Three-letter acronyms* figure heavily in medicine and medical education. Three of these that are intertwined in much of our pre-clerkship classroom-based learning are DIL, RAT and SGL.
These abbreviations are for three key learning event types that, when combined, comprise Michaelsen’s Team-Based Learning (TBL) model. This form of teaching unfolds in three steps and is designed to make best use of students’ and teachers’ time and expertise. The steps are:
Students receive preparatory materials either in a lecture, in a Directed Independent Learning (DIL) assignment, in a module, in previous courses, or preparatory readings. This material is typically fact/knowledge-based information.
Students’ understanding of this material is assessed in some way. This could be through formal Readiness Assessment Tests (RATs). These tests consist of 10-12 multiple choice questions. Each student completes an individual RAT (iRAT), then complete the same quiz in their SGL group (gRAT). The instructor then takes up any questions with which groups had difficulties. This could also be assessed via an online self-assessment quiz or some other method (e.g. completing a previous unit).
Having completed the preparation material, been assessed on their readiness, and having problem areas explained, students are ready to apply this knowledge through cases and problem solving application exercises, what we call Small Group Learning (SGL) session.
Directed Independent Learning (DIL) sessions provide content delivery, followed by Readiness Assessment Tests (RATs), culminating in Small-Group Learning (SGL) events where students engage in application exercises.
SGL sessions provide an opportunity for students to apply material they have already learned in order to extend their learning. Specifically, application exercises:
- Help students develop understanding and apply the course material.
- Address any misconceptions that may have developed, as students apply and integrate knowledge (Kubitz & Lightner p. 66).
- Provide opportunities for students through practice, to transfer what they learned to application questions (Kubitz & Lightner p. 67).
- Ensure students integrate “several different skills to answer application questions that require transfer of learning,” including accessing prior knowledge and identifying which knowledge applies and which does not (Kubitz and Lightner p. 67, citing Ambrose, Bridges, DiPietro, Lovett, & Normal, 2010).
This model means most of non-lecture classroom-based time will be students working in their small groups of seven to eight students. The instructor’s role is to design the cases, ask challenging questions and then emphasize, reinforce, highlight, and clarify key teaching points throughout the session through the case debriefs.
Case application questions balance the line between too easy and too hard:
If questions are too easy: Can’t have spirited discussion when all teams agree on answers.
If questions are too hard: Predictable frustration if groups of well-prepared students cannot arrive at the most reasonable answer because question has design flaws or requires outside knowledge
Here are eight great types of questions that can be incorporated into application exercises:
- What is the key phrase in the case that will cause you to proceed down a particular path?
Change a variable:
- If variable X is changed in the case, how would your approach change?
- You can only order one test from this list. Which is the best one to choose? Why?
- What is the BEST choice, given the case history? Why?
- What’s the NEXT best choice to make?
- Give groups the decision, then ask them to provide a rationale for it.
- Given a particular pathophysiological insult, have groups determine what caused it.
- Given the case history and a particular course of action, what will the outcome be?
- Rank tests, procedures, medications, in order of importance vis-à-vis the case history or learned protocol. Have the group explain why they decided on that order.
If you’re a faculty member looking for assistance with preparing to teaching using TBL methods, please get in touch. If you’re a student with feedback on a particular SGL session or TBL in general, please get in touch, too. Reach me at firstname.lastname@example.org
* As an aside, TLA is the three-letter acronym for three-letter acronyms.
Sweet, M. & Michaelsen L.K. (eds) (2012) Team-Based Learning in the Social Sciences and Humanities. Sterling, Virginia: Styllus Publishing LCC (and Kubitz & Lightner in this volume)
Harris, S.A. and Watson, K.J. (1-1-1997), Small Group Techniques: Selecting and Developing Activities Based on Stages of Group Development. University of Nebraska- Lincoln. digitalCommons@University of Nebraska – Lincoln Paper 378