he construct of team-basedlearning (TBL) was originally coined, during the 1970s, by Larry Michaelsen at the University of Oklahoma (Michaelsen, Knight & Fink, 2004). Michaelsen (2004) identified the utility of integrating group assignments in his smaller classes and therefore decided to apply the same strategy to his larger classes. Team-basedlearning (TBL) transforms how classroom time is used and the roles that students and teachers play in the learning process (McInerney & Fink, 2003). It also helps students change their attitude towards responsibilities, develop human relationships from working as a team, exchange ideas, and apply knowledge to real-life situations and/or to new problems (Paulson & Faust, 2000). As McInerney and Fink (2003) observed from their experiences with TBL, students become more motivated, develop understanding of content, and learn complex problem-solving. Most importantly, as the authors observed, TBL “promotes a learning- centered culture” (p. 3).
Background: While Problem BasedLearning (PBL) has long been established internationally, Team-basedlearning (TBL) is a relatively new pedagogy in medical curricula. Both PBL and TBL are designed to facilitate a learner- centred approach, where students, in interactive small groups, use peer-assisted learning to solve authentic, professionally relevant problems. Differences, however, exist between PBL and TBL in terms of preparation requirements, group numbers, learning strategies, and class structure. Although there are many similarities and some differences between PBL and TBL, both rely on constructivist learning theory to engage and motivate students in their learning. The aim of our study was to qualitatively explore students ’ perceptions of having their usual PBL classes run in TBL format.
Reports on the implementation of TBL in engineering education are still scarce, despite its potential to be used as an effective instructional strategy for teaching problem-solving skills in large class formats. Furthermore, working in teams is an essential skill for undergraduate engineers. Thus, Van der Loos et al. 2009 reported about the TBL approach in design elements module, evidencing increased in-class discussion, peer-learning and attendance, as well as an improved course effectiveness based on student evaluation. The same group described an enhancement in the students' perception of the mechanical module and student performance on exams (Ostafichuk et al. 2012). Also, Price et al. 2010 from Monash University carefully engineered team-basedlearning exercises to develop team work, collaboration, lateral thinking and problem solving as well as, the often necessary, conflict resolution.
This paper has explored the principles and strategies involved in meeting the unique and evolving challenges of teaching in an online environment. A number of educators are shifting the face-to-face tenets of Team-BasedLearning™ to address these distinctive needs for team engagement in online environments. The early adopters of these changes have turned to Quality Matters™ to ensure high quality best practices in their online courses. Student orientation, readiness assurance, application exercises, and peer evaluation are all essential elements for a successful “Off-to-On” for online TBL. Each of these elements must be well thought out and addressed in each course. One of the major considerations as adaptations are made is the time/space matrix. All exercises from the RATs to the application assignments will require additional time to completion that is not needed in a face-to-face setting. A thorough understanding of how to make technology enhance the online experience is not only possible but also crucial. This is an evolving paradigm, much like the technology that makes online team engagement possible, and therefore one that requires creativity and flexibility.
Team-basedlearning (TBL), a pedagogical model of small-group learning, was originally developed by Dr. Larry Michaelsen for use in business schools . TBL was an increasingly popular style of active learning peda- gogical approach around the world . In traditional LBL pedagogy, students mainly memorize the content from the class lecturer, while TBL is a pedagogical method of active learning. TBL enhances students’ learn- ing motivation, and then impels students to apply these knowledge materials to solve problem and combine the- ory with practice [2, 3]. At present, multiple medical schools have adopted TBL pedagogical approach globally [4, 5]. For example, some medical schools in Japan, Korea, India, Singapore, Oman, the USA, Lebanon and Australia already have adopted TBL pedagogical ap- proach [6–12].
Team-basedlearning (TBL) is a current innovation of an interactive flipped learning which direct instruction moves from the group learning space to the individual learning space. This innovation strategically conducted to utilise a limited number of content experts in a faculty. It primarily relies on a teacher to manage numerous small groups in a classroom. TBL has been used as standard practice in several faculties in the United States of America (1–4); however in Malaysia, this method has not yet been fully implemented in tertiary education. Indeed, TBL was only recently adopted in the Faculty of Medicine, Universiti Kebangsaan Malaysia (5), and the Faculty of Education, Universiti Putra Malaysia (6). TBL has received a good response from members of the Faculty of Medicine, Universiti Kebangsaan, Malaysia (UKM), who agreed that the technique is an interactive method of teaching compared to the conventional lecture (5). It is also evident that TBL favours both students and faculty members in learning anatomy which increase students’ comprehension and optimise the presence of lack of anatomists in the faculty (7). The principles and application of TBL, as well as its implementation, have significantly influenced
The purpose of this study is to perform a review to account for currently published studies on team-basedlearning (TBL) in medical education by accredited researchers. In doing so, our two goals included seeking information and critical appraisal. First, the literature was scanned by means of manual and computerized methods to identify pertinent documents. Selected works were then critically appraised to identify the most prevalent themes in the applications and effects of TBL in medical education. After considerable data reduction strategies, six major themes are discussed; 1) experimental TBL approaches; 2) student experiences and perceptions of TBL; 3) student examination performance; 4) faculty impressions; 5) peer evaluations in TBL; 6) TBL in gross anatomy. Although TBL is just beginning to be implemented in medicine, usage of this teaching method is thriving. Students and faculty appear to view TBL favourably and to be highly satisfied with it.
An alternative to PBL that adopts a blended learn- ing approach, is Team-basedlearning (TBL), which has gained recent popularity in medical education . TBL allows medical educators to provide stu- dents with resource effective, authentic experience of working in teams to solve real life clinical problems . Our 2014 pilot study (n = 20) of TBL , indi- cated that students favoured many aspects of the TBL process, including the pre-class work, the in- class initial tests with immediate feedback, and the problem-solving activities. Students found the advan- tages of TBL over PBL included better engagement in learning, deeper understanding of concepts, and a sense of responsibility towards teammates . How- ever, negative aspects of the students’ TBL experi- ence included limited time to complete problem- solving activities, and a de-emphasis on the student- centred approach involving clinical reasoning among student groups. In 2016, based on our previous TBL pilot experience, as well as wider literature eviden- cing the effectiveness of TBL in health education, we sought to incorporate a sustainable and standardised TBL model across the Musculoskeletal sciences, Re- spiratory sciences, and Cardiovascular sciences blocks of the Year 1 medical program. Key features of TBL principles were adopted, including appropriate alloca- tion of individuals to groups, prescribed out-of-class preparation, pre-class individual and team tests, im- mediate feedback, and problem-solving activities with all team work within a single session .
Background: A traditional and effective form of teaching within medical education has been Problem BasedLearning (PBL). However, this method of teaching is resource intensive, normally requiring one tutor for every ten students. Team-basedlearning (TBL) has gained recent popularity in medical education, and can be applied to large groups of up to 100 students. TBL makes use of the advantages of small group teaching and learning, but in contrast to PBL, does not need large numbers of teachers. This study sought to explore the efficacy of using TBL in place of PBL in Year 1 of a medical program.
Thus, this model is responsible for the training of professionals who dominate the most varied types of technologies but who are not very skilled at dealing with the subjective, social and cultural dimensions of people (Brant, 2005; Feuerwerkel and Sena, 1999; Carvalho, 2010). In andragogy, "the art and science of helping adults learn" (Knowles, 2005; Bellan, 2005), learning is shared responsibility between teacher and student - based on "learning by doing", valuing the student's previous experience, independence and self-management learning with practical application in everyday life (Hamze, 2010). In addition, TBL (Team-BasedLearning) or Team- BasedLearning is a strategy that has created a fertile area for medical education (Parmelee and Michaelsen, 2010). It was described by Larry Michaelsen, a professor at the University of Oklahoma's University of Management. In 1999, Michaelsen and David Ross conducted the TBL application with educators from College of Medicine of Baylor (Haidet, O’Malley and Richards, 2002).
The learning needs of medical students are also thought to have changed over time. Today’s medical students are highly interconnected, enjoying teamwork and collaborative practice, and the use of social media for learning . They are also reported to have a unique outlook on assessment, desiring continuous, explicit feedback. They want structured learning activ- ities, with clear expectations, and enjoy a sense of ac- complishment on their achievements. In addition to modifications in teaching methods, educators have embraced technological advancement in the delivery of medical education. Adopting blended learning models has the potential to enhance student engage- ment both inside and outside of the class room . In particular, the ‘flipped’ classroom approach has the capacity to maintain the collaborative nature of learn- ing within large class structures , and is being in- creasingly adopted in health professional education . The conflation of these issues has seen many medical schools adopt the model of Team-basedlearning in place of Problem-basedlearning [7, 8].
interaction in large groups and enhance learner atten- tion, involvement and initiate discussions. Teachers found it useful for obtaining immediate results and thereby receiving feedback on their teaching [18,19]. After a short introduction of the topic by an expert (ca. 10–15 minutes), participants are divided into small groups of four to six participants. The group work uses team-basedlearning  with prepared paper cases on realistic patient problems in diabetes care and a discus- sion of the group’s joint solutions in a plenary session with the expert. In our CPD course, an additional evidence-based summary is presented by the expert at the end of the course (ca. 20–30 minutes).
Clicker supported team-basedlearning environment was developed in this study. Physics-I course was carried out in this environment for five weeks and student per- ceptions related to this environment were examined. The interviews with the students indicated that this environment enhanced learning. Receiving instant feedback after sending problem solving results on clickers could be effective in discussing any wrong answers reach the correct answer. It was also found out that this application increased student concentration and motivation, resulted in active participation and created an entertaining environment. In parallel with the findings in this study,  stated that using clicker in classrooms provided instant feedback for better learning and motivated students with low self-confidence and shyness. In addition, this envi- ronment developed students’ feeling of work and working together. This finding of the present study is similar with  which stated that clicker activities in groups contributed significantly to learning, developed relationships and formed team-spirit as well as positive competition. Similarly,  stated that group-based interactive response system resulted in more student participation, raised motivation and created positive approaches. It is assumed that students’ satisfaction with the clicker support- ed team-basedlearning environment was related with sound integration of team-basedlearning strategy into clicker technology.
• Evaluation and summarization stage: teachers evaluated and summarized the students’ discussions and team effort, noted problems, and proposed recommendations for improve- ment, which lasted ∼ 5 minutes. After the class, the students were asked to answer an online questionnaire in which a peer review was performed by evaluating the contribution of each member in the subgroup to the team. The score of students in the TBL group is 5 points. TBL score = 30% IRAT + 30% GRAT + 30% ITT1 + 10% peer review. The teaching effectiveness of TBL and the effort by stu- dents in learning were investigated through a questionnaire survey. The feedback survey on teaching effectiveness was performed only in the TBL group. Researchers made ques- tionnaires according to the domestic and foreign literature and combined with our experience of teaching practice. It had 10 items and was scored using a Likert five-level scoring method. 14 The information on the students’ learning time and
When compared to a lecture-based course for residents, TBL led to a similar increase in knowledge with greater participant engagement, although residents perceived TBL to have less educational value than lectures . Using modified TBL to replace a lecture series led to improved knowledge scores with high ratings for perceived know- ledge acquisition and enjoyment of interactive team dis- cussions . When primary care residents were given TBL “booster sessions” to learn the skill of alcohol screen- ing and brief intervention, TBL was well received and reinforced their acquisition of a new clinical skill . In a psychiatry residency training program focusing on the acquisition of psychotherapy skills, residents rated the presentation format as excellent, and specific comments about the TBL experience were overwhelmingly positive . Since TBL moves beyond the basic acquisition of facts to focus on real life scenarios, it is an ideal didactic method for clinicians. As clinicians are used to solving patient problems and learning from them, TBL may be a natural way of learning for doctors in residency training.
Seeking to achieve a comprehensive understanding of the research question, we sought to converge both quantitative and qualitative data and therefore to triangulate. The experience and personal perspectives of students regarding TBL were of importance in this regard, and a 21-question in-house survey was designed and distributed to the 2016/ 2017 batch. Nineteen of the questions were based on the 5-point Likert scale. Options were strongly agree (rated 5), agree (4), neutral (3), disagree (2), and strongly disagree (1). Two of the questions were open-ended asking for positive and negative feedback regarding TBL. The anonymous survey was applied via an online application (Socrative), and informed consent was taken from the students at the beginning of the survey assuring freedom to participate and anonymity. Student comments were analyzed to identify strengths, weaknesses, and emerging repetitive themes that give insight into the acceptance and impact of this novel learning modality on students.
Thirdly, due to time constraints in a busy nine-week internal medicine posting, we conducted a modified TBL focusing on Phases 1 and 2 instead of a full programme . However, as prior medical TBL studies have also per- formed similarly modified TBL, such modifications may be sufficiently effective in medical education [10,13,18,23]. In our TBL implementation we adhered wherever possible to core TBL principles by using a scorecard  and the ‘4S’ principles . Some authors are concerned that par- tial TBL implementations may lead to negative conclu- sions about the efficacy of TBL . Despite a modified TBL programme, we found TBL superior to PL; a full implementation may have shown an even greater effect. Finally, our finding of a larger effect in weak students is based on a subgroup analysis . This finding needs cor- roboration by further studies, but the a priori defined sub- group, confirmation with formal testing for interaction, statistical significance and lack of multiple subgroup test- ing  in our study suggest that this may be a true effect.
Recent research has also found that TBL has positive effects on the students’ self-control and self-management. According to Michaelsen et al. (1997), group answering in TBL leads to students’ higher efficiency and better management of available resources (50): self-regulated learners will effectively use their teammates as sources of knowledge. Similarly, Zimmerman and Schunk (2007) pointed to the key role of resource- management cognitive strategies in self-regulated learning (51). It was believed that in integrated learning, where TBL was accompanied by the WebQuest method and learners were allowed more freedom, they felt the need for more self- regulation, and accordingly tried to achieve more independence and self-regulation; however, the expectation was not realized.
The frequency and percentages were used for the description of sample characteristics. Mean and standard deviations (SD) were calculated for all instrument scores. One-sample t-test was used for the comparison of TBL-SAI subscale and total scores as well as CES scores with the reference values (20, 33). We used repeated-measures analysis of variance (RM-ANOVA) to evaluate the effect of educational interventions (i.e. TBL vs. conventional lecture-based sessions) on knowledge retention over time (i.e. at 0, 2, and 4 weeks after the intervention) in a within-subjects design. In this regard, the “Type of Education Intervention” and the “Time of Assessment” were regarded as repeated measures variables and the students’ scores obtained from the SAQs as the outcome measure. We used repeated contrasts for post hoc analysis. P-values less than 0.05 were considered statistically significant. We used partial eta squared (ηp2) for effect size calculations. We used ηp2 as a quantitative measure of the strength of the observed effects in RM-ANOVA. According to a general “rule of thumb” ηp2 effect sizes equal to 0.01, 0.06 and 0.14 are considered small, medium, and large effect sizes, respectively (37). We used SPSS software, version16 for statistical calculations. Results
The TBL Scholars group was designed to provide support through its programming to those engaged in TBL scholarship and aims to create a sense of community for TBL scholar/practitioners at Iowa State. The survey findings and focus group data supported that both of these goals were being met by the Scholars’ learning community activities. Survey respondents who said they attend the TBL Scholars meetings were asked to select their moti- vations from a pre-determined list, or cite another motivation not found in the list. Participants were then asked to rank these motivations in terms of importance. The most cited reasons for attending the TBL Scholars group was to collaborate on grants with other TBL scholar/practitioners (68.8%), fol- lowed by “to learn more about what the scholarship of teaching and learning (SoTL) generally” and “to feel a sense of community with other seasoned TBL practitioners” (tie, 62.5%). When ranked in terms of importance, learning more about SoTL was the most important, followed by collaboration on grants; collaboration on publications ranked third in importance. Other reasons included “to learn what scholarship in this area looks like.”