Team-based learning sets College of Medicine Physician Assistant Program apart
By Carolyn Kimmel
Throughout college and graduate school, Amelia Poplawski learned very efficiently from her textbooks and lectures, so the first-year student in Penn State College of Medicine’s Physician Assistant Program was surprised when a tool she had never heard of – team based learning – enhanced her studying.
“I am amazed at how much more enjoyable learning is,” said Poplawski, who was introduced to team-based learning when she sat in on a class during her interview process. “I could never have anticipated how much of an impact it would make.”
Sometimes referred to as “the flipped classroom,” team-based learning encourages the student to develop deep thinking and teamwork skills that are especially important in an increasingly team-based approach to medicine, according to Chris Bruce, program director and team-based learning coordinator of the PA Program. In comparison to other programs nationally, Penn State’s program devotes significant classroom hours weekly to true team-based learning.
The team-based learning model has three main components. Before class, students read educational materials or complete another activity. As class begins, a test is completed individually on that material. Students then join their pre-assigned group to collaborate on a group test that contains the same questions. Group members select and defend their answers; in cases of disagreement, students discuss until they select the correct answer.
The third part of team-based learning is what really “blows us out of the water compared to other programs,” Bruce said: Clinical scenarios are presented and student groups must problem solve together on diagnosis or next steps for care and defend their choices.
For example: A 45-year-old patient has recurrent right upper quadrant abdominal pain that moves to the right side of her back and right shoulder. She is nauseous and vomiting. Three months ago, she had a similar episode after going out to eat. She already had an ultrasound that was negative for any stones or abnormalities. What’s the next step you should pursue in this patient’s care?
“Peer to peer teaching becomes very meaningful,” said Bruce, who intentionally makes the groups as diverse as possible to broaden perspectives. “Active student engagement is the secret to developing deep knowledge and being able to apply it in the clinical setting.”
If the groups disagree on answers to the medical vignettes, they must try to convince other groups why they are right.
“If you walk into class, it can be very loud as they argue their position. This impassioned exercise is what is driving their learning.” Bruce said. “It also allows for instant feedback. To the group that gave the wrong answer, I can say, ‘Here’s exactly where your thought process broke down.’”
“As situations come up, the first thing that comes to my mind is ‘I remember this from team-based learning,’” said Sue Thurman, a second-year student currently in rotations. “You remember something much more because you’ve talked about it and applied it to a real-life situation. That’s something that reading from a textbook can’t give you.”
While being faced with diverse opinions in her team-based learning group was somewhat intimidating last year, now she says she realizes it boosted her confidence to speak up during on-floor rounds with the attending physician, residents and other medical students. “I realize I do know what I’m talking about,” she said.
“To have the perspectives of multiple people in my group was an incredible experience. There’s only so much you can learn by staring at a PowerPoint,” said Amanda Shibley, a member of the first graduating class of 2016 and currently a physician assistant at Penn State Medical Group on Fishburn Road in Hershey. “Having that first go-round in lecture and then doing it again in team-based learning was a great way to solidify my knowledge.”
Poplawski said the ability to work with other people is an essential skill that team-based learning teaches. “That ability will impact my success as an individual, in my career and in life,” she said.
For students who don’t come from previous jobs in the medical field, team-based learning can be a lifesaver.
“I don’t have a medical background like many of my classmates who may have seen a patient like this before. Since team-based learning is very case oriented, it helps me to see what an actual patient would look like,” said Michael McClellan, a first-year student.
The university’s first scores from the national boards give proof that team-based learning is working, Bruce said.
“Out of the 20 individual scores for topics or skill sets, our single highest performance was in applying scientific concepts, which was one of the lowest-performing areas across the country,” she said.
This type of learning takes extra time since there is no textbook that provides the clinical scenarios. Luckily, since Penn State faculty are practicing clinicians, there is no shortage of material to draw from, however, it may take Bruce 10 hours of writing to put together 10 clinical scenarios for a two-hour class. Often students will tell her what concepts are challenging in traditional lecture classes and she will come up with a team-based learning lesson to mirror it.
When students apply to the PA Program, they participate in a team-based learning session because it is so unique, Bruce said. The current class had 3,400 applicants and 30 slots available, she said. Only four students turned down their admission offers and Bruce is convinced that the team-based learning model had something to do with that.
First-year student Padmini Harchandrai said she chose Penn State’s PA Program because of its team-based learning approach. Formerly a videographer, the native of India says she appreciates the varied knowledge her team members bring to their team-based problem solving.
“We have a big workload. By breaking things down into a division of labor and then pooling our knowledge, it makes learning easier. The group interaction also mimics multiple professions coming together to figure out what’s best for the patient,” she said.
The medical school offers a much more time-intensive, problem-based learning approach, which requires students to react to a clinical scenario by researching learning outcomes outside the classroom and then again when the correct outcomes have been presented. The fast-paced PA program doesn’t have the luxury of that much time, Bruce said.
“There’s a lot to learn in two years and at the end of it, these students have to be ready to go out there and practice,” she said.
The College’s program also has attracted international attention. Visiting faculty from Ben-Gurion University in Beer-Sheva, Israel, traveled to the United States recently to visit three schools that use team-based learning, including the College of Medicine.
“The concept of a physician assistant is very new in Israel. We are just starting our PA program,” said Chanita Cohen, a teacher in the nursing school at Ben Gurion University. “Our doctors are very reluctant to give away their responsibility.”
“Our university still teaches in the old way – very large lecture halls with 90 to 150 students or more. When we got to know team-based learning, that seemed very attractive to us and the best way to get very large classes engaged,” said Keren Levitin, another teacher from the Israeli university. “We have started trying team-based learning in our women’s health classes instead of traditional lectures. Seeing how Penn State and other facilities we visited do it helps us find what’s the best way for us to do it.”
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