Over recent years team-based learning (TBL) has been utilized by numerous medical, veterinary, and health professions’ curricula in order to move away from didactic teaching to a format that encourages active learning by application of knowledge to specific learning scenarios (Parmelee et al., 2012; Reimschisel et al., 2017). Learning relies on a sequence of recurring steps requiring independent study, feedback, and a group approach to a problem or task, which has been reported to ensure accountability for all team members (Stein et al., 2015). Here we reflect on the impact of TBL in an undergraduate veterinary curriculum.
Veterinary curricula, in common with human clinical curricula, are commonly structured around a dense timetable with direct teaching in the first three to four years followed by a period of clinical rotations lasting at least twelve months. The BVSc course at the University of Liverpool has around thirty hours of timetabled teaching per week and, while 50% is didactic lecture-based teaching, students are provided with a wide range of learning activities.
Veterinary graduates are required to demonstrate the ability to work in teams, critically evaluate evidence, undertake self-audit and peer review, and adapt knowledge to different scenarios and contexts (RCVS, 2020), and as such our curriculum must provide students with the opportunity to develop these skills. Hence, during a curriculum review in 2013, TBL was introduced into the curriculum for the first time; students were introduced to a cased-based scenario, which reviewed content taught in the previous fortnight using the TBL format including pre-reading, readiness assurance tests (RAT), and a case to work through in their student teams.
A common theme in published literature is initial resistance of students to the TBL format. This initial opposition to the format is, however, generally followed by increased satisfaction throughout the academic year (Della Ratta, 2015; Roh et al., 2014). Indeed, numerous studies indicate that students prefer the TBL format to more traditional forms of learning, with increased attendance at TBL classes when compared to non-TBL sessions (Hazel et al. 2013; Branney & Priego-Hernández, 2018; Reimschisel et al., 2017). However, this is not a pattern we have seen repeated in veterinary undergraduates, where attendance at TBL sessions is generally poor in comparison to other classes. Similarly, while it has been reported that TBL appears to help poorer performing students academically (Kang et al., 2016; Koles et al., 2005; Koles et al., 2010), it is these students who have seemingly opted out of attending TBL on the BVSc course.
Given the popularity of TBL with students on non-veterinary courses, we must consider why this success has not translated with our students. Examination of the implementation of TBL on the BVSc course offers some answers as to the lack of student engagement alongside the mixed feedback it receives from students. Firstly, we must consider the role of TBL. Successful TBL-based modules and programmes use a backwards design approach where TBL is at the centre of module design with clear aims and learning outcomes on which students are assessed (Khogali & Schofield, 2016). In contrast, TBL is utilized on the BVSc to review content previously delivered in another format, in order to help students to consolidate and integrate their knowledge. Students are therefore aware there is no new information delivered in sessions and erroneously feel the time would be better spent reviewing their notes rather than engaging in an active approach to their learning.
Secondly, we must look at the structure of the TBL sessions on the BVSc course. Parmelee et al. (2012) provide clear guidance on the need to use all of the key components and follow the defined process in order for TBL sessions to be successful. While some authors have effectively adapted the process to fit their local curricula (Inuwa et al., 2012; Vasan et al., 2011), the same cannot be said for our experience. As we do not run a modular course, students receive teaching on different subjects from different members of staff in each fortnight, meaning different individuals are responsible for running each TBL scenario. This has led to variable implementation of the TBL format with different components missing, and an associated lack of continuity for students. We really must therefore, question, ‘can we expect students to embrace this method of learning if we do not provide a standardized approach?’.
The final area to consider is student accountability. TBL traditionally requires students to undertake peer evaluation of their team members, which counts toward their final TBL grade (Parmelee et al., 2012; Stein et al., 2015) alongside marks from individual and group RATs. This is an area of particular concern for our implementation of TBL for two main reasons: the absence of formal peer evaluation and lack of specific TBL related grading. Implementation of TBL without peer evaluation has been reported by Punja et al. (2014) due to reported student resistance to its use (Farland et al., 2013). These authors did, however, ensure accountability through increased weighting of individual RATs. A lack of specific grading of TBL sessions on the BVSc course alongside the absence of peer evaluation has led to no accountability for students who do not attend and a feeling of resentment in those students who do attend, resulting in falling attendance throughout the academic year. If TBL is to become a valued component of the student learning experience we should consider implementing tools that drive participation. Veterinary students tend to be highly strategic in their learning (Sykes et al., 2011), focusing on knowledge or skills they feel will lead to success in assessments. It is here we may need to consider improving the perceived value to students. One driver for the use of group-based tasks is that it encourages co-operative learning, which in itself conveys a number of recognized benefits (Panitz, 1999). This can be enhanced by the use of peer evaluation (Divaharan & Atputhasamy, 2002), with the introduction of a peer assessed component providing a ‘reward’ for student participation and reducing the resentment felt in situations where group members are awarded the same mark, regardless of their input. Much of the literature discusses peer evaluation solely as an assessment tool, but it should be noted that there are other benefits. Pocock, Sanders and Bundy (2010) discuss the use of peer evaluation as a learning tool in medical problem-based learning (PBL) classes, stating that it has benefits which reach beyond simply contributing to a final ‘mark’. They propose the use of face-to-face discussion for evaluation of contribution, rather than the traditional anonymous marking system, claiming that this contributes to the development of skills which are vital in the workplace.
The inclusion of RAT scores as part of summative assessment may be another way of encouraging student participation. The impact of this, however, on the overall assessment on the BVSc programme will need to be considered in order to avoid excessive assessment of students in an already dense curriculum.
It is clear that despite the success of TBL implementation in many health education programmes, the use of this approach in veterinary education is uncommon. There is very little peer-reviewed literature discussing the implementation of TBL in veterinary curricula and any evidence of successful implementation is usually associated with an approach in which whole subject areas are taught using this method (Hazel et al., 2013; Malone and Spieth, 2012). In order to rectify the issues we have had, it is important to consider whether the structure of TBL can ever fit in with our non-modular programme. We must first examine what we wish the outcomes of our case-based scenario sessions to be, and more clearly examine whether these can be achieved through the TBL process. It is clear that some aspects of TBL are valued by the students, so consideration could be given to developing a hybrid approach which may be more appropriate for our situation, without the sole use of assessment as a driver.