Does Critical Reflection by Biochemistry Learning Teams Foster Patient-centered Beliefs among Medical Students?

Abstract

The authors measured patient-centered orientation scores of first-year osteopathic medical students before vs. after implementing exercises to foster critical reflection by learning teams. In the 2008–09 academic year, 60 of a total of 130 classroom hours were devoted to team-based learning (TBL) in a sequence of three Biochemistry courses (1500, 1501 and 1502). TBL was modified to include required and extra-credit team critical reflection assignments. Index questions were used to compare student learning on their own using modified TBL to learning facilitated by instructors in the preceding year. Individual student performances on index questions improved using modified TBL as the sequence of three courses progressed from 8% lower than in the prior year for the first course (p<0.001) to 7% higher than in the prior year for the third course (p<0.005). Moreover, team members cooperated more on team tests as they progressed from Biochemistry 1500 through Biochemistry 1502 (p<0.01). Finally, students became more patient-centered and caring (p<0.0001) using modified TBL, whereas the reverse was observed (p<0.01) prior to implementing exercises to foster critical reflection by team-based learning teams. Thus, TBL, modified to include opportunities for team critical reflection, fostered both cooperation and patient-centered orientations in first-year medical students.