TBL: Pre-Class Preparation is Not Just for Students

By Lydia C. Newsom, PharmD, BCPS; Chris Johnson, PharmD, MEd, BCACP; Jared Butler, PharmD, BCPS, DPLA

Team-based learning (TBL) continues to be a popular pedagogy in pharmacy education, but how does the evidence inform our use of this teaching strategy? In a previous Pulses post, we discussed the evidence related to the impact of TBL on our students’ perceptions, preparation, grades, and knowledge retention. However, what evidence is there related to the faculty member’s role? Compared to traditional lecture, a faculty member’s preparation and facilitation skills are more important than the ability to deliver lecture content (Figure 1). In this post, we’ll discuss preparation, including design and facilitation best practices.

Figure 1: Faculty Preparation and Facilitation for Team-Based Learning (TBL) and Traditional Course Sessions

Preparation and Design of TBL Modules

• Seek out training: Appropriate training is vital for your success! Reach out to faculty within your institution with TBL experience or attend a workshop where you can experience TBL firsthand. Educate yourself using published evidence, training modules, and videos available from the Team-Based Learning Collaborative.
• Schedule enough preparation time: Designing TBL modules often takes much longer than expected, especially during the first year of TBL module delivery.¹ A good rule of thumb is to set aside twice as much time as it takes to develop a traditional lecture.
• Begin with the end in mind: This concept is called “backwards design.” What do you want your students to know and be able to do at the end of your TBL session? Use these concepts to write knowledge-focused learning objectives for pre-class preparation and readiness assurance tests (RAT) and application-focused objectives for the team exercises.^2,3
• Use different preparatory materials: Consider using other resources such as pre-recorded videos, narrated PowerPoint slides, or review articles. If a complex resource is used, a study guide may be helpful to guide student preparation.
• Create the Readiness Assurance Test (RAT): Pharmacy literature suggests the use of 5 – 15 RAT questions with around 1 minute per question.² The RAT questions should be derived from and cover the main points associated with the learning objectives of the pre-class material. Sticking to this structure will ensure the majority of class time is dedicated to the team application exercises.
• Be creative with your team application exercises, but don’t forget the 4 S’s: The team application exercises should promote higher level thinking and team dialogue. The 4 S’s (significant, specific, same, and simultaneous) are core components for every team application exercise.³ The multiple choice format is in line with the 4 S’s, but don’t shy away from using open-ended questions. Be creative with Google Docs or tools within your learning management system for answer reporting. Piloting the exercises in a lower stakes setting and getting faculty feedback may also be helpful prior to using the exercises in your module.²

Preparing to Facilitate

• Estimate time and find an online timer: Effectively moving groups through the team application exercises will ensure you keep students engaged. The time it takes a team to work through a team application exercise is variable (3 – 15 minutes) and is based on factors such as topic difficulty, case complexity, and student knowledge.² When half of the groups have completed an exercise, consider using a visible timer to alert the rest of the teams about the remaining time for that exercise. Don’t forget about the time needed for inter-team discussion to wrap up each team application exercise.
• Think through your facilitation in advance: In TBL, you are facilitating student learning, not lecturing to deliver information. What learning points should be highlighted in the discussion of RAT questions or application exercises, especially if teams provide divergent answers? Consider asking open-ended questions to allow the facilitated discussions to be student-led. Also, consider using time at the end of class to ensure difficult concepts or questions are clarified.⁴
• Arrange for feedback: While we know the importance of student peer review in TBL, don’t underestimate the value of peer review as a faculty facilitator. Ask other faculty to provide you feedback regarding your facilitation skills.² Consider using the Facilitator Instrument for TBL proposed by Levine, et al. to obtain additional feedback from students regarding your facilitation skills.⁵ Reflect on the feedback to determine the success of your TBL module. This can prove beneficial immediately following delivery of a module or as a way to prepare for future sessions.

Faculty are important factors in TBL’s success. While there is significant literature describing best practices for TBL session structure and content (design), more evidence is needed on assessing a TBL facilitator’s effectiveness.

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:

1. Tweddell S, Clark D, Nelson M. Team-based learning in pharmacy: the faculty experience. Curr Pharm Teach Learn. 2016;8(1):7–17.
2. Farland MZ, Sicat BL, Franks AS, Pater KS, Medina MS, Persky AM. Best practices for implementing team-based learning in pharmacy education. Amer J Pharm Educ, 2013;77(8):Article 177.
3. Parmelee DX, Michaelsen, LK. Twelve tips for doing effective Team-Based Learning (TBL). Med Teach. 2010;32(2):118–122.
4. Gullo C, Ha TC, Cook S. Twelve tips for facilitating team-based learning. Med Teach. 2015;37(9):819–824.
5. Levine RE, Hsieh P, Kelly PA, et al. The facilitator instrument for team-based learning (FIT). Teach Learn Med. 2019 Aug 7: 1–9 [Epub ahead of print].

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.

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.

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.

Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning