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Team-Based Learning Column 2: Instructor's Viewpoint on TBL

Written by Lori Schirmer

How did the idea to introduce Team Based Learning into Drake COPHS evolve?
In 2005, Drake College of Pharmacy and Health Sciences developed a plan to reconfigure the Therapeutics course to three semesters instead of two after new graduate surveys reported that two semesters was too overwhelming. Once the plan for changing the Therapeutics sequence to three semesters was approved by the faculty, course coordinators (myself and two others) were assigned to determine what changes were necessary to develop the course.

I began working with the other coordinators and faculty who teach the course to address what other changes were needed to improve the course for students. We asked faculty to think about the outcomes that students should achieve in the course, and submit proposals.

The faculty agreed with educational literature that shows students need to be actively engaged with the material to learn it, retain it, and be able apply it later in life to patients. Through experiential teaching, I have seen that students remember things when they create their own solutions to drug therapy problems. We researched methods used to engage students that are associated with good retention of material. We heard many proposals, and considered many options before selecting TBL as the method that fits best with the resources (faculty, students, technology and physical classroom space) available at Drake COPHS.

What was the process for implementing TBL into Drake’s curriculum?
Once we selected TBL as the classroom strategy we were going to use in Therapeutics, we had to consider the number of credit hours and number of faculty who teach in the course. We wanted to both lessen the overwhelming feeling for students and provide more continuous contact time for students to spend with each of our faculty. We therefore divided the 12 credit hours into 1 credit hour modules and assigned one to each of the 12 faculty teaching in the course.

We wanted to begin with foundational topics, and organize each topic by area of practice since that is how our faculty’s sites are arranged. We set up faculty and their specialty areas into semesters from Pediatrics and Ambulatory care in the spring of the P2 year to Inpatient Medicine in the fall and spring of the P3 year and finally ending with Geriatrics in the spring of the P3 year. This is a very brief overview of two years’ worth of meetings, retreats, phone calls, emails and hallway conversations.

Describe the learning process and how the class varies from a typical lecture.
In a lecture only class, students sit and listen to the instructor explain concepts and are then expected to practice using the concepts on their own time by doing homework after class or by attending a recitation session as in the previous version of Therapeutics. In the TBL model, students work on learning the concepts before class on their own and then their knowledge is assessed when they attend class using a Readiness Assessment Test or RAT. The rest of the class time is spent working on the application of the concepts (Application Exercises) and discussion with the faculty member. This is a bit of an oversimplification but TBL is a way to organize the material so that the easier stuff is covered by students on their own before class and the hard material (learning to use the concepts) is discussed in class with the assistance of the expert (the instructor). Again an oversimplification, but in lecture-based classes, the teacher tells students what is important and leaves the hardest work—using the material—for students to do afterwards on their own.

How does faculty and student preparation for a class differ between a TBL course and a lecture?
The faculty preparation is somewhat different in that we have to organize the material differently and create study questions to guide students’ pre-class preparation, RAT questions and Application Exercise cases in addition to having material in PowerPoint format to help explain concepts and problems in class. In a lecture only course, the teacher would create a PowerPoint document only. There is quite a bit of initial preparation for the faculty member, but I expect that it will lessen for subsequent semesters just as the first time one lectures over a topic it takes longer to prepare than the following times.

Preparation for class is also somewhat the same in that we are trying to focus on what students will need to be able to do after the module is complete. Keeping a focus on what students will be doing with the material, helps us separate the ‘need to know’ from the ‘nice to know’. In some cases, the topic in question could be a specialty like Nutrition support. I spent two years of residency training learning about Nutrition support. I have only about eight hours of class time to discuss Nutrition! I spend quite a bit of prep time ‘working backwards’ from what students will be expected to do within a topic area and selecting what they need to know to be able to do that.

Student preparation is different because they are asked to do work before class for TBL. They have reading assignments and study questions to answer to help prepare them for spending class time using the material they learned on their own. In a lecture class students rarely are required to prepare before class but may have homework for afterwards.

How has this learning process affected students?
We are very early in the implementation of TBL and have only completed one semester so far. We have conducted one focus group and have one set of semester evaluations so far and have plans for continued quality evaluations. Based on student feedback we have been able to make some improvements to how class is structured. Students have made some positive comments about how TBL helps them keep up with class material instead of ‘cramming’ just before a test. We have also received some negative comments that relate to a dislike of change in general. Humans tend to like familiarity and comfort and many people react negatively at first to a request to change. We will continue to monitor and assess the impact of TBL on student learning. Our number one goal as faculty at Drake is for students to learn.

What challenges has TBL presented and how have they been/are they being overcome?
Change is challenging for students and faculty. The most challenging thing for me so far is the amount of time I have spent working with others (students AND faculty) to get them to ‘buy-in’. Being an agent of change requires a large commitment of time and energy. We have asked faculty to dedicate a lot of time to redoing all their previous course preparation to fit the TBL model. We have asked students to change how they prepare for class.

What advice do you have for other instructors who want to implement TBL?
Attend a class and see how it works first. It is amazing to go to the classroom and see students discussing and working on problems. You can really ‘see’ students thinking and that is very exciting for a ‘teacher nerd’ like me! There are several books [see reference list below] and a website [] as well as a Team-Based Learning Collaborative []. The collaborative is a group of faculty who use the method in every possible discipline and they have an annual meeting where you can interact with those who use this method and those who pioneered it.

What tips do you have for students who are studying for a TBL style course?
This recommendation is not specific to TBL but be sure and communicate with your teachers. Your teachers want to help you but can’t if you don’t let them know you don’t understand something! Advice specific to TBL is to complete the readings before class and write out the study questions. The teacher designed those questions to help walk you through the readings, and to guide you.

Team-Based Learning: Small Group Learning’s Next Big Step. New Directions for Teaching and Learning, Eds. Larry K. Michaelsen, Michael Sweet & Dean X. Parmelee, (2008)

Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Eds. Larry K. Michaelsen , Dean X. Parmelee , Kathryn K. McMahon , Ruth E. Levine, (2007)

Team-based Learning: A Transformative Use of Small Groups in College Teaching. Eds. Larry K. Michaelsen, Arletta Bauman Knight, L. Dee Fink. (2004) Sterling, VA: Stylus Publishing.