Adopting Team-Based Learning: Translating Evidence Into Practice

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As faculty members teaching in 1 core medical-surgical nursing course, we decided to adopt team-based learning (TBL), a pedagogical approach that emphasized student engagement. Despite the benefits and many resources on TBL in health professions’ education,1,2 TBL has not been used before in our curriculum. Furthermore, in a search of the literature, we were unable to locate a sufficiently detailed example of TBL in nursing education that provided the specificity that we desired to help us in course planning. Therefore, the purpose of this article is to share our experiences in the design and integration of TBL within the final semester of a baccalaureate nursing program.
Using TBL, students work both individually and as members of assigned teams that they keep throughout the course. Key components of TBL include 3 sequential steps: step 1, individual preclass preparation; step 2, readiness assurance (RA); and step 3, group application activity.1,3
In step 1, students are given reading assignments to be finished before class. These readings include key concepts and content that will be addressed in the next classroom session. Class begins with step 2, the RA step. This involves an individual readiness assessment test (IRAT) conducted at the start of the classroom session, immediately followed by a group readiness assessment test (GRAT). The items for both the IRAT and the GRAT are the same and are presented in the same order. Next, time is allotted for written appeals, a brief period when groups can develop a written request for 1 or more test items to be reconsidered by the teacher. Step 2 concludes with teacher feedback and any needed clarification. In step 3, student groups work on activities that require the application of course content and problem-solving skills to effectively reach solutions or resolve issues. Finally, step 3 allows students to apply preparation and classroom learning to activities involving higher-level learning that emphasize application.1,3
For example, when addressing step 1 and the topic of cirrhosis, students were given a reading assignment with specific page numbers and objectives. In step 2, students arrived to the classroom and immediately began the IRAT followed by joining their groups and completing the GRAT. Test items included 20 knowledge-based questions on the liver, its functions, pertinent laboratory tests, and alterations in liver function. After the GRAT, time was allowed for appeals and teacher clarification. For step 3, groups completed a complex case study involving a patient with cirrhosis.
The components of TBL serve as a pedagogical framework, promoting student engagement, knowledge acquisition, accountability, teamwork, and lifelong learning.2,4,5 These were the attributes that we wanted to bring into our classroom to change passive learners into active learners. Our course, a mix of medical-surgical and community nursing concepts, included 2 sections, 4 different teachers per section, and 40+ students in each section. Each section met for one 4-hour block of class time per week. Minus breaks, this equated to 200 minutes of class time. Having 3 or 4 faculty for a theory course with a clinical component is typical in our program because it allows faculty to teach in their areas of expertise and still enables a fair distribution of workload.
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