Recently I had the pleasure of observing a team based learning (TBL) session at the newly established Lee Kong Chian (LKC) School of Medicine, a joint initiative between Imperial College London and Nanyang Technological University. As a doctor having trained via problem based learning (PBL) I was able to appreciate the stark difference between the two forms of instruction.
Despite evidence by many a senior scholar proclaiming its worth, the reality for students undertaking PBL is much different. For those readers unaware, PBL comprises weekly group sessions centred on a clinical case where members would define unknown terms and draw links between certain occurrences. For example, an alcoholic presenting with jaundice (a yellowish discolouration of skin and sclerae) should prompt students to investigate the link between the two events as well as how best to investigate and subsequently manage such a patient. The concept appears great on paper yet is hindered by a lack of direction. Often tutors are non-clinicians with little understanding of the field in question. The reason for this is to encourage students to be active learners seeking out the information for themselves, based primarily on the fact that medicine is a lifelong learning process. I, along with many others, often raised concerns about this do-it-yourself approach. How as young adults can we be expected to teach ourselves? Theory is one thing yet appropriate application and experience is the true basis for safe and effective practice. Another dampened aspect of PBL lies upon students determining their own learning objectives. So in the case above, the group may determine how to treat such a patient yet miss the more important aspects of prevention. After all it comes as no surprise that prevention is better than cure.
So as I witnessed the new form of TBL instruction at LKC, I was in awe of the new cohort. The process in this case involves both content experts and session facilitators. Prior to the session, students are given the required curriculum objectives so that there is no confusion as to what the learning outcomes should be as well as the relevant learning materials. The session itself then first focuses on an MCQ exercise undertaken individually on questions relevant to the topic. The same exercise is then repeated in groups so that students can discuss with their peers their answers and more importantly any discrepancies. And this is essentially where the fun begins! Any discrepancies which are unable to be agreed upon are then posed to the content experts who are able to provide their take on a particular question and reasoning behind an answer. Often in medical MCQs more than one option is suitable but determining what is the most likely option is the challenge. The final aspects of TBL then rely on application exercises designed for teams to understand the application of theory to clinical practice. After all the practice of medicine isn't textbook based and appropriate patient care relies on one's ability to adapt theory in reference to the patient at hand. And again content experts are at hand to help ensure clarity.
As the session drew to a close, I was still very much envious of the training process LKC's students were part of. Whilst many an educationalist can draft the pros and cons of instructional methods, the reality is there is no gold standard approach. However, the concepts of leadership, teamwork, application to a clinical setting and my most preferred domain of instant feedback will no doubt help to ensure a world class set of clinicians at a time when life expectancy is increasing and patients are presenting with complex chronicity coupled with polypharmacy. TBL certainly has the thumbs up from my side!