A Multiyear Analysis of Team-Based Learning in a Pharmacotherapeutics Course

Objectives. To evaluate the impact of team-based learning (TBL) in a pharmacotherapeutics course on pharmacy students’ ratings of faculty instructors and the course, and to assess students’ performance after implementation of team-taught TBL.Design. Teaching methodology in a pharmacotherapeutics course was changed from a lecture with recitation approach in 2 semesters of a 6 credit-hour course to a TBL framework in a 3-semester 3+4+5 credit hour course. The distribution of faculty of instruction was changed from 4 faculty members per week to 1 faculty per 1-credit-hour module. TBL consisted of preclass study preparation, readiness assurance (Individual Readiness Assessment Test and Group Readiness Assessment Test), and in-class application exercises requiring simultaneous team responses.Assessment. Retrospective analysis of student ratings of faculty and instructional methods was conducted for the 2 years pre-TBL and 4 years during TBL. Final course grades were evaluated during the same time period. Student ratings showed progressive improvements over 4 years after the introduction of team-based learning. When aggregated, ratings in the “excellent teacher” category were unchanged with TBL compared to pre-TBL. Improvements in faculty instructor approaches to teaching were noted during TBL. Group grades were consistently higher than individual grades, and aggregate course grades were similar to those prior to TBL implementation.Conclusion. Implementation of TBL in a pharmacotherapeutics course series demonstrated the value of team performance over individual performance, indicated positive student perceptions of teaching approaches by course faculty, and resulted in comparable student performance in final course grades compared to the previous teaching method.     

Team-based learning in pharmacotherapeutics

Objective. To compare student examination performance in pharmacotherapeutics before and after implementation of team-based learning.Design. After the traditional lecture and workshop method for teaching pharmacotherapeutics was replaced with team-based learning in January 2009, students were expected to come to class having read assigned chapters in order to successfully complete an individual quiz, a group quiz, and group application exercises.Assessment. Student learning was assessed using performance on individual quizzes, group quizzes, and the examination at the end of the psychiatry module. Students performed as well on the examination at the end of the module as they did prior to team-based learning implementation.Conclusion. Substituting team-based learning for traditional lecture ensured that students prepared for class and increased student participation in class discussions.     

Comparing team-based and mixed active-learning methods in an ambulatory care elective course

Objectives

To assess students'' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members'' perceptions of team-based learning.

Methods

Using the 2 teaching methods, students'' grades were compared. Students'' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning.

Results

The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course.

Conclusions

Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning.     

Student Perceptions of Team-based Learning vs Traditional Lecture-based Learning

Objective. To evaluate pharmacy student perceptions of team-based learning (TBL) vs traditional lecture-based learning formats.Methods. First professional year pharmacy students (N=111) at two universities used TBL in different courses during different semesters (fall vs spring). Students completed a 22-item team perceptions instrument before and after the fall semester. A 14-item teaching style preference instrument was completed at the end of the spring semester. Data were analyzed using Wilcoxon signed rank test and Mann-Whitney U test.Results. Students who experienced TBL in the fall and went back to traditional format in the spring reported improved perceptions of teams and preferred TBL format over a traditional format more than students who experienced a traditional format followed by TBL. Students at both universities agreed that the TBL format assists with critical-thinking, problem-solving, and examination preparation. Students also agreed that teams should consist of individuals with different personalities and learning styles.Conclusion. When building teams, faculty members should consider ways to diversify teams by considering different views, perspectives, and strengths. Offering TBL early in the curriculum prior to traditional lecture-based formats is better received by students, as evidenced by anecdotal reports from students possibly because it allows students time to realize the benefits and assist them in building teamwork-related skills.     

Enhancing Team-Based Active Learning Through Hands-On Experience With Nicotine Replacement Therapy

Objectives. To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session.Design. A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use.Assessment. Students’ scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students’ perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive.Conclusion. Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students’ confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product’s characteristics.     

A Team-Based Learning Course on Nutrition and Lifestyle Modification

Objective. To create, implement, and evaluate an elective team-based learning (TBL) course on nutrition and lifestyle modification for pharmacy students.Design. An elective course with 15 contact hours was developed for second-year pharmacy students based on the principles of TBL. Student knowledge gained and satisfaction with the course were measured.Assessment. Sixty-two students completed the course. Knowledge about nutrition and lifestyle modification was significantly improved by completing the course (59% and 91%, respectively, p=<0.001). The satisfaction survey instrument had a response rate of 97%, and the majority of students (>85%) responded favorably to the TBL components.Conclusion. An elective course using TBL effectively delivered course content while teaching students communication and teamwork skills. The course was well received by students.     

A modified team-based learning physiology course

Objective. To implement and assess an interactive, clinically applicable first-year physiology course using team-based learning.Design. The course was designed on a team-based learning backbone using 6 modules, pre-class preparation, a readiness-assurance process, and in-class application. Integrative cases were used to review concepts prior to examinations. Various assessment methods were used to measure changes, including course evaluations, an attitudinal survey tool, and a knowledge examination.Assessment. Course evaluations indicated a higher perception of active learning in the revised format compared with that of the previous year''s course format. There also were notable differences in opportunities to promote communication skills, work as part of a team, and collaborate with diverse individuals. The assessment of content knowledge indicated that students who completed the revised format course outperformed the previous year''s students in both foundational knowledge and application-type questions.Conclusion. Using more team-based learning within a physiology course had a favorable impact on student retention of material and attitudes toward the course.     

The impact of team-based learning on a foundational pharmacokinetics course

Objective. To assess the impact of team-based learning (TBL) in a foundational pharmacokinetics course.Design. The course was arranged into 5 modules based on the TBL format. Each module contained preclass preparation; readiness-assurance process; and in-class, clinical cases. Survey instruments on professionalism and attitudes of team learning were administered pre- and post-course.Assessment. Examination grades focused at the evaluation/creation level were significantly higher in the TBL format compared with the previous year. Professionalism scores increased over the course of the semester, particularly in altruism and honesty. Other measures of team-learning attitudes significantly increased over time, although there was no change in major subscales. End-of-semester course evaluations showed improvements in active engagement and in various areas of skill development.Conclusion. The TBL format can be used successfully in a foundational pharmacokinetics course to increase higher levels of learning, team-learning skills, and professionalism in pharmacy students.     

A multi-instructor, team-based, active-learning exercise to integrate basic and clinical sciences content

Objectives. To introduce a multiple-instructor, team-based, active-learning exercise to promote the integration of basic sciences (pathophysiology, pharmacology, and medicinal chemistry) and clinical sciences in a doctor of pharmacy curriculum.Design. A team-based learning activity that involved pre-class reading assignments, individual-and team-answered multiple-choice questions, and evaluation and discussion of a clinical case, was designed, implemented, and moderated by 3 faculty members from the pharmaceutical sciences and pharmacy practice departments.Assessment. Student performance was assessed using a multiple-choice examination, an individual readiness assurance test (IRAT), a team readiness assurance test (TRAT), and a subjective, objective, assessment, and plan (SOAP) note. Student attitudes were assessed using a pre- and post-exercise survey instrument. Students’ understanding of possible correct treatment strategies for depression improved. Students were appreciative of this true integration of basic sciences knowledge in a pharmacotherapy course and to have faculty members from both disciplines present to answer questions. Mean student score on the on depression module for the examination was 80.4%, indicating mastery of the content.Conclusions. An exercise led by multiple instructors improved student perceptions of the importance of team-based teaching. Integrated teaching and learning may be achieved when instructors from multiple disciplines work together in the classroom using proven team-based, active-learning exercises.     

Team-based Learning in Therapeutics Workshop Sessions

Objectives

To implement team-based learning in the workshop portion of a pathophysiology and therapeutics sequence of courses to promote integration of concepts across the pharmacy curriculum, provide a consistent problem-solving approach to patient care, and determine the impact on student perceptions of professionalism and teamwork.

Design

Team-based learning was incorporated into the workshop portion of 3 of 6 pathophysiology and therapeutics courses. Assignments that promoted team-building and application of key concepts were created.

Assessment

Readiness assurance tests were used to assess individual and team understanding of course materials. Students consistently scored 20% higher on team assessments compared with individual assessments. Mean professionalism and teamwork scores were significantly higher after implementation of team-based learning; however, this improvement was not considered educationally significant. Approximately 91% of students felt team-based learning improved understanding of course materials and 93% of students felt teamwork should continue in workshops.

Conclusion

Team-based learning is an effective teaching method to ensure a consistent approach to problem-solving and curriculum integration in workshop sessions for a pathophysiology and therapeutics course sequence.     

The Impact of Problem-Solving Feedback on Team-Based Learning Case Responses

Objective. To determine the amount and type of feedback needed to improve pharmacy students’ problem-solving skills using team-based learning (TBL) and a problem-solving rubric.Methods. A problem-solving rubric was developed to assess the ability of pharmacy students’ to prioritize, organize, and defend the best and alternative options on TBL cases The study involved 3 groups of pharmacy students: second-year students in a cardiology class who received no feedback (control group), third-year students in an endocrinology class who received written feedback only, and third-year students in an endocrinology class who received written and verbal feedback. Students worked in groups on all TBL cases except the first and last one (beginning and end of course), which students completed independently as it served as a pretest and posttest.Results. Significant improvements were seen in the ability of the third-year students who received verbal and written feedback to prioritize the information presented in the case and in their total score on the problem-solving rubric.Conclusion. Providing pharmacy students with written and verbal explanations may help them improve their problem-solving skills overall. During verbal feedback, faculty members can provide more examples of how to improve and can field questions if needed.     

Comparison of Answer-Until-Correct and Full-Credit Assessments in a Team-based Learning Course

Objective. To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit).Methods. Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale.Results. Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004).Conclusion. Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.     

Pharmacy Students’ Ability to Think About Thinking

Objective. To investigate students’ metacognitive skills to distinguish what they know from what they do not know, to assess students’ prediction of performance on a summative examination, and to compare student-identified incorrect questions with actual examination performance in order to improve exam quality.Methods. Students completed a test-taking questionnaire identifying items perceived to be incorrect and rating their test-taking ability.Results. Higher performing students evidenced better metacognitive skills by more accurately identifying incorrect items on the exam. Most students (86%) underpredicted their performance on the summative examination (actual=73.6 ± 7.1 versus predicted=63.7 ± 10.5, p<0.05). Student responses helped refine items and resulted in examination changes.Conclusion. Metacognition is important to the development of life-long learning in pharmacy students. Students able to monitor what they know and what they do not know can improve their performance.     

Using Team-based Learning in an Endocrine Module Taught Across Two Campuses

Objectives

To implement a team-based learning (TBL) format in an endocrine module to promote students'' active learning in a course delivered to 2 campuses.

Methods

Course lectures were transformed into 13 TBL sessions consisting of content pre-assignments (self-directed learning), in-class readiness assurance tests (accountability), and team problem solving of patient cases and faculty-led class discussion (knowledge application). Student performance was evaluated through multiple assessments during the TBL sessions and on unit examinations. Students evaluated each individual TBL session and the course as a whole.

Results

Course grades were higher using the TBL method compared to the traditional lecture-based method that was used previously. Individual readiness assurance tests and team contribution scores significantly predicted overall course grades (p<0.001). Students accepted the change in course format as indicated by course evaluation results.

Conclusions

TBL is an effective active-learning, instructional strategy for courses with large student-to-faculty ratios and distance education environments.     

Developing Entrepreneurial Skills in Pharmacy Students

Objective. To create, implement, and evaluate a workshop that teaches undergraduate pharmacy students about entrepreneurship.Design. Workshops with 3 hours of contact time and 2 hours of self-study time were developed for final-year students. Faculty members and students evaluated peer assessment, peer development, communication, critical evaluation, creative thinking, problem solving, and numeracy skills, as well as topic understanding. Student evaluation of the workshops was done primarily via a self-administered, 9-item questionnaire.Assessment. One hundred thirty-four students completed the workshops. The mean score was 50.9 out of 65. Scores ranged from 45.9 to 54.1. The questionnaire had a 100% response rate. Many students agreed that workshops about entrepreneurship were a useful teaching method and that key skills were fostered.Conclusion. Workshops effectively delivered course content about entrepreneurship and helped develop relevant skills. This work suggests students value instruction on entrepreneurship.     

A process-oriented guided inquiry approach to teaching medicinal chemistry

Objective

To integrate process-oriented guided-inquiry learning (POGIL) team-based activities into a 1-semester medicinal chemistry course for doctor of pharmacy (PharmD) students and determine the outcomes.

Design

Students in the fall 2007 section of the Medicinal Chemistry course were taught in a traditional teacher-centered manner, with the majority of class time spent on lectures and a few practice question sets. Students in the fall 2008 and fall 2009 sections of Medicinal Chemistry spent approximately 40% of class time in structured self-selected teams where they worked through guided-inquiry exercises to supplement the lecture material.

Assessment

The mean examination score of students in the guided-inquiry sections (fall 2008 and fall 2009) was almost 3 percentage points higher than that of students in the fall 2007 class (P < 0.05). Furthermore, the grade distribution shifted from a B-C centered distribution (fall 2007 class) to an A-B centered distribution (fall 2008 and fall 2009 classes).

Conclusions

The inclusion of the POGIL style team-based learning exercises improved grade outcomes for the students, encouraged active engagement with the material during class time, provided immediate feedback to the instructor regarding student-knowledge deficiencies, and created a classroom environment that was well received by students.     

Active-learning assignments to integrate basic science and clinical course material

Objective

To develop, implement, and evaluate active-learning exercises requiring the integration and application of pathophysiology, medicinal chemistry, pharmacology, and therapeutics knowledge of osteoarthritis and rheumatoid arthritis to formulate therapeutic recommendations for patients with musculoskeletal disorders.

Design

Two team-based case study exercises, one evaluating a patient with osteoarthritis and the second, a patient with rheumatoid arthritis, were developed, incorporating material and questions from pathophysiology, medicinal chemistry, pharmacology, and therapeutics. The learning assignments were implemented in a required pharmacotherapy module.

Assessment

Student learning was evaluated using performance on the team-based case study exercises and on 2 examinations. A standard student course evaluation was used to assess students'' impressions of the learning activity. The mean student grades for the osteoarthritis and rheumatoid arthritis activities were 9.1 and 8.9, respectively, on a 10-point scale. The majority of students indicated that the learning exercises were more than adequate to excellent in helping students learn.

Conclusion

The addition of active-learning activities was successful in teaching pharmacy students the knowledge needed to formulate therapeutic recommendations for patients with musculoskeletal disorders.