Team-based learning replaces problem-based learning at a large medical school.

Absract: BACKGROUND: With increased student numbers in the Sydney Medical Program, and concerns regarding standardisation across cohorts, student satisfaction of the problem-based learning (PBL) model had decreased in recent years. In 2017, Team-based learning (TBL) replaced PBL in Years 1 and 2 of the medical program. This study sought to explore students' perceptions of their experience of TBL, and to consider resource implications.

Methods: In 2017, Years 1 and 2 medical students (n = 625) participated in weekly TBL sessions, with approximately 60 students per class, consisting of 11 teams of five or six students. Each class was facilitated by a consultant, a basic scientist and a medical registrar. Prior to each class, students were given pre-work, and completed an online Individual Readiness Assurance Test (IRAT). During face-to-face class, students completed the Team Readiness Assurance Test (TRAT), and received feedback with clarification from facilitators, followed by clinical problem-solving activities. Student feedback was collected by questionnaire, using closed and open-ended items. Data were analysed using descriptive statistics and thematic analysis.

Results: In total, 232/275 (84%) Year 1 and 258/350 (74%) Year 2 students responded to the questionnaire. Students found positive aspects of TBL included the small group dynamics, intra- and inter-team discussions, interactions with facilitators, provision of clinical contexts by clinicians, and the readiness assurance process. Suggested improvements included: better alignment of pre-reading tasks, shorter class time, increased opportunity for clinical reasoning, and additional feedback on the mechanistic flowchart. Resource efficiencies were identified, such as a reduction in the number of teaching sessions and required facilitators, and the ability to provide each classroom with clinical expertise.

Conclusions: Our findings demonstrate that TBL, as a replacement for PBL in Years 1 and 2 of the medical curriculum, provided a standardised approach to small group learning on a large scale, and also provided resource efficiencies. Students perceived benefits related to the active learning strategy of TBL that encourage individual learning, consolidation of knowledge, retrieval practice, peer discussion and feedback. However, improvements are needed in terms of better alignment of pre-reading tasks with the TBL patient case, and greater facilitator interaction during the problem-solving activities. Additionally, consideration should be given to reducing class time, and providing TRAT scores.