Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL)

Abstract

Background Two established small-group learning paradigms in medical education include Case-based learning (CBL) and Team-based learning (TBL). Characteristics common to both pedagogies include the use of an authentic clinical case, active small-group learning, activation of existing knowledge and application of newly acquired knowledge. However, there are also variances between the two teaching methods, and a paucity of studies that consider how these approaches fit with curriculum design principles. In this paper we explore student and facilitator perceptions of the two teaching methods within a medical curriculum, using Experience based learning (ExBL) as a conceptual lens. Methods A total of 34/255 (13%) Year 2 medical students completed four CBLs during the 2019 Renal and Urology teaching block, concurrent to their usual curriculum activities, which included weekly TBLs. Questionnaires were distributed to all students (n = 34) and CBL facilitators (n = 13). In addition, all students were invited to attend focus groups. Data were analysed using descriptive statistics and thematic analysis. Results In total, 23/34 (71%) of students and 11/13 (85%) of facilitators completed the questionnaires. Twelve students (35%) participated in focus groups. Findings indicate their experience in CBL to be positive, with many favourable aspects that built on and complemented their TBL experience that provided an emphasis on the basic sciences. The learning environment was enriched by the CBL framework that allowed application of knowledge to solve clinical problems within the small groups with consistent facilitator guidance and feedback, their capacity to focus discussion, and associated efficiencies in learning. Conclusion While the TBL model was integral in developing students’ knowledge and understanding of basic science concepts, the CBL model was integral in developing students’ clinical reasoning skills. The strengths of CBL relative to TBL included the development of authentic clinical reasoning skills and guided facilitation of small group discussion. Our findings suggest that delivery of a medical curriculum may be enhanced through increased vertical integration, applying TBL in earlier phases of the medical program where the focus is on basic science principles, with CBL becoming more relevant as students move towards clinical immersion.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

“…In CBL students are encouraged to engage in peer learning and apply new knowledge to these authentic clinical problems under the guidance of a facilitator. CBL encourages a structured and critical approach to clinical problem-solving, and, in contrast to PBL, is designed to allow the facilitator to correct and redirect students [ 5 ]. On the other hand, TBL offers a student-centered, instructional approach for large classes of students who are divided into small teams of typically five to seven students to solve clinically relevant problems.…”

Effective Veterinary Clinical Teaching in a Variety of Teaching Settings

“…The advantage of the CBL is it is a less time-consuming approach to delivery of clinical teaching. The role of the clinical instructor, who is the 'expert in the field' is to correct, direct, and provide feedback [55].…”

“…Teach-others learning may be used during discussion with the client, when implementing peer-assisted learning [14], or utilizing mini-lecture discussions [30]. Indeed, peer-assisted learning may also be a valuable tool for feedback on performance, frequently accepted as less confronting than when provided by the clinical instructor [14,31,55]. It is worth noting that peer-based feedback only is not preferred, as learners appreciate expert opinion on their performance and progress.…”

“…• Team-based learning (TBL). Although TBL is a teaching method aimed at delivery of clinical teaching to early stages of development of learners in veterinary and medical sciences, it is assumed to be very suitable for clinical teaching in advanced years [32,55,62]. Team-based learning clinical teaching has been praised for three elements of clinical teaching, inclusion of development of clinical reasoning, team work from learner's perspective [31], and time efficiency.…”

“…There should be a proper pre-activity preparation (e.g., readings, prerecorded lectures) and individual-and group-level testing should be incorporated (i.e., readiness assurance tests), followed by immediate feedback on performance. Use of the four S approach (significant problem, same problem, specific choice and simultaneous reporting) during the activity is relevant for reflection, clinical reasoning and problem-solving [31,55,62,63]. • Combination of any of the above proposed strategies.…”