First students to experience team-based learning as an alternative to frontal teaching

Team-based learning (TBL), translated as team-based learning, is a collaborative learning method defined as "active learning in small groups through opportunities to apply contextual knowledge in a sequence of activities involving individual and team work and through immediate feedback". In the world, it has been in use since the 1970s, but in the Czech Republic it is still rather an exception. At the Faculty of Medicine of Masaryk University, students could experience it in the recent past through special lectures organised in the premises of SIMU, but since the new academic year, the Theoretical Foundations of Clinical Medicine II seminar for fourth-year students of general medicine is based on the TBL concept. Dr. Tamara Skříšovská, who plays the role of a content expert or clinical expert in the lessons, and Martina Bruzlová, a master's student, as a facilitator, will explain its innovative character. Such staffing is one of the aspects that characterise TBL seminars.

24 Nov 2023

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You were historically the first lecturers of the innovative lesson in the course Theoretical Foundations of Clinical Medicine II. How would you approach the TBL method of teaching? What does a typical class look like?

TS: It is a collaborative learning method, so students should be able to discuss what they think is correct in both the test and application portions that make up the class. The test part can be discouraging for students, but for us it's basically just a validation that they have spent time preparing. Because if a student comes to class unprepared, it makes it harder for any further transfer of information. The test has ten questions and is done in three phases, where first everyone answers for themselves, then the questions are discussed as a team. During the application part, we are already working with a virtual patient who guides us through a specific story that might happen in a real situation.

TBL lessons are always attended by two representatives from the teaching staff. A so-called facilitator and a content expert. What is the role of the facilitator? Madam Master, you come from a middle philosophy faculty, it might surprise some that you don't have a medical background...

TS: The fact that the facilitator does not have a medical background is not an obstacle, but on the contrary it can be an advantage. We as content experts tend to start lecturing the students. So the facilitator needs to be well versed in the scenario and be able to step in when the content expert feels the urge to go into frontal teaching. At that point, he or she will ignore it and give space to the students.

MB: Because TBL teaching is primarily student-driven. It's about their perspective, their discussion, how they understand the different exercises and how they can explain the information to each other. Within each lesson, certain goals are set and we as facilitators lead the discussion, facilitate interactions and make sure that we reach the goals together.

So the facilitator is something between a teacher, a psychologist, a scriptwriter and a director, and he is actually kind of in the student's shoes...

MB: That's an interesting name. Maybe I would have added an element of performance, because each of the facilitators has their own style and their personality is also reflected in the teaching. At the same time, we're also kind of like the moderators of that discussion and kind of the mediators between the students and the content experts, because we also deal with things outside of the actual teaching, including things like excuses. So we're kind of a fixed point for the students. While the lessons and content experts change, we're always there for them. We want to get to know the students and know what they think. We're happy if they're not afraid to come to us if there's a problem.

What, on the other hand, is the professional role of content experts?

MB: In the lessons, the content expert is a person with clinical experience and a guarantee of expertise. He can tell students how things work in hospitals, what's cheap, what's expensive, what they can afford, who to turn to for help, in short, all the things they haven't been able to experience.

TS: And he should ideally enter into teaching as little as possible. His role is in preparing the lesson, setting up the test questions and the virtual patient. But in some cases, it's necessary to clarify what's right or wrong in practice. Thus, we provide crucial information from our own clinical practice so that no factual ambiguities arise.

What was the impetus for the application of TBL in Theoretical Foundations of Clinical Medicine?

MB: The facilitation method can be applied in other subjects as well. The purpose is to focus more on the students, to teach them to think as they will have to in practice. Our virtual patients show the complexity and intricacy of the situations they may find themselves in as future physicians. The scenarios therefore involve, for example, working with a patient who is unpleasant, deliberately lies or does not want to undergo an examination. This adds a broader context to the learning and students have to successfully resolve such situations.

What do you see as the main benefit, compared to conventional teaching methods?

MB: The fundamental change is that while students used to learn on their own, now they work in teams and with a time frame. And also in the fact that they are in the lead roles. We're basically just allowing them the space for this to happen and for that space to be safe. That means making sure that they're okay not knowing or making a mistake. We're actually re-teaching students to express themselves because you can see how huge the barrier and the fear of saying the wrong thing is. That's why we keep reminding them not to be afraid to express themselves, not to be afraid to ask who has a question, because there are no stupid questions.

TS: I think it's a good form of teaching because it emphasizes something that young people today are not as used to using, which is interpersonal communication. It's nice to see how students who are uncomfortable or shy at the beginning leave at the end of the class, discussing the topic and full of emotion. Which is something that I think moves them on.

Are there differences in this respect between Czech students, who are more accustomed to classical frontal teaching from previous levels of education, and those from abroad?

MB: It is clear that foreign students seem to be a bit more enthusiastic about this type of teaching. They enjoy discussing it because they are more used to it and they finally feel that there is a type of teaching where they can do it again. Sometimes we almost have to moderate them, but it's interesting to see how they are able to find out information, either from each other or from content experts. I also wish Czech students would not be afraid to open up, show emotion and argue calmly when defending their arguments. I went through the same education system that taught us to be quiet, not to talk to each other and to do everything independently, so I understand that certain closed-mindedness. But I believe we are succeeding in our endeavors and it's nice to see students open up and come up with ideas that didn't occur to me or the content expert when preparing the lesson. It also raises their self-esteem.

Were the students concerned about this change in teaching?

MB: It is true that students were afraid for some reason that this course would be an elimination course. I personally feel that they are generally pushed a lot into thinking that if they don't get a hundred percent on a test, they're done... In our case, it's not so much about the classical assessment. The tests are mainly there to develop discussion.

TS: The course really isn't about making it difficult for students to pass the next year. It's about them learning to work with a new teaching method and learning to be a little more open, communicative and able to defend their opinion.

How could the TBL method develop teaching in medical school in general in the future?

TS: We'll see where it leads. But I believe that the whole concept of the new teaching methods that we are starting to use at SIMU will educate new generations of students who will be different from, say, mine, when it was really difficult to get a good answer or to get a good practice. The older generations were taught not to talk too much, not to ask too much, but we are trying to get the idea into students that it is okay to ask questions and to make mistakes and learn from them in a safe learning environment. Just that attitude towards mistakes should change from the first year when students come to the simulation centre for first aid. I can say from my own experience that working with students who have not yet had the opportunity to experience simulation learning, as opposed to those who have had it basically since first year, is then diametrically different in those higher years. You can tell that they have a healthy confidence, they ask questions, they enjoy it, they are engaged and motivated. That's what we're all about. To move learning to a level where they see me, as a teacher, as someone who wants to teach them something and is there to help them.

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