Wiener at the GMA conference proved to be very helpful due to the lack of expertise on-site and made it possible to experience important TBL principles as a kind of self-test. Moreover, the art of moderating discussions, which is not usually a component of other teaching methods, was demonstrated. Training other TBL instructors on-site through live demonstrations with discussions and sharing appears thoroughly feasible now following the first TBL series.
At the time this pilot study was conducted, no group-based learning methods were offered as part of the Freiburg curriculum covering clinical study, except for the use of problem-oriented learning POL in two subjects pharmacology and dermatology. Achieving sufficient recruitment of volunteers for TBL by following a good information strategy was therefore initially important for the pilot study. Despite the lack of experience with TBL, there were no problems with implementing the individual steps after explaining the principles during the introduction — a result also of the clear structure of TBL.
As can be seen in the evaluations, many of the TBL participants spend little time learning with their fellow students.
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This makes the high acceptance of the TBL approach among the participants and their desire for more TBL courses that much more surprising. This supports the basic demands for more active and team-based learning strategies which have been expressed specifically in connection with recent studies of the so-called Millennial Generation [ 27 ].
The possibility to impart concepts and principles through the use of questions and subsequent discussions is one of the strengths of TBL and very important especially for the subject of neurology. During the RAT, special value was placed on the communication of important principles e. In addition, during the discussions it was possible to discover any problems or concepts that were not understood and to then address these as part of the feedback.
As a result, a percentage of the participants were able to recognize and eliminate errors in reasoning see Figure 2 Fig. Indication of specifically improved understanding of the topics handled is seen in the better exam performance of the TBL participants on the TBL-related questions. This is consistent with the enhanced performance on TBL-taught content by test-takers described in the literature [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ].
However, the analysis of the effects of TBL participation on the exam results also has critical limitations: among all students taking the exam, the TBL participants were highly motivated students — ultimately demonstrated by their voluntary participation in TBL — with an interest in a group-based learning method.
The transferability of these results to a group with varying motivational levels regarding participation in a group-based teaching method or to the subject of neurology itself is thus not taken as a given. Another limitation comes into existence through comparison of the results of one group with structured intervention to another without intervention performance bias. In addition, the preparatory materials were freely accessible to all the participants in the neurology course and were downloaded by an average of 30 to 40 non-TBL participants. Numbers of downloads are registered on the learning platform.
Since this pilot study was not designed to be a demonstration of effectiveness, the extent of the TBL effect, in particular on complex skills such as problem solving, in comparison to other established teaching methods should be analyzed by a controlled study. Finally, an important point arising from the evaluation results should be addressed: a predominant majority of the TBL participants stated on the final evaluation that TBL had further increased their interest in the subject of neurology.
In summary, the pilot study described here shows a good degree of feasibility for the TBL approach in the clinical subject neurology. The relatively intense amount of preparation at first, which then tapers off, is justified by the expected effectiveness concerning an improved understanding of neurology and the resulting higher level of interest in the subject.
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In general, there is a very advantageous cost-benefit ratio similar to that of a lecture. The acceptance on the part of a group of students without experience in team-oriented methods was very high, so that in the case of appropriate preparation, transferability to other pre-clinical and clinical subjects can be made without difficulty. The effectiveness in regard to measurably better results in clinical reasoning and problem solving should be analyzed within the context of controlled studies. Due to the positive resonance, the TBL neurology course will continue for now on a voluntary basis in Freiburg.
National Center for Biotechnology Information , U. Published online May Author information Article notes Copyright and License information Disclaimer. You are free to copy, distribute and transmit the work, provided the original author and source are credited. This article has been cited by other articles in PMC.
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Keywords: undergraduate education, team-based learning, neurology. Introduction Neurology is rated as one of the most difficult clinical fields not only by medical students, but also by physicians specialized in other areas, which leads to a high degree of subjective uncertainty in terms of neurological issues [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]. Neurology Exam The final exam for the block practicum consisted of 40 multiple-choice questions which reflected a mix of reproduction and transfer questions, as well as case-based problem solving.
Statistical Analysis All evaluation and examination data were analyzed using Microsoft Excel and the statistics software PAST, which is available online free of charge [ 26 ]. Evaluation 26 participants 13 female, 13 male took part in the evaluation. Open in a separate window. Figure 1. Figure 2. Figure 3. Correlation with Exam Performance The group of TBL participants achieved a significantly higher overall point total Table 1. Discussion In the search for a teaching method that can optimally impart to students the subject of neurology, which is already perceived to be complex, and at the same time be simply realized without requiring extra personnel, TBL appeared at first glance to be the ideal solution.
Conclusion In summary, the pilot study described here shows a good degree of feasibility for the TBL approach in the clinical subject neurology. Acknowledgement J. Competing interests The author declare that he has no competing interests. References 1. Eur J Neurol. Is clinical neurology really so difficult? J Neurol Neurosurg Psychiatry. Interest in neurology during medical clerkship in three Nigerian medical schools. BMC Med Educ. Youssef FF. Neurophobia and its implications: evidence from a Caribbean medical school.
Attitudes of US medical trainees towards neurology education: "Neurophobia" - a global issue. Jozefowicz RF. Neurophobia: the fear of neurology among medical students. Arch Neurol. Vygotsky L. Hrynchak P, Batty H.
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The educational theory basis of team-based learning. Med Teach. Bandura A. Social learning theory. New York: General Learning Press; McInerney MJ. Team-based learning enhances long-term retention and critical thinking in an undergraduate microbial physiology course. Microbiol Educ J. Transforming a clinical clerkship through team learning.
Teach Learn Med. Dunaway GA. Adaption of team learning to an introductory graduate pharmacology course. Active learning in a Year 2 pathology curriculum. Med Educ. Team learning in a medical gross anatomy course. A controlled study of team-based learning for undergraduate clinical neurology education. A comparison of in-class learner engagement across lecture, problembased learning, and team learning using the STROBE classroom observation tool. Haidet P, Fecile ML. Team-based learning: A promising strategy to foster active learning in cancer education.
J Canc Educ. The effects of using team learning in an evidence-based medicine course for medical students. Validation of an observation instrument for measuring student engagement in health professions settings.
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Eval Health Prof. Do you feel short of breath when you walk? In a practical sense, it is not necessary to memorize an extensive ROS question list. Rather, you will have an opportunity to learn the relevant questions that uncover organ dysfunction when you review the physical exam for each system individually. In this way, the ROS will be given some context, increasing the likelihood that you will actually remember the relevant questions.
The patient's reason for presenting to the clinician is usually referred to as the "Chief Complaint. Then try to make the environment as private and free of distractions as possible. This may be difficult depending on where the interview is taking place. The emergency room or a non-private patient room are notoriously difficult spots. Do the best that you can and feel free to be creative. If the room is crowded, it's OK to try and find alternate sites for the interview. It's also acceptable to politely ask visitors to leave so that you can have some privacy.
If possible, sit down next to the patient while conducting the interview. Remove any physical barriers that stand between yourself and the interviewee e. These simple maneuvers help to put you and the patient on equal footing. Furthermore, they enhance the notion that you are completely focused on them. You can either disarm or build walls through the speech, posture and body languarge that you adopt. Recognize the power of these cues and the impact that they can have on the interview. While there is no way of creating instant intimacy and rapport, paying attention to what may seem like rather small details as well as always showing kindness and respect can go a long way towards creating an environment that will facilitate the exchange of useful information.
If the interview is being conducted in an outpatient setting, it is probably better to allow the patient to wear their own clothing while you chat with them. At the conclusion of your discussion, provide them with a gown and leave the room while they undress in preparation for the physical exam. Initial Question s : Ideally, you would like to hear the patient describe the problem in their own words.
Open ended questions are a good way to get the ball rolling.
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These include: "What brings your here? How can I help you? What seems to be the problem? While it's simplest to focus on a single, dominant problem, patients occasionally identify more then one issue that they wish to address. When this occurs, explore each one individually using the strategy described below. Follow-up Questions: There is no single best way to question a patient. Successful interviewing requires that you avoid medical terminology and make use of a descriptive language that is familiar to them.
There are several broad questions which are applicable to any complaint. These include: Duration: How long has this condition lasted? Is it similar to a past problem? If so, what was done at that time? Does it interfere with your daily activities? Does it keep you up at night?
Try to have them objectively rate the problem. If they are describing pain, ask them to rate it from 1 to 10 with 10 being the worse pain of their life, though first find out what that was so you know what they are using for comparison e. Furthermore, ask them to describe the symptom in terms with which they are already familiar. When describing pain, ask if it's like anything else that they've felt in the past. A sensation of pressure?
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A toothache? If it affects their activity level, determine to what degree this occurs. For example, if they complain of shortness of breath with walking, how many blocks can they walk? How does this compare with 6 months ago? Has this changed over time? If the symptom is not focal, does it radiate to a specific area of the body? Have they tried any therapeutic maneuvers? Pace of illness: Is the problem getting better, worse, or staying the same? If it is changing, what has been the rate of change?
Are there any associated symptoms? Often times the patient notices other things that have popped up around the same time as the dominant problem. These tend to be related. Why today? Does this relate to a gradual worsening of the symptom itself? Has the patient developed a new perception of its relative importance e. Do they have a specific agenda for the patient-provider encounter? If, for example, the patient's initial complaint was chest pain you might have uncovered the following by using the above questions: The pain began 1 month ago and only occurs with activity.
It rapidly goes away with rest.