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

Purpose
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.

Methods
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.

Results
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%).

Conclusions
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.