- Email: [email protected]
Faculty perception of team-based learning over multiple semesters
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Research Paper
Faculty perception of team-based learning over multiple semesters Clark D. Kebodeauxa,⁎, Golden L. Petersb, Paul M. Strangesc, Jamie L. Woodyardd, Scott Martin Vourie a
Pharmacy Practice and Science, UK College of Pharmacy, Bio Pharm Complex 247, 789 South Limestone, Lexington, KY 40536-0596, United States St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States University of Illinois at Chicago College of Pharmacy, 833 S Wood St, Chicago, IL 60612, United States d Purdue University College of Pharmacy, 575 Stadium Mall Drive, RHPH G35, West Lafayette, IN 47907, United States e Department of Pharmacy Practice, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States b c
AR TI CLE I NF O
AB S T R A CT
Keywords: Team-based learning (TBL) Pharmacy Pharmacy curricula Self-care Faculty workload Active learning
Introduction: Perspectives from faculty regarding team-based learning (TBL) are not well understood. Previous studies describe faculty preference for TBL due to increased student interaction despite requiring increased time for design. The perception of changes in faculty workload over multiple semesters has not been measured. This research evaluates faculty workload and perceived student engagement after implementing TBL in a required non-prescription medication course over multiple semesters. Methods: TBL was implemented in the non-prescription medication course and continued for three consecutive semesters. Faculty members’ perception of TBL was captured using an anonymous survey. The survey was an 11 item questionnaire with five Likert-type response options to identify changes in workload, training, and student interaction using TBL. Results: Twenty-eight total responses were collected from 10 faculty members who taught in at least one of the four semesters. Results were aggregated based on the number of semesters faculty continually taught in the course. More respondents agreed than disagreed that participation from and interactions with students increased with the TBL course compared to traditional lectures. However, more respondents believed the TBL course approach was more difficult and reported increased workload in the initial semester taught. Enjoyment of teaching increased for a majority of respondents. Discussion and conclusions: This is the first study to explore the impact of TBL implementation over multiple semesters. These data can be used to help implement TBL in pharmacy school curricula.
Introduction Team-based learning (TBL) is an instructional method of teaching that requires small group interaction to facilitate student learning.1,2 Four essential elements are required to implement TBL: groups, accountability, feedback, and assignment design.1 The goal of TBL is to replace traditional didactic methodologies of lecture to transform the classroom experience from instructor teaching to student learning. This transformation can enable students to be more active in the learning process.2
Abbreviations:TBL, Team-based learning ⁎ Corresponding author. E-mail addresses: [email protected] (C.D. Kebodeaux), [email protected] (G.L. Peters), [email protected] (P.M. Stranges), [email protected] (J.L. Woodyard), [email protected] (S.M. Vouri). http://dx.doi.org/10.1016/j.cptl.2017.07.004
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Kebodeaux, C.D., Currents in Pharmacy Teaching and Learning (2017), http://dx.doi.org/10.1016/j.cptl.2017.07.004
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C.D. Kebodeaux et al.
TBL has been implemented in a variety of higher education settings and has expanded to many health professions.3 In particular, there has been an increased uptake of TBL in pharmacy education.4–6 As a result, many researchers and academicians have evaluated its impact on students’ perceptions and learning outcomes with significant improvements in student performance and confidence.7–11 While much of the research focuses on students, data on longitudinal perception from faculty are limited. Previous literature suggested faculty satisfaction improved following TBL implementation with no effect on overall student grades.12 In addition, previous research described increased faculty workload during the first year of TBL implementation.4,12–14 In a national survey of pharmacy faculty in United States (US) colleges and schools of pharmacy, implementing TBL required greater preparation time than traditional lectures.4 Also, faculty indicated a greater effort for instructors to facilitate TBL activities compared to traditional lecture.13,14 A recent study revealed thematic analysis on faculty perception about implementation of TBL; workload was noted as one of the challenges.15 No data that quantifies faculty workload, engagement/satisfaction of teaching, and implementation of TBL over a longitudinal period of time exists. Rationale and objectives Workload impact and design time for subsequent use of TBL in the same course over multiple semesters has not been measured. This research aims to evaluate faculty workload and perceived student engagement after implementing TBL in a required nonprescription medication course over four consecutive semesters. Methods Implementation At St. Louis College of Pharmacy, TBL was implemented in PP2120: Introduction to Pharmaceutical Care: Nonprescription Products and Drug Information in 2012. The course was designed using accepted TBL methodology.1,2 PP2120 was a required standalone self-care, three credit hour course divided into two, two-hour course periods during a standard week. The course was taught to first year professional transfer students and students in their final semester of the pre-professional curriculum, prior to matriculating into the professional program. Given the experience of the students, the course began with two weeks of introductory patientcentered care and drug information topics that provided students with the necessary background and experience to complete required TBL sessions. The course was then divided into 10 self-care therapeutic topics for which over-the-counter therapy was available. TBL was used to facilitate student learning in each of the 10 distinct topics. The use of TBL continued in these specific topics for each subsequent semester. Students were required to complete two hours of pre-class content weekly including lecture-based videos and required readings. During the first lecture period, students completed a 20 question individual readiness assurance test (iRAT) online followed by the same quiz taken in assigned groups, or teams, as the team readiness assurance test (tRAT). Students were allowed to appeal questions as a team using student-supplied evidence after completion of the initial assessment. The remaining time in the first lecture period was dedicated to student-generated “muddiest points”—areas that lacked clarity and time for the instructor to provide any clinical pearls that may help the student comprehend the material at a higher level. Muddiest points submitted by students could not be related to a specific question from the iRAT/tRAT, but could be regarding a general concept. The students were expected to complete an assigned 17-question case in their assigned groups as their application exercise in the second session. Students had 50 min to complete the case that was then submitted online. Next, faculty led a discussion of the case materials that included the simultaneous response of correct answers, thus providing students with immediate feedback on their performance. Each semester consisted of two exams and a comprehensive final exam. This design was purposeful and consistent with accepted methodology for the standard model of TBL implementation.2 Assessment of faculty perception Data collection was based on a survey tool used to evaluate faculty perception on workload, engagement/satisfaction of teaching, and implementation of TBL over a longitudinal period of time.16 This same 11 item questionnaire with five Likert-style response options was administered for four consecutive semesters to non-resident faculty in PP2120 via SurveyMonkey® (SurveyMonkey; San Mateo, CA). Identifiable data points were not collected from faculty in order to maintain anonymity. Data collection and research was classified as exempt by the St. Louis College of Pharmacy Institutional Review Board. Subsequent semesters included pharmacy residents as instructors but were not included in the survey due to the inability to participate in all semesters. Additional faculty were later involved in the course due to faculty turnover or changes in faculty teaching responsibilities. New faculty members to the course completed the survey even if he/she did not participate in the initial semester of TBL in this course. In total, faculty could have been surveyed up to four times if teaching in all consecutive semesters in the study period. Analysis Likert scales were transformed into three variables: 1) increased/agree, 2) did not change/no preferences, or 3) decreased/ 2
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
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Table 1 Baseline characteristics. Respondents
n
Number of semesters facilitated 1 2 3 4 Years employed as faculty – mean years (range) Utilized TBL prior to this course Yes No Taught in this course prior to this semester Yes No
10 7 6 5 4 (1–10) 2 8 6 4
TBL = Team-Based Learning.
disagree. Responses marked not applicable were removed from analysis. Descriptive statistics were used to evaluate data over multiple semesters. Analysis was performed using SPSS v22.
Results In total, five faculty completed the survey over four semesters, one faculty completed the survey over three semesters, one faculty completed the survey over two semesters, and three faculty only completed the survey after the initial semester. Ultimately, 10 faculty participated in at least one of the four semesters, and 28 faculty-semesters were recorded (100% response rate; one partial response). Respondents had a mean of four years teaching experience prior to participating in this course, 80% (8/10) had not used TBL in previously taught courses, and no respondent had taught for more than two semesters of TBL prior to implementation in PP2120 (Table 1). Results for faculty perception of student participation, student interaction, workload, and interest in using TBL in the future were aggregated based on the number of semesters faculty taught in the course (Table 2 and 3). Over all four semesters, respondents believed student participation increased (24/28, 85%) with increased interactions with students (19/28, 68%). Perception of increased student interaction consistently improved with each semester taught. Enjoyment of teaching increased in 19/27 (70%), decreased in 4/27 (15%), and did not change in 4/27 (15%) of respondents (Fig. 1). A majority of faculty agreed that they would consider implementing TBL outside of this course. Table 2 Survey Results among Faculty Teaching 1 or More TBL Semestersa,b. Question
Compared to traditional lecture in this course, TBL student participation _____________. Compared to traditional lecture in this course, TBL ______ the interaction I had with students. Compared to traditional lecture in this course, TBL ___________ my workload. Compared to traditional lecture in this course, TBL ________ the number of course-related meetings in which I needed to attend. After completing a semester of TBL teaching in this course, my workload ________.
After completing a semester of TBL teaching in this course, the number of course-related meetings in which I needed to attend ________.
Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased No Answer Increased Neutral Decreased No Answer
One Semester (n=10)
Two Semesters (n=7)
Three Semesters (n=6)
Four Semesters (n=5)
Total Responses (n=28)
70% 10% 0% 40% 10% 30% 70% 10% 20% 40% 50% 10% N/A
86% 0% 0% 71% 0% 14% 86% 0% 14% 14% 57% 29% 43% 14% 43% N/A 14% 57% 29% N/A
100% 0% 0% 83% 17% 0% 50% 0% 50% 17% 50% 33% 17% 33% 33% 17% 0% 50% 33% 17%
100% 0% 0% 100% 0% 0% 60% 0% 20% 0% 80% 20% 20% 20% 60% N/A 0% 100% 0% N/A
85% 4% 0% 68% 7% 14% 68% 3% 29% 21% 57% 21% 28% 22% 44% 6% 6% 66% 22% 6%
N/A N/A
TBL = Team Based Learning a Faculty perception of Student Participation, Student Interaction, Workload, and Interest in Using TBL in the Future Courses, Aggregated by Semesters Taught. b Percentages do not equal 100% in areas where participants selected not applicable, or failed to respond to a specific question
3
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Table 3 Survey Results among Faculty Teaching 1 or More TBL Semesters (continued)a,b.
(Agree/ Neutral/ Disagree)
Two Semesters (n=7) (Agree/ Neutral/ Disagree)
Three Semesters (n=6) (Agree/ Neutral/ Disagree)
Four Semesters (n=5) (Agree/ Neutral/ Disagree)
Total Responses (n=28) (Agree/ Neutral/ Disagree)
60% 20% 20% 60% 20% 20% 60% 20% 20% 60% 10% 30% N/A
57% 14% 29% 29% 29% 43% 57% 29% 14% 57% 14% 29% N/A
50% 17% 33% 67% 17% 17% 83% 17% 0% 83% 0% 0% 17%
40% 20% 40% 80% 0% 20% 80% 20% 0% 60% 20% 0% 20%
54% 14% 32% 46% 21% 32% 68% 21% 11% 64% 18% 11% 7%
One Semester (n=10)
Question
Adjusting to a TBL course approach from traditional lecture was difficult. I was given adequate training in TBL prior to utilizing it in the classroom. After teaching TBL in this course, I would like to teach using TBL in other therapeutic-series of courses (e.g., Therapeutics, Pathophysiology). After completing this TBL course, I would like to teach using TBL in other non-therapeuticseries of courses (e.g., Advanced Pharmacy Practice, Introduction to Pharmacy Practice).
Agree Neutral Disagree Agree Neutral Disagree Agree Neutral Disagree Agree Neutral Disagree Not Applicable
TBL = Team Based Learning a Faculty perception of Student Participation, Student Interaction, Workload, and Interest in Using TBL in the Future Courses, Aggregated by Semesters Taught. b Percentages do not equal 100% in areas where participants selected not applicable, or failed to respond to a specific question
Fig. 1. Faculty perception of enjoyment of teaching. TBL = team-based learning.
More faculty reported increased workload (19/28, 68%) compared to decreased workload (8/28, 29%) as a result of participation in the course. However, after teaching at least one semester, more faculty reported a decreased workload than an increased or unchanged workload. More respondents agreed than disagreed that the TBL course approach was more difficult compared to traditional lectures (54% vs. 32%, respectively). Discussion This research evaluates TBL from the faculty perspective, including workload, in a non-prescription medication course taught over four semesters. The objective was to address the current lack of evidence examining longitudinal faculty member perceptions of TBL compared to traditional lectures. Understanding faculty perception of TBL is essential for both implementation and course and curricular assessment. Study results regarding perceived student participation are consistent with research by Allen et al.4 showing an increase in participation with TBL compared to a traditional lecture format. In this study, an increase in participation occurred regardless of how many semesters faculty taught and was observed by all participating faculty members teaching TBL for three or more semesters. Increased accountability for students to understand material prior to class along with the active nature of in-class participation with TBL likely contributed to increased participation relative to traditional lectures. Faculty reported increased student interaction with TBL which, given faculty buy-in, may be the reason for increased student participation. The increase in student interactions appeared to increase with each semester that faculty taught TBL. This may potentially lead to greater student and faculty satisfaction in the semesters after TBL is implemented in a course. The increase in workload primarily with in the first semester of TBL, as demonstrated in this study and others, may concern faculty when TBL is implemented in a course.4,12 This research cohort stated at least two-thirds of respondents reported decreased or 4
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no change in workload after three or four semesters. This may be attributed to faculty becoming more familiar and comfortable with the TBL approach along with a reduced requirement needed to update teaching materials. What is not known is how much of an increase in workload was experienced, how workload changes impacted other responsibilities, and what areas of the TBL process affected workload most (e.g., before, during or following class/the semester). An increase in workload in the first semester of teaching TBL did not appear to dissuade faculty as they would be willing to use TBL in other courses. The more semesters faculty taught using TBL, the greater proportion of faculty indicated they would be willing to use TBL in other courses. Another barrier to implementation expressed by faculty was incorporating TBL in a large class size.15 In the context of this study, TBL was used in a class size of approximately 200 students. Strategies used to assist with logistical barriers of TBL in a large class included administering assessment items online and engaging support from an administrative assistant and teaching assistants. Administering assessments such as iRATs and online case assignments increased grading efficiency and reporting, while the administrative assistant helped with attendance tracking, formatting, uploading and organizing content for an online learning management system, and preparing group folders. Teaching assistants were hired to help the administrative assistant with various duties including meeting with students to review their iRATs and to proctor assessments. This was the first course in the curriculum in which students encountered TBL; therefore, course coordinators found it helpful to spend time at the beginning of each semester discussing the process of TBL and their expectations of students. This study has limitations including small sample size and assessing TBL at a single institution; however, this survey can be used as faculty feedback to coordinators for course planning, training, and workload assessment. The inclusion of residents, teaching assistants, and administrative staff within the course, but not the survey, may limit the understanding of the perception of TBL to everyone that was involved. Despite only being at one institution, the research does include multiple perspectives from different faculty members over four consecutive semesters. Changes in teaching responsibilities and faculty turnover may have impacted the longitudinal description of this survey; however, this is likely representative of the dynamics of responsibility seen at most institutions. Conclusions Based on faculty perception, TBL has an initial increase on workload; however, workload remains constant or diminishes over time. This is the first study to explore TBL implementation over multiple semesters from a faculty perspective. Having this understanding may help administration account for potential additional workload up front with TBL implementation. The additional benefits of TBL from the faculty perspective include increased enjoyment, student interaction, student accountability, and class participation. Faculty may perceive more benefits of TBL the longer a faculty member is involved with this teaching method. Disclosure statement The authors listed on this manuscript have no financial relationships, commercial interests, nor any conflicts of interest to disclose with respect to the publication of this material. Dr. Vouri reports funding by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award KL2TR000450, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). Acknowledgements The authors would like to thank Nicole M. Gattas, Pharm.D., BCPS, FAPhA and Peter Hurd, Ph.D. for their contributions to study design. References 1. Michaelsen LK, Sweet M. The essential elements of team‐based learning. New Dir Teach Learn. 2008;2008(116):7–27. 2. Michaelsen LK, Sweet M. Team‐based learning. New Dir Teach Learn. 2011;2011(128):41–51. 3. Fatmi M, Hartling L, Hillier T, Campbell S, Oswald AE. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach. 2013;35(12):e1608–e1624. 4. Allen RE, Copeland J, Franks AS, et al. Team-based learning in US colleges and schools of pharmacy. Am J Pharm Educ. 2013;77(6) Article 115. 5. Ofstad W, Brunner LJ. Team-based learning in pharmacy education. Am J Pharm Educ. 2013;77(4) Article 70. 6. Nelson M, Allison SD, McCollum M, et al. The regis model for pharmacy education: a highly integrated curriculum delivered by team-based learning™(TBL). Curr Pharm Teach Learn. 2013;5(6):555–563. 7. Frame TR, Gryka R, Kiersma ME, Todt AL, Cailor SM, Chen AM. Student perceptions of and confidence in self-care course concepts using team-based learning. Am J Pharm Educ. 2016;80(3) Article 46. 8. Frame TR, Cailor SM, Gryka RJ, Chen AM, Kiersma ME, Sheppard L. Student perceptions of team-based learning vs traditional lecture-based learning. Am J Pharm Educ. 2015;79(4) Article 51. 9. Camiel LD, Mistry A, Schnee D, et al. Students' attitudes, academic performance and preferences for content delivery in a very large self-care course redesign. Am J Pharm Educ. 2016;80(4) Article 67. 10. Bouw JW, Gupta V, Hincapie AL. Assessment of students' satisfaction with a student-led team-based learning course. J Educ Eval Health Prof. 2015;12:23. 11. Bleske BE, Remington TL, Wells TD, et al. A randomized crossover comparison of team-based learning and lecture format on learning outcomes. Am J Pharm Educ.
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2016;80(7) Article 120. 12. Conway SE, Johnson JL, Ripley TL. Integration of team-based learning strategies into a cardiovascular module. Am J Pharm Educ. 2010;74(2) Article 35. 13. Kolluru S, Lemke TL. An assessment model for multidisciplinary, team-taught integrated pharmacy courses. Am J Pharm Educ. 2012;76(8) Article 157. 14. Letassy NA, Fugate SE, Medina MS, Stroup JS, Britton ML. Using team-based learning in an endocrine module taught across two campuses. Am J Pharm Educ. 2008;72(5) Article 103. 15. Tweddell S, Clark D, Nelson M. Team-based learning in pharmacy: the faculty experience. Curr Pharm Teach Learn. 2016;8(1):7–17. 16. Kebodeaux CD, Vouri SM, Hurd PD. Team-based learning (TBL): an argument for faculty's evaluation. Innov Pharm. 2014;5(2):1–5.
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Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Research Paper
Faculty perception of team-based learning over multiple semesters Clark D. Kebodeauxa,⁎, Golden L. Petersb, Paul M. Strangesc, Jamie L. Woodyardd, Scott Martin Vourie a
Pharmacy Practice and Science, UK College of Pharmacy, Bio Pharm Complex 247, 789 South Limestone, Lexington, KY 40536-0596, United States St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States University of Illinois at Chicago College of Pharmacy, 833 S Wood St, Chicago, IL 60612, United States d Purdue University College of Pharmacy, 575 Stadium Mall Drive, RHPH G35, West Lafayette, IN 47907, United States e Department of Pharmacy Practice, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States b c
AR TI CLE I NF O
AB S T R A CT
Keywords: Team-based learning (TBL) Pharmacy Pharmacy curricula Self-care Faculty workload Active learning
Introduction: Perspectives from faculty regarding team-based learning (TBL) are not well understood. Previous studies describe faculty preference for TBL due to increased student interaction despite requiring increased time for design. The perception of changes in faculty workload over multiple semesters has not been measured. This research evaluates faculty workload and perceived student engagement after implementing TBL in a required non-prescription medication course over multiple semesters. Methods: TBL was implemented in the non-prescription medication course and continued for three consecutive semesters. Faculty members’ perception of TBL was captured using an anonymous survey. The survey was an 11 item questionnaire with five Likert-type response options to identify changes in workload, training, and student interaction using TBL. Results: Twenty-eight total responses were collected from 10 faculty members who taught in at least one of the four semesters. Results were aggregated based on the number of semesters faculty continually taught in the course. More respondents agreed than disagreed that participation from and interactions with students increased with the TBL course compared to traditional lectures. However, more respondents believed the TBL course approach was more difficult and reported increased workload in the initial semester taught. Enjoyment of teaching increased for a majority of respondents. Discussion and conclusions: This is the first study to explore the impact of TBL implementation over multiple semesters. These data can be used to help implement TBL in pharmacy school curricula.
Introduction Team-based learning (TBL) is an instructional method of teaching that requires small group interaction to facilitate student learning.1,2 Four essential elements are required to implement TBL: groups, accountability, feedback, and assignment design.1 The goal of TBL is to replace traditional didactic methodologies of lecture to transform the classroom experience from instructor teaching to student learning. This transformation can enable students to be more active in the learning process.2
Abbreviations:TBL, Team-based learning ⁎ Corresponding author. E-mail addresses: [email protected] (C.D. Kebodeaux), [email protected] (G.L. Peters), [email protected] (P.M. Stranges), [email protected] (J.L. Woodyard), [email protected] (S.M. Vouri). http://dx.doi.org/10.1016/j.cptl.2017.07.004
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Kebodeaux, C.D., Currents in Pharmacy Teaching and Learning (2017), http://dx.doi.org/10.1016/j.cptl.2017.07.004
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
C.D. Kebodeaux et al.
TBL has been implemented in a variety of higher education settings and has expanded to many health professions.3 In particular, there has been an increased uptake of TBL in pharmacy education.4–6 As a result, many researchers and academicians have evaluated its impact on students’ perceptions and learning outcomes with significant improvements in student performance and confidence.7–11 While much of the research focuses on students, data on longitudinal perception from faculty are limited. Previous literature suggested faculty satisfaction improved following TBL implementation with no effect on overall student grades.12 In addition, previous research described increased faculty workload during the first year of TBL implementation.4,12–14 In a national survey of pharmacy faculty in United States (US) colleges and schools of pharmacy, implementing TBL required greater preparation time than traditional lectures.4 Also, faculty indicated a greater effort for instructors to facilitate TBL activities compared to traditional lecture.13,14 A recent study revealed thematic analysis on faculty perception about implementation of TBL; workload was noted as one of the challenges.15 No data that quantifies faculty workload, engagement/satisfaction of teaching, and implementation of TBL over a longitudinal period of time exists. Rationale and objectives Workload impact and design time for subsequent use of TBL in the same course over multiple semesters has not been measured. This research aims to evaluate faculty workload and perceived student engagement after implementing TBL in a required nonprescription medication course over four consecutive semesters. Methods Implementation At St. Louis College of Pharmacy, TBL was implemented in PP2120: Introduction to Pharmaceutical Care: Nonprescription Products and Drug Information in 2012. The course was designed using accepted TBL methodology.1,2 PP2120 was a required standalone self-care, three credit hour course divided into two, two-hour course periods during a standard week. The course was taught to first year professional transfer students and students in their final semester of the pre-professional curriculum, prior to matriculating into the professional program. Given the experience of the students, the course began with two weeks of introductory patientcentered care and drug information topics that provided students with the necessary background and experience to complete required TBL sessions. The course was then divided into 10 self-care therapeutic topics for which over-the-counter therapy was available. TBL was used to facilitate student learning in each of the 10 distinct topics. The use of TBL continued in these specific topics for each subsequent semester. Students were required to complete two hours of pre-class content weekly including lecture-based videos and required readings. During the first lecture period, students completed a 20 question individual readiness assurance test (iRAT) online followed by the same quiz taken in assigned groups, or teams, as the team readiness assurance test (tRAT). Students were allowed to appeal questions as a team using student-supplied evidence after completion of the initial assessment. The remaining time in the first lecture period was dedicated to student-generated “muddiest points”—areas that lacked clarity and time for the instructor to provide any clinical pearls that may help the student comprehend the material at a higher level. Muddiest points submitted by students could not be related to a specific question from the iRAT/tRAT, but could be regarding a general concept. The students were expected to complete an assigned 17-question case in their assigned groups as their application exercise in the second session. Students had 50 min to complete the case that was then submitted online. Next, faculty led a discussion of the case materials that included the simultaneous response of correct answers, thus providing students with immediate feedback on their performance. Each semester consisted of two exams and a comprehensive final exam. This design was purposeful and consistent with accepted methodology for the standard model of TBL implementation.2 Assessment of faculty perception Data collection was based on a survey tool used to evaluate faculty perception on workload, engagement/satisfaction of teaching, and implementation of TBL over a longitudinal period of time.16 This same 11 item questionnaire with five Likert-style response options was administered for four consecutive semesters to non-resident faculty in PP2120 via SurveyMonkey® (SurveyMonkey; San Mateo, CA). Identifiable data points were not collected from faculty in order to maintain anonymity. Data collection and research was classified as exempt by the St. Louis College of Pharmacy Institutional Review Board. Subsequent semesters included pharmacy residents as instructors but were not included in the survey due to the inability to participate in all semesters. Additional faculty were later involved in the course due to faculty turnover or changes in faculty teaching responsibilities. New faculty members to the course completed the survey even if he/she did not participate in the initial semester of TBL in this course. In total, faculty could have been surveyed up to four times if teaching in all consecutive semesters in the study period. Analysis Likert scales were transformed into three variables: 1) increased/agree, 2) did not change/no preferences, or 3) decreased/ 2
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C.D. Kebodeaux et al.
Table 1 Baseline characteristics. Respondents
n
Number of semesters facilitated 1 2 3 4 Years employed as faculty – mean years (range) Utilized TBL prior to this course Yes No Taught in this course prior to this semester Yes No
10 7 6 5 4 (1–10) 2 8 6 4
TBL = Team-Based Learning.
disagree. Responses marked not applicable were removed from analysis. Descriptive statistics were used to evaluate data over multiple semesters. Analysis was performed using SPSS v22.
Results In total, five faculty completed the survey over four semesters, one faculty completed the survey over three semesters, one faculty completed the survey over two semesters, and three faculty only completed the survey after the initial semester. Ultimately, 10 faculty participated in at least one of the four semesters, and 28 faculty-semesters were recorded (100% response rate; one partial response). Respondents had a mean of four years teaching experience prior to participating in this course, 80% (8/10) had not used TBL in previously taught courses, and no respondent had taught for more than two semesters of TBL prior to implementation in PP2120 (Table 1). Results for faculty perception of student participation, student interaction, workload, and interest in using TBL in the future were aggregated based on the number of semesters faculty taught in the course (Table 2 and 3). Over all four semesters, respondents believed student participation increased (24/28, 85%) with increased interactions with students (19/28, 68%). Perception of increased student interaction consistently improved with each semester taught. Enjoyment of teaching increased in 19/27 (70%), decreased in 4/27 (15%), and did not change in 4/27 (15%) of respondents (Fig. 1). A majority of faculty agreed that they would consider implementing TBL outside of this course. Table 2 Survey Results among Faculty Teaching 1 or More TBL Semestersa,b. Question
Compared to traditional lecture in this course, TBL student participation _____________. Compared to traditional lecture in this course, TBL ______ the interaction I had with students. Compared to traditional lecture in this course, TBL ___________ my workload. Compared to traditional lecture in this course, TBL ________ the number of course-related meetings in which I needed to attend. After completing a semester of TBL teaching in this course, my workload ________.
After completing a semester of TBL teaching in this course, the number of course-related meetings in which I needed to attend ________.
Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased Increased Neutral Decreased No Answer Increased Neutral Decreased No Answer
One Semester (n=10)
Two Semesters (n=7)
Three Semesters (n=6)
Four Semesters (n=5)
Total Responses (n=28)
70% 10% 0% 40% 10% 30% 70% 10% 20% 40% 50% 10% N/A
86% 0% 0% 71% 0% 14% 86% 0% 14% 14% 57% 29% 43% 14% 43% N/A 14% 57% 29% N/A
100% 0% 0% 83% 17% 0% 50% 0% 50% 17% 50% 33% 17% 33% 33% 17% 0% 50% 33% 17%
100% 0% 0% 100% 0% 0% 60% 0% 20% 0% 80% 20% 20% 20% 60% N/A 0% 100% 0% N/A
85% 4% 0% 68% 7% 14% 68% 3% 29% 21% 57% 21% 28% 22% 44% 6% 6% 66% 22% 6%
N/A N/A
TBL = Team Based Learning a Faculty perception of Student Participation, Student Interaction, Workload, and Interest in Using TBL in the Future Courses, Aggregated by Semesters Taught. b Percentages do not equal 100% in areas where participants selected not applicable, or failed to respond to a specific question
3
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Table 3 Survey Results among Faculty Teaching 1 or More TBL Semesters (continued)a,b.
(Agree/ Neutral/ Disagree)
Two Semesters (n=7) (Agree/ Neutral/ Disagree)
Three Semesters (n=6) (Agree/ Neutral/ Disagree)
Four Semesters (n=5) (Agree/ Neutral/ Disagree)
Total Responses (n=28) (Agree/ Neutral/ Disagree)
60% 20% 20% 60% 20% 20% 60% 20% 20% 60% 10% 30% N/A
57% 14% 29% 29% 29% 43% 57% 29% 14% 57% 14% 29% N/A
50% 17% 33% 67% 17% 17% 83% 17% 0% 83% 0% 0% 17%
40% 20% 40% 80% 0% 20% 80% 20% 0% 60% 20% 0% 20%
54% 14% 32% 46% 21% 32% 68% 21% 11% 64% 18% 11% 7%
One Semester (n=10)
Question
Adjusting to a TBL course approach from traditional lecture was difficult. I was given adequate training in TBL prior to utilizing it in the classroom. After teaching TBL in this course, I would like to teach using TBL in other therapeutic-series of courses (e.g., Therapeutics, Pathophysiology). After completing this TBL course, I would like to teach using TBL in other non-therapeuticseries of courses (e.g., Advanced Pharmacy Practice, Introduction to Pharmacy Practice).
Agree Neutral Disagree Agree Neutral Disagree Agree Neutral Disagree Agree Neutral Disagree Not Applicable
TBL = Team Based Learning a Faculty perception of Student Participation, Student Interaction, Workload, and Interest in Using TBL in the Future Courses, Aggregated by Semesters Taught. b Percentages do not equal 100% in areas where participants selected not applicable, or failed to respond to a specific question
Fig. 1. Faculty perception of enjoyment of teaching. TBL = team-based learning.
More faculty reported increased workload (19/28, 68%) compared to decreased workload (8/28, 29%) as a result of participation in the course. However, after teaching at least one semester, more faculty reported a decreased workload than an increased or unchanged workload. More respondents agreed than disagreed that the TBL course approach was more difficult compared to traditional lectures (54% vs. 32%, respectively). Discussion This research evaluates TBL from the faculty perspective, including workload, in a non-prescription medication course taught over four semesters. The objective was to address the current lack of evidence examining longitudinal faculty member perceptions of TBL compared to traditional lectures. Understanding faculty perception of TBL is essential for both implementation and course and curricular assessment. Study results regarding perceived student participation are consistent with research by Allen et al.4 showing an increase in participation with TBL compared to a traditional lecture format. In this study, an increase in participation occurred regardless of how many semesters faculty taught and was observed by all participating faculty members teaching TBL for three or more semesters. Increased accountability for students to understand material prior to class along with the active nature of in-class participation with TBL likely contributed to increased participation relative to traditional lectures. Faculty reported increased student interaction with TBL which, given faculty buy-in, may be the reason for increased student participation. The increase in student interactions appeared to increase with each semester that faculty taught TBL. This may potentially lead to greater student and faculty satisfaction in the semesters after TBL is implemented in a course. The increase in workload primarily with in the first semester of TBL, as demonstrated in this study and others, may concern faculty when TBL is implemented in a course.4,12 This research cohort stated at least two-thirds of respondents reported decreased or 4
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no change in workload after three or four semesters. This may be attributed to faculty becoming more familiar and comfortable with the TBL approach along with a reduced requirement needed to update teaching materials. What is not known is how much of an increase in workload was experienced, how workload changes impacted other responsibilities, and what areas of the TBL process affected workload most (e.g., before, during or following class/the semester). An increase in workload in the first semester of teaching TBL did not appear to dissuade faculty as they would be willing to use TBL in other courses. The more semesters faculty taught using TBL, the greater proportion of faculty indicated they would be willing to use TBL in other courses. Another barrier to implementation expressed by faculty was incorporating TBL in a large class size.15 In the context of this study, TBL was used in a class size of approximately 200 students. Strategies used to assist with logistical barriers of TBL in a large class included administering assessment items online and engaging support from an administrative assistant and teaching assistants. Administering assessments such as iRATs and online case assignments increased grading efficiency and reporting, while the administrative assistant helped with attendance tracking, formatting, uploading and organizing content for an online learning management system, and preparing group folders. Teaching assistants were hired to help the administrative assistant with various duties including meeting with students to review their iRATs and to proctor assessments. This was the first course in the curriculum in which students encountered TBL; therefore, course coordinators found it helpful to spend time at the beginning of each semester discussing the process of TBL and their expectations of students. This study has limitations including small sample size and assessing TBL at a single institution; however, this survey can be used as faculty feedback to coordinators for course planning, training, and workload assessment. The inclusion of residents, teaching assistants, and administrative staff within the course, but not the survey, may limit the understanding of the perception of TBL to everyone that was involved. Despite only being at one institution, the research does include multiple perspectives from different faculty members over four consecutive semesters. Changes in teaching responsibilities and faculty turnover may have impacted the longitudinal description of this survey; however, this is likely representative of the dynamics of responsibility seen at most institutions. Conclusions Based on faculty perception, TBL has an initial increase on workload; however, workload remains constant or diminishes over time. This is the first study to explore TBL implementation over multiple semesters from a faculty perspective. Having this understanding may help administration account for potential additional workload up front with TBL implementation. The additional benefits of TBL from the faculty perspective include increased enjoyment, student interaction, student accountability, and class participation. Faculty may perceive more benefits of TBL the longer a faculty member is involved with this teaching method. Disclosure statement The authors listed on this manuscript have no financial relationships, commercial interests, nor any conflicts of interest to disclose with respect to the publication of this material. Dr. Vouri reports funding by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award KL2TR000450, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). Acknowledgements The authors would like to thank Nicole M. Gattas, Pharm.D., BCPS, FAPhA and Peter Hurd, Ph.D. for their contributions to study design. References 1. Michaelsen LK, Sweet M. The essential elements of team‐based learning. New Dir Teach Learn. 2008;2008(116):7–27. 2. Michaelsen LK, Sweet M. Team‐based learning. New Dir Teach Learn. 2011;2011(128):41–51. 3. Fatmi M, Hartling L, Hillier T, Campbell S, Oswald AE. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach. 2013;35(12):e1608–e1624. 4. Allen RE, Copeland J, Franks AS, et al. Team-based learning in US colleges and schools of pharmacy. Am J Pharm Educ. 2013;77(6) Article 115. 5. Ofstad W, Brunner LJ. Team-based learning in pharmacy education. Am J Pharm Educ. 2013;77(4) Article 70. 6. Nelson M, Allison SD, McCollum M, et al. The regis model for pharmacy education: a highly integrated curriculum delivered by team-based learning™(TBL). 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