DILs, RATs, and SGLs: a primer on team-based learning

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.

QMed students engaged in an SGL application exercise.

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:

Preparation:

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.

Readiness:

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).

Application:

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:

Key Phrase:

  • 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?

Forced choice:

  • You can only order one test from this list. Which is the best one to choose? Why?

Evaluation:

  • What is the BEST choice, given the case history? Why?
  • What’s the NEXT best choice to make?

Justification:

  • Give groups the decision, then ask them to provide a rationale for it.

Backward-looking:

  • Given a particular pathophysiological insult, have groups determine what caused it.

Prediction:

  • Given the case history and a particular course of action, what will the outcome be?

Ranking:

  • 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 theresa.suart@queensu.ca


* As an aside, TLA is the three-letter acronym for three-letter acronyms.


References

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

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Decoding Learning Event Types

Tucked on the right-hand side of every Learning Event Page on MEdTech are notations about the date & time and location of the class, followed by the length of the session and then the “Breakdown” of how the time will be spent. In other words: the learning event type.

We use 14 learning event types* in the UGME program. The identification of a learning event type indicates the type of teaching and learning experience to be expected at that session.

Broadly speaking, our learning event types can be divided into two categories: Content Delivery and Content Application.

For content delivery, students are presented with core knowledge and/or skills with specific direction and/or commentary from an expert teacher. Content delivery learning events include:

  • Directed Independent Learning (DIL) — these are independent learning sessions which are assigned curricular time. Typically students are expected to spend up to double the assigned time to complete the tasks – i.e. some of the work may occur in “homework time”. DIL’s have a specific structure and must include:
    • Specific learning objectives
    • A resource or set of resources chosen by the teacher
    • Teacher guidance indicating the task or particular focus that is required of students. This may be a formal assignment, informal worksheet or study guide.
    • The session must link to a subsequent content application session
    • Formative testing in the form of MCQ or reflective questions are an optional component of DILs
  • Lecture – Whole class session which is largely teacher-directed. We encourage the use of case illustrations during lectures, however these alone do not fulfil the criteria for content application or active learning.
  • Demonstration – Session where a skill or technique is demonstrated to students.

For content application (sometimes described as “active learning”), students work in teams or individually to use and clarify previously-acquired knowledge, usually while working through case-based problems. These learning event types include:

  • Small group learning (SGL): Students work in teams to solve case-base problems which are revealed progressively. Simultaneous reporting and facilitated inter-team discussion is a key component of this learning strategy which is modeled on Team-based learning. SGL cases may be preceded by in class readiness assessment testing (RAT) done individually and then as a team. This serves to debrief the preparation and provide for individual accountability for preparation.
  • Facilitated small group learning (FSGL)Students work in teams and with a faculty tutor to solve case-base problems which are revealed progressively. While there is structure to FSGL cases, students are encouraged to seek out and share knowledge based on individual research.
  • Simulation: Session where students participate in a simulated procedure or clinical encounter.
  • Case-based Instruction (CBI): Session where students interact with guest patients and/or health care providers who share their experience. Builds on prior learning and often includes interactive Q+A component.
  • Laboratory: Hands-on or simulated exercises in which learners collect or use data to test and/or verify hypotheses or to address questions about principles and/or phenomena, such as Anatomy Labs.

The other learning event types we use don’t fit as neatly into the content delivery/content application algorithm. These include:

  • Clerkship seminar – instruction provided to a learner or small group of learners by direct interaction with an instructor. Depending on design, clerkship seminars may be either content delivery or content application.
  • Self-Directed Learning (SDL) is scheduled time set aside for students to take the initiative for their own learning. A minimum of eight hours per week (pro-rated in short weeks) is designated SDL time.
  • Peer Teaching is learner-to-learner instruction for the mutual learning experience of both “teacher” and “learner” which includes active learning components. This includes sessions that require students to work together in small groups without a teaching, such as Being a Medical Student (BAMS) sessions, the Community Based Project and some Critical Enquiry sessions.
  • Career Counseling sessions, which provide guidance, direction and support; these may be in groups or one-on-one.

Two other notations you’ll see are “Other-curricular” and “Other—non-curricular”. Other—curricular is used for sessions that are directly linked to a course but that are not included in calculations of instructional methods. This includes things like examinations, post-exam reviews, and orientation sessions. Other—non-curricular are sessions of an administrative nature that are not directly linked to a particular course and are outside of curricular time, for example, class town hall meetings and optional events or conferences.

Incorporating a variety of learning event types in each course is important to ensure a balance of knowledge acquisition and application. Course plans are set by course directors with their year director, in consultation with the course teachers and with support from the UG Education Team and the Teaching, Learning, and Integration Committee (TLIC).


— With contributions from Lindsay Davidson, Director of Teaching, Learning, and Integration

*In 2015, Queen’s UGME adopted the MedBiquitous learning event naming conventions to ease sharing of data amongst institutions. For this reason, some  learning event type categories may be different from ones used here prior to 2015, or ones used at other, non-medical schools or medical schools which have not adopted these conventions.

 

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