Online Team-Based Learning in Teaching Hyponatremia Among Medical Clerks of the University of Santo Tomas Faculty of Medicine and Surgery, Philippines
Melvin Remulla Marcial
Dec 2022 DOI 10.35460/2546-1621.2022-sp14 Access
Objectives: To determine if online team-based learning (TBL) is effective in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work up, and management among fourth year medical students
Study design: A quantitative evaluative design.
Population and Setting: Fourth year medical students (medical clerks) rotating in the Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines from July to December 2020.
Methodology: A modified TBL workshop is adopted in teaching fourth year medical clerks about hyponatremia. The TBL session was held with a group of medical clerks weekly from July to December 2020. As a pre-workshop preparation, the medical clerks were assigned to read ahead of time the clinical practice guidelines on the diagnosis and treatment of hyponatremia developed by the European Renal Best Practice. After reading it, they were asked to answer an Individual Readiness Assessment Test (IRAT) composed of 20 case-based multiple-choice questions (MCQ). The group was thereafter divided into 4 subgroups and asked to discuss the same MCQ-based exam and present it as a Team Readiness Assessment Test (TRAT). As each subgroup presented their IRAT, the facilitator discussed the underlying concepts for each question and its application in actual cases of hyponatremia. The facilitator then summarized the learning outcomes at the end of the TBL workshop. For team application (TAPP), the students created a concept map and formulated admitting orders. The medical clerks were then surveyed on their confidence in hyponatremia diagnosis and management during pre-TBL workshop, after IRAT, after TRAT, and after discussion with the facilitator.
Statistical Design: Descriptive statistics were used to summarize the study variables and included the mean, standard deviation, frequency, and percentage. Within-group comparisons of different outcomes across the different timeframes were conducted using one-way multivariate analysis of variance (one-way MANOVA). Cognizant that the study has multiple outcomes or dependent variables which were compared at four different timeframes, multivariate analysis was utilized to minimize the inflation of family-wise errors (FWE).
Results: Comparative analysis indicated that the mean readiness scores of the respondents after TRAT was significantly higher (t=–91.61, p=0.001) compared to the mean readiness scores after IRAT. Comparative analysis using paired t-test indicated that the mean confidence scores of the respondents in the recognition, diagnosis, and treatment of hyponatremia were significantly higher among the respondents after the IRAT (t=–24.26, p=0.001), TRAT (t=–34.58, p=0.001), and facilitator discussion (t=–42.72, p=0.001) approaches compared to the mean pre-TBL confidence score. The mean knowledge score of the respondents on the creation of a concept map and the formulation of admission orders of patients with hyponatremia was 25.54±1.98 (95% CI 25.26-25.82).
Conclusion: Findings of this study are not to be interpreted as demonstrating a causal relationship. Furthermore, the results are only hypothesis-generating at best. The study showed that online TBL has the potential to be an effective method in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work-up, and management among fourth year medical students. As a preliminary evaluation of TBL, further studies can be conducted to determine its effectiveness as a teaching modality in the medical curricula in comparison to the traditional method before being adopted as a teaching-learning activity.
Key words: team-based learning, online learning, COVID-19, hyponatremia, medical education
- Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team based learning: A practical guide: AMEE guide no. 65. Med Teach. 2012; 34:e275–87
- Johnson C. Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. J Chiropr Educ. 2009 Spring;23(1):47–8.
- Burgess AW, McGregor DM, Mellis CM. Applying established guidelines to team-based learning programs in medical schools: a systematic review: A systematic review. Acad Med [Internet]. 2014;89(4):678–88. Available from: http://dx.doi.org/10.1097/ACM.0000000000000162
- Searle NS, Haidet P, Kelly PA, Schneider VF, Seidel CL, Richards BF. Team learning in medical education: Initial experiences at ten institutions. Acad Med [Internet]. 2003;78(Supplement):S55–8. Available from: http://dx.doi.org/10.1097/00001888-200310001-00018
- Parmelee DX, Michaelsen LK. Twelve tips for doing effective Team-Based Learning (TBL). Med Teach [Internet]. 2010;32(2):118–22. Available from: http://dx.doi.org/10.3109/01421590903548562
- Haidet P, Levine RE, Parmelee DX, Crow S, Kennedy F, Kelly PA, et al. Perspective: Guidelines for reporting team-based learning activities in the medical and health sciences education literature. Acad Med [Internet]. 2012;87(3):292– 9. Available from: http://dx.doi.org/10.1097/ ACM.0b013e318244759e
- Koles P, Nelson S, Stolfi A, Parmelee D, Destephen D. Active learning in a Year 2 pathology curriculum. Med Educ [Internet]. 2005;39(10):1045–55. Available from: http://dx.doi.org/10.1111/j.1365-2929.2005.02248.x
- Nieder GL, Parmelee DX, Stolfi A, Hudes PD. Team-based learning in a medical gross anatomy and embryology course. Clin Anat. 2005;18:56–63.
- Michaelsen LK, Sweet M. (2008) The essential elements of team-based learning. New Dir Teach Learn. 2008; 116:7–27.
- Cushing A, Abbott S, Lothian D, Hall A, Westwood OMR. Peer feedback as an aid to learning--what do we want? Feedback. When do we want it? Now! Med Teach [Inter net]. 2011;33(2):e105-12. Available from: http://dx.doi. org/10.3109/0142159X.2011.542522
- Arnold L, Shue CK, Kalishman S, Prislin M, Pohl C, Pohl H, et al. Can there be a single system for peer assessment of professionalism among medical students? A multi-institutional study. Acad Med [Internet]. 2007;82(6):578– 86. Available from: http://dx.doi.org/10.1097/ ACM.0b013e3180555d4e
- Hrynchak P, Batty H. The educational theory basis of team based learning. Med Teach. 2012;34(10):796-801.
- Mcleod S. Vygotsky’s Sociocultural Theory of Cognitive Development. Simply Psychology. 2022.
- Shabani K. Applications of Vygotsky’s sociocultural approach for teachers’ professional development. Cogent educ [Internet]. 2016;3(1):1252177. Available from: http://dx.doi.org/10.1080/2331186x.2016.1252177
- Babakr ZH, Soran University, Mohamedamin P, Kakamad K. Piaget’s cognitive developmental theory: Critical review. Educ Q Rev [Internet]. 2019;2(3). Available from: http://dx.doi.org/10.31014/aior.1993.02.03.84
- Kurt S. Vygotsky’s zone of proximal development and scaffolding [Internet]. Educational Technology. 2020 [cited 2022 Nov 5]. Available from: https://educationaltechnology.net/vygotskys-zone-of-proximal-development-and-scaffolding/
- Schmidt HG, Rotgans JI, Rajalingam P, Low-Beer N. A psychological foundation for team-based learning: Knowledge reconsolidation: A psychological foundation for team based learning. Acad Med [Internet]. 2019;94(12):1878– 83. Available from: http://dx.doi.org/10.1097/ACM.0000000000002810
- Raykov T, Marcoulides GA. An introduction to applied multivariate analysis. Routledge; 2008., DOI: 10.4324/9780203809532
- Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol [Inter net]. 2014;170(3):G1-47. Available from: http://dx.doi. org/10.1530/EJE-13-1020
- Vasan NS, DeFouw DO, Holland BK. Modified use of team based learning for effective delivery of medical gross anatomy and embryology. Anat Sci Educ. 2008 Jan;1(1):3-9
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.