The Egyptian Journal of Medical Education
2020;3(3) eISSN 2090-2816
Problem-Based Learning and Team-Based Learning: Strengths, Weakness and Assessment Reliability.
El-Khawanky, Mohamed M.*
Department of Hematopathology, Unit of Medical Education, College of Medicine, Najran University, Saudi Arabia.
Context: Team-Based Learning like Problem-Based Learning is a student-centered learning strategy. In TBL the students have a pre-defined reading assignment for later discussion. While in PBL students learn their problem in two sessions. Both have advantages and disadvantages. One of the main important points for evaluating the effectiveness of an educational model is its ability to assess the students’ level adequately. Aims: To assess the reliability of TBL and PBL as assessment methods. In addition, to identify the weaknesses and strengths we faced during application. Settings and Design: A cross-sectional study was conducted on 29 undergraduate medical students. Methods and Material: The reliability of TBL and PBL as assessment methods were evaluated through a correlation with other assessment methods. Statistical analysis used: The collected data was analyzed using the SPSS statistical software (IBM SPSS Statistics 20). Results: TBL assessment showed a positive correlation with quizzes, final practical exam, final theory and total degrees, while PBL assessment did not show any correlation with any of the assessment methods. Conclusion: TBL is reliable method for assessment while PBL is not. The integration of the two learning modalities has a synergistic effect in order to boost the success of the educational process.
*Author: +966507907719; Department of Cl. Hematopathology, College of Medicine, Najran University, Saudi Arabia ; email@example.com
Received : 10 February, 2020
Accepted: 13 February, 2020
Published : 14 Mars, 2020
Keywords : PBL, TBL, learning, Reliability..
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
Medical schools all over the world continuously develop their curricula through application of new teaching modalities to offer students optimal preparation for their work in the changing world of the health professions . The development of medical education is witnessing tremendous developments in the concept and mechanism, from knowledge and skill acquisition to profession competence based on scientific foundations. In order to keep pace with this development, the College of Medicine at the University of Najran recently introduced the team based learning (TBL) as one of the college's adopted teaching methods, which established as a hybrid, integrated system based on problem based learning (PBL).
Problem-based learning was first developed and incorporated in medical education by Howard Barrows in the late 1960s, to structure the knowledge in a clinical context and boost self-directed learning skills to make the medical education more professional .
TBL like PBL being a student-centered learning, however; the students have a pre-defined reading assignment “according to intended learning objectives” for later discussion through small student teams. The students' knowledge is assessed individually in a multiple-choice test then reassessed after team discussion. Thereafter the teacher clarifies the concepts related to the test questions that students struggled with. Unlike the PBL, one specialized teacher facilitates all students’ teams in one hall [3-5]. PBL empowers students to engage in problem solving and collaborative learning and improves confidence, presentation and communication skills and critical thinking . While TBL is believed to be more powerful practical for fostering both collaboration and learning than is possible through the interaction between the lecturer and students, and intra- and inter- groups .
Our aim in this study is to identify the weaknesses and strengths we encountered for both teaching modalities "PBL and TBL" and to assess their effectiveness as reliable assessment methods.
Subjects and Methods
This study was conducted on 29 undergraduate medical students had completed the Growth and Development (G&D) block in 2019, which is given at Year 2. This course was taught in five weeks. The student studied four problems through PBL and three subjects through TBL. The study was carried out at the College of Medicine, Najran University.
The college adopts an integrated hybrid problem based learning system through a group of well-organized curriculum (blocks) based on horizontal and vertical integrated topics. The block evaluation is carried out through formative and summative assessment. The formative assessment is represented by a weekly quiz that includes multiple choice (MCQs) and short essay questions. The summative assessment includes a final theoretical exam, which consists of MCQs and a final practical test which include a group of OSPE or OSCE stations.
Structure of problem based learning
Four objective based constructed problems were discussed in the G&D block in small student groups; each group was 9 or 10 students. Every problem spanned through one academic week (from Sunday to Thursday) and discussed in two sessions. In the first session, the problem was presented to the students to extract the intended learning objectives for further studying through self-reading and lectures with guidance of a tutor. After self-study, students of each group meet again to discuss the extracted objectives in what is known "outcome session", in which the students listen to each other to present what they have learned, to exchange knowledge, and to discuss the unclear topics. The tutor plays an important role as a facilitator by encouraging and boosting the discussion among students.
Structure of team based learning
Before the TBL session, the students were given the objectives and contents of what would be discussed later. We created 5 permanent teams, each of five to six students. The teams were characterized by the converging representation of students' levels. For each TBL session, students first take an individual readiness assurance test (iRAT), which is a short multiple-choice quiz. The iRAT holds each student accountable for learning the material and decreases the likelihood of social loafing. Once students have completed the iRAT, they complete a group readiness assurance test (gRAT), which is the same multiple-choice quiz they completed individually that generate the discussion among the teammates followed by immediate feedback led by the content expert. Students then moved on to the case-based problem-solving activities "group assessment" that were based around the same subject.
PBL and TBL assessment
Student’s performance in PBL sessions for each problem was evaluated as follow: session 1: (discussion session) was evaluated according to the student ability to extract the intended learning objectives, peer- interaction and attendance. Session 2: (outcome session) was assessed according to the quality of presentation and scientific content, peer-interaction and adding new information. Student’s performance in TBL sessions was calculated according to the cumulative scores of iRAT (60%), tRAT (20%) and group assessment (20%).
The results of PBL and TBL were correlated to the final theory and practical exams to ensure their effectiveness as assessment methods to complement their effectiveness as teaching methods.
The collected data was tabulated, and analyzed statistically using the SPSS statistical software (IBM SPSS Statistics 20). Statistical difference was considered significant if the P-value was less than 0.05 and highly significant if the P-value was less than 0.001.
TBL assessment showed a highly positive correlation with quizzes, final theory and final total degrees (P = 0.004, 0.009, 0.003) respectively, and a positive correlation with final practical exam (P = 0.026) [Table 1]. On the contrary, PBL assessment did not show any correlation with any of assessment methods [Table 2].
Figure 1: TBL showed positive correlation with quizzes, final theory, final practical and total degrees.
It is important to ensure that the evaluation methods of different teaching methods are reliable. In our study, we have compared the results of problem-based learning with the quizzes and final exams' results, which based on a matrix on which all parts of the curriculum are represented in proportions consistent with the academic load.
We found that the PBL evaluation marks did not always reflect the learning outcomes and the intended level of understanding was not always measured properly. In addition, the teacher and students thought that the assessment criteria were unclear, which in turn led to the unreliability of the assessment. These problems led to perceptions that the assessment was unfair. The results imply that grades should be critically evaluated as indicators of the quality of learning outcomes .
This does not mean that PBL is not valid as a learning model, but the reevaluation and modification of the assessment process is required. The students acquired many skills through PBL, other than gain of knowledge only, as in traditional education, such as research and self-study skills, that guarantees the ability of continuous update. In addition, PBL promotes student self-confidence through peer-discussion, argumentation and presentation. The students also acquire the skills of communication, collaboration and teamwork.
Several studies reported the merits of PBL as an innovative educational approach focused towards the students in which they decide what need to learn [9, 10], and achieve the competencies required by medical graduates that encompass the ability to effectively collaborate, communicate and problem solve. As graduates must be lifelong learners, capable of accessing, assessing and synthesizing a wealth of information relevant to health care [11, 12].
PBL offers a great tool for students’ self-instruction. The behavioral theory on self-regulation includes students’ self-instruction as well as their responsibility for an ongoing monitoring of their own progress that encourages their critical thinking, imagination, and engagement [13, 14]. We have seen some flaws in PBL, which made us look for alternatives or pillars that support these deficiencies such as TBL. One of these major disadvantages is that the intended educational goals are distributed on students for self-studying, and each student prepares his educational goal only without the subject being prepared as a whole. In addition, sometimes the choice of the problem subject does not suit the week theme and this matter can be avoided by choosing the appropriate subject.
Another problem faced us was the unreliable evaluation process so far, it does not correlate the other evaluations despite numerous attempts to avoid this matter. Glew (2003) was believing that several reasons may explain why PBL has failed to achieve its expectations, of them, inadequate support of the curriculum from basic scientists who do not support the concept itself, poor oversight and inadequate implementation and assessment .
In addition there is a serious problem that results from inadequate implementation is the missing of some topics. A previous study showed that PBL is not appropriate for gaining systematic knowledge of a subject, as students would fill the gaps left in the knowledge base later during their career . Another issue makes PBL application more difficult is the time shortage. The average of actual study time during the last five academic years was 40 months, which is insufficient time for medical program. On the contrary, it was found that student contact hours are four times greater in PBL than for traditional learning [6, 17].
These problems made us to engage the team-based learning as one of our program educational modalities, and it may be an alternative of other learning and teaching methods in the future if it proves to be the optimal educational model. Team-based learning (TBL) is an attractive instructional approach especially for the acquisition of teamwork skills . TBL shifts the focus of instruction from the teacher as dispenser of information to student centered activity to foster the development of self- learning and team collaboration .
TBL can evaluate the student performance and understanding of the pre-session assignments through iRAT , and assess the student's benefit of the receiving immediate feedback from the gRAT , as both mechanisms "pre-session assignments and session feedback" are essential to consolidate information and concepts. Unfortunately, the feedback process was often lacked in PBL, errors may go uncorrected, and a students’ sense of being “lost” with new content is amplified . As the PBL tutor is often not specialized in the subject of study, unlike the TBL facilitator must be specialized.
This study showed that TBL assessment is reliable in assessing the students level, TBL showed a highly positive correlation with quizzes, final theory and final total degrees (P = 0.004, 0.009, 0.003) respectively, and a positive correlation with final practical exam (P = 0.026). [Table 1] A previous study indicated that students found more advantages of TBL over PBL including better engagement in learning, deeper understanding of concepts, and a sense of responsibility towards teammates . Another advantage of TBL is that one facilitator runs the session for all groups in one class, while in PBL there must be a tutor and class for each group . The aforementioned does not detract from PBL its merits, as it was the seed of student-centered learning from which many modalities split. In addition, it still has the benefit of discussion before self-study in which students activate their prior knowledge, a strategy that has positive cognitive effects on learning [22, 23].
The assessment results of TBL are reliable, while of PBL is not. TBL showed a positive correlation with quizzes, final theory and practical exams and final total marks, while PBL assessment did not show any correlation with any assessment method. In addition, the integration of the two learning modalities "PBL & TBL" has a synergistic effect in order to boost the success of the educational process.
The author would like to thank Prof. Dr. Mohamed S. Zayed, Dean of the College of Medicine, Najran University and Dr. Moawia A. Alshiekh for their all support provided.
The article has not been previously presented or published, and is not part of a PhD or thesis project.
CONFLICT OF INTEREST
There are no financial, personal, or professional conflicts of interest to declare.
Dolmans D, Michaelsen L, Nboer J and Vleuten C. Should we choose between problem-based learning and team-based learning? No, combine the best of both worlds! Medical Teacher J. 2015;37: 354–359. doi: 10.3109/0142159X.2014.948828
Barrows HS. A taxonomy of problem‐based learning methods. Medical education. 1986;20 (6): 481-486.
Michaelsen LK, Parmelee DX, McMahon KK. Team-based learning for health professions education: A guide to using small groups for improving learning. Sterling, VA: Stylus Publishing, LLC, 2008. PMCID: PMC2670235
Parmelee DX, Michaelsen LK. Twelve tips for doing effective Team- Based Learning (TBL). Med Teach. 2010;32 (2):118–122. doi: 10.3109/01421590903548562
Haidet P, Levine RE, Parmelee DX, Crow S, Kennedy F, Kelly A, Perkowski L, Michaelsen L, Richards BF. Perspective: Guidelines for reporting team-based learning activities in the medical and health sciences education literature. Acad Med. 2012; 87(3):292–299. doi: 10.1097/ACM.0b013e318244759e
Jindal M, Mahajan H, Srivastav S, Baro G. Pros and Cons of Problem-Based Learning in Medical Education: Students’ Viewpoint, NJIRM; 2016; 7(4):78-81.
Michaelsen, LK, Davidson N. & Major CH. Team-based learning practices and principles in comparison with cooperative learning and problem-based learning. Journal on Excellence in College Teaching 2014; 25(3&4), 57-84.
Räisänen M, Tuononen T, Postareff L, Hailikari T and Virtanen V. Students’ and Teacher’s Experiences of the Validity and Reliability of Assessment in a Bioscience Course. Higher Education Studies; 2016; Vol. 6, No. 4. doi:10.5539/hes.v6n4p181
Barrows, H. S. Is it truly possible to have such a thing as dPBL? Dist Educ. 2002; 23(1), 119-122. doi: 10.1080/01587910220124026
Hmelo-Silver CE, & Barrows HS. Goals and strategies of a problem-based learning facilitator. The interdisciplinary J of PBL 2006; 1(1), 21-39. doi: 10.7771/1541-5015.1004
Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no 65. Med Teach. 2012; 34:e275–87. doi: 10.3109/0142159X.2012.651179
Burgess A , Haq I, Bleasel J, Roberts C, Garsia R, Randal N and Mellis C. Team-based learning (TBL): a community of practice. BMC Medical Education 2019; 19:369-76. doi: 10.1186/s12909-019-1795-4
Bowles DJ. “Active learning strategies...not for the birds!” International Journal of Nursing Education Scholarship 2006; 3: 22. doi: 10.2202/1548-923X.1184
Orsmond P and Zvauya R. “Community of learners: charting learning in first year graduate entry medical students during problembased learning (PBL) study”. Advances in Health Sciences Education. Theory and Practice 2015; 20.2: 479-497. doi: 10.1007/s10459-014-9542-4
Glew R. The Problem with Problem-based Medical Education, promises not kept. Biochemistry and Molecular Biology Education. 2003; 31, (1):52–56. doi: 10.1002/bmb.2003.494031010158
Abdelkarim A, Schween D and Ford T. “Advantages and Disadvantages of Problem-Based Learning from the Professional Perspective of Medical and Dental Faculty”. EC Dental Science 2018; 17.7.
Al-Naggar RA, Bobryshev YV. Acceptance of Problem Based Learning among Medical Students. J Community Med Health Educ, 2012; 2(5):146. doi: 10.4172/2161-0711.1000146
Hopper M.K. Alphabet Soup of Active Learning: Comparison of PBL, CBL, and TBL. HAPS Educator 2018; 22 (2): 144-149. doi: 10.21692/haps.2018.019
Hattie J and Timperley H. The power of feedback. Review of educational research. 2007; 77(1): 81-112. doi: 10.3102/003465430298487
Burgess A, Mellis C. Feedback and assessment during clinical placements: achieving the right balance. Adv Med Educ Pract 2015; 6:373–81. doi: 10.2147/AMEP.S77890
Burgess A, Ayton T, Mellis C. Implementation of team-based learning in year 1 of a PBL based medical program: a pilot study. BMC Med Educ. 2016; 16:49. doi:10.1186/s12909-016-0550-3
Dolmans D, Schmidt HG. What do we know about cognitive and motivational effects of small group tutorials in problem-based learning? Adv Health Sci Educ. 2006; 11:321–336. doi:10.1007/s10459-006-9012-8
Van Blankenstein FM, Dolmans DHJM, Vleuten van der CPM, Schmidt HG. Which cognitive processes support learning during small-group discussion? The role of providing explanations and listening to others. Instr Sci. 2011; 39:189–204. doi: 10.1007/s11251-009-9124-7