Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching

摘要

Background? Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education.;Methods? Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests.;Results? Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions.;Conclusions? We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.;What was known and gap Team-based learning (TBL) is known to enhance learning, and promote learner engagement and collaboration, yet there are few studies of its application in resident education.;What is new An internal medicine program instituted TBL for its 4?+?1 ambulatory rotation curriculum.;Limitations The single specialty, single program study and lack of a comparison group limit generalizability.;Bottom line The TBL approach required a small amount of ongoing preparation by facilitators and was preferred by residents and faculty.;Editor's Note: The online version of this article contains a list of team-based learning module topics developed for ambulatory curriculum year 1; individual and group readiness assessment tests (IRAT/GRAT); clinical vignettes and learning objectives; a sample of an anonymous survey for peer evaluation and feedback; and comparison of IRAT and GRAT scores for a patient-centered medical home and a hospital-based clinic.;Introduction Team-based learning (TBL) was developed to promote active learning, problem solving, and concept application in college classrooms.1,2 TBL is an active learning strategy that uses a structured combination of presession preparation, an individual readiness assurance test (IRAT), and a group readiness assurance test (GRAT), as well as application exercises to engage learners in their education.2–4 TBL has been increasingly used in undergraduate medical education.5,6 However, there is little data on the use of TBL in graduate medicine education (GME).7,8 The Accreditation Council for Graduate Medical Education (ACGME) competency of practice-based learning and improvement requires that residents be able to assess their own learning needs and self-improve based on feedback. The ACGME competency of professionalism requires residents to collaborate and work in teams.9 The TBL pedagogy fosters skills to develop both of these competencies. Residents are required to complete prework, work in teams, and use feedback from peers to self-improve. In 2012, we substituted our faculty-led, case-based interactive sessions with a TBL pedagogical approach to improve resident participation and learning in the ambulatory setting. This curriculum was designed to evaluate whether TBL resulted in (1) resident/faculty engagement an