual commitment to the welfare of the group High level of trust among members of team 98% of teams will out perform the best member on learning- related tasks* Team 2 or more people who interact on a common activity Individual commitment to the welfare of the group High level of trust among members of team 98% of teams will out perform the best member on learning- related tasks* Group 2 or more people who interact on a common activity Individual commitment to group is casual, temporary or permanent Group 2 or more people who interact on a common activity Individual commitment to group is casual, temporary or permanent What makes TBL? *From Michaelsen, L., Watson, W. and Black, R. (1989). A realistic test of individual versus group consensus decision making. Journal of Applied Psychology, 74(5), 834-839.

18. The Student TBL Advantages Motivated to Attend -Offered alternative to large lecture classes -Becomes part of a team Motivated to Attend -Offered alternative to large lecture classes -Becomes part of a team Participates Actively in Education -Acquires life-long skills -Engages students who prefer to work alone -Assists “at risk” students Participates Actively in Education -Acquires life-long skills -Engages students who prefer to work alone -Assists “at risk” students Applies Knowledge -Achieves higher-level cognitive skills -Learns basic concepts and experiences their application in assignments Applies Knowledge -Achieves higher-level cognitive skills -Learns basic concepts and experiences their application in assignments Develops Interpersonal skills -Student learn about themselves in collaborating with others on tasks -Students learn to work as a team to accomplish difficult intellectual tasks Develops Interpersonal skills -Student learn about themselves in collaborating with others on tasks -Students learn to work as a team to accomplish difficult intellectual tasks

19. 1.Faculty-to-student interaction High amount 2.Motivation to teach Taps enthusiasm of empowering students to learn in teams 3.Individual class preparation Little needed so can focus on guiding teams 4.Student attendance not an issue Attendance responsibility of student to team 5.Low faculty-to-student ratio Facilitator works with large class in teams 6.No special facilities required No need for small group rooms 1.Faculty-to-student interaction High amount 2.Motivation to teach Taps enthusiasm of empowering students to learn in teams 3.Individual class preparation Little needed so can focus on guiding teams 4.Student attendance not an issue Attendance responsibility of student to team 5.Low faculty-to-student ratio Facilitator works with large class in teams 6.No special facilities required No need for small group rooms The TBL Advantages for Facilitators Why use TBL?

20. Questions for a TBL Course 1.What do I as the instructor want students to do? 2.What do the students have to learn? 3.How do I as the instructor know the students mastered the concepts? 4.How can I as the instructor tell if the students will be able to use the knowledge? 1.What do I as the instructor want students to do? 2.What do the students have to learn? 3.How do I as the instructor know the students mastered the concepts? 4.How can I as the instructor tell if the students will be able to use the knowledge? 1.Specify student performance in the learning objectives 2.Prepare a content outline & assignments 3.The students will be evaluated by the Readiness Assurance Test (RAT) 4.The students will use the knowledge in the application assignments. 1.Specify student performance in the learning objectives 2.Prepare a content outline & assignments 3.The students will be evaluated by the Readiness Assurance Test (RAT) 4.The students will use the knowledge in the application assignments. QuestionsAnswers How to do TBL?

21. Sample Team-Based Learning Process Phase 1 Preparation (Pre-class) Phase 2 Readiness Assurance (In-class) Phase 3 Application of Course Concepts Individual Study Individual Test Group Test Instructor Feedback Small Group Assignments -Attend a lecture -Review Lab 2 -Read textbook or journal articles IRAT and GRAT assess student’s preparation to begin Group Assignment Read case history and view visuals, then apply core concepts to complete group assignment 40% 50% 60% 70% 80% 90-100% Level of Content Understanding

22. Implementation Steps 1. Before class begins: Make course plans A. Divide course content into units B. Identify learning objectives C. Design a grading system 3. Near End of Class: Review learning objectives A.Recognize effective team interaction B.Identify how the students learned about themselves 2. 1 st Class: Get started A. Explain why and how TBL course is conducted B. Form the groups C. Describe grading D. Develop positive group norms How to do TBL?

23. Change Your Teaching Role From “Sage on the Stage,” and disseminating information to “Guide on the Side,” and asking open-ended questions to prompt the team to find the information How to do TBL?

24. Facilitator Activities in 1st Class Getting started 1.Explain your rationale for using TBL and how the class will be conducted 1.Compare TBL to traditional lecture 2.Demonstrate Readiness Assurance Test by having the students read a portion of the syllabus, take an individual test and a group test 2.Form the groups 1.Identify Student characteristics 2.Group 5-7 students by lining up the students by characteristic and asking them to count down. All the student with the same number form a group. 3.Describe the grading – Individual tests count and set grade weights 4.Develop positive group norms – pre-class preparation and class attendance (use team folders) Getting started 1.Explain your rationale for using TBL and how the class will be conducted 1.Compare TBL to traditional lecture 2.Demonstrate Readiness Assurance Test by having the students read a portion of the syllabus, take an individual test and a group test 2.Form the groups 1.Identify Student characteristics 2.Group 5-7 students by lining up the students by characteristic and asking them to count down. All the student with the same number form a group. 3.Describe the grading – Individual tests count and set grade weights 4.Develop positive group norms – pre-class preparation and class attendance (use team folders) How to do TBL?

25. Rationale for Using TBL If a students asks you why the class is using TBL, here are some answers: To encourage team performance behavior and skills because the highest quality of medical care is from effective medical teams To apply complex concepts because the instructor spends less time on basics and more on applications To learn from team tasks that are too difficult for individuals How to do TBL?

26. Student Accountability Student accountability includes setting the grade weights for the major performance areas: 1) Individual -- (IRAT ) maximum value 50% 2) Group -- (GRAT and group assignments) minimum value 10% 3) Peer Evaluation -- minimum value 10% Please note: The ranges for grade weights usually* are: 1) Individual performance: 15-20% 2) Group performance: 60-65% 3) Peer Evaluation: 10-30% * Michaelson, LK, Knight, AB & Fink, LD (2004). Team-based learning. Sterling, VA: Stylus Publishing. How to do TBL?

27. Near the End of TBL Unit Remind students of learning objectives Briefly review course content Review content applications Appreciate the significance of Team-Baased Learning Recognize effective team interaction Identify how the students learned about themselves How to do TBL?

28. Facilitating TBL Getting Started 1st Class Phase 2 Readiness Assurance (In-class) Phase 3 Application of Course Concepts A. IRAT B. GRAT C Instructor Feedback Small Group Assignments Individual Work Small Group Discussion Total Class Discussion XX= Impact on Learning 1. Distribute RATS and collect answers in Group folders 1. Distribute case 2. Time Teams 3. Facilitate team discussions 4. Collect answers 5. Call for answers 6. Provide feedback on team work 1. Describe the TBL unit 2. Form the Teams 3. Set grading weights 4. Develop positive group norms 2. Ask for GRAT answers and provide feedback How to do TBL?

29. Summary Team Based Learning is a small learning group method where individual work is done outside the class and team work is completed in class. The four principles of TBL are (1) properly formed and managed groups, (2) student accountability, (3)team assignments that promote learning, group interaction and team development, and (4) frequent and immediate feedback to students. The rationale for using TBL is that it is a good interactive alternative to passive lectures, requires no extra facilities or faculty, develops interpersonal skills and assists “at risk” students. Implementation of TBL involves planning before the class, forming groups in the 1 st class and reminding the students of the learning objectives, content application and team work near the end of the class. What is TBL? What makes TBL? Why use TBL? How to do TBL?

30. TBL Websites Team Learning Collaborative, a public site developed as a team learning resource for medical educators, www.tlcollaborative.org www.tlcollaborative.org Baylor College of Medicine, Team-Based Learning in Medical Education www.bcm.tmc.edu/fac- ed/team_learningwww.bcm.tmc.edu/fac- ed/team_learning Team-Based Learning, University of Oklahoma www.ou.edu/idp/teamlearning www.ou.edu/idp/teamlearning Team-Based Learning Resources, Wright State University School of Medicine Faculty Development site, www.med.wright.edu/aa/facdev/TBL www.med.wright.edu/aa/facdev/TBL