Team Based Learning revisited

I have been forced to confront a prejudice this week and I’m very glad I have because I have significantly changed my perspective on Team Based Learning (TBL) as a result. When I cook I rarely use a recipe: rough amounts and a ‘bit of this; bit of that’ get me results that wouldn’t win Bake Off but they do the job.  I’m a bit anti-authority I suppose and I might, on occasion, be seen as contrary given a tendency to take devil’s advocate positions.  As a teacher educator, and unlike many of my colleagues over the years, I tend to advocate a more flexible approach to planning, am most certainly not a stickler for detailed lesson plans and maintain a sceptisicm (that I think is healthy) about the affordances of learning outcomes and predictably aligned teaching. I think this is why I was put off TBL when I first read about it. Call something TBL and most people would imagine something loose, active, collaborative and dialogic. But TBL purists (and maybe this was another reason I was resistant) would holler: ‘Hang on! TBL is a clearly delineated thing! It has a clear structure and process and language of its own.’ However, after attending a very meta-level session run by my colleague, Dr Pete Fitch, this week I was embarrassed to realise how thoroughly I’d misunderstood its potential flexibility and adaptability as well as the potentials of different aspects I might be sceptical of in other contexts.

Established as a pedagogic approach in medical education in the US in the 1970s, it is now used widely across medical education globally as well as in many other disciplinary areas. In essence, it provides a seemingly rigid structure to a flipped approach that typically looks like this:

  • Individual pre-work – reading, videos etc.
  • Individual readiness assurance test (IRAT) – in class multi-choice text
  • Team readiness assurance teast (TRAT) – same questions, discussed and agreed- points awarded according to how few errors are made getting to correct response
  • Discussion and clarification (and challenge)- opportunities to argue, contest, seek clarification from tutor
  • Application- opportunity to take core knowledge and apply it
  • Peer evaluation

This video offers a really clear summary of the stages:

Aside from the rigid structure, my original resistance was rooted in the knowledge-focussed tests and how this would mean sessions started with silent, individual work. However, having been through the process myself (always a good idea before mud slinging!), I realised that this stage could achieve a number of goals as well as the ostensible self-check on understanding. It provides a framing point for students to measure understanding of materials read; it offers-completely anonymously- even to the tutor, an opportunity to guage understanding within a group; it provides an ipsative opportunity to measure progress week by week and acts additionally as a motivator to actually engage with the pre-session work (increasingly so as the learning culture is established). It turns a typically high stakes, high anxiety activity (individual test) into a much lower stakes one and provides a platform from which intial arguments can start at the TRAT stage. A further advantage therefore could be that it helps students formatively with their understanding of and approaches to multi-choice examinations in those programmes that utilise this summative assessment methodology.  In this session I changed my mind on three questions during the TRAT, two of which I was quietly (perhaps even smugly) confident I’d got right. A key part of the process is the ‘scratch to reveal if correct’ cards which Pete had re-imagined with some clever manipulation of Moodle questions. We discussed the importance of the visceral ‘scratching’ commitment in comparsion to a digital alternative and I do wonder if this is one of those things that will always work better analogue!

The cards are somewhat like those shown in this short video:

To move beyond knowledge development, it is clear the application stage is fundamental. Across all stages it was evident how much effort is needed in the design stage. Writing meaningful, level appropriate multi-choice questions is hard. Level-appropriate, authentic application activities are similarly challenging to design. But the payoffs can be great and, as Pete said in session, the design lasts more than a single iteration. I can see why TBL lends itself so well to medical education but this session did make me wish I was still running my own programme so I could test this formula in a higher ed or digital education context.

An example of how it works in the School of Medicine in Nanyang Technological University can be seen here:

The final (should have been obvious) thing spelt out was that the structure and approach can be manipulated. Despite appearances, TBL does enable a flexible approach. I imagine one-off and routine adaptations according to contextual need are commonplace.  I think if I were to design a TBL curriculum, I’d certainly want to collaborate on its design. This would in itself be a departure for me but preparing quality pre-session materials, writing good questions and working up appropriate application activites are all essential and all benefit from collaboration or, at least, a willing ‘sounding board’ colleague.  I hope to work with Pete on modelling TBL across some of the sessions we offer in Arena and I really need to get my hands on some of those scratch cards!


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