Team-Based Learning, a Learning Strategy for Clinical Reasoning, in Students with Problem-Based Learning Tutorial Experiences

Abstract

Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4 th year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in , 2006 , and 2007. Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure. Team-based learning (TBL) is a particular instructional strategy that is designed to support the development of high performance learning teams and to provide opportunities for these teams to engage in significant learning tasks in the same educational circumstance as ordinary lectures in large classrooms (Michaelsen et al. 2002(Michaelsen et al. , 2004. Individual members of the team have a better understanding of the material and the team becomes capable of solving challenging and complex problems through repeated reading assignments, the Individual Readiness Assurance Test (IRAT), intra-team discussion, the Group Readiness Assurance Test (GRAT), inter-team discussion and feedback from instructors. In TBL, learners experience in-class and out-of-class activities through preparation, application, and assessment phases.Our students study basic science, basic medicine, and clinical medicine through a hybrid of lectures, problembased learning (PBL) tutorials, and practical laboratory training in the first 4 years of the 6-year medical program (Kozu 1997;Yoshioka et al. 2005; PBL Tutorial Committee 2009). We strategically integrated TBL, using clinical cases for 4 th year students with abundant PBL experience, to Y. Okubo et al. 24determine whether this would improve students' clinical reasoning ability. Assumed advantages ...

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