By Jared Butler, PharmD, BCPS, DPLA; Chris Johnson, PharmD, MEd, BCACP; Lydia Newsom, PharmD, BCPS
Team-based learning (TBL), introduced by Larry Michaelsen in the 1970’s, was an evolution for making a large classroom feel smaller and more intimate.1 This pedagogy has been adopted by some into the education of health professionals, pharmacy included, to step away from traditional lecture classrooms. Although the popularity continues to rise, how much do we truly know about TBL’s impact? Considerations include, but are not limited to: the perception of the pedagogy, changes in learner preparation, impact on examination scores, and impact on knowledge retention.
TBL Refresher
Utilizing TBL as Michaelsen designed, requires the formation of teams (4-7 people), pre-class preparation material, immediate feedback within the classroom, utilization of team-based application exercises, and peer feedback (Figure 1). In addition to these tenants, a change in planning, preparing, and executing individual lessons is required when transitioning from lecture-based to TBL-based classrooms.
Figure 1. (Adapted from Michaelsen, et. al.)1
Perception of Pedagogy
TBL and lecture pedagogies have different elements for success in the classroom. Compared to lecture, TBL preparation, attendance, and participation all require more activity from the learner. Remington et. al. compared learner perceptions of these two pedagogies (Table 1).2 The least favored aspect of TBL from the learner perspective was the required pre-class preparation.
Table 1. Positive Learner Perceptions2
| TBL | · Application-based problem solving · Development of clinical reasoning skills · Clinical viewpoints from faculty |
| Lecture | · Clearer key points · Most important points for the exam better delineated |
Learner Preparation
In TBL, pre-class assignments are designed to aid in acquisition of factual knowledge needed for analyzing in-class activities. DeJongh, et. al compared preparation time for lecture and TBL pharmacotherapeutics courses.3 Overall, less time was utilized to prepare for a lecture versus TBL classroom setting. (see Table 2)
Table 2. Learner-Perceived Preparation Time (adapted from DeJongh et. al)3
| Time Spent | Lecture; % of learners | TBL; % of learners |
| I did not prepare | 40.9% | 3.4% |
| Less than 30 min | 36.4% | 7.4% |
| Between 30 min and 1 hr | 13.5% | 20% |
| Between 1 and 1.5 hrs | 4.5% | 25.5% |
| Between 1.5 and 2 hrs | 1.2% | 15% |
| Greater than 2 hrs | 3.5% | 28.8% |
Examination Scores
Currently, available exam score data comparing lecture and TBL appears to be variable. The basic pedagogy format for lecture is fact-based, whereas application-based learning is the focus of TBL. Bleske, et. al compared TBL and lecture classrooms with regard to effectiveness of achieving predefined learning outcomes.4 P3 learners in traditional lecture were compared with P2 learners who utilized TBL covering similar core cardiac disease states. This study demonstrated that recall of knowledge favored lecture (p=0.01), whereas no difference was found in application of knowledge (p=0.24), based on multiple-choice questions. The study did reference the potential limitation of comparing students in different years of the curriculum. Although recall of knowledge is important. it is important to remember what we want students to do with their knowledge. Consistency was demonstrated in knowledge application between pedagogy styles.
Knowledge Retention
Knowledge retention is important in the classroom and is imperative as a pharmacy practitioner. Our understanding of knowledge retention and ability to recall knowledge continues to be an evolving field of research. Roediger et. al looked at several studies on utilization of retrieval practices to enhance knowledge retention.5 Some conclusions from the reviewed studies include:
- Repeated retrieval practice improved one-week retention of word pairs compared to a single retrieval activity, regardless of other study time
- A longer time between retrieval (1 versus 6 minutes) improved recall
- A plateau in testing improvement was seen after five to seven recall practice attempts
- Immediate correct answer feedback is potentially more impactful than correct answers during retrieval practice.
TBL utilizes immediate feedback on individual readiness assurance tests, team readiness assurance tests, and in-class activity exercises, these learning activities may demonstrate a type of retrieval practice, but more study in the context of TBL is needed to determine how much immediate feedback impacts knowledge retention.
Expanding the Research
The optimization of TBL requires upfront time for success, but the enhanced potential for connections with students through sharing your clinical wisdom is a great opportunity. As with all pedagogies, ownership and buy-in are essential for success. TBL is no different and SoTL research is imperative. To improve faculty ownership, further research into retrieval practice and knowledge retention within advanced pharmacy practice experiences and future pharmacist roles will be important. To improve learner buy-in for the extra required pre-class work, it would be beneficial to learn if tangible differences are present in the amount of post-class studying required in TBL compared to lecture. What other research opportunities should be explored to enhance the evolution of TBL?
Acknowledgements
The authors want to acknowledge the work of the AACP Junior Faculty Learning Community Committee, especially the committee chair, Kate Smith, PharmD, BCACP for her efforts to set up this Pulses series.
References
- Michaelsen LK, Parmelee DX, McMahon KK, Levine RE. Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning, Stylus Publishing, 2008.
- Remington T, Bleske B, Bartholomew T, et. al. Qualitative analysis of student perceptions comparing team-based learning and traditional lecture in a pharamcotherapeutics course. Am J Pharm Educ. 2017;81(3):Article 55.
- DeJongh B, Lemoine N, Buckley E, Traynor L. Student preparation time for traditional lecture versus team-based learning in a pharmacotherapy course, Curr Pharm Teach Learn. 2018;10(3):360-6.
- Bleske BE, Remington TL, Wells TD, et. al. Team-based learning to improve learning outcomes in a therapeutics course sequence. Am J Pharm Educ. 2014;78(1):Article 13.
- Roediger HL, Butler AC, The Critical Role of Retrieval Practice In Long-Term Retention, Trends Cogn Sci, 2011;15(1):20-7.
Jared Butler, PharmD, BCPS, DPLA is an Assistant Professor of Pharmacy Practice at Drake University College of Pharmacy and Health Sciences. Educational scholarship interests include team based learning and the use of play in graduate education. In his free time, Jared enjoys watching and participating in sporting events, hanging out with his family, and relaxing with country music on the radio.
Chris Johnson, PharmD, MEd, BCACP is an Assistant Professor of Pharmacy Practice at the University of Arkansas for Medical Sciences College of Pharmacy. Educational scholarship interests include underserved pharmacy practice, ambulatory care practice development, and impacts of innovative pedagogical approaches on student learning. In his free time, Chris enjoys hiking and spending time with his wife, Kati, and son, Lincoln.
Lydia C. Newsom, PharmD, BCPS is a Clinical Assistant Professor at Mercer University College of Pharmacy. Educational scholarship interests include the use of technology in the classroom and the teaching and assessment of clinical reasoning. In her free time, Lydia enjoys playing tennis, watching college football, and spending time with family and friends.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning
Pulses 
Well done piece team! You summarize the literature, issues and opportunities moving forward very well. I have observed, as with many things, that it takes a critical mass of TBL utilization in a curriculum to achieve perceived overall benefit. I am curious about how schools are getting to that critical mass. Based on the literature, it is difficult to currently support policy expecting TBL use, but there is so much potential (working in a team, decision making, study skills) with this method not realized or studied in the absence of using consistently. Thanks for starting this dialogue!
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