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Using Team-Based Learning in Osteopathic Medical Education to Improve Understanding and Communication Regarding Chronic Diseases
Harp, E. [2]
Rutledge, A. [1]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e114-e116. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

cross sectional study [597]
learning [61]
osteopathic medicine [1540]
USA [1086]

Abstract:

Hypothesis: Team-based learning (TBL) can improve both understanding of chronic diseases and the ability to communicate to patients about the processes. TBL is one of the most commonly adopted new teaching methods in undergraduate medical education. Originally developed as part of a business education curriculum by Dr Larry Michaelson in the 1970s, it is currently in use in many disciplines. These active learning sessions further enhance communication skills, as modules require both intra- and inter-team communication. TBL also offers an additional opportunity to integrate osteopathic principles into both basic science and clinical topics. Learning modules can be created that challenge students to articulate the roles of structure and function and how they relate to pathophysiology as well as explain the rationale behind treatments based on the emphasized principles of body unity, self-regulation, and the interrelationship of structure and function. At OSU-COM, we introduced TBL into several areas of the curriculum. In this study, we focused on the effect of TBL on high yield areas in endocrine disease pathology: thyroid disease and type 2 diabetes. Students’ examination performance and self-perception of their communication skills were surveyed. These TBL topics were selected as critical, chronic diseases likely to be managed by the majority of graduates. In addition, these chronic diseases often require significant education of patients regarding their management. Preparation for this patient education requires both an enhanced disease understanding as well as the ability to communicate effectively. Well-designed TBL modules can better prepare students to provide this education. Methods: The first part of the study focused on objective information regarding the impact of TBL in the form of knowledge retention and application. Data from class examinations were gathered from our assessment program (ExamSoft). Examination performance on TBL topics was compared with other pathology topics taught with traditional lecture content delivery within the endocrine system. Performance based on question category was additionally stratified. The second part of the study focused on subjective information regarding the impact of TBL on students with particular focus on communication skills. An 8-question survey was sent electronically to all second-year students who had participated in the TBL events as part of the endocrine system (SurveyMonkey). Six questions used a 5-point Likert scale asking students to assess their experience with the TBL sessions. All 6 of these questions evaluated communication skills, 1 involved clinical reasoning, and 1 measured comprehension of underlying pathophysiology. Two additional questions documented students’ previous experience with TBL. Data analysis was performed using Microsoft Excel (Microsoft Corporation). Results: An independent sample t test was conducted to compare examination performance on TBL topics to lecture-based pathology topics within the same medical school class. There was no significant difference between the mean (SD) scores for the TBL questions (84.93 [11.5]) and the lecture-based questions (83.43 [9.9]) conditions (t114=−0.02; P=.207). Within the TBL group, mean examination performance was highest for questions involving “compare and contrast” (89.38), slightly lower for “underlying mechanism” (88.35) and “clinical application” (87.94), and lowest for “recall” (85.92). From the second part of the study, students reported enhanced communication skills, clinical reasoning ability, and disease understanding. 67 of 114 students responded to the survey (59%). No incentive was offered for survey completion. For the 6 questions relating to enhanced communication, 66% of students either agreed or strongly agreed with improved communication ability. Regarding improved clinical reasoning, 72% of students either agreed or strongly agreed. Regarding improved comprehension of underlying pathophysiology, 58% of students either agreed or strongly agreed. 55% of students reported previous experience with TBL at the undergraduate level and 16% of those with previous graduate school experience having used it in their training. Discussion: A significant difference in examination performance was not observed between TBL and lecture-based topics. These findings are similar to what others have found. Promising, however, was that overall performance was highest on questions involving compare/contrast and recognizing underlying mechanisms of disease processes. These types of examination questions are likely more reflective of the processes applied during the TBL events. The majority of student responses from the second part of the study support improved communication skills and disease comprehension. One of the goals of medical education is to equip future physicians to communicate effectively with both colleagues and patients. A solid understanding of and ability to explain disease processes to patients is especially important with chronic disease management. TBL offers students an environment to discuss and defend ideas with the expectation of deeper understanding under the direction of faculty facilitators. Assessment of improved communication skills, however, is inherently challenging in the short term. Data can be obtained from students’ perceptions as was done in this study. A limitation of this type of assessment is the use of subjective criteria to quantify effectiveness. Other studies have also used observational data taken from TBL event facilitators. This added perspective would have been helpful in our current study. We also included examination performance as quantifiable data chosen to represent disease understanding. This assessment, however, can be dependent on the types of questions used on examinations. In our pathology curriculum, we ascribe examination questions into 1 of 4 categories: underlying mechanism, compare/contrast, clinical application, and recall. The majority of questions used fall into the former 3 categories. We suggest these types of questions offer a better assessment of disease comprehension. While TBL has proven effectiveness at improving student engagement in medical education, we propose that additional dividends include improved communication as well as preparedness to explain disease processes and rationales to colleagues and patients. Results from the second portion of the study support this proposal. We further suggest that improved disease understanding and enhanced communication skills can translate to improved chronic disease management. Opportunities for further study include longitudinal follow-up during clinical training to see if these enhanced skills continue into the clerkship years as could be assessed by preceptors. Conclusion: TBL is a promising method of teaching osteopathic undergraduate medical education. While increasing student engagement, additional benefits include improved communication skills and disease understanding. These skills may translate to improved chronic disease management as physicians are better prepared to educate their patients regarding their conditions.

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