Team Based Learning and its discontents

[Votaku]

Fellow SDN'ers,


I just recently started team-based learning in my school, and two sessions in I'm firmly in the "this is a useless time suck" camp.
Now before I get accused of trolling, I'd like to give my reasons and hear your thoughts.

1. TBL is inefficient: relatively little information is gone over in a period over 2-3 hours

2. TBL is inconsistent: since teams are so small, you will always have an asymetric distribution of talent. Some groups have braniacs that dominate the group, with others ceding all work to them, others are filled with dimmer bulbs (myself among them) trying to thrash things out with no guidance on if we're on the right track or not. Teams can also become bifurcated between those working, those socializing, and those indifferent.

3. TBL gets silly: To ameliorate the above issue, our professors randomly select several teams to present their reasons for picking a couple of answers. Half of those selected make poor jokes/ silly comments. The other half give intelligent answers which are often crippled by poor or inconsistent delivery.

4. TBL is too long: Our TBL sessions take anywhere from 3-3.5 hours. not only is this way beyond the attention span of many of us, but the length of the stay affects the quality of learning. Due to the inconsistent teaching noted above, many times questions really should be thrashed out further. However, because TBL is so long, asking further questions would just lengthen an already unnecessarily bloated session, so questions are usually not asked.

Now I don't want to be a gloomy gus, but the above is getting to be an increasing source of frustration for me, especially as the professors are promising to include more TBL as the school year and the next academic year progresses.

Does it get better? Anybody out there all for TBL?

I'd love to hear your thoughts...

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[Wordead]

LCME has splooged all over medical education.

 

[Isoprop]

I actually like TBL, but our TBL sessions are shorter--1.5 to 2 hours. We do get our fair share of silly answers or plain wrong answers, but that's okay. We learn from our mistakes.

And as far as the inefficiency, I have to disagree. TBL is not the time to go over a lot of information. The point of TBL is to learn to apply the information to a problem or a clinical situation.

Also, in our school our groups are pretty fairly divided in my opinion. Keep in mind that the brainiacs in your class may have talent in one subject but may struggle with another. Even though you may feel like you are a "dimmer bulb" now, you may feel more confident in later subjects and topics.

 

[MrBird]

Fellow SDN'ers,


I just recently started team-based learning in my school, and two sessions in I'm firmly in the "this is a useless time suck" camp.
Now before I get accused of trolling, I'd like to give my reasons and hear your thoughts.

1. TBL is inefficient: relatively little information is gone over in a period over 2-3 hours

2. TBL is inconsistent: since teams are so small, you will always have an asymetric distribution of talent. Some groups have braniacs that dominate the group, with others ceding all work to them, others are filled with dimmer bulbs (myself among them) trying to thrash things out with no guidance on if we're on the right track or not. Teams can also become bifurcated between those working, those socializing, and those indifferent.

3. TBL gets silly: To ameliorate the above issue, our professors randomly select several teams to present their reasons for picking a couple of answers. Half of those selected make poor jokes/ silly comments. The other half give intelligent answers which are often crippled by poor or inconsistent delivery.

4. TBL is too long: Our TBL sessions take anywhere from 3-3.5 hours. not only is this way beyond the attention span of many of us, but the length of the stay affects the quality of learning. Due to the inconsistent teaching noted above, many times questions really should be thrashed out further. However, because TBL is so long, asking further questions would just lengthen an already unnecessarily bloated session, so questions are usually not asked.

Now I don't want to be a gloomy gus, but the above is getting to be an increasing source of frustration for me, especially as the professors are promising to include more TBL as the school year and the next academic year progresses.

Does it get better? Anybody out there all for TBL?

I'd love to hear your thoughts...

I'm assuming you go to one of the New York state schools or Temple.

 

[Mace1370]

My school had pretty minimal TBL since we mostly had a traditional curriculum. What we did have was pretty awful, more or less for all the reasons you cited. I'm sure it works for a select few, though. The main problem is that when it is mandatory those that learn differently are forced to attend.

 

[DrBowtie]

Agree with the OP. Our TBL was very minimal but what we did have was absolutely useless. Sorry that you go to a heavy TBL school. If its not graded just crush review books in your spare time.

 

[dummymummy]

Ultimately, I think it depends on how your school structures their PBL/Team based learning. My school does an excellent job of structuring it. I find that many schools have PBL just for the sake of it, and I see how this might impact negatively on the students. Like I said, my school does a great job of organizing and structuring it, and it has helped me and many people I have spoken with learn better, and reinforce what we are taught in lecture. Also, in working on our cases, I believe I have become more adept at research, and putting stuff together to come up with the right diagnosis, even though I'm only a first year.


Again, it depends on how your school structures it, and if not well done, it can be a big waste of time. But if well done like my school, you will surely end up benefiting from it.

 

[Isoprop]

How much is minimal? Our TBL is about once a week.

 

[mvenus929]

TBLs at my school have... gotten better. We're the first class to experience them, and last year, they were horrible wastes of time. This year, they're much more streamlined and do help solidify information. I think they're best used to combine different disciplines... we had one where we had ethics integrated into the application exercises, in addition to the clinical judgment questions. Much better than having a straight class on ethics.

 

[Best4Med]

The point you may be missing is that TBL is not only about getting the right answers, but learning how to work as a team. As odd as it sounds, medical staff DO have to solve problems as a team, in many cases, and you need to practice this. All through the education system, you may never have to work together with anyone else, so med schools want to give you the proper experience to make collective decisions, learn how you work in a group, see your strengths and learn your weaknesses. It's actually very important.

 

[MilkmanAl]

I agree that working as a team is an important concept. However, I strongly disagree with trying to shoehorn the mass memorization of the first two years of med school into a format that doesn't suit it at all. Learning tons of facts is not a team activity.

 

[Jack is Back]

I've found very few people who actual enjoy it.

It is wasted time. Good intentions and awful execution.

 

[Brewmeister]

Some people learn from this format, some don't. Administrations need to recognize that different students have different learning styles and allow those that would rather not spend hours upon hours in a classroom, go home and hit the books. Basically, PBL should be optional.

 

[Votaku]

So far, I've had two different TBL's -- one with new material that we were responsible for learning, and another that was application of already learned material. Although I disliked both TBL's, admittedly the second format--applying stuff we already knew--was a little more effective.

Nonetheless, as a method for learning science, I still feel it is a no go--in the end, you'll have to teach it to yourself anyway, so 3 mandatory (and graded, we have quizes at the beginning) hours stuck doing TBL is just poor stimulus for mental masturbation .

If TBL was used solely for discussing ethical issues, I would be all for it however. That's what we did for our "practice" session for TBL. There we got interesting discussions going and were kept awake. For science 👎

 

[turkeyjerky]

It's interesting that there's pretty wide enthusiasm for PBL among med school applicants, then this turns to almost unanimous disdain for it once in med school. In fact, I think even the people who enjoy feel that it's a inefficient way to learn and a waste of time overall.

 

[Siverhideo1985]

I think there is something to be said for reminding students in the first two years that a career in medicine, for the majority of us, will be a group effort. It gives every student the opportunity to learn, to teach, and to interact in a team. Of course, this isn't as efficient as studying material on your own (for the most part)...but neither is caring for a patient by working with a team in clinical medicine. Dealing with those inefficiencies and learning how to integrate into a diverse group is, in my opinion, a worthwhile lesson...even (and maybe especially) during the first two years of med school.

 

[MilkmanAl]

Dealing with those inefficiencies and learning how to integrate into a diverse group is, in my opinion, a worthwhile lesson

We already have 2 years of that. I don't really see why trying to make something that is inherently not a team-based activity into one seems like a good idea to some.

 

[Siverhideo1985]

We already have 2 years of that. I don't really see why trying to make something that is inherently not a team-based activity into one seems like a good idea to some.

remembering facts =/= team-based activity. "Learning" in general very much is.

 

[MilkmanAl]

For the basic sciences, I disagree.

 

[Siverhideo1985]

For the basic sciences, I disagree.

Fair enough...to each their own. Chances are though...PBL is here to stay for a while so students may as well make the best out of it.

 

[Jack is Back]

Fair enough...to each their own. Chances are though...PBL is here to stay for a while so students may as well make the best out of it.

Making the best of it is spending as little time as possible on it.

The reason premeds think it is cool is because it is interesting in some ways. The problem is, it is a horribly inefficient of learning science. You could probably learn 10 cases in the time it takes to do 1 in PBL.

Who will be the better clinician, the guy who wasted time chit chatting and looking up info for PBL on 10 cases OR the guy who thoroughly learned 100 cases?

I think we all know who would be the better clinician. I can learn people skills and teamwork hanging out or in some specialty interest group.

 

[Morsetlis]

That sounds very inefficient. Isn't there an MD tutor there to give you answers and clarify/teach, or do you look everything up yourself and guess/argue as to what's right?

 

[Votaku]

That sounds very inefficient. Isn't there an MD tutor there to give you answers and clarify/teach, or do you look everything up yourself and guess/argue as to what's right?

In my TBL--which is only basic sciences/biochem so far--a question is put forth and we're given 10-15 minutes to figure it out as a group. Once each group submits their answer, if there are different answers submitted, one of the groups in the minority is asked to present their reasoning, and another in the majority will present their reasons. I was surprised by how little moderation the professors did. Once 4-5 groups have spoken, the professors just move on. Sometimes people ask what the right answer is, and they will tell us and just move on. No explanation, just the answer. Damned annoying.😡

Some people in my class have speculated that the professors are writing a paper on the effectiveness of TBL. They're taking lots of pictures and are noting down individual answers (which are given by quiz) vs group answers. Stuff they're saying also seems to indicate that they're sticking strictly to a set of rules...If this is the case, I'm even more pissed off...I don't need to waste hours of my time so that they can have an extra publication on their CV.

 

[Morsetlis]

That sounds as fun as dissecting using only forceps.

 

[meowdoc]

I agree TBL sucks. I remember streamlining my experience, catering to my course grade. If you're forced to do it (b/c of grades or whatever) try to look at it as practice for working with people. Try to make your group more efficient. Exercise some leadership or some other bull**** like that. All I'm saying is if you can't get out of it, at least get something out of it.

 

[Mace1370]

Fair enough...to each their own. Chances are though...PBL is here to stay for a while so students may as well make the best out of it.

By putting earplugs in, studying on your own, and leaving at the earliest available opportunity, for example.

 

[mvenus929]

Who will be the better clinician, the guy who wasted time chit chatting and looking up info for PBL on 10 cases OR the guy who thoroughly learned 100 cases?

I want to make a distinction here, especially for those of you who don't do either PBL (problem based learning) or TBL (team/table based learning) sessions. Our school does both.

We have afternoon sessions once a week where we go through a case as a group. It usually takes an hour to do the case (at least, it does for our group), and is basically a patient presentation where we're trying to figure out the diagnosis. This is what I see as PBL sessions, because often the case has something in it that we haven't learned about yet. It's not a pure PBL session in that we don't look up things much during the case, and our learning objectives aren't based on trying to figure out the diagnosis, but rather things that we were unclear on as we went through the case.

These are a horribly inefficient way to learn because they are huge time sinks. I do enjoy well structured problem sets that we do individually, and come together to discuss the answers as a group, but we don't get those too often.

TBLs, on the other hand, are pure application exercises. You're expected to know the basic information before you get to class. There's a short quiz at the beginning of class (we do it both individually and as a group) based on the pre-class materials. Then, we do the application exercises. We're not allowed to look up information during this part. So, in that sense, it's anti-PBL. The 'problems' are purely meant to solidify your knowledge and point out holes in it; if you don't know something, then it's a chance for your group members to teach you, helping both of you in the process.

The moderators at my school also go through the 'answers' to the questions (there are often shades of gray), and explain their reasoning for picking the answer, which helps clarify what sometimes goes into clinical decision making.

So, in that sense, TBLs are all about working in a team. You have to balance opinions, using 'clinical judgment' (as much as you can as a preclinical student) to come to an answer.

 

[ArcGurren]

I for one thought my school ran TBL/PBL sessions very well during the basic science years and that I learned a lot. In fact the clinical PBL sessions during the basic science classes stuck with me well and I carried it into third year... and hey, it's helped me do well. I do think this is largely dependent on how your school runs it; if it's not done well then of course it is going to sour people on the idea, but if it's done well and other people besides yourself show enthusiasm to learn/work at these sessions, it'll go by more nicely.

IDK I think these things are more accepted than SDN would lead everyone to believe lol. I think this forum self-selects for people who are generally:

- more content doing stuff "on their own" than in a group
- would love to spend the least amount of time possible at the medical school/hospital as possible, and still somehow try to learn
- want to go into a "chill" field which requires less real teamwork like derm, anesthesia, rads, etc (come on, you know this much is at least true).

 

[ArcGurren]

I agree that working as a team is an important concept. However, I strongly disagree with trying to shoehorn the mass memorization of the first two years of med school into a format that doesn't suit it at all. Learning tons of facts is not a team activity.

I highly, highly disagree that much of the first two years is pure memorization. I could never have done well on my step 1 purely by memorizing; there were multiple questions where I didn't know the answer off the bat purely from memory but with understanding of the concepts I was able to reason out the answers. The concepts are an excellent thing to discuss in TBLs, and that's what my school more or less used them for.

 

[Jack is Back]

I highly, highly disagree that much of the first two years is pure memorization. I could never have done well on my step 1 purely by memorizing; there were multiple questions where I didn't know the answer off the bat purely from memory but with understanding of the concepts I was able to reason out the answers. The concepts are an excellent thing to discuss in TBLs, and that's what my school more or less used them for.

There are lots of concepts, but how in the world could you deny that M1 and M2 has a huge volume of memorization?

 

[ArcGurren]

There are lots of concepts, but how in the world could you deny that M1 and M2 has a huge volume of memorization?

Reread my post...I didn't say that there isn't any memorization; I said that it isn't PURELY memorization. I think if you understand the basic underlying concepts and the tougher concepts on top of those, then memorizing the nitty gritty details is much easier. Sorry if it was a little unclear.