TBL is the application of small-group, active-learning methods in which students are held responsible for both individual and group learning. The idea of TBL was originally formulated by Larry Michaelsen in the 1970s 1. Team learning was also described in 1990 by Senge for the corporate environment, and small-group team learning has been used as an educational tool for several decades 2. In the book by Michaelsen et al.3, the authors offered detailed instructions for how a health profession educational institution may implement this method of learning. They argued that as health professionals, we must work in teams for the best interest of our patients. TBL helps to prepare students to be effective health care providers.
In recent years, TBL has shown better teaching effects than classical LBL and PBL in the fields of microbiology 4, anatomy 5, 6, neuroscience 7, genetics 8, and physical therapy 9. Before 2016, the TBL teaching method was introduced into the field of ophthalmology. The TBL group achieved better results in IRAT, GRAT, GAP and FESs than the groups using other teaching methods 10.
We found that in neurology teaching, TBL was better than PBL at making students take the initiative to find learning materials and combine basic and neuroanatomical knowledge with clinical cases. In recent years, the implementation of TBL and PBL has required 1 ~ 2 students responsible for reviewing neuroanatomy using pictures and other models (3-D apps, videos, etc.), making it easy for students to localize nervous system disorders. Especially in the TBL group, neurology knowledge was reviewed and consolidated. Students said that this was the first systematic review course after the study of neuroanatomy, and it enabled them to understand the practical significance of knowledge.
Students in the TBL and PBL groups gained a new understanding of the diagnostic process for neuromuscular disease. A variety of teaching methods, including case analysis and watching videos of neuromuscular disorders and electromyography, could simulate the actual diagnosis process and improve medical students’ clinical thinking. Students could also understand “the gap between theory and practice”, and the clinical process would neither be strange nor over idealistic for them. For example, when observing in the electromyography room, students found that not all patients had perfect electromyography figures.
The greatest benefit of the TBL group was team spirit and specialization. Because the case analysis involves much knowledge, it would be difficult for one intern to finish. In a team of 6 ~ 8 students, each member had a division of tasks, and they had to cooperate to complete the whole process. The teamwork of 6 ~ 8 students was proven to be most efficient. Although there was no significant difference in the overall evaluation of teaching between the 2 groups (4.16 vs 4.07, p = 0.518), the TBL group was superior to the PBL group in classroom atmosphere, initiative thinking, teamwork and communication between teachers and students. Both TBL and PBL have advantages and disadvantages, and it remains unclear which is more suitable for students. One article published in 2017 suggests that students prefer the TBL teaching mode 11.
The study found that when using the TBL teaching mode, the basic knowledge and clinical thinking ability of interns improved. Clinical thinking and its combination with basic medical knowledge are the foundation of doctors’ diagnoses. The teaching is based on actual clinical cases and self-study. Guided to summarize the characteristics of cases and diagnosis, interns participated in the clinical diagnosis and treatment process of real cases and learned the characteristics of abstract neuromuscular diseases. Observing electromyography (EMG) operation helps students understand the relationship between EMG data and neuromuscular dysfunctions, as well as the relationship between the structure and function of the nervous system. These findings are beneficial for both clinical work and research on neuromuscular disorders in the future. In addition, 1 ~ 2 students on the team were assigned a literature review and guideline summarization. This arrangement could train students’ ability to retrieve and summarize literature and efficiently save other students’ time for other tasks.
Due to improvements in various abilities, medical students were in a mode of continuous inquiry learning after clinical internship and continued to think deeply about clinical problems and published papers during internship 12, 13.