Curriculum Transition From Lecture-Based to Team-Based Learning is Associated With Improved Performance on Internal Medicine In-Training Examination.

BACKGROUND: Team-based learning (TBL) is an alternative to traditional lectures in graduate medical education, but evidence is scarce regarding its impact on knowledge acquisition and standardized testing performance. OBJECTIVE: We examined the association between resident performance on the Internal Medicine In-Training Examination (IM-ITE) and these 2 educational methods. METHODS: In 2013, the internal medicine residency program at Albany Medical College transitioned from a lecture-based curriculum to TBL. Residents enrolled in academic years 2011-2012 and 2012-2013 comprised the lecture cohort, and those enrolled in 2015-2016 and 2016-2017 the TBL cohort. Covariates included the type of medical school attended, gender, and United States Medical Licensing Examination Step 2 Clinical Knowledge scores. We performed univariate analysis and multivariable regression to determine the association between covariates and ITE scores. RESULTS: Of 120 residents, 60 were in the lecture cohort and 60 in the TBL cohort. The IM-ITE percent correct scores were higher with TBL than lecture (PGY-1 61.0% vs 55.0%, P < .001; PGY-2 69.0% vs 59.7%, P < .001; PGY-3 73.2% vs 61.7%, P < .001). In a multivariable regression analysis of 3 PGYs combined, the transition from lecture to TBL resulted in an increase in IM-ITE Z-score of 0.415 (P < .001), equivalent to 0.415 SD, when including the effects of all covariates. CONCLUSIONS: Compared to a lecture-based curriculum, TBL was associated with improved resident medical knowledge acquisition as evidenced by higher IM-ITE scores.

Feasibility of a Comprehensive Medical Knowledge Curriculum in Internal Medicine Using Team-Based Learning.

BACKGROUND: Team-based learning (TBL) is an active learning strategy with descriptions of its use in resident education limited to pilot studies. OBJECTIVE: We developed a comprehensive medical knowledge TBL curriculum for an internal medicine residency, and assessed feasibility. METHODS: We developed a 135-topic TBL curriculum to replace a noon conference lecture series, and implemented it over a 3-year period (2013-2016). In this article we describe the planning, curricular design, faculty recruitment and development, and lesson structure. We assessed feasibility in terms of faculty participation, resident preparedness, resident and faculty satisfaction, and costs. RESULTS: Most faculty initially were unfamiliar with TBL. Through faculty resource materials and flexible faculty development, participating faculty increased from 3 to 74. In a 2015 faculty survey (N = 64, 69% response rate), 73% (32 of 44) reported faculty development was adequate, 70% (31 of 44) indicated lesson preparation time reasonable, and 95% (42 of 44) reported preparation materials were helpful. A 2016 resident survey (N = 89, 72% response rate) revealed that most residents completed reading assignments in advance, 78% (50 of 64) found readings manageable, and 77% (49 of 64) felt they learned better from TBL compared to lectures. Costs included compensated time for 1 faculty TBL "champion" and an assistant. CONCLUSIONS: Implementing a comprehensive medical knowledge curriculum using TBL in an internal medicine residency was feasible, and resulted in high faculty acceptance and learner satisfaction. Departmental support of a TBL champion, flexible faculty development, and well-designed resource materials were determinants of success.