Abstract
BackgroundThe lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students’ lack of ability in clinical reasoning. Team-based learning (TBL) was proposed to improve the students’ ability in clinical reasoning as it is applying a course concept of real complex scenarios. In this study, we aimed to assess and compare the effects of TBL and LBL of postpartum hemorrhage topics on the clinical reasoning and classroom engagement of midwifery students in Indonesia.MethodsWe conducted a cluster randomized controlled trial to compare the effects of TBL and LBL. The unit was schools and random allocation was conducted using a simple random sampling method (i.e., coin flipping). There was 1 cluster in the intervention group (n = 62 students) and 1 cluster in the control group (n = 53 students). The students in the intervention group participated in a TBL class (90 min) three times, whereas the students in the control group attended an LBL class on postpartum hemorrhage topics. The primary outcome was the clinical reasoning on postpartum hemorrhage score measured at pre-test, post-test, and 2 weeks post-test. The secondary outcome was Classroom Engagement Survey (CES) score measured after each class finished. We used an unpaired t-test to evaluate the differences between the two groups. The baseline characteristics of the participants were compared using standardized difference.ResultsWe evaluated a total of 115 participants. Regarding the baseline characteristics, there was a small difference in the age, Grade Point Average and knowledge at pre-test between the intervention and control groups. The mean clinical reasoning on postpartum hemorrhage scores were significantly higher in the TBL students than in the LBL students at post-test (p < .001; Cohen’s d = 1.41) and 2 weeks post-test (p < .001; Cohen’s d = 1.50). The CES showed a significantly higher in the intervention group than in the control group.ConclusionsTBL is an effective learning method for enhancing the clinical reasoning ability of students. This learning method allows for more independent and active learning. Having a strong background knowledge, and discussing cases comprehensively with peers can sharpen the clinical reasoning ability of students.
Highlights
Postpartum hemorrhage (PPH) is a primary cause of maternal mortality worldwide, primarily in low- and middle-income countries [1]
Of the 118 midwifery students who were assessed and met the eligibility criteria, 115 (97.5 %) participated in the study. Of these 115 students, 62 students from the mountain site setting were enrolled in the intervention group and participated in the Team-based learning (TBL) classes, and 53 students from the sea site setting were enrolled in the control group and received the lecture-based learning (LBL) classes
Characteristic of participants The baseline characteristics of the participants were compared between the control group and the intervention group (Table 1) using standardized difference
Summary
Postpartum hemorrhage (PPH) is a primary cause of maternal mortality worldwide, primarily in low- and middle-income countries [1]. The other main factors that influence the quality of medical care are the medical staff’s knowledge, clinical reasoning, and skills [4,5,6]. Their lack of ability in preventing and managing hemorrhage often stems from their poor interpretation and implemention of guidelines in handling hemorrhage. The lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students’ lack of ability in clinical reasoning.
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