Team-based Learning

Initial situation

Until 2016, the public health and occupational medicine course was delivered ex cathedra. To address low attendance, it was decided to make the course more dynamic by offering pre-course readings followed by team exercises during the sessions. The reading work is evaluated at the beginning of the course with the help of questionnaires, then the knowledge is consolidated by application exercises carried out in small groups, followed by discussions in plenary. The objective is to improve student learning by promoting their active participation, following the principle of team-based learning (TBL), which is one form of the flipped classroom.

Project implementation

Before each session, students find instructions and material to be studied individually (readings and videos) on an e-learning platform. Then, an individual readiness assessment test (iRAT) taken at the beginning of each “in-class” session (face-to-face or distance learning) measures the degree of individual preparation. Part of the knowledge is thus acquired through individual work, and the time during the session is devoted to exchanges with colleagues and the teacher.

This preparatory work is then evaluated by a group test (team readiness assessment test: tRAT) which encourages interaction and debate between students. Based on the answers given, the teachers then take a moment to clarify certain points. The rest of the course is dedicated to exercises where the team applies its knowledge to solve complex problems, such as clinical vignettes. Each team must agree on an answer and justify it. Teams are then encouraged to interact with each other and defend their points of view in a plenary debate.

The answers to the preparation tests and exercises are collected on the e-learning platform (Moodle). For each session, the evaluation is composed of an individual evaluation (iRAT) and 2 group evaluations (tRAT + exercise). A grade is given for each session, and the semester grade (average of all sessions) is thus acquired at the end of the last session. There is no exam at the end of the semester and this system guarantees the presence of the students during the sessions (some absences are however tolerated).

One of the original features of this method is the evaluation by group quizzes that count for the grade. A plugin developed by our university allows to do these quizzes in group on Moodle and to attribute the answer of the reporter automatically to the other members of the group.

As an example, for the public health course in the Faculty of Medicine, a series of 7 successive courses given via this method allows for continuous evaluation of the students (for 80 people, this makes a total of 8037= 1680 evaluations collected during the 7 sessions) and to attribute grades on this basis without having a final exam.

Thoughts and advice

This format requires careful and advance preparation. The scenario, explained to the class beforehand, allows for flexibility (the student can manage his or her time during individual learning), but also for greater accountability (the student must be prepared to actively participate in the tests and team application exercises). Teamwork adds an extra dimension to learning, as it develops the ability to communicate, to work together and to confront and argue points of view.

For course leaders, setting up such a course requires careful consideration of the pedagogical objectives, since the material for individual preparation, MCQ tests and application exercises must be all structured. This material can include chapters from books, published articles or excerpts from MOOCs, it is not always necessary to create new material.

The first year is a learning year in which the teacher must develop the ability to lead a large group, which is often a new skill. The teaching team has noticed positive changes in the attitude of the students: much better attendance at classes and good preparation; better ability to apply theory in exercises; development of collaborative skills; teamwork works well; group members think together and debate.

The teaching team should be proficient in Moodle and able to facilitate 15-16 groups of 5 people in one room. The optimal team size seems to be 5 people.

Student feedback

[Feedback freely translated from French] “I encourage continuing lessons in this format. Working through the raw material before the class allows us to focus on the more complex points during the lesson, making it more interesting and relevant.” “It was a great session; lots of interaction with the students and the teacher generates a lot of interest in the material.” “Our group works great. Everyone participates, opinions and arguments are all listened to, discussions are rich.” “Not very constructive discussions at times. When there was a stalemate/difference of opinion it was difficult to find a way to settle and move forward. Positions a bit rigid and lack of listening at times, creating problems understanding what others were saying.”