Our study population comprised Year 3 medical students (clinical of Medicine) from Central South of China University. In the third year, students move to hospital, where they rolled into various medical subspecialties including ophthalmology; undergoing clinical clerkship during our TBL course. Eight faculty members who had been a part of the TBL teacher. In total 140 students participated in the TBL session. Human Research Ethics Committee of Central South University approved study. All methods were carried out in accordance with relevant guidelines and regulations.
Learning outcomes of the TBL
The score of IRAT and GRAT, including of score of comprehensive clinical application at the end of class and FESs were selected to provide learning outcomes in our assessment. What’ s more, satisfaction questionnaire and evaluation of teaching goal also contain in our results.
Structure of team-based learning
The TBL session was 2.5 h in duration. It was held outside of the students’ regular weekly schedule to preview with MOOC video and book. The students divided into 10 teams per class and distribute with evenly gender, each team consisted of approximately 14 members. Two or three teachers were randomly allocated to these group to participate the discussion section during GRAT and comprehensive clinical application task.
The process of team-based learning
Pre-class reading Prior to class, all students were allocated compulsory readings and pre-recorded lectures to review.
Individual readiness assurance test (IRAT)
All students were required to complete an online quiz with superstar APP on the beginning of class. The quiz consisted of 10 multiple choice questions, with one single best answer or multi choice for each question. The questions were aligned with the pre-class reading and pre-recorded lectures. Students were provided with a 15min window to complete the quiz, and at completion, they were provided with their total score.
Group readiness assurance test (GRAT)
The same IRTA quiz was repeated by the students in their teams. The test was administered online, and students submit once answer per team, with the intent of promoting discussion to establish team consensus.
Immediate feedback and clarification from the facilitators
The correct answers were then released and explained, giving immediate feedback on team responses in about 30min. The teacher offered clarification, particularly where individuals or teams had trouble.
Our teachers give an interest lecture with an intend of exploiting the horizon of medical student on ophthalmology learning, the content of lecture including the progress of scientific research, operation of each disease and advanced medical technology. The time of this lecture last about 1 hour.
Clinical problem-solving activities
Students worked in their teams on problem solving activities, using knowledge consolidated through the prior steps. There was opportunity within the immediate feedback session for students to initiate discussion and challenge answers.
Each TBL class had a professional team of facilitators including: three ophthalmologists. The facilitators had been provided with prior training in TBL facilitation by either attending face-to-face training semester. In our modification we provide additional profession research lecture and specialty clinical lecture with international language, which including elements such as how to prompt clinical reasoning through questioning.
We collected data using a multiple questionnaire regarding the TBL experiences. The questionnaire was distributed to student immediately following completion of the TBL session. The questionnaires included closed items (using a five-point Likert Scale, with 1 being ‘strongly disagree’, and 5 being ‘strongly agree’).
The interviewers used a guide that contained 7 standardized, open-ended interview questions 13 which asked about general impressions of the dissemination of TBL at the school, degree of TBL use in specific courses, scholarship on TBL and future. A series of prompts were included to ensure that each question was explored in similar detail between interviewers. A copy of the interview guide is provided in Table 1. All interviews were conducted over the telephone.
We used the descriptive statistics method to analyze our questionnaire data. Thematic analysis was used to build an understanding of the students’ experience of the TBL session. A portion of the data was read by the first author and analyzed to identify initial themes. Following negotiation of meaning with the second author, a coding framework was developed and applied to the full data set.
Differences in proportions between TBL and PL groups were tested using the c2 test; differences in means of IRAT and GRAT scores were tested using two-sample t-test if normality and homogeneity assumptions were satisfied otherwise the non-parametric Mann-Whitney-U test was applied. A one-way analysis of variance (ANOVA) was used to compare the IRAT, GRAT, application exercise and final examination scores among the four quartiles of students stratified according to BOLs. All analyses were performed by SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA).
The IRB (Institutional Review Board) at Xiangya Hospital, Central South University, approved the study. Participation was voluntary, consent forms were signed, and anonymity was guaranteed. All methods were carried out in accordance with relevant guidelines and regulations.