Review of 21st Century Learning in Medicine: Traditional Teaching versus Team-based Learning

Published in the Medical Science Educator (2012) 22(2) 57-64 by Robert K. Kamei, Sandy Cook, Janil Puthucheary and C. Frank Starmer

Review by Lynn C. Yeoman - July 18, 2012

Recognizing that learning by modern students has adapted to take greater advantage of digital resources the authors acknowledge that there is a disparity between the lecture-based teaching style that persists in too many medical school classrooms and the learning style of current medical students. While there has been some progress in moving away from discipline-based memorization, most medical school curricula still do not include enough problem-solving in their educational programs. Furthermore, the practice of medicine has move away from the competitive soloist to a role that is more likely to be a team member or team leader.

To address this disparity a learning strategy was developed by Duke-NUS educators, called TeamLEAD, incorporating Team-Based Learning principles. Lectures, readings and e-learning on a given topic are completed before class; in-class activity focuses on understanding, applying principles, and solving problems. Key to this approach are the elements of individual self-directed learning, small-group activity followed by combined group faculty facilitation. The advantages of this approach include: rewards for self-directed learning, more efficient use of faculty than other small group methods, but retention of the engagement and enjoyment found in many small group learning methods.

At the same time changes were made to the format of the overall curriculum. The first year was devoted entirely to TeamLEAD learning. The basic sciences were wrapped around Larry Michaelsen’s Team-based learning method, which has rarely been used throughout a preclinical curriculum. The emphasis of the first year was shifted from memorization to critical and creative thinking and in-class problem solving. The second year was composed of clerkships. The third year was devoted to research. The fourth year was built around various activities designed to round out an individual’s medical education.

TeamLEAD was implemented on 130 medical students at Duke-NUS and their performance on national standardized examinations was compared to pooled data collected from 18, 390 students in the United States. A comparison of demographic data suggests that the two populations were comparable, but not identical, i.e., the average MCAT performance and GPA data for DUKE-NUS students was not quite as high as that for aggregated US medical school data.

What is remarkable are the results obtained when Duke-NUS student performance on CBSE and USMLE Step 1 exams are compared with those achieved by US medical students. Duke-NUS students, at the end of their first year, perform comparably on the CBSE to second year US medical students. At the end of their second year the Duke-NUS students scored significantly higher than the US students (66.5±7.8 vs. 61.0±11.0) (p<.0.05; 95% CI [65.1 to 67.9]). The first two years of Duke-NUS students also scored significantly higher than US students on the USMLE Step 1 (228.4±20.7 vs. 222±24) (p<.028; 95% CI [223.5 to 233.3]). While one would certainly like to see the size of the Duke-NUS cohort increase, as well as comparisons that include controls for other potential population variables, these data suggest that the TeamLEAD method for learning the preclinical curriculum may outperform lecture-based and other forms of small group instruction.

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