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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 41-45

Team-based learning in pathology: Lessons learned from a pilot study


1 Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
3 Department of ENT, SMS Medical College, Jaipur, Rajasthan, India
4 Department of Forensic Medicine, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission04-Jan-2021
Date of Acceptance02-Jun-2021
Date of Web Publication26-Dec-2021

Correspondence Address:
Shruti Bhargava
8/250, Malviya Nagar, Jaipur, Rajasthan.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dypj.dypj_2_21

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  Abstract 

Introduction: Team-based learning (TBL) is an approach where the learners are organized in groups where they learn from each other. This TBL is a student-centric approach, which ensures active participation of each member and also promotes teamwork and learning ability. Looking at the teacher-centric approach of the conventional teaching–learning (CTL) methods in medical education, where the students are mere passive learners and the sessions can be monotonous, TBL seems to be extremely relevant today as a more student-centric teaching–learning method. Methods: This randomized crossover study was conducted in the department of pathology, at one of the largest government medical colleges, on students of II MBBS, wherein they were exposed to TBL session and their learning outcome and perception was compared to that after CTL method that is lecture (CTL). The data were analyzed using Primer version 6 software. Results: In this study, there was a statistically significant improvement in the score of students after exposure to TBL. Furthermore, there was a significant difference in the learning outcome of students of TBL as compared to CTL. The student perception trends reveal a positive tilt toward TBL. Conclusion: Our pilot study concludes that TBL can be used as a supplement to the conventional lectures for improving the learning as well as teamwork and leadership skills of students.

Keywords: Learning outcome, student perception, team-based learning


How to cite this article:
Bhargava S, Jain M, Grover M, Pathak D. Team-based learning in pathology: Lessons learned from a pilot study. D Y Patil J Health Sci 2021;9:41-5

How to cite this URL:
Bhargava S, Jain M, Grover M, Pathak D. Team-based learning in pathology: Lessons learned from a pilot study. D Y Patil J Health Sci [serial online] 2021 [cited 2022 Jan 24];9:41-5. Available from: http://www.dypatiljhs.com/text.asp?2021/9/2/41/333767




  Introduction Top


Team-based learning (TBL) is an approach where the learners are organized in groups where they learn from each other.[1] Looking at the teacher-centric approach of the conventional teaching–learning (CTL) methods in medical education, where the students are mere passive learners and the sessions can be monotonous, today the need for a more student-centric teaching–learning method is felt by all.

This TBL is a student-centric approach, which ensures active participation of each member and also promotes teamwork and learning ability.[2],[3]

The traditional method of teaching can be improved by introducing the TBL approach for better learning and outcome of students.[4],[5] TBL is a cost-effective teaching–learning method which uses the principle of small group learning to a class comprising large number of students.[5] This method requires just one teacher to manage multiple groups simultaneously in a large classroom setting.[6]

TBL uses strategies that ensure the effectiveness of small groups working independently with high student-to-faculty ratios, without losing the benefits of faculty-led small groups.[6]

It also enables the learners to have profound insights into their strengths and weaknesses and thus become more self-directed in learning.[5] This innovation generates interest in learning in students, increases interaction, teamwork, develops better communication skills as well as improves the overall learning ability of the students.[5]

The objectives of our study were to introduce the concept of TBL in pathology and evaluate the perception of students regarding this innovative teaching–learning method and then compare the learning outcome of students exposed to TBL versus CTL method.


  Methods Top


Ethics

This study was conducted after obtaining approval from the institutional ethics committee (approval letter no. 56 MC/EC/2018).

Study design

This randomized crossover study for TBL was conducted at one of the largest government medical colleges in the department of pathology for 3rd-semester (II MBBS) students of the academic year 2018–2019. Two sessions were conducted of 2-h duration each, as follows:

For the first session, at the onset, all 3rd-semester students were given a week’s time to read the topic of thromboembolism (preclass preparation). On the day of the first session, all students who were present for the class and gave informed consent were randomly divided into two groups (Group A – TBL and Group B – CTL) by chit-box method.

Group A (TBL) was taken for TBL session for thromboembolism. For this first, the students were given a pretest of 20 multiple-choice questions (MCQs) for solving. After 20 min, their responses were collected and then they were divided into 14 smaller teams of 8 students each. Now, these 14 teams were given the same set of MCQs for solving together as a group in the next 20 min. Meanwhile, their individual pretest responses were evaluated by a faculty. Every correct MCQ was assigned a score of 0.5, so that the maximum score was 10. This gave their individual readiness assurance test (iRAT) score. After 20 min, all the 14 teams were given different colored placards of responses, namely A (red), B (green), C (yellow), and D (blue) showing responses. The teacher posed the question, and all teams were told to respond by raising the placard corresponding to their answer simultaneously (to avoid cheating). The scores of these teams were recorded as team readiness assurance test (tRAT) score. It is important to note that all the members of a particular group had the same score. During this, the teacher acted as a facilitator and cleared the doubts of these student groups. After collecting iRAT answer sheets, students were prompted to join their teams and take the exact same test as a team. The students were given 30 min for the tRAT. During this time, team members were encouraged to collaborate, discuss, and reach at a consensus. After the tRAT, all teams were encouraged to simultaneously report the response for each MCQ using placards. The correct answers were provided by the instructor. Teams that did not agree or were unable to give the correct answer were allowed to appeal, and the teacher immediately clarified any misconceptions regarding their answers. After the session, the students were given a prevalidated questionnaire to find out their perception for this new innovative teaching–learning method.

Simultaneously, in a second classroom, Group B (CTL) was taken for a conventional lecture for thromboembolism. For this first, the students were given a pretest of 20 MCQs for solving. These MCQs were same as those given to Group A. After 20 min, their responses were collected. Now, a faculty took a conventional lecture on thromboembolism for 30 min. After the lecture, the students were given the same set of MCQs for solving (posttest) in 20 min. Their pretest and posttest scores were recorded.

After 1 week, the second session was conducted on the same students who participated in the first session. However, the students who were absent during this second session were excluded from the study. They were given a week’s time to read about shock (preclass preparation), and on the day of session, they were divided into same Group A and Group B as in their session 1. Now, a crossover was done, and this time, Group A was exposed to conventional lecture while Group B was exposed to TBL. At the end of this session, student perception regarding TBL was recorded for Group B. The MCQ scores from this session were not used for statistical analysis to avoid student bias.

Statistical analysis

For the final outcome of the study, the student perception regarding the TBL session was collected with the help of prevalidated feedback questionnaire using the five-point Likert scale. The data were analyzed using percentage and proportion.

A comparison of the learning outcomes of TBL and CTL method was done after the first session only in the form of

  • a. Intragroup (Group A – TBL group) – The iRAT and tRAT scores of Group A (TBL) were compared using paired t-test


  • b. Intragroup (Group B – CTL group) – the pretest and posttest scores of Group B (CTL) were compared using paired t-test


  • c. Intergroup (Group A and B) – the tRAT score of Group A (TBL group) was compared to the posttest score of Group B (CTL group) using unpaired t-test.


The data were analyzed using the Primer version 6 software. P < 0.05 was considered statistically significant.


  Results Top


A total of 224 students of 3rd semester (II MBBS) participated in this study, and were randomly distributed into two groups, namely Group A and Group B, comprising 112 students each.

On comparing the individual readiness assurance test (iRAT) scores and tRAT scores of Group A (TBL) students, it was found that the mean score (± standard deviation [SD]) of students increased from 3.70 (±1.84) to 7.21 (±0.86) after the TBL session, with a significant P < 0.001 [Figure 1].
Figure 1: Mean individual readiness assurance test team readiness assurance test score of Group A (team-based learning)

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On comparing the pretest and posttest scores of Group B (CTL) students, who were exposed to the conventional lecture, it was observed that the mean score (± SD) of students increased from 3.59 (±1.92) to 6.09 (±1.65) after the lecture, with a significant P < 0.001 [Figure 2].
Figure 2: Pretext and posttest scores of Group B conventional teaching–learning

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On comparing the tRAT score of Group A (TBL) with the posttest score of Group B (CTL), it was found that the mean score of Group A was more than that of Group B, with a significant P value [Figure 3]. Therefore, although the final scores of students of both the groups increased from their respective pretest scores, but the improvement was slightly more in the TBL group as compared to the CTL group.
Figure 3: Team-based learning team readiness assurance test score versus conventional teaching–learning posttest score

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The perception of students regarding TBL was taken as per the prevalidated feedback questionnaire comprising ten questions, and all the 224 students graded each question on a five-point Likert scale [Table 1].
Table 1: Perception of students for team-based learning (n=224)

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The findings clearly indicate the positive feedback of students about this innovation. As depicted, majority of the students (70.98%) totally agreed that TBL was a better learning strategy as compared to lectures, whereas 66.5% were in total agreement that TBL was more effective in achieving learning objectives.

Most of the students were more focused and motivated during the TBL session as compared to lectures, and also felt that the knowledge that they gained by TBL was likely to be more permanently retained by them.

Maximum students realized that the TBL session was an excellent opportunity for them to gain insight about their weaknesses and strengths and also helped them to develop interpersonal skills as well as a good rapport with the facilitator.

More than 77% of students thoroughly enjoyed the TBL session and have recommended the use of this innovative teaching–learning method in future also.


  Discussion Top


This pilot study reveals a statistically significant improvement in the learning of students after exposure to TBL, as indicated by an increase in the mean tRAT score as compared to their iRAT score. The studies by Alwahab et al., Brandler et al., and Chhabra et al. have also shown similar findings.[1],[3],[5]

We also found a statistically significant increase in the posttest score of students who were exposed to the conventional lecture, as compared to their pretest score. This has also been documented by Du and Yang and Punja et al.[2],[4] Hence, the importance of lectures cannot be undermined, and lectures cannot be totally replaced by TBL.

Although, in our study, the final scores of students of both the TBL and CTL groups increased from their respective pretest scores, the improvement was slightly more in the TBL group as compared to the CTL group. This was also observed by previous researchers.[6],[7],[8],[9],[10],[11] Devi et al. have concluded that the TBL actually helped the academically weaker students to succeed.[8]

Regarding the perception of students, our study infers that most of the students have a positive feedback for this innovative teaching–learning method. Majority of the students totally agreed that TBL was a better learning strategy as compared to lectures and was more effective in achieving learning objectives. Most of the students were more focused and motivated during the TBL session as compared to lectures, and also felt that the knowledge that they gained by TBL was likely to be more permanently retained by them. Maximum students realized that the TBL session was an excellent opportunity for them to gain insight about their weaknesses and strengths and also helped them to develop interpersonal skills as well as a good rapport with the facilitator. Almost all the students thoroughly enjoyed the TBL session and have recommended the use of this innovative teaching–learning method in future also. These findings corroborate with almost all the previous authors except Frame et al., who have found an almost equal perception score for conventional lecture and TBL.[12]

Thus, a synergistic approach between TBL and traditional lectures should be followed, and TBL should be used as a supplement to conventional lectures for improvement of students’ performance, as mentioned by other researchers.[4],[7]

There were few limitations of our study. Since this innovation required at least 2 h for completion of each session, it would not be possible to conduct it in 1-h lecture time allotted routinely, as per the presently laid undergraduate timetable.

Although there was a significant statistically documented short-term positive change in learning of undergraduate students exposed to TBL as compared to CTL in this pilot study, we need to carry out more sessions to generate data before a final conclusion about a lasting improvement in learning outcome and change in behavior can be authentically drawn. Furthermore, since this study was conducted in one department only, that is pathology and that too for a single topic, so it would be difficult to draw generalized conclusions about advantages, limitations, and feasibility of TBL.

We plan to carry out this pilot study further by having more sessions in pathology and further start this innovation in other departments as well. Through the medical education unit, we also plan to sensitize other department faculty regarding this innovative teaching–learning method.


  Conclusion Top


Our preliminary study clearly reflects that TBL can be a better teaching–learning method, as compared to conventional didactic lectures, wherein the principles of effective small group teaching can be easily applied to a large group of 250 undergraduates without needing too many teachers at one time. Improvement in the final scores indicates an increase in the learning of students. Trends in the student perception questionnaire very clearly point toward the fact that this method can be used to motivate students toward studies, learning communication skills, and collaborating as teams as well as provide insight into its implementation further at a larger scale.

Furthermore, since TBL requires fewer faculty members compared to other active learning strategies (e.g., self-directed learning and problem-based learning), and because it promotes greater student accountability in learning, it could serve as a useful alternative to other active learning strategies.

The high student satisfaction as well as improvement in the learning outcome observed in this study is indeed a positive reflection that we need to incorporate such newer innovations for better teaching–learning in medical colleges. However, conventional lectures cannot be totally replaced by TBL, but a combination of TBL approach and CTL methods should be used to improve students’ learning in pathology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alwahab A, Abdulqader S, Nugud A, Nugud S, Cyprian F, Shaikh AA, et al. Team-based learning in an undergraduate pathology curriculum and its effects on student performance. J Taibah Univ Med Sci 2018;13:496-501.  Back to cited text no. 1
    
2.
Du B, Yang X. The effect of team-based learning on conventional pathology education to improve students’ mastery of pathology. Int J High Educ 2017;6:12-20.  Back to cited text no. 2
    
3.
Brandler TC, Laser J, Williamson AK, Louie J, Esposito MJ. Team-based learning in a pathology residency training program. Am J Clin Pathol 2014;142:23-8.  Back to cited text no. 3
    
4.
Punja D, Kalludi SN, Pai KM, Rao RK, Dhar M. Team-based learning as a teaching strategy for first-year medical students. Australas Med J 2014;7:490-9.  Back to cited text no. 4
    
5.
Chhabra N, Kukreja S, Chhabra S, Chhabra S, Khodabux S, Sabane H. Team-based learning strategy in biochemistry: Perceptions and attitudes of faculty and 1st-year medical students. Int J Appl Basic Med Res 2017;7:S72-7.  Back to cited text no. 5
    
6.
Hashmi NR. Team based learning (TBL) in undergraduate medical education. J Coll Physicians Surg Pak 2014;24:553-6.  Back to cited text no. 6
    
7.
Ali AN, Elbayouk K, Osman A. Medical students’ perspective on the place of team-based learning in the curriculum. Adv Med Educ Pract 2018;9:773-5.  Back to cited text no. 7
    
8.
Devi SR, Reddy CV, Rao RP, Nagpal DK. Team based learning – A new approach for teaching pathology to medical students. Nat J Med Dent Res 2016;4:252-6.  Back to cited text no. 8
    
9.
Alimoglu MK, Yardım S, Uysal H. The effectiveness of TBL with real patients in neurology education in terms of knowledge retention, in-class engagement, and learner reactions. Adv Physiol Educ 2017;41:38-43.  Back to cited text no. 9
    
10.
Doshi NP. Effectiveness of team-based learning methodology in teaching transfusion medicine to medical undergraduates in third semester: A comparative study. Asian J Transfus Sci 2017;11:87-94.  Back to cited text no. 10
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11.
Burgess A, Bleasel J, Haq I, Roberts C, Garsia R, Robertson T, et al. Team-based learning (TBL) in the medical curriculum: Better than PBL? BMC Med Educ 2017;17:243.  Back to cited text no. 11
    
12.
Frame TR, Cailor SM, Gryka RJ, Chen AM, Kiersma ME, Sheppard L. Student perceptions of team-based learning vs traditional lecture-based learning. Am J Pharm Educ 2015;79:51.  Back to cited text no. 12
    


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