This Team-based Learning Research Articles

An Active-Learning Framework for Educating Medical Students on SARS-CoV-2 Variants and COVID-19 Epidemiology

Background The emergence of multiple Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) variants presented an escalated risk to public health globally and prompted epidemiologic monitoring and classification. Health professionals are vital for patient education regarding Coronavirus Disease 2019 (COVID-19), discussing patient concerns, and providing guidance. Students enrolled in professional healthcare programs benefit from being adept with the evolution and spread of SARS-CoV-2 variants, and a team-based learning module can be helpful for applying foundational concepts to clinical problems. Methods This team-based learning (TBL) framework was developed in response to the COVID-19 pandemic and the emergence of viral variants. It was placed at the end of a hematology block within the first semester of year one of the medical school during the academic years 2021–2022. It consists of a 7-question readiness assurance process and a four-question application exercise. Results The average score increased from 58.8% (iRAT) to 85.9% (tRAT) (n=104). The post-session survey data showed an increase in students’ understanding of the classification of COVID-19 variants and the role of genetic mutations in viral pathogenesis. Qualitative data yielded positive feedback for the session, notably in students' ability to interpret phylogenetic trees and understand the role of variants. Conclusions This TBL framework cultivates higher-order thinking skills among medical students and effectively integrates virology, epidemiology, and pathology. Additionally, it provides a framework for developing a robust and up-to-date platform for the discussion of novel variants of COVID-19 or other infectious diseases.

Hypertensive Emergency Team-Based Learning.

The target audiences for this team-based learning (TBL) activity are resident physicians and medical students. According to the Centers for Disease Control and Prevention (CDC), nearly half of the adults in the United States have hypertension,1 which is a leading cause of cardiovascular disease and premature death.2 In extreme cases, patients may present in hypertensive emergencies, defined as an acute, marked elevation of systolic blood pressure >180mmHg or diastolic blood pressure >120mmHg with evidence of organ dysfunction.3,4 Patients presenting to the emergency department (ED) with symptoms of hypertensive emergencies must be promptly diagnosed and treated to prevent further morbidity and mortality. This TBL utilizes four clinical cases to educate resident physicians and medical students not only on the recognition of hypertensive emergencies, but also on the workup, management, and disposition of patients who present to the ED with hypertension. By the end of this TBL session, learners should be able to: 1) define features of asymptomatic hypertension versus hypertensive emergency, 2) discuss which patients with elevated blood pressure may require further diagnostic workup and intervention, 3) identify a differential diagnosis for patients presenting with elevated blood pressures, 4) recognize the features of different types of end-organ damage, 5) review an algorithm for the pharmacologic management of hypertensive emergencies, 6) indicate dosing and routes of various anti-hypertensive medications, 7) choose the appropriate treatment for a patient who is hypertensive and presenting with flash pulmonary edema, 8) identify an aortic dissection on computed tomography (CT), 9) choose the appropriate treatment for a patient who is hypertensive and presenting with an aortic dissection, 10) identify intracranial hemorrhage on CT, 11) choose the appropriate treatment for a patient who is hypertensive and presenting with an intracranial hemorrhage, and 12) describe the intervention for warfarin reversal. This is a classic TBL that includes an individual readiness assessment test (iRAT), a multiple-choice group readiness assessment test (gRAT), and a group application exercise (GAE). Learners and instructors were given the opportunity to provide verbal feedback after completion of the TBL. Learners included senior medical students and first-, second-, and third-year emergency-medicine residents. Learners were specifically asked if they felt the cases were educational, relevant, and useful to their training. Six resident physicians and three medical students volunteered their verbal feedback, and agreed when they were specifically asked if the cases were educational, relevant, and useful to their training. The same learners also agreed when asked if they felt the TBL was a more enjoyable activity than a direct lecture to refresh their knowledge and skills. One instructor observed that interns and medical students were generally able to reach a correct diagnosis; however, they seemed to struggle more with describing appropriate pharmacologic interventions when compared to more senior learners. Hypertension is a common complaint and incidental finding in patients presenting to the ED. Given its non-specific value, it can be a difficult topic for the novice healthcare provider to master. The differential diagnosis for a patient presenting with hypertension is vast, ranging from benign to emergent, and can sometimes necessitate minimal to substantial workups. Thus, this TBL is a useful, relevant, and effective exercise for residents-in-training to review and understand the management of hypertension. Hypertension, hypertensive emergency, asymptomatic hypertension, flash pulmonary edema, aortic dissection, intracranial hemorrhage, warfarin reversal, team-based learning.

Implementation of novel team-based and flipped classroom technique to promote self-directed learning in the first MBBS students: A mixed-method approach

Background: Globalization has significantly impacted the field of medical education. Medical students need to be more competent to adapt to diverse patient populations and medical practices, understanding the cultural differences, and overcoming the language barriers. While the cognitive domain is important, it cannot fulfill the other domains of learning (affective, psychomotor). Therefore, medical education has to be enhanced to produce well-rounded health-care professionals. Integrating traditional teaching with interactive learning methods can bridge the gap between theoretical knowledge and practical application. Flipping the classroom is one such interactive teaching method that prioritizes the needs, interests, and autonomy of students. By organizing the students into small teams to solve problems and discuss cases, it additionally encourages accountability within the team, which further enhances enthusiasm and commitment to their studies. Aim and Objective: This team-based learning (TBL) in the settings of the flipped classroom (FCR) model can promote self-directed learning (SDL), critical thinking, and pursuing lifelong learning, which was the objective of the present study. Materials and Methods: The study was conducted on 200 undergraduate 1st-year MBBS students, 100 each in the study and control groups. The study group was subjected to flipped classroom (FCR) and the control group to traditional large group teaching. A pre-class assessment (pre-test) using Google Forms, including MCQ, open-ended questions, and case-based physiology, was administered to both the study and control groups of students. In the study group, the team test was conducted in the class. Both groups were subjected to a post-test to evaluate the efficacy of the flipped classroom over the traditional lecture. Qualitative feedback and a focus group interview were taken from the study groups to get the insight of the students regarding the flipped classroom. The incorporation of seminars in the study group further enriched the contents with lucidity of concepts. Results: In the comparison of the pre-test and post-test assessment scores, there was a weighty improvement after the post-FCR session among the study group. Furthermore, the comparison of the pre-test and team-test scores revealed the effectiveness of TBL among the study group students. Thus, the amalgamated approach of FCR with TBL enhances student engagement and comprehension of course material. It also boosts SDL, empowering the students to take ownership of their learning journey. Conclusion: Thus, employing a combination of teaching and learning techniques can be more promising than didactic teaching for cultivating medical students with SDL abilities, and certainly flipped classroom and TBL can improve learning outcomes in medical education, creating a more engaging and stimulating learning environment.

The Suicidal Patient in the Emergency Department Team-Based Learning Activity.

Emergency medicine resident physicians, (PGY1-4), medical students rotating in the emergency department. Emergency physicians have a duty to recognize and provide care for patients who attempt to harm themselves or commit suicide. Mental health-related chief complaints account for 12.5% of emergency department (ED) visits.1 Additionally, patients with depressive symptoms who are discharged from the ED are at the highest risk for suicidal thoughts and behaviors.1 Therefore, evaluating and screening for suicide and determining appropriate dispositions for this patient population is extremely important. This team-based learning (TBL) activity will help prepare residents and medical students to evaluate, recognize, and disposition this at-risk patient population. By the end of the session, participants will be able to: 1) describe risk factors for suicide; 2) summarize the emergency physician's role in assessing patients with psychiatric emergencies; 3) assess a patient using a mental status evaluation; 4) identify the criteria for involuntary psychiatric hold placement; 5) develop a safe discharge plan for patients experiencing depression; and 6) Formulate a plan for evaluating a suicidal patient who is acutely intoxicated. This team-based learning activity is a classic TBL that includes learner responsible content (LRC), an individual readiness assessment test (iRAT), a multiple choice group readiness assessment test (gRAT) with immediate feedback assessment technique (IF/AT), and a group application exercise (GAE). A post-TBL survey was provided to each participant. A Likert scale was used for the survey questions to assess the relevance of the session to emergency medicine practice, learner perception of knowledge gained, learner perception of improvement of clinical practice, session engagement, and session delivery. The post-activity evaluation had a response rate of 33% (11/33). Overall, all the participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the session improved their knowledge of caring for the suicidal patient in the ED with an average score of 4.6/5. All participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the material presented was relevant to their clinical practice in the ED for an average score of 4.6/5. Constructive feedback included requesting learner responsible content (LRC) be sent earlier than one week prior to the activity. Depression and suicidal ideation are common ED complaints. However, it can be difficult to evaluate these patients and select an appropriate disposition because their symptoms can range from benign to life-threatening. The team-based learning (TBL) session allows for discussion of the complexities of the depressed and suicidal patient. Learners found this TBL to be beneficial in providing a diagnostic pathway and treatment algorithm to manage these complex, high-risk patients. Suicide, depression, substance abuse, disposition, team-based learning.

Hemolysis and Hemoglobin Structure and Function: A Team-Based Learning Exercise for a Medical School Hematology Course.

IntroductionThis team-based learning (TBL) exercise focused on hemolysis and hemoglobin structure and function. The goal was to emphasize content that directly impacts clinical practice, but obliges students to understand underlying pathophysiology. The readiness assurance test (RAT) covers oxygen affinity, diagnosing hemolysis, inherited causes of hemolysis (G6PD deficiency, hereditary spherocytosis, sickle cell disease, thalassemia) and acquired causes of hemolysis (thrombotic microangiopathies, autoimmune hemolytic anemia). The application activity focused on thalassemia, sickle cell disease, and autoimmune hemolytic anemia.MethodsSecond-year students were divided into teams of five to six students each with one facilitator for each classroom. Students completed an individual RAT (iRAT) followed by a group RAT (gRAT). The facilitator reviewed answers of the RATs emphasizing questions where there was a lack of clarity about the correct answer. Students completed the application activity within their teams followed by a discussion guided by the facilitator.ResultsOn average, students answered 63% of answers correctly on the iRAT. The average team score on the gRAT was 26.7 out of 30 points. The session was well reviewed by both students and facilitators. Students ranked the quality of all facilitators as excellent with an average rating of 4.4 of 5. Exam scores improved compared to prior to the introduction of TBL, but this was also found for material not covered.DiscussionThe use of TBL to emphasize the relationship between pathophysiology and the diagnosis and management of patients was both an effective teaching method and a successful way to engage medical students.

Build Your Own Eye: A Method for Teaching Ocular Anatomy and Pathophysiology.

Residents and medical students. The eye is a critical, but often neglected, part of medical learning. This team-based learning (TBL) module was developed for emergency medicine residents and medical students; however, is applicable to any learner who should know basic eye anatomy and pathology. Emergency medicine teams, primary care providers, and ophthalmologists are most likely to encounter ocular emergencies.1-3 These emergencies are uncommon but quite dire when they occur and can result in permanent disability and life-changing morbidity.2, 4 It is critical that medical practitioners who are exposed to these types of emergencies are well prepared to evaluate and treat them.To fully understand how pathology affects the eye, it is critical that learners understand the anatomy and physiology of the eye.5, 6 Many diagnoses are associated with specific parts of ocular anatomy;5, 6 therefore, teaching pathology in an anatomy-based lesson will help learners understand the physiology. This lesson teaches learners about physiology and pathology in a systemic, anatomically oriented way. By the end of this session the participant will be able to:Describe basic anatomy of the eye.Build a basic model of the eye.Identify which diseases are associated with which parts of the eye.Identify the pathophysiology behind diseases of the eye.Name correct treatment for each disease. The "build your own eye" lesson was taught as a classic team-based learning (cTBL) exercise. The modality of TBL with hands-on construction of an eye allow for social learning, competition and spatial learning related to anatomy. The creation of an eye allows residents to fully understand ocular anatomy which is not as evident when a two-dimensional paper image is used. Some learners need tactical stimuli for better understanding. This aspect of the exercise was focused on using alternative modalities to enhance spatial learning. These concepts are reinforced by the GRAT and IRAT portions of the exercise which tend to multiple choice learners. The fill-in the-blank aspect of the exercise requires recall and research to match the three-dimensional eye parts with pathology. Learners were given the opportunity to complete an anonymous survey. Verbal feedback was also obtained from learners during the lesson. The survey asked learners questions about the effectiveness and value of the exercise, whether the content was applicable to work in the emergency department, whether this exercise should be kept as a part of the curriculum, and whether there was any practice-changing information. Learners enjoyed the competitive aspects of the exercise and also noted that they felt much more comfortable with ocular anatomy and pathology after the lesson. Learners felt that the ocular team-based learning module was effective in teaching more about the eye in an atypical way. Some learners felt that an explanation in advance of the eye building aspects of the project may have been helpful so they could have brought supplies from home. Other learners felt that they would not have brought supplies from home; thus no explanation was necessary. Learners seemed to enjoy the experience. The competitive aspects of the TBL, where the eye models were judged for accuracy, creativity, and appearance as well as the correct answers on the worksheet, seemed to enhance learner enjoyment and engagement. Learners felt that enough time was provided for the exercise. While some learners would have preferred an explanation in advance of the project in order to bring supplies from home, others felt that this was not necessary. Educators should determine what would be preferred by their particular learning group for future implementations. Eye lid, tear duct, cornea, conjunctiva, pupil, iris, lens, anterior chamber, vitreous body, posterior chamber, retina, macula, choroid, optic disc, optic nerve, retinal artery, retinal vein, blepharitis, hordeolum, chalazion, canaliculus, dacryocystitis, corneal abrasion, corneal ulcer, ultraviolet keratitis, herpes keratitis, astigmatism, bacterial conjunctivitis, viral conjunctivitis, episcleritis, globe rupture, iritis, uveitis, anterior uveitis, posterior uveitis, hypopyon, hyphema, acute angle closure glaucoma, congenital pupillary deformity, coloboma, globe rupture, nevus, essential iris atrophy, cataracts, presbyopia, myopia, hyperopia, traumatic iritis, iridocyclitis, ciliary body melanoma, vitreous degeneration, vitreous hemorrhage, endophthalmitis, macular degeneration, retinal detachment, choroid nevus, choroid detachment, papilledema, optic nerve glioma, optic nerve meningioma, anterior ischemic optic neuropathy, retinal artery occlusion, retinal vein occlusion.

Pedigree Analysis: A Team-Based Learning Activity

Regardless of their specialty, physicians, particularly those practicing primary care in rural areas, typically encounter genetic conditions. Therefore, it is important to incorporate genetic principles into medical training prior to students' clinical rotations. The advance preparation assignment for this team-based learning (TBL) resource includes lectures and directed study assignments on the following topics: Mendelian genetics, sexual genetics, population genetics, and pedigree analysis. Students then demonstrate their understanding of the content through a formal TBL lesson utilizing a gallery walk for group application exercises. Course evaluations clearly indicated that students enjoyed and learned from this TBL. Student performance on the team readiness assurance test and the summative exam scores showed significant signs of improvement when compared to individual readiness assurance test performance. In this TBL module, students develop an understanding of basic genetics, pedigree analysis, and calculation of risks for inheriting autosomal recessive and X-linked recessive diseases. This TBL can be easily adapted to other allied health programs.

Warfarin Management in Practice

OPEN ACCESSOctober 7, 2015Warfarin Management in Practice Jane Graham, Rob Noble, Jecko Thachil, MRCP, FRCPath Jane Graham Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author , Rob Noble Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author , Jecko Thachil, MRCP, FRCPath Central Manchester University Hospitals NHS Foundation Trust Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10234 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This team-based learning (TBL) session was developed to equip clinicians and undergraduates with the background knowledge and practical skills to manage patients on warfarin who present with bleeding, potential bleeding, or a high international normalized ratio in the absence of bleeding. The resource was developed in response to identification of patient safety issues and poor compliance to recommended guidelines surrounding the management of patients on warfarin. Methods: The prereading material contained in the resource is provided to students approximately 1 week before the session. During the session, students engage in an individual readiness assurance test before being grouped into teams where they complete a group readiness assurance test and a series of team application exercises. Results: This session has been successfully implemented in various formats to a broad range of practicing United Kingdom clinicians. Learner reactions to the session, as evidenced by anonymous feedback and verbal comments to faculty, have been positive. The session works well for both large and small groups and for those with differing clinical backgrounds and experience. Analysis of readiness assurance testing results (both individual and group) demonstrates evidence of knowledge acquisition relating to the session's defined learning objectives. Group interaction with the team application scenarios and interteam debates provides evidence of increased analytical skills and clinical application of the learning objectives to real-life practice. Discussion: TBL is well established within undergraduate and postgraduate medical education, ensuring knowledge acquisition, application of knowledge to real-life cases, and development of auxiliary skills such as teamwork. This resource has been developed to be a highly versatile tool. The content is relevant to both undergraduate and postgraduate education, enabling delivery of clinically relevant continuing education to practicing clinicians. The session has been designed to enable applicability to a global audience. Educational Objectives By the end of this module, learners will be able to: Describe the pharmacological actions, interactions, and monitoring of warfarin.Appropriately prescribe and administer treatment for a patient on warfarin with actual or potential major bleeding, including prothrombin complex concentrate, and vitamin K.Define major bleeding.Manage patients on warfarin with minor bleeding.Appropriately action a high international normalized ratio in the absence of bleeding.Assess which patients on warfarin are at highest risk of bleeding. ReferencesHaidet P, Levine RE, Parmelee DX, et al. Guidelines for reporting team-based learning activities in the medical and health sciences education literature, Acad Med.2012;87(3):292–299. http://dx.doi.org/10.1097/ACM.0b013e318244759eMedline, Google ScholarKhogali SE. Team-based learning: a practical guide: guide supplement 65.1—viewpoint, Med Teach.2013;35(2):163–165. http://dx.doi.org/10.3109/0142159X.2013.759199Medline, Google ScholarParmelee DX, Michaelsen LK. Twelve tips for doing effective team-based learning (TBL), Med Teach.2010;32(2):118–122. http://dx.doi.org/10.3109/01421590903548562Medline, Google ScholarParmelee DX, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no. 65, Med Teach.2012;34(5):e275–e287. http://dx.doi.org/10.3109/0142159X.2012.651179Medline, Google ScholarTeam-Based Learning Collaborative Web site. http://www.teambasedlearning.org/. Accessed August 12, 2015.Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Preparatory Material Warfarin.docx RAT Warfarin Tutor.docx RAT Warfarin Student.docx IRAT Answer Sheet.docx tAPP Warfarin Tutor.doc tAPP Warfarin Student.doc tAPP Answer Cards.docx Resource Template Warfarin.docx 1. Warfarin-Chest 2012.docx 2. Warfarin Reversal-ASH 2011.pdf 2. Warfarin Reversal-BCSH 2011.pdf 2. Warfarin Reversal-Chest 2012.docx 3. PCC-eMC Beriplex.docx 3. PCC-eMC Octaplex.docx 3. PCC-FDA Kcentra.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationGraham J, Noble R, Thachil J. Warfarin Management in Practice. MedEdPORTAL. 2015;11:10234. https://doi.org/10.15766/mep_2374-8265.10234 Copyright & Permissions© 2015 Graham et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEducationBlood Coagulation FactorsClinical Laboratory TechniquesTeam-Based LearningLearningAnticoagulantsWarfarinHemorrhageTBL Disclosures None to report. Funding/Support None to report. tabs.loading

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