|ORIGINAL RESEARCH ARTICLE
|Year : 2015 | Volume
| Issue : 1 | Page : 41-44
Effectiveness of team-based learning in microbiology: A non-randomized control study
Sheetal U Harakuni1, Jyoti M Nagamoti2, Maheshwar D Mallapur3
1 Associate Professor, Department of Microbiology, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
2 Professor, Department of Microbiology, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
3 Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
|Date of Web Publication||31-Jul-2015|
Sheetal U Harakuni
Associate Professor, Department of Microbiology, Jawaharlal Nehru Medical College, Belgaum - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: As per the present curriculum in India, pre- and paraclinical subjects are taught away from the clinical setting. Therefore, students fail to connect the subject taught through didactic lectures to the clinical setting. Team-based learning (TBL) can be used in conjunction with lectures to teach applied microbiology. This study aims to evaluate the effectiveness of TBL sessions in conjunction with lectures to enhance learning of applied microbiology, among Indian students. Methods: All students enrolled in the study were taught systemic bacteriology through lectures. Of the 88 students, 49 students (study group) attended TBL sessions on the topics of diarrhea, fever of unknown origin, urinary tract infection and 39 students (control group) preferred self-study on the topics without attending the TBL sessions. Students' feedback on their perception on TBL sessions was collected using a questionnaire of 10 items. The performance of both the groups on the pre- and post-test were analyzed using unpaired t-test and analysis of variance (ANOVA). Gender-wise performance within the teams was analyzed by paired t-test using SPSS version 12. Results : The TBL group outperformed the self-study group on the post-test [F 1 = 5.521, P = 0.021]. Female students as a whole performed better than males on the pre-test, scoring higher within both the TBL and self-study groups. Male students in the TBL group performed significantly better on the post-test than female students who participated in TBL sessions (P = 0.013). Students generally enjoyed and appreciated the TBL sessions. Discussion : TBL sessions can be used judiciously in combination with the lectures to enhance learning of applied microbiology in India. In this study, TBL improved the performance of male students over self-study, but performance for female students following TBL was no better than when they simply studied by themselves.
Keywords: Active learning, microbiology, team-based learning
|How to cite this article:|
Harakuni SU, Nagamoti JM, Mallapur MD. Effectiveness of team-based learning in microbiology: A non-randomized control study. Educ Health 2015;28:41-4
| Background|| |
In India, most of the medical curriculum provides education through didactic theoretical lectures. Pre- and paraclinical subjects are taught away from the clinical setting. Moreover, students have expressed the need for clinical case-oriented learning to understand the role of microbiology in clinical circumstances.  The Medical Council of India's Vision 2015 document emphasizes reconstructing the present curriculum by adopting newer learning methodologies involving active learning.  Active learning is known to enhance learning and thus generally improves the quality of medical education. 
To facilitate active learning, Small Group Teaching (SGT) is being largely adopted worldwide and is also evolving as the most researched topics in medical education. Some of the popular types of SGT are problem-based learning (PBL), case-based learning (CBL) and team-based learning (TBL).  In India, with the typical medical school class strength of 150-250 students, practicing SGT seems less feasible, however, TBL can be best adopted to facilitate active learning in a large class.
TBL is mostly practiced in USA, the place where it originated. Although there is a significant literature on the methodology and students' perspectives on TBL,  there are few publications on TBL from Asia and there is only one study from India.  The study has reported on the students' positive perceptions on TBL,  leaving scope for research on the effectiveness of TBL in Microbiology in our country. Thus the present study was undertaken to evaluate the effectiveness of TBL in conjunction with lectures in enhancing learning of applied microbiology.
The students studying microbiology in the private institute, Jawaharlal Nehru Medical College, Karnataka Lingayat Education University in southern India attended the TBL session with advance preparation of the given topic, and they answer a set of multiple choice questions individually (individual readiness assurance test; IRAT) and then in groups following discussion (group readiness assurance test; GRAT). A case scenario is presented to the study group following which the students apply the knowledge gained (application exercise). The session ends with peer feedback among the groups.
The academic performance of the students is affected by their attitudes, behaviors and learning styles, and to some extent gender. It is generally observed that female students score better academically than male students. Hence this study also aims to evaluate the gender difference in learning through TBL.
Intervention and evaluation methods
After the study was approved by the Institutional Review Board of the Jawaharlal Nehru Medical College, a class of 145 students in their second year was selected of which 88 students consented to participate in the study [Figure 1]. The reason for selecting second term students was that they were already well versed with basics of microbiology and had certain amount of clinical exposure as well.
Among the 88 students, 49 opted to participate in TBL session (study group) and 39 preferred self-study (control group). The entire class initially attended a series of lectures on systemic bacteriology, which covered the classification, pathogenecity and laboratory diagnosis of medically important bacteria. Both TBL group (study) and self-study (control) groups completed a pre-test after completion of lectures and before the TBL sessions. These tests consisted of multiple choice questions (MCQs) and short answer questions (SAQs). SAQs were included principally to avoid enhancement of mere recall of knowledge.
The lectures were followed by three TBL sessions on the topics of diarrhea, fever of unknown origin, urinary tract infections using standard protocol on the study group. , Before beginning the TBL sessions, the study group was divided into six teams of eight to nine students each. These groups remained fixed for all of the TBL sessions. The students were informed about the topics a week in advance. During TBL sessions, the teams answered IRAT, GRAT and application exercise. The IRAT consisted of 10 MCQs, which were answered by individual students in the first 10 min and the same set of MCQs were answered by the groups after having discussion in next 30 min (GRAT) [Annexure]. During the last 20 min of the class, a challenging case scenario was given with relevant details and the teams were allowed to discuss over the diagnostic and treatment strategies on the given case (application exercise step). Students' doubts over the TBL topic were resolved by a single facilitator and relevant points summarized before concluding the session.
All responses on IRAT, GRAT and application exercises were collected and evaluated using standardized answer keys. The best performing student and team for every session were acknowledged and rewarded with chocolates. The feedback from students about their perceptions on TBL was anonymously collected using a questionnaire of 10 items answered on a 5-point Likert grading scale created de novo for this study. Students' suggestions on strengths and weaknesses of TBL sessions were collected and analyzed. The self-study group students engaged in studying the same TBL topics, in a corner of the classroom where the TBL sessions were being held for the TBL group.
The post-test (MCQs and SAQs) was conducted a week later for both the TBL and self-study groups.
The students' performances on pre- and post-test were evaluated based on standardized answer keys. The statistical analysis was done by comparing means of performance of two groups on pre- and post-test scores, using unpaired t-test and analysis of variance (ANOVA). Mean of groups were compared by ANOVA, pre-test scores being taken as covariate. Gender wise comparison of pre-post score difference within group was analyzed by paired t-test. The data was analyzed using SPSS version 12. Students' perceptions were divided into three categories - disagree (1, 2), neutral (3) and agree (4, 5). Responses were converted into percentages agreeing on each item on the questionnaire.
| Results|| |
The students in the class were aged 18-20 years and had entered medical school after completing their secondary education. The study and control groups consisted of 57% and 67% of female students, respectively.
The mean pre-test scores for the study and control groups were 25.8 ± 5.3 and 22.6 ± 4.6, respectively [Table 1]. As the pre-test scores of the TBL group were higher than the self-study group, the pretest comparison of post-test scores was done through analysis of covariance.
The post-test performance of the TBL group was better than the self-study group. The performance of male students of TBL group improved with the mean pre- to post-test difference of 3.2 ± 5.4 (P = 0.013) [Table 1]. There was marginal improvement in performance of female students of TBL group, with their pre-test scores being higher than male students. When compared with pre-test performance, within the TBL group female students performed better in post-test, whereas the performance of male students worsened.
Marginal mean (post-test) scores for the TBL and self-study groups adjusted for pre-test score were 27.5 ± 4.8 and 24.5 ± 5.07, respectively [F 1 = 5.521, P = 0.021] [Table 2].
Gender-wise difference in posttest performance adjusted for pre-test scores were 25 ± 4.8 for males and 27.4 ± 4.7 for females [Table 2]. The performance of females was generally better than males [F1 = 4.374, P = 0.040] within the groups, with pre-test scores being higher [Table 1].
In students' perceptions, 66% felt that the TBL sessions provided additional knowledge after the lectures and 68% felt that the cases facilitated active discussion. A total of 56% of students felt that they were also able to relate microbiological investigations to the clinical settings [Figure 2].
|Figure 2: Analysis* of students' feedback on Team-based learning sessions *Students' 5-point Likert responses for each statement were converted to percentages|
Click here to view
| Discussion|| |
This study assessed the effect of TBL on students' understanding of microbiology and their ability to relate the subject to the clinical setting. TBL is a teaching method developed by Michaelson et al. for large classes in the business school setting. The methodology is now widely practiced in various educational courses, including medical education. TBL provides scope to active learning in a gradual and sequential manner wherein students are challenged to work as a team to take on assignments with increasing difficulty.  TBL is found to improve the written test performance of students and also help them connect their preclinical knowledge to clinical applications.  The effectiveness of TBL is demonstrated in many studies , and is known to increase the long-term retention of knowledge.  Although it is appreciated worldwide for its various advantages as a teaching method, there is little literature on its application within India.  The present study demonstrates the effectiveness of TBL in improving the performance of students in India, but perhaps only for male students.
To our knowledge there are no reports separately assessing the performance of female and male students following TBL. The present study finds that female students performed well through either TBL or through time spent in self-study, whereas male students benefitted more from the TBL sessions. The gender difference in performance in post-test following TBL sessions and self-study, though unexpected, is perhaps explained through Gardner's theory of multiple intelligences, which states that people have different learning styles. Gender theory states that males and females enter an educational system with different sets of attitudes and behaviors.  Thus, a study by Nguyen and Giang  suggests a teaching modality should enable students of different attitudes and learning styles to succeed. TBL sessions incorporate different knowledge acquisition steps, improving the performance of all the students irrespective of their learning style. An instructional method like TBL, which promotes autonomy (to choose appropriate solution), competence (to achieve a prefixed goal) and relatedness (active engagement in learning process), is known to have higher impact on learning by male students than by female students.  The male students perhaps became more intrinsically motivated to learn following TBL than did female students. Females tend to be more introspective and self-critical, thus perform better following self-study. 
TBL sessions were enjoyed by the students and they felt that the sessions added to their knowledge acquired through active lectures. As observed in other studies, our students found TBL sessions to be actively engaging. , Students stated that they needed more time for discussion within the TBL sessions following each MCQ and case. As the sessions were designed to fit within one class hour, more time could not be allotted for elaborate discussions.
Limitations. The present study demonstrates that TBL sessions added to lectures improves the students' performance; however, a randomized control study involving larger groups would further validate the effectiveness of TBL in the Indian context. This study has explored the short-term learning benefits through TBL and did not explore its sustained effects on learning. In addition, this study was conducted within a single institution and addressed students' learning on only a single subject. However, a prior study from the pharmacology department of our school found TBL tutorials more effective than traditional tutorials.  Further, students' feedback shows some measure of dissatisfaction with learning by TBL. This may reflect the not-unexpected discomfort of students when faced with a new approach to learning. Lastly, this study used a questionnaire adapted from a study of Garvey et al., cited in a review:  It needs to be validated within our setting.
| Conclusion|| |
TBL can flexibly be added to other teaching methodologies.  This study within the Indian context finds that TBL sessions conducted after lectures can improve the performance of male students over self-study, but for unclear reasons does not do so for female students. TBL can be adapted in conjunction with the lectures to enhance learning of applied microbiology.
| Acknowledgement|| |
The authors would like to thank Dr. Mark Gellula, Assistant Professor of Medical Education, Department of Medical Education, University of Illinois at Chicago College of Medicine, for his valuable suggestions and encouraging us to take up the study. The authors thank all the students who participated and gave their valuable responses in this study.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]