Very Short Answer Questions in Team-Based Learning: Limited Effect on Peer Elaboration and Memory.

Introduction: In team-based learning (TBL), single best answer questions (SBAQs) are traditionally used because immediate computer-assisted feedback facilitates team discussions. Recent improvements in digital marking systems and criticisms of non-analytical strategies in SBAQs have prompted the consideration of very short answer questions (VSAQs) as an alternative to SBAQs. We aim to compare the effect of VSAQs and SBAQs on peer elaboration and knowledge retention in TBL. Materials and Methods: Twenty-four second-year students from the Lee Kong Chian School of Medicine participated in a mixed-methods study that included a randomised controlled crossover trial with two intervention arms (TBL-VSAQs and TBL-SBAQs). Two TBL sessions were conducted, with one topic covered each. Students were randomly allocated into six teams of four members. Individual and team scores and completion times were measured, and students were surveyed on their TBL experience. A follow-up quiz on the same topics was administered two weeks later to assess knowledge retention. Results: Individuals scored lower for VSAQs than SBAQs in the second TBL topic (7.17 ± 1.52 versus 8.25 ± 1.48; p = 0.046), while findings in other metrics were non-significant. Follow-up quiz scores showed no significant difference in knowledge retention, although effect size and power were low. Students perceived VSAQs as more authentic and challenging, though most preferred the continued use of SBAQs for TBL. Discussion: VSAQs have a limited impact on peer elaboration and knowledge retention versus SBAQs in TBL. Conclusions: We should be circumspect about implementing VSAQs in TBL especially for medical students at the pre-clinical level. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01716-5.

Students' learning experiences of three-dimensional printed models and plastinated specimens: a qualitative analysis.

BACKGROUND: Traditional cadaveric dissection is declining whilst plastinated and three-dimensional printed (3DP) models are increasingly popular as substitutes to the conventional anatomy teaching and learning methods. It is unclear about the pros and cons of these new tools and how they impact students' learning experiences of anatomy including humanistic values such as respect, care and empathy.  METHODS: Ninety-six students' views were sought immediately after a randomized cross-over study. Pragmatic design was used to investigate the learning experiences of using plastinated and 3DP models of cardiac (in Phase 1, n = 63) and neck (in Phase 2, n = 33) anatomy. Inductive thematic analysis was conducted based on 278 free text comments (related to strengths, weaknesses, things to improve), and focus group (n = 8) transcriptions in full verbatim about learning anatomy with these tools. RESULTS: Four themes were found: perceived authenticity, basic understanding versus complexity, attitudes towards respect and care, and multimodality and guidance. CONCLUSIONS: Overall, students perceived plastinated specimens as more real and authentic, thus perceived more respect and care than 3DP models; whereas 3DP models were easy to use and prefered for learning basic anatomy.

Effect of Seating Arrangement on Class Engagement in Team-based Learning: a Quasi-Experimental Study.

INTRODUCTION: This study investigated the effects of seating distance and orientation on engagement in novice and experienced learners in a large classroom explicitly designed for team-based learning (TBL). Learning what affects TBL engagement may improve its implementation. METHODS: Participants were novice first-year and experienced second-year undergraduate medical students in Singapore (male = 103, female = 57). Their age ranged from 18 to 23 (M = 19.5, SD = 1.06). This quasi-experimental study considered two factors. Firstly, the distance from the teams' table to the tutor's table. Secondly, students' orientation at each table, with either their front or back facing the tutor. Engagement was measured using two instruments, Situational Cognitive Engagement Measure and Classroom Engagement Survey at two TBL sessions - before and after swapping seating arrangements. RESULTS: For experienced students, seating distance did not significantly affect engagement (p = 0.08-0.89). Novice student's engagement levels decreased significantly for those who moved further; M = 3.30 to 2.98 (p = 0.009-0.023). However, overall engagement also decreased post-swap regardless of direction moved; M = 3.26 to 3.00 (p = 0.004). For both cohorts, seating orientation did not significantly affect engagement (p = 0.07-0.62). Those unaffected by seating arrangement commended the classroom's design, such as screens all around and quality audio-visual system. Novice students exhibited a stronger preference to sit nearer to the tutor than experienced students. Both groups preferred sitting with their front-facing the tutor. DISCUSSION: Within specially designed TBL classrooms, seating distance and orientation did not significantly affect engagement. Technologically enhanced team-centric spaces provide a favourable environment for TBL, though students' preferences for seats may change with more TBL experience. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01469-7.

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools.

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser-Meyer-Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of x 2 (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.

Investigating the effectiveness of three-dimensionally printed anatomical models compared with plastinated human specimens in learning cardiac and neck anatomy: A randomized crossover study.

Three-dimensional printing (3DP) technology has been increasingly applied in health profession education. Yet, 3DP anatomical models compared with the plastinated specimens as learning scaffolds are unclear. A randomized-controlled crossover study was used to evaluate the objective outcomes of 3DP models compared with the plastinated specimens through an introductory lecture and team study for learning relatively simple (cardiac) and complex (neck) anatomies. Given the novel multimaterial and multicolored 3DP models are replicas of the plastinated specimens, it is hypothesized that 3DP models have the same educational benefits to plastinated specimens. This study was conducted in two phases in which participants were randomly assigned to 3DP (n = 31) and plastinated cardiac groups (n = 32) in the first phase, whereas same groups (3DP, n = 15; plastinated, n = 18) used switched materials in the second phase for learning neck anatomy. The pretest, educational activities and posttest were conducted for each phase. Miller's framework was used to assess the cognitive outcomes. There was a significant improvement in students' baseline knowledge by 29.7% and 31.3% for Phase 1; 31.7% and 31.3% for Phase 2 plastinated and 3DP models. Posttest scores for cardiac (plastinated, 3DP mean ± SD: 57.0 ± 13.3 and 60.8 ± 13.6, P = 0.27) and neck (70.3 ± 15.6 and 68.3 ± 9.9, P = 0.68) phases showed no significant difference. In addition, no difference observed when cognitive domains compared for both cases. These results reflect that introductory lecture plus either the plastinated or 3DP modes were effective for learning cardiac and neck anatomy.

Is Virtual Team-Based Learning Feasible and Effective in Teaching Neurolocalisation?

We investigated the feasibility and effectiveness of virtual team-based learning (TBL) in teaching neurolocalisation (NL) in a sample of 18 student volunteers. Student satisfaction and knowledge outcomes were evaluated using the modified TBL Student Assessment Instrument and Extended Matching Questionnaire (EMQ), respectively. Mean student satisfaction rating was good at 3.9 out of 5.0 (SD 0.3). Participants achieved high mean EMQ scores of 84.2% (SD 2.9) with moderate correlation between individual assessment scores and EMQ scores (ρ = 0.587, p = 0.01). Virtual TBL is feasible for teaching NL with good student satisfaction and knowledge outcomes.

Exploring the feasibility of using very short answer questions (VSAQs) in team-based learning (TBL).

BACKGROUND: Team-based learning (TBL) currently relies on single best answer questions (SBAQs) to provide immediate feedback. Very short answer questions (VSAQs) are a reliable and discriminatory alternative that encourage learners to use more authentic clinical reasoning strategies compared to SBAQs. However, the challenge of marking VSAQs has limited their integration into TBL; we therefore explored the feasibility of VSAQs within a TBL session. METHODS: An online platform was developed to allow immediate marking of VSAQs during the TBL sessions. As part of the readiness assurance process, students completed VSAQs and SBAQs, which were marked in real time. RESULTS: Instructors were able to mark all VSAQs during the individual readiness assurance test (iRAT), which facilitated the provision of immediate feedback during the team readiness assurance test (tRAT). The mean time to mark five VSAQs was 422 seconds (SD 73 seconds). For VSAQs, the number of attempts to reach the correct answer ranged from 1 to 38, compared to 1 to 4 for SBAQs. In total, 71.6% of students agreed that using VSAQs in TBL helped to emphasise group discussions. DISCUSSION: The wide range of attempts at, and students' perspectives of VSAQs are suggestive of their positive impact on student discussion during TBL. We demonstrate how new technology allows VSAQs to be feasibly integrated into TBL with the potential to enrich group discussions.

Are Two Teachers Better than One? Team Teaching in TBL.

Teaching the medical sciences using team-based learning (TBL) is a complex task, which requires knowledge of both the subject matter and pedagogy. To deal with these increased demands on the teacher, a strategy where every TBL session is co-taught by a Content Expert and a Facilitator was implemented. Twelve classroom sessions focusing on the interaction between these groups of teachers and their contribution in class were observed. There are quantitative and qualitative differences in the nature of the questions that they ask. The findings provide insight into how effective TBL sessions arise from complementary questioning strategies from these parties.

A Psychological Foundation for Team-Based Learning: Knowledge Reconsolidation.

Although team-based learning is a popular instructional approach, little is known about its psychological foundation. In this Perspective, the authors propose a theoretical account of the psychological mechanisms through which team-based learning works. They suggest a knowledge reconsolidation hypothesis to explain how the distinct phases of team-based learning enable students to learn. Knowledge reconsolidation is the process whereby previously consolidated knowledge is retrieved from memory with the purpose of actively consolidating it again. Reconsolidation aims to preserve, strengthen, and adjust knowledge that is already stored in long-term memory. This process is generally considered an important reason why people who reactivate what they have previously learned many times develop knowledge structures that are extremely stable and easily retrieved.The authors propose that 4 psychological mechanisms enable knowledge reconsolidation, each of which is tied to a distinct phase of team-based learning: retrieval practice, peer elaboration, feedback, and transfer of learning. Before a team-based learning session, students engage in independent, self-directed learning that is often followed by at least one night of sleep. The latter is known to facilitate synaptic consolidation in the brain. During the actual team-based learning session, students are first tested individually on what they learned, then they discuss the answers to the test with a small group of peers, ask remaining "burning questions" to the teacher, and finally engage in a number of application exercises.This knowledge reconsolidation hypothesis may be considered a framework to guide future research into how team-based learning works and its outcomes.

Effects of graded versus ungraded individual readiness assurance scores in team-based learning: a quasi-experimental study.

Pre-class preparation is a crucial component of team-based learning (TBL). Lack of preparation hinders both individual learning and team performance during TBL. The purpose of the present study was to explore how the grading of the individual readiness assurance test (iRAT) can affect pre-class preparation, iRAT performance and performance in the end-of-year examination. Using a quasi-experimental design, Year 1 and 2 students' download frequency for their pre-class materials, performance on iRAT and examination were examined under two conditions; (1) under which the iRAT was graded and (2) under which the iRAT was ungraded. Medical students (N = 220) from three cohorts were included in the study. Differences between both conditions were tested by means of six separate ANCOVAs, using medical school entry test scores as the covariate to account for potential cohort effects. Results revealed that students were downloading more pre-class materials prior to their TBL sessions, and were performed significantly better on iRAT when their performance was graded, even after controlling for cohort effects. Analysis of covariance demonstrated that performance on iRAT also appeared to affect performance on their examination scores. The results of the study suggest that grading has a positive effect on students' iRAT scores. Implications for TBL are discussed.

Implementation of team-based learning on a large scale: Three factors to keep in mind.

Team-based learning (TBL) is a structured form of small group learning that can be scaled up for delivery in large classes. The principles of successful TBL implementation are well established. TBL has become widely practiced in medical schools, but its use is typically limited to certain courses or parts of courses. Implementing TBL on a large scale, across different courses and disciplines, is the next logical step. The Lee Kong Chian School of Medicine (LKCMedicine), a partnership between Nanyang Technological University, Singapore and Imperial College London, admitted its first students in 2013. This new undergraduate medical program, developed collaboratively by faculty at both institutions, uses TBL as its main learning and teaching strategy, replacing all face-to-face lectures. TBL accounts for over 60% of the curriculum in the first two years, and there is continued learning through TBL during campus teaching in the remaining years. This paper describes our experience of rolling out TBL across all years of the medical curriculum, focusing on three success factors: (1) "team-centric" learning spaces, to foster active, collaborative learning; (2) an e-learning ecosystem, seamlessly integrated to support all phases of the TBL process and (3) teaching teams in which experts in pedagogical process (TBL Facilitators) co-teach with experts in subject matter (Content Experts).

How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement.

The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (ß = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.