Oral Abstracts: TBL/PBL

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Presented By: Stephen Schneid, University of California at San Diego School of Medicine

In the summer of 2020, our prematiculation course (PMC) was offered online for the first time. After two interations, there was a need to make changes to eliminate virtual lectures and replace class time with a collaborative learning format that emphasized problem-solving.

The seven-week PMC is open to incoming medical students and pharmacy students who share the School of Medicine (SOM) biomedical sciences courses. Twenty-one medical students and five pharmacy students were enrolled in 2022 and twenty-three medical students in 2023. Three modifications to traditional TBL RATs were made to promote problem-solving and collaboration: (1) the RATs were created at an application-level difficulty, (2) extra time and an open-note policy were created for RATs, and (3) the IRAT did not count towards the grade. Each week, the students engaged in a three-part cycle, with two TBL days, followed by an individual closed-note quiz of equivalent difficulty.

The TBL model of the online PMC was associated with higher student evaluations. For the first two years of implementation, the evaluation question about facilitation of learning was rated 4.88/5 and 4.95/5 compared to an average of 4.42/5 for 2020 and 2021. As intended, the IRATs were challenging, with a class mean of 58.4% (SD = 10.9%), but students performed significantly better on the TRATs with a mean of 95.5% (SD = 2.3%). The class showed significant improvement from the IRATs to the higher-stakes end of week quizzes, with mean scores increasing to 81.4% (SD = 8.5%).

Students embraced the challenge of solving items of high difficulty in a team setting if given adequate time to first think through the problem with zero-stakes and encouraged to use and share their learning resources with each other. The success of our PMC led to the adoption of TBL in our pre-clerkship curriculum.

Best Faculty Oral Presentation Nominee

Presented By: Samar Hegazy, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Co-Authors: Barbara Masi, Icahn Medical School at Mount Sinai
Kellie Mullany, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Grace Park, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Imanni Sheppard, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Jaya Yodh, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign

Understanding the role of social determinants of health (SDOH) in disease process and patient management is essential to high-quality health care to promote health and prevent disease. Despite the increasing interest in incorporating SDOH into medical curricula, there is no consensus on the instructional approaches to teach SDOH or assess students' learning/competencies relevant to SDOH. We introduced a novel approach to teaching SDOH and assessing relevant clinical decision-making abilities in Problem-Based Learning (PBL) using concept mapping (CM). 

This study occurred during two PBL cases for students at Carle Illinois College of Medicine. Fourteen pre-Clerkship medical students voluntarily participated and were randomly assigned to control and experimental groups. Both groups received pre-intervention training on CM. Only the experimental group experienced linking SDOH to the disease process and treatment plans using CM and specific probes in their PBL sessions. Students in both groups completed individual post-PBL assignments of designing a treatment plan using CM and a recorded reflective narrative on the CM design based on a new clinical vignette. Concept maps were scored using a validated scoring rubric. Recorded reflections were transcribed and analyzed using inductive thematic coding. 

Quantitative data analysis demonstrated statistically significant differences (p<0.01-0.001) in concept map scores between experimental and control groups in the rubric main categories of connections and links, SDOH, disease process, and treatment plan. Qualitative data analysis comparing the experimental and control group thematic codes highlighted differences in how this curricular intervention enhanced students' sociocultural competency in designing a patient-centered treatment plan following an SDOH-informed clinical reasoning process. 

This innovative curricular approach of integrating the SDOH framework in PBL using CM as an evidence-based teaching and assessment tool helped medical students visualize and reflect on integrated basic, clinical, and SDOH concepts. Additionally, it enhanced medical students' sociocultural competency in providing holistic patient-centered care.

Presented By: Sarah Lerchenfeldt, Oakland University William Beaumont School of Medicine
Co-Authors: Suzan Kamel-ElSayed, Oakland University William Beaumont School of Medicine
Simon Keep, Oakland University William Beaumont School of Medicine
Gustavo Patino, Western Michigan University Homer Stryker M.D. School of Medicine

Healthcare providers are often expected to make important decisions when well-defined answers are not available. Despite the widespread recognition of the importance of medical uncertainty, formal preparation for navigating such ambiguity is lacking in medical school curricula. Team-Based Learning (TBL) clinical application exercises (AEs) present a potential avenue for educating students on acknowledging and responding to medical uncertainty. This study aims to determine if TBL AEs enhance medical students' ability to address uncertainty and help students develop appropriate management strategies when faced with difficult decisions.

This investigation employed exploratory qualitative research, conducting a series of six focus group sessions. Each session comprised medical students or alumni of a program with extensive use of TBL, including ungraded AEs. Participants were interviewed through semi-structured interviews to gather their perspectives on medical uncertainty, including its relationship to TBL. The interviews were transcribed, and independent reviewers conducted thematic analysis on the responses.

A total of 5 first-year students, 12 second-year students, 2 fourth-year students, and 4 alumni (residents and attendings) participated in the focus groups, revealing three primary themes. The first theme highlighted the evolving definition of medical uncertainty over time, influenced by the TBL process and increased exposure to content. The second theme emphasized the significance of exposure to medical uncertainty, and whether this exposure occurred during clerkship or pre-clerkship stages. In the third theme, clinical cases emerged as crucial for encountering medical uncertainty in TBL application exercises, stressing the necessity for team discussion, open-ended real-life examples, and thoughtful reasoning behind answers.

TBL application exercises may offer a valuable opportunity to learn about medical uncertainty for learners. As the perception of medical uncertainty evolves over time, an initial exposure to clinical cases in TBL may be pivotal in fostering an understanding of medical uncertainty.