Assessing Medical Students’ satisfaction and perception with a new Team- Based Learning experience

doi:10.21203/rs.3.rs-3346223/v1

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Assessing Medical Students’ satisfaction and perception with a new Team- Based Learning experience

https://doi.org/10.21203/rs.3.rs-3346223/v1

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Background: Team learning is relatively new to medical education. It was integrated into the pre-clinical programme of a medical school in 2002, in our faculty of medicine of Sousse, Tunisia in 2017.

The aim of this study was assessing the perceptions of teamwork with this method "team based learning" by medical students of fourth medical year for the topic “Disaster management in emergency medicine ".

Method: It was a cross sectional analytic study describing the first implementation of a Critical medicine Team Based Learning among the fourth under-graduate medical students in the t faculty of medicine of Sousse, Tunisia during the university year 2022-2023, after institutional educational development committee approval. Data were analyzed using SPSS 20.0.

Results: Significant attitudinal satisfaction was found in the areas of professional development, satisfaction with the team experience, satisfaction with peer review, the impact of the team on the quality of learning and the impact of the team on clinical reasoning skills.

Conclusion: This study demonstrates the students' positive attitude to teamwork, their sense of professional development, and their comfort and satisfaction with peer assessment.

Satisfaction

Medical student

Team-Based Learning

Over the last decade, educators on university campuses have increasingly used a teaching method known as team-based learning (TBL)(1). The TBL integrates several small groups into one large group. (2). Part of the appeal of TBL for vocational schools is the combination of efficient use of resources (one teacher to manage several groups simultaneously) and the promise of active student participation, which is generally only possible with other small group work methods (3).

Medical education is undergoing a major revolution. With the increasingly accepted idea that adults learn by (4) actively engaging and modifying what they learn in the context of that engagement (2). Certainly there are difficulties in applying this method because of the intensity of the resources required to teach in small groups. However, in the last decade, medical educators have begun to use a cost-effective teaching method called team-based learning (TBL). This method, originally used in business schools, allows a single teacher to bring small groups into the teaching room and simultaneously conduct activities with all learners in the room.

In the literature the impact of this method of teaching and the satisfaction of medical students in various fields were studied (5) but for the critical medicine we didn’t find studies which speaks about it from where the idea of our study following a first experiment of TBL within the certificate of medical studies of 2nd cycles in medicine "critical medicine" on course “Disaster management in emergency medicine " in the faculty of medicine of Sousse.

Our objectives in this study were to measure the perceptions and satisfaction of teamwork with the method "team based learning" by the medical students of fourth year of under-graduate for the topic “Disaster management in emergency medicine ".

It was a cross sectional analytic study describing the first implementation of a Critical medicine Team Based Learning among the fourth under-graduate medical students in the t faculty of medicine of Sousse, Tunisia during the university year 2022-2023, after institutional educational development committee approval.

At baseline, 180 fourth year undergraduate medical students were electronically targeted in the end of TBL course to complete an anonymous questionnaire regarding their attitudes and perceptions about Team-Based Learning.

Inclusion criteria: Students agreeing to participate in this study.

Exclusion criteria: Incomplete survey data.

Composition of the teams

Before the module, 180 fourth year undergraduate medical students from the Faculty of Medicine in Sousse were divided into two groups of 90. The students in each group were then divided into 9 teams. Each team consisted of nine to 10 students. To avoid organising the learners into predefined sub-groups (for example, a single-sex team) according to their choices, the teachers formed the teams randomly by giving them rules. The teams were given a fixed space in the classroom for the duration of the module. All the procedures for this session were approved in advance by the teaching team in the development centre at the Faculty of Medicine in Sousse and by the coordinators of the "critical medicine" certificate.

Background

The Faculty of Medicine of Sousse has been committed to the quality of medical education since its creation in 1974. Its openness to other French and Canadian faculties of medicine has made it a pioneer in the field of teaching and an innovator, with talk of self-training and student- centered teaching.

In 2006, as part of the Quality Support Program (Programme d'Appui à la Qualité - PAQ), a team of teachers from the Faculty of Medicine involved in teaching - Professor Laarbi Chaieb, head of the project, Professor Ali Mtiraoui, Professor Mohammed Denguezli and Professor Hassen Ghannem, to whom we pay tribute - submitted a project aimed at strengthening teaching skills, entitled "Pedagogical Development and Learning Management". It was as part of this project that the Pedagogical Development Centre (CDP) was created and became operational in 2009.

This long-term preparatory work facilitated the implementation of the reform, which came into being in 2016. This change of direction subsequently necessitated a vast teacher training operation specific to the different tasks carried out by the teachers involved in this program. This operation has never ceased since the following professors took over: Prof. Béchir Ben Haj Ali, Prof. Mohamed Ben Dhiab, Prof. Olfa Bouallègue and Prof. Latifa Lassoued.

many active learning methods were used, and to facilitate their implementation, pedagogical training for the faculty's academics in the form of pedagogical seminars, in-service training and an enriched program for a certificate of complementary study in medical pedagogy were developed within the faculty, as well as clear and practical guides on the faculty's website under the heading of pedagogical development centre, to help them put these innovative methods into practice, from which we took the basis of our Team Based Learning session.

Design of TBL sessions according to FMS guidelines

TBL session schedule (6)

15min: Welcome of students and teams organization

15 min: Activity 1: individual test (i-RAT)

15 min: Activity 2: Team test (t-RAT)

30 min : Activity 3 : Calls 30 min

30 min: Activity 4: Feedback

15 min: Break

45 min: Activity 5: Application and discussion within and between teams

The course and its objectives are prepared and made available to students on the faculty's virtual platform (ent.uvt.rnu.tn).

Access is based on a code issued to each student at the time of administrative registration.

Location: library room Duration: 03.30 hours (from 12.30 to 15.00 for the 1st group then from 15.30 to 19.00 for the second group)

Teachers: 3 teachers for one TBL session

Target population: fourth year under-graduated students from Faculty of Medicine of Sousse.

The students are divided by the administration into 8 groups named in alphabetical order from A to H.

For the conduct of a TBL session, 4 groups were assembled for 2 TBL sessions (one session for groups A, B, C and D, and a 2nd session for groups E, F, G and H).

During the TBL session, the students are divided into teams of 8 to 9 students.

The TBL session itself:

According to the founder of this new learning method, the TBL takes place in 3 phases and 6 stages, as explained in the following diagram (Figure 1)

Student perceptions

The questionnaire used in this study included 19 statements with Likert-type responses ranging from "Strongly disagree" (1) to "Strongly agree" (4). Consentement of students was necessary to complete the questionnaire. The declarations were divided into 5 sub-groups: overall satisfaction with the team experience/ impact of the team on quality of learning/ satisfaction with peer review/ impact of the team on clinical reasoning skills and professional development ( Figure 2).

The questionnaire for this study was inspired by the Minnesota Satisfaction Questionnaire (7). Many of the specific questions in our survey can be found in a variety of studies on participants' perceptions of satisfaction with group experiences (Parmele et al. questionnaire).

The assessment instrument used was changed from a 5-point scale to a 4-point scale. The questionnaire was converted into French and distributed online; the confidentiality of participants was respected.

However, no other changes were conducted before obtaining our students' responses.

Data Analyses

Qualitative variables were expressed as absolute and relative frequencies with 95% confidence intervals. Quantitative variables were represented by the median and quartiles after checking the normality of their distribution using the KOLMOGOROV SMIRNOV TEST. For statistical tests, test t student and fisher were used and the significance level was at 0.05.

Characteristics of the participants

A total of 180 students took part. After excluding students with missing data, complete data was available for 126 students. The effective response rate was 70% (126 out of 180 eligible students). In total, 79.4% (n=100) of the applicants were women. The sex ratio (M/F) was 0.26.

Their median age was 22 years (IQR: [22- 23]). A female predominance was noted (100 (79.4%) women and 26 (20.6%) men).

Four nationalities were present in our study group, the first being Tunisian (118 students; 93.7%), followed by Algerian (4 students; 3.2%), Moroccan and Palestinian (2 students each; 1.6%).

Almost all of the group (98.4%) had previous experience with this learning method.

The demographic profile of the candidates who took part in the survey is shown in Table 1.

Table 1 : Demographic Characteristics

Demographic

% (n=126)

Median

Age

Gender Male

Female

Previous experience with TBL

Nationality

Tunisian

Algerian

Moroccan

Palistinian

20.6% (26)

79.4% (100)

98.4%

93.7 (118)

3.2 (4)

1.6 (2)

22 ans

Results of the satisfaction scale

In our population, the satisfaction rate was high, with an “overall satisfaction with team experience” rate of 100 (79.4%).

Analysis of each domain showed greater satisfaction for Team impact on clinical reasoning ability (88.9%), followed by Professional development (82.5%). The results were shown in the Table 2.

Table 2 : Students satisfaction in the five domains of the satisfaction survey (n=126)

Question	Insatisfaction n (%)	Satisfaction n (%)
Overall Satisfaction with Team Experience	26 (20.6)	100 (79.4)
I have found working as part of a team in my classes to be a valuable experience	18 (14.3)	108 (85.7)
In most of the teams I have been on, the other team members have generally contributed as much as I have	54 (42.9)	72 (57.1)
In most of the teams I have been on, the team has worked well together	0 (0)	126 (100)
In most of the teams I have been on, I felt the other team members respected me	30 (23.8)	96 (76.2)
I have found teamwork to be a productive use of course time.	62 (49.2)	64 (50.8)
Team Impact on Quality of Learning	42 (33.3)	84 (66.7)
I have found that teams help me learn course material more than if I just studied alone	52 (41.3)	74 (58.7)
I have learned more in courses where I have been a member of a team	38 (30.2)	88 (69.8)
I have found being part of a team improves my course grade	28 (22.2)	98 (77.8)
Satisfaction with Peer Evaluation	38 (30.2)	88 (69.8)
I have found that my peers have been fair in judging my contributions to a team	18 (14.3)	108 (85.7)
I have found that peer evaluation motivates me to work harder	48 (38.1)	78 (61.9)
I have generally liked the use of peer evaluation as part of my team experience	36 (28.6)	90 (71.4)
I have found that peer evaluation motivates me to work more collaboratively	34 (27)	92 (73)
Team Impact on Clinical Reasoning Ability	14 (11.1)	112 (88.9)
I have found that being on a team has helped me become better at problem solving	12 (9.5)	114 (90.5)
I have found that teams make good decisions	18 (14.3)	108 (85.7)
Being part of a team discussion has improved my ability to think through a problem	24 (19)	102 (81)
Professional Development	22 (17.5)	104 (82.5)
I have found that working with a team helps me develop skills in working with others	20 (15.9)	106 (84.1)
I have found that working with a team has helped me develop cooperative leadership skills	22 (17.5)	104 (82.5)
I have found that working with a team has helped me develop more respect for the opinions of others	16 (12.7)	110 (87.3)
I have found that working with a team has enhanced my sense of who I am	26 (20.6)	100 (79.4)

Correlation between Gender and satisfaction:

Analysis of the satisfaction rate for each domain by gender showed greater satisfaction among females for Overall Satisfaction with Team Experience, Team Impact on Clinical Reasoning Ability and Professional Development, with p-values calculated at 0.012, <0.001 and 0.003 respectively. No significant difference for other domains (Table 3).

Table 3 : Satisfaction difference between male and female (n=126)

	Insatisfaction n (%)	Satisfaction n (%)	p
Overall Satisfaction with Team Experience
Male	10 (38.5)	16 (61.5)	0.012
Female	16 (16)	84 (84)	0.012
Team Impact on Quality of Learning
Male	12 (46.2)	14 (53.8)	0.12
Female	30 (30)	70 (70)	0.12
Satisfaction with Peer Evaluation
Male	8 (30.8)	18 (69.2)	0.939
Female	30 (30)	70 (70)	0.939
Team Impact on Clinical Reasoning Ability
Male	10 (38.5)	16 (61.5)	<0.001
Female	4 (4)	96 (96)	<0.001
Professional Developement
Male	10 (38.5)	16 (61.5)	0.003
Female	12 (12)	88 (88)	0.003

This study investigates the perception and satisfaction with the new practice of TBL in the faculty of Medicine of Sousse among the bloc of critical care for “Disaster management in emergency medicine”.

Our study demonstrates overall students' high level positive perception and satisfaction toward the TBL.

The questions in our survey were developed over a period of 5 years as part of the organisational courses in the Department of Communication at Wright State University (8). These particular questions have been identified in numerous studies of participant satisfaction with previous group experiences (9).

There is overall (male and female cohort) agree that the TBL in critical medicine is an effective learning process especially the female group which is similar to what had been reported in litterature (10). This highlighted some of the benefits and useful TBL as a precious tool in learning critical medical topic.

Survey data from Parmelee et al. showed that the implementation of this new teaching approach increased their satisfaction with teamwork. We believe that this positive perception may be due to the fact that TBL provided one of the few opportunities for our students to actively discuss and share information and knowledge with other colleagues.

Numerous other studies have evaluated students' feelings about TBL, although they have used different tools to assess it. Irrespective of the category of population studied and the instrument used, student feedback on this relatively new teaching method was generally judged to be favourable and positive in all the research (11) (12).

The TBL method has been around for over 32 years. Like other innovations, it spread slowly at first, mainly in business education and at the University of Oklahoma, where many of its pioneers were faculty members (5). This trend has been partly stimulated by the explosion in their use in the scientific field. Moreover, in 1998, TBL was known in medical faculties; today, more than 120 institutions worldwide use this method in their classroom (13).

Apart from the use of team-based learning in various medical school programmes (14) (15) and health training, there is a gap in the literature regarding medical students' attitudes towards team-based learning. Team-based learning was initiated in our medical school in 2017–2018.

During the first two years of a curriculum based mainly on passive receptive teaching, active team learning sessions were offered in all courses, replacing or supplementing lecture-based teaching. We thought it essential to describe students' impressions of teamwork, given that this was a new approach to group teaching in our critical medicine block.

Numerous studies have already described the effectiveness of these methods in learning, mainly from the point of view of specialists, educators and teachers (2) (16). However, when it comes to students' perceptions, it is not always easy to identify a clear choice for the active method over the classic method used. Frame et al. (2015) revealed that learners prefer conventional teaching methods even though they initially have a positive view of active methods, particularly when they have taken courses using both methods in the same session (17).

A research study was conducted with 33 Australian ICU nurses to understand their views of the TBL experience. The results indicate that the method is a powerful teaching strategy in terms of student engagement in learning and the outcomes derived from that engagement (18). Furthermore, in order to improve learners' learning capabilities, it is important to better understand their conception of the TBL methodology and to identify the facets of this method that need to be perfected.

Study Limitation

Several potential limitations reduce the possibility of transposing the results to other contexts. For example, the results may be affected by the fact that participation in this study was voluntary and mainly included motivated learners. Another restriction of our research is the fact that long-term effects were not analysed by focusing on a single intervention. Further studies are needed to determine whether the benefits of TBL, which can probably be observed after a long period of time. This research was restricted by the small participation of candidates, particularly male students. In other hand, students' lack of familiarity with the modified TBL and the psychological pressure of a busy academic schedule may have played a role in lowering student satisfaction levels, in addition to the use of a self-administered questionnaire which is more prone to subjectivity.

Using Google Forms with auto marking gave a rapid analysis of students' perception, and facilitated the tutor to identify areas of non satisfaction by students to be clarified.

We considered this study as a pilot study to further large study.

TBL has now been integrated since seven years in our medical school in Sousse and, as this approach has become a fixed part of our medical curriculum and is under development, it would be important to explore the position of our learners. Further study of this type would give us a better idea of the design associated with attitude change when team learning is initially integrated into a block and when it is a really a part of it.

The TBL uses all the levels of knowledge acquisition in Bloom's taxonomy. First, learners use the knowledge and comprehension levels through preparatory reading. Then, they call on the higher levels of Bloom's taxonomy, i.e. analysis, re-evaluation and creation, when they are invited to solve a problem in a team and share their solutions with the whole team.

Active learning methods are now central to the reform of medical studies. Indeed, the new medical education programme aims to adopt teaching approaches that are most likely to lead students to success.

ACKNOWLEDGMENTS

The authors would like to acknowledge all the medical trainees who participated in this research and contributed their time. A big thank to our comitee of pedagogy in the faculty of medicine (in their head and not only Dr Chouchene Imed and Dr Lasoued Latifa) for their participation in forming teachers to practice the TBL.

Declaration of interest statement :

no conflicts of interest for authors.

Participants consent:

Students were informed in the bottom of the Google forms sheet of the study ( anonymity and confidentiality were respected) and it was necessary to check the consent question before completing the questionnaire: written consentement

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No competing interests reported.

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Assessing Medical Students’ satisfaction and perception with a new Team- Based Learning experience

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