Team-Based Learning (TBL)

Ben and Maytee Fisch College of Pharmacy

Changing the Classroom

Over the past 20 years or so there has been a shift in how college students are taught. This change has occurred as we gained a better understanding of how people learn and what improves the retention of what they learned. As a result, more faculty members are moving away from the sole use of traditional lectures and are incorporating active learning as part of their teaching. This active learning may include intermittent question and answer periods, writing exercises, or other activities that engage students in the classroom as they learn the course material.

One of the active learning techniques that has gained popularity in health care education over the past decade is team-based learning. This method focuses on students working in teams to solve problems in the classroom rather than only listening to lectures during class time and doing homework exercises at some later point. Read more about TBL in pharmacy education.

A few pharmacy programs have begun to incorporate TBL into their curriculum with only a small number using the method more than just occasionally. Our Doctor of Pharmacy (Pharm.D.) program uses TBL through much the curriculum. In fact, our new pharmacy building, W.T. Brookshire Hall, home of the Fisch College of Pharmacy, was designed specifically for TBL in the classroom and collaborative learning outside the classroom.

The Appeal of TBL

Being a successful pharmacist involves more than knowing a lot about drug therapy. While medication therapy knowledge is essential, equally important is the ability to think critically and solve problems. Since it is impossible for a single person to learn every possible nuance of medication therapy management in pharmacy school, the ability to take core knowledge and apply this knowledge to new situations is what will differentiate our graduates as exceptional pharmacists. This is where TBL shines.

Students in our Pharm.D. program will be learning the foundational sciences and drug therapy management skills while developing critical thinking and problem solving skills.

Another attribute of an exceptional pharmacist is being able to communicate clearly. With TBL, students will constantly interact with their team members as they work though problems, deliberate possible solutions, and agree on answers. As students progress through the program, they will hone their communication skills and learn how to comprehend and explain complex concepts in a clear and concise way using language that both professionals and patients can understand.

The ability to work well on a team is vital to being an exceptional pharmacist. No pharmacist works alone. Although a pharmacist may be the only person in a specific location, that pharmacist is a member of a health care team who must work effectively with others to ensure the best care for their patients. As the name implies, TBL places students in groups who work together in and out of the classroom as they learn about pharmacy and how to manage drug therapy. This is very different from "team projects" when a group of students occasional meet to work together and the result was anything but work from the entire group.

To function well as a team takes a bit of time and a lot of work, just like any good interpersonal relationship. TBL helps students learn how to develop these professional relationships through improved communication and collaborative learning. In our Pharm.D. program, we place the students in teams at the beginning of each semester and students will remain in these same teams for that semester. Over the first few weeks the teams will become cohesive as they communicate and work collaboratively to solve real-world problems. By the end of the school semester, our goal is that the incoming group of individuals will have developed into a knowledgeable, high-functioning team who respect and trust one another. This is the hallmark of an effective health care team.

Each semester the teams will be reorganized. Students will get to work with new team members from the class just like they did in the prior semester. Using this approach, students will continue to develop and refine the team-building and team-maintenance skills so valued in the workplace today.

The TBL Difference

TBL is a significant departure from how many students have been taught in school. Rather than only receiving content in class and then going away to solve homework problems, the process is essentially reversed. Class time is also used to solve problems and time outside the class is used to reflect on the content. TBL is different from "flipping" the classroom by using the readiness assurance process. This is the real key to TBL's success. Coming to the classroom truly prepared to solve problems is what will keep our student on top of the material and be able to apply and retain what was learned.

TBL uses modules. Modules are a collection of related topics that are best learned together and that build on prior knowledge. For each TBL module, a general process is followed that begins with (1) guided preparation, (2) assessment of readiness for class, and (3) application exercises that allow students to apply knowledge and skills in such a way that students learn to think critically and solve problems.

Guided Preparation

Pre-class preparation can take many forms including pre-recorded presentations, specific reading assignments, and introductory problem sets. It all depends on the faculty member and the content to be learned. In general, an instructor will assign the pre-class material with appropriate learning objectives that guide you as to what needs to be accomplished before class begins.

The expectation is you will understand important foundational concepts prior to coming to class so deeper learning can occur during class time. It is not the goal to have you master material before class, but rather have a solid fundamental understanding of the important concepts so those concepts can be applied during class. Of course, you can always work with your team or seek help from the instructor before class on those really tough topics.

Assessment of Classroom Readiness

At the start of class, students take an individual quiz that assesses their readiness to actively participate in the class. This graded quiz is called an individual readiness assessment test (iRAT) and assesses a student's preparation for class. It also serves as a powerful incentive for students to keep up with the course material since the iRATs are graded.

Following the iRAT, each student team takes the same graded RAT together; this is called the team readiness assessment test (tRAT). The team discusses, negotiates and selects the best answer for each of the questions. Since not all students study the same way or come to class with the same level of understanding of the pre-class material, discussions that occur during the tRAT are great for refining conceptual understanding and preparing the team to solve problems in the classroom.

After the iRAT and tRAT, the instructor reviews the questions and has an interactive discussion with the entire class. This helps to ensure the students have an appropriate understanding of the pre-class material. At this time, instructors will generally review more challenging concepts and perhaps introduce more advanced topics in preparation for the problems to be solved during class. This facilitated discussion, often called a mini lecture, is important for both the instructor and students to help identify areas that may still be perplexing and provides topics the instructors can address with individual teams later during the class period.

When the iRAT, tRAT, and the facilitated discussion is finished, the readiness assurance process is complete.

Application Exercises

The problems student teams solve in the classroom are called application exercises. These exercises are at the core of learning to use TBL. These problems are designed for teams to delve into real situations that face practicing pharmacists. Just like in the real world, these problems often don't have a single right answer, but have several correct answers where one may be better than the others. This approach helps the teams appreciate that in practice, pharmacists need the ability to seek alternative solutions when multiple potential solutions are available.

Following completion of the application exercises, teams are often asked to present and defend their answers. At times, teams even debate each other over the merits of their choices. Instructors use these events to enrich the learning experience as a team may present an approach to solving a problem not intended by the instructor. Instructors will also use this time to explore new avenues of critical thinking that help students enhance their problem solving skills.

Midterms and Finals are Different

At designated intervals during the semester, most courses will have major examinations, such as midterm exams. At the end of the semester, a final exam will be given to assess the knowledge gained during the course. These exams are different than with traditional courses because the way students study for them is greatly influenced by the use of TBL.

Students keep up with the material as they prepare for class and take the iRATs and tRATs. The students then apply that knowledge during class. As a result, there is less of a pre-exam scramble to study that lessens the stress for many students. In other words, the exams are just as detailed and tough as traditional courses, but students are better prepared and end up not needing to cram for the exams.

Why Not Lecture?

That's a valid question with an easy answer. The lecture format is not the most commonly teaching method used at the Ben and Maytee Fisch College of Pharmacy, because lectures really don't work well at engaging students in the learning moment. As odd as that may sound, it's true. The lecture format is very common in colleges of pharmacy and within colleges and universities because lectures are efficient at delivering content. However, lectures are not the most effective method for learning. Another reason lectures are efficient for giving information, is lectures can be given to a large number of people. It takes the same energy to prepare and deliver a slide presentation for hundreds of students as it does for dozens of students. With this teaching method, more people may have heard the information but the individuals may not have learned more as a result. Probably the most likely reason many teachers teach using lectures is they were taught using lectures. We model what we know. Although bright and talented teachers may be exceptional at delivering a lecture, it's clear that when students are actively engaged in the classroom and responsible for their learning, they have better comprehension and greater retention. And that's what learning is all about.

A Better Way to Learn

We believe that using TBL is a better way to teach and a better way for you to learn. Not only will our students prepare better for class, but their time in class will be spent applying this material in a way that improves communication and critical thinking. This will lead to a deeper understanding of the complex world of pharmacy and a stronger set of skills when you enter into the profession. Instructors will challenge the students both in and out of the classroom to be the best possible pharmacist for their patients. Our Pharm.D. students will develop lasting professional relationships with their classmates as they learn and teach each other throughout the curriculum. We believe our graduates will have the best education in pharmacy.