D. Parmelee, P. Hudes and L.K. Michaelsen

What is team-based learning?

Team-based learning (TBL) is an active learning instructional strategy that provides students with opportunities to apply conceptual knowledge through a sequence of events that includes individual work, teamwork and immediate feedback. It is very much learner-centred and engages students with the kinds of problems they will encounter in clinical practice. It also promotes the development of professional competencies in interpersonal skills, teamwork and peer feedback (Michaelsen et al 2008a).

The evidence for its academic effectiveness is beginning to grow, with an emerging track record for improving academic outcomes (Thomas & Bowen 2011, Koles et al 2010, Shellenberger et al 2009). TBL was first developed in the business school domain for large classes. Since 2001, its use in medical and other health professions schools has grown because it enables students to learn a great deal in small groups while still being in a large class setting: there is no need for multiple faculty and separate rooms for each small group.

How does TBL work?

Team-based learning’s sequence of steps are forward thinking, guiding students into thinking progressively, gaining the ability to look beyond the ‘now’ and constantly asking, ‘What’s next?’ TBL sequences the learning process (Michaelsen et al 2008b) for the students through the following steps (Fig. 21.1).

What does a TBL session look like?

If you visit a classroom while there is ongoing TBL, you will be impressed by the amount of body movement and talking. No student will be snoozing or reading the news. It is noisy because, for most of the time frame, the students are discussing, debating, even arguing within their teams as they achieve consensus on the instructor’s questions. There is a great deal of peer–peer teaching as members of a team ensure that they all ‘get on the same page’ with what they know and don’t know. Those with strong personalities learn to take turns in making their point, listen to those with a different opinion and develop some humility. Reticent students are drawn in to participate because the team needs everyone’s brainpower.

If you start class on time with the iRAT, then all students will be in-class early and ready to go. The room will be silent as they answer the set of questions, then when time is called, they will burst into discussion about the questions transitioning into the tRAT.

Students use the Immediate Feedback Assessment Technique (IF-AT) form to answer the tRAT questions. The IF-AT is a multiple-choice answer form with a thin opaque film covering the answer options. Instead of using a pencil to fill in a circle, students scratch off the answer as if scratching a lottery ticket. If the answer is correct, a star appears somewhere within the rectangle indicating the correct answer. Students earn partial credit for a second attempt and learn the correct response for each question while taking the tRAT. One member of a team gets picked by the team to do the scratch off on the IF-AT form, and all are at rapt attention as he or she determines whether or not the team’s decision on a question is the preferred one. Generally, teams will give out a small cheer when right and a light groan if wrong. If they do not get it right the first time, they will immediately re-engage on that question and make another selection, but not without careful consideration since the stakes are higher. More information about the IF-AT form is available at the Epstein Educational Enterprises website.

The instructor moves about the classroom, taking a seat with a team to listen in to the discussion to monitor the pulse of their discussions. If many hands go up during the tRAT to ask questions about the questions, then there are problems with the questions, usually regarding how they have been written.

Once all teams have completed the tRAT using the IF-AT form, there should be time for a whole class discussion of one or two of the questions that the class should select (remember, by now, a lot of peer teaching has occurred, as well as immediate feedback). The instructor either makes decisions on the spot about whether or not to accept more than one answer or defers to the Appeal process. The instructor takes the time to assure that all key concepts tested in the RATs are understood by the whole class. If there is a scheduled break between the RAP (Readiness Assurance Process) and the tAPP (Team Application), then the instructor provides guidance to the class on what more they need to master before coming back for the tAPP. Often, the instructor provides a brief, focused presentation (Instructor Clarification Review) that explicates the ambiguities in the key concepts in preparation for the tAPP.

Following the RAP, everyone in the room moves on to the tAPP. The case/problems for this phase can be accessed in envelopes at each team location, displayed on screens in the classroom or posted on a website so that a team can view easily. There is quiet as individual students read through and study the presenting vignettes, which often include CAT scan images, laboratory data or microscopic images that need interpretation. Once members of a team feel that they are ready to discuss, they do so. The noise level rises, students get up and re-position to scrutinize images, and each team discovers its own process to make the best decisions on the options provided in the questions. The instructor calls time and requests the simultaneous response posting of team choices: methods used for posting answers include large colour-coded laminated cards with the options A, B, C, etc., and Audience Response System ‘clickers’. When all postings go up, the instructor has to say ‘Great choices!’ without disclosing the designated ‘best’ answer.

Next, the instructor must probe for why a team made a specific choice, why not another one, to get all teams engaged in defending their choices. Once there has been sufficient but not excessive presentation of differing positions on a question, the instructor states why he or she likes one or another better. The instructor may concur that two of the choices are equal depending upon how one interprets the data, referring to how a particular team articulated their position. If this component counts for a grade, then Appeals are invited for those teams that disagree with the final in-class answer(s).