Presented By: Joshua Costin, Nova Southeastern University
Co-Authors: Makenna Bowman, Nova Southeastern University
Michelle Demory-Beckler, Nova Southeastern University
Arlene Giczkowski, Nova Southeastern University
Robert Rust, West Chester University

Background
The impact of in-person active learning is established at the undergraduate and medical school levels. However, there is little evidence about the success of online active learning at the biomedical graduate level, particularly the intra- and interprofessional skills associated with success in an active learning environment in this population. This study aimed to demonstrate a correlation between intra- and interprofessional skills in the context of a small group, TBL session with performance in both the small group activity and the course.

Methods
The previously fully didactic online Microbiology and Immunology course was modified to include three interactive TBL sessions. All TBL sessions were conducted online using a breakout room feature. Student perceptions of TBL were measured using Pre- and Post-Surveys (80 and 76 respondents respectively). Student performance on exams and TBLs were recorded throughout the semester and compared to student performance during the previous semester. Intra- and interprofessional skills were scored according to a central rubric.

Results
Student perceptions of intra- and interprofessional competencies in the online TBL environment increased. Student perceptions of productivity, communication, and enjoyment increased significantly, and student performance was significantly better when answering cased-based questions. There were several skills, both intra- and interprofessional, that were correlated with success in the course.

Conclusions
This study was limited by a relatively small sample size and by the subjective nature of scoring the rubric. Never-the-less, students' ability to correctly answer case-based questions and general student perceptions of interactive online TBL sessions significantly improved after TBL sessions. These results suggest TBL has a positive impact on students' perceptions of intra and inter-professional competency development as well as application of knowledge in case-based scenarios in a masters level course in a biomedical bridge program. Likewise, observation of students using intra- and interprofessional skills correlated with these perceptions and overall success in the course.

Presented By: Barbara Warner, Bowling Green State University
Co-Authors: Ariel Cascio, Michigan State University College of Human Medicine
Julia Knopes, Case Western Reserve University School of Medicine
Ed McKee, Central Michigan University College of Medicine

Purpose 
In our educational program, team-based learning (TBL) is used to assess and extend small group Case-Based-Learning (CBL), which is considered the pre-work for the TBL. In this intervention, students were assigned to either work with the same "static" group for TBL CBL or work with a "hybrid" group comprised of members from 6-7 different CBL groups. The primary aim was to compare outcomes and experiences of students on hybrid versus static teams. The secondary aim is to understand student perspectives on these curricular choices. 

Methods 
Data were collected over three years. In years 1 and 3, students engaged in this intervention during two course blocks. Each group was "static" for one course and "hybrid" for the other. TBL scores (IRAT, GRAT, and GAE) and exam scores for questions mapped to TBL sessions were compared between static and hybrid conditions using a two-tailed t-test. Pandemic circumstances prohibited the intervention in Year 2; those data are analyzed as control. Students completed surveys (n = 96) and focus groups (n = 7) on their experiences. Responses were analyzed thematically. 

Results 
There were no significant differences in exam scores between static and hybrid groups. Across all years, in course 1, hybrid groups performed significantly better on IRAT and static in GRAT. In Course 2, hybrid groups performed significantly better in GRAT and static in GAE. In year 1, the same groups scored significantly higher in GRAT regardless of being static or hybrid. In Year 3, Course 2, static groups performed significantly better in GAE. In surveys, many respondents expressing a preference for static groups. Qualitative results demonstrated mixed sentiments about hybrid groups.

Conclusions
Multiple peer-based learning groups do not consistently impact academic outcomes. Students recognize advantages and disadvantages of each condition. Educators could pursue either condition based on their mission and goals.

Presented By: Zoë Soon, University of British Columbia Okanagan
Co-Authors: Elizabeth Prabhakar, Brunel Medical School

Purpose 
An international collaboration between two different yet complimentary health care programs formed to develop a novel, visually-engaging, thought-provoking interactivity dimension to Team-Based Learning (TBL).  The goal being to enhance both the learning experience and learning gains for students.  This abstract describes the project and its outcomes. 

Methods 
An Ella's Law Case Study lesson was developed to allow students to test their knowledge of the following aspects of Chronic Asthma:  etiology, risk factors, pathogenesis, signs and symptoms, diagnostic tests, treatment options, typical prognosis, lifestyle recommendations, and possible complications.  The inspiration for this case study is Ella Kissi-Debrah, aged 9, who was the first person in the UK to have air pollution listed as cause of death by a coroner.  In this case study, the traditional TBL becomes more interactive by using a live Virtual Patient Simulator coupled with variety of electronic question types.  During the lesson, the virtual patient experienced the progression of an asthmatic attack.  Students in the class were asked to predict what would happen to HR, RR, MAP, SpO2 at each stage (mild, moderate, severe) and offer suggestions for appropriate medical diagnostic tests and interventions.  The goal was not only to learn and demonstrate knowledge, but also to save the patient and prevent respiratory failure. 

Results 
Approximately two hundred students took part and learning gain measurements found there was an average of 23% improvement in scores after participating in the virtual patient simulation TBL. 

Conclusions 
A mutually beneficial collaboration between two different health care programs lead to the creativity and sharing of resources that not only helped students better master fundamental knowledge of respiratory disease, but also exposed them to current and relevant health care news, the Clean Air Bill, and socioeconomic determinants of health. 

Presented By: Jade Woodcock, Western Michigan University Homer Stryker M.D. School of Medicine
Co-Authors: Charles Henderson, Western Michigan University
Maria Sheakley, Western Michigan University Homer Stryker M.D. School of Medicine

Purpose 
The purpose of this study is to identify what elements are essential to the implementation of Team-based learning (TBL) in the pre-clerkship medical curriculum, and how to best implement each element. TBL is widely used in medical schools, yet the literature shows that many facilitators do not implement all the identified essential features of TBL. This limits research and practice related to TBL. 

Methods 
Data was collected via a review of the TBL literature over the past twenty years along with interviews with 17 TBL trainer-consultants from US medical schools. 

Results 
The main outcome of this work is an innovation configuration map for TBL. This map identifies a set of seven essential elements of TBL: (1) Orientation, (2) Pre-assigned materials, (3) Properly formed and managed teams, (4) Accountability, (5) Feedback, (6) Reflection, and (7) Application phase. Each essential element has multiple possible implementation components with indications of which components are recommended or most widely utilized.

Conclusion 
This study created a comprehensive list of essential elements and components of TBL with a recommended use for each of those elements for faculty to review when implementing TBL into their curriculum. The table created in this study can help medical educators better understand the essential elements of TBL, and how to utilize them when implementing TBL in their curricula.  It will also help researchers focus on optimizing the implementation of TBL.

Presented By: Chasity O'Malley, Wright State University Boonshoft School of Medicine
Co-Authors: Jeannette Manger, Wright State University Boonshoft School of Medicine

Purpose 
Problem based learning (PBL) is becoming more widely used and accepted in medical education, but gaps remain in terms of understanding how faculty facilitators and students approach and perceive it. One of the benefits of PBL is that it pushes learners to perform self-directed learning which is an essential skill for development of life-long learners, yet research related to the connection between student attitudes toward life-long learning and experiences in PBL is limited. This study offers a qualitative exploration of WrightQ, a modified version of traditional PBL. Our research identifies the range of student and facilitator experiences and offers suggestions for more effective implementation of PBL modalities. 

Methods
Ten faculty facilitators and ten learners participated in semi-structured interviews to evaluate their attitudes towards WrightQ in terms of effectiveness and overall goal. Interviews were recorded then transcribed for qualitative analysis. Constant comparative analysis was used to identify emergent themes. 

Results 
Preliminary results indicate that the faculty facilitators and students held a wide range of ideas regarding the purpose of WrightQ. Students held differing perspectives on their preferences for faculty facilitators and the overall effectiveness of WrightQ. Although faculty found the modality to be effective when approached appropriately, they, too, were unclear on the goals. 

Conclusions 
These preliminary findings suggest that although WrightQ is a useful tool in a medical curriculum, more emphasis should be placed on the explanation and introduction to both students and faculty. Additionally, tying the self directed learning of PBL to life long learning may also help to clarify the goals of PBL. The results of this research can be used to highlight the specific areas for facilitator development and promotion to students.

Presented By: Paul Megee, Oakland University William Beaumont School of Medicine
Co-Authors: James Grogan, Oakland University William Beaumont School of Medicine
Alan Silverman, Oakland University William Beaumont School of Medicine
Virginia Uhley, Oakland University William Beaumont School of Medicine

Purpose 
A long-standing goal of undergraduate medical education is the integration of foundational and clinical science, which benefits learners by promoting retention of critical knowledge and skills as well as their transfer to the clinical setting. Active learning resources that promote foundational science skill transfer to a clinical setting are under-represented in the medical education literature. 

Methods 
We developed a team-based learning (TBL) module in which foundational knowledge and skills from the disciplines of biochemistry, nutrition, and genetics are leveraged in a simulated patient encounter for diagnosis and management of a patient with dyslipidemia. The resource was designed for a first-year medical student cardiovascular system course with 125 students. Following individual and team readiness assurance tests (iRAT and tRAT, respectively), teams participated in an initial application exercise that requires consideration of clinical and laboratory data and other risk factors to engage the patient in a shared decision-making process. Using dietary and family history narratives in subsequent application exercises, teams completed recommendations for an individualized diet plan and an assessment of potential disease inheritance patterns to formulate appropriate patient care management strategies. 

Results 
Student engagement with pre-learning materials and session team activities was high as judged by RAT performance and application exercise outcomes. iRAT question performance ranges from 89-99% for individual items. Learners reported that the exercises were impactful and instilled belief that the learned foundational knowledge and skills are transferable to future patient care. 

Conclusions 
The dyslipidemia TBL module provides an illustration for early clinical learners of how foundational knowledge and skills can be operationalized and transferred for optimal patient care. Furthermore, facile adaptation of the exercise is possible to focus on pharmacological options for treatment of dyslipidemia or the ethical implications for disclosing a genetic diagnosis to first-degree relatives.

Presented By: Orla O'Donoghue, New York University Grossman Long Island School of Medicine
Co-Authors: Louis Ragolia, New York University Grossman Long Island School of Medicine

Purpose 
With ever-changing healthcare environments, impacts of pandemics such as Covid-19, increased physician caseloads, and medical knowledge doubling every 73 days, medical students must constantly adapt their learning and clinical practice approach. Having confidence to address any new problem is critical to students and their medical careers. NYU Grossman Long Island School of Medicine (NYUGLISOM) is a 3-year medical school, where students engage in 53 PBL cases in Phase 1 (pre-clerkship) and 11 cases in Phase 2 (clerkship). While PBL effectiveness on confidence promotion has been shown in mathematics and engineering education, few studies exist in undergraduate medical education (UME). This study investigates the effect of Problem Based Learning (PBL) on building clinical confidence to address any new problem encountered from 2019-2023 at NYUGLISOM.

Methods 
Quantitative analyses of students rating the effectiveness of PBL in building their clinical confidence in any new problem encountered at the end of year evaluations for pre-clerkship (year 1) and clerkship (year 2) were carried out, and compared to a baseline survey.  

Results 
87% (P<0.05) of pre-clerkship students (n= 89; Respondents: 79% for Class of 2022, and 100% for 2023, 2024 and 2025) and 88% (P<0.05) of clerkship students (n= 62; Respondents: 58% Class of 2022, and 100% for 2023, 2024) agreed that PBL gave them confidence to address any new clinical problem encountered. These results were an increase on baseline of 82% for class of 2026 (n=23; Respondents: 96%). 

Conclusion 
We propose that PBL is an excellent method to build clinical confidence to address any new problems encountered in UME. High exposure of PBL cases during pre-clerkship and clerkship promotes this confidence.  Study limitations include low baseline data and subjective confidence bias. Strengths include PBL as an opportunity to build and monitor student clinical confidence from the beginning of medical school, especially in 3-year programs.