효과적인 TBL을 위한 12가지 팁 (Medical Teacher, 2010)

효과적인 TBL을 위한 12가지 팁(Medical Teacher, 2010)

Twelve tips for doing effective Team-Based Learning (TBL)

DEAN X. PARMELEE1 & LARRY K. MICHAELSEN2

1Wright State University, USA, 2University of Central Missouri, USA

의학교육학자들이 인지한 두 가지 중요한 현실. 여러 질병에 대해서 줄줄 읊을 수 있는 것과 실제 환자를 보고 빠르게 진단내리는 능력은 별개의 것이다. 의과대학생은 이 두 가지를 모두 알아야 한다.

Medical educators have long recognized two important realities. 

• One is that being able to recite all the subtle differences between one form of a disease and another is a very different kind of knowledge than being able to quickly diagnose the correct form of that disease suffered by a real, living patient. 
• The other is that medical students must master both kinds of knowledge.

전통적으로 학생들은 이 두 가지 서로 다른 지식을 서로 다른 시간에 서로 다른 상황에서 다뤄왔다. 

In traditional medical education, students were exposed to the two different kinds of knowledge at different times and in different settings. The content was typically taught in lecture-based courses and, later (some years later) students learned to use the content during their time in clinical rotations.

그러나 배운 내용을 학습할 수 있는 환경을 뒤로 미뤄두는 것은 '성인이 가장 잘 배우는 방법'과 맞지 않는다. 이에 의학교육자들은 학생이 배우는 내용과 그것을 적용할 수 있는 환경을 최대한 근접하게 만드는 방법을 개발해왔고, PBL이나 사례발표가 그 예다.

Delaying students’ opportunity to learn to use the content, however, does not fit well with what we now know about how adults learn best – the kind of learning that both ‘sticks’ and can be transferred to novel situations. As a result, medical educators have experimented with a number of approaches for enabling students to more closely connect the content and concept acquisition with its application – e.g. problem-based learning (PBL), case presentation.

(...)

TBL진행 개요

For a course with TBL as part of its learning activities, 

• students are strategically organized into permanent groups (for the entire term of the course) and the course content is organized into major units (typically five to seven). 
• Before each in-class event, students must study assigned materials because each module begins with the readiness assurance process (RAP). The RAP consists of a short test (over the key content and concepts from the readings or other activities, e.g. dissection) which students first complete as individuals, then they take the exact same test again as a team, coming to consensus on each question. 
• Students receive immediate feedback on the team test and they then have the opportunity to write evidence-based appeals if they feel they can make valid arguments for their answers to questions which they got wrong. 
• The final step in the RAP could be a ‘lecture’ (usually very short and always very specific) to enable the instructor to clarify any misperceptions that become apparent during the team test and the appeals, but also could be a between-team discussion about why the selected correct answers are best – fielded by the instructor. 
• Once the RAP is completed, the remainder (and the majority) of the learning module is spent on in-class activities and assignments that require students to practice using the course content by solving challenging problems.

12개의 팁

TWELVE TIPS

좋은 교과목 설계로부터 출발하라

Tip 1: Start with good course design

교과목의 주요 이슈는 다음과 같다.

TBL is an instructional strategy that works best when it is integrated tightly with a course's design. It can be the primary mode of instruction or work alongside other learning activities, i.e. focused lecture, service learning, self-directed online tutorials. We recommend using Dee Fink's Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses (2003) for guidance in defining a course's (or curriculum's) contextual issues, 

• goals, 
• assessments, 
• learning activities, and 
• feedback mechanisms. 

기존 강의의 한두시간을 대체해서 시도해볼 수 있다.

Often, instructors will ‘try out’ a TBL module or two in an existing course, either replacing a set of lectures or small group sessions that had required recruiting and herding many faculties. This is a valid way to gain experience with how to implement it, but, usually, it is hard to incorporate the peer evaluation component since the number of meetings will be few.

TBL과정과 모듈을 만들 때 후향 설계(backwards design)를 해보라

Tip 2: Use a ‘backwards design’ when developing TBL courses and modules

후향적 설계란 "이 시간이 끝난 후 학생들이 무엇을 할 수 있기를 바라는가?"를 스스로 질문하는 것이다.

With backwards design (Wiggins & McTighe 1998) the first question to ask yourself is, ‘What do I want my students to be able to DO by the end of this unit of study?’ Whether designing a single TBL module for a unit of study, e.g. Starling's Law and cardiovascular physiology, or a series of modules that form the basis of an entire course, clarify what you want the students to be able to do by the end of the module or course. For example, a goal for a module in physiology/pharmacology focused on Starling's Law would be for the students to be 

• able to apply their understanding of Starling's law to accurately interpret physiologic data from a case of congestive heart failure, 
• explain how Starling's Law governs which findings, 
• predict which pharmacologic agent will affect specific components of heart function. 

(...)

내용에 대해 잘 아는 교수자들이 스스로 이 질문에 답을 하기는 어려울 수 있다.

This single question is often the hardest one for instructors who are ‘content-driven’ to ask themselves. There is just so much ‘content’ that we feel our students must know before they can make use of it – but, TBL provides a way to have them master the content while they are applying it and get feedback on how well they are ‘getting it’ as they go.

학생들이 도달할 수 있으면서 교수자(그리고 학생이) 어느 정도 도달했는가를 알 수 있는 모듈 구성

Tip 3: Make sure you organize the module activities so that students can reach your learning goals and you (and they) will know that they have done it

어떤 활동을 할 것인가를 구성해야 하는데, 일련의 문제를 제시해서 학생들의 사고과정을 이끌어나가는 수단으로 활용하고 싶은 욕망을 억제해야 한다. 학생들이 스스로 어려운 선택을 하고, 함께 작업하여 그 개념을 익혀하도록 해야 한다.

After clarifying what you want your students to be able to do by the end of the module, the next step in backwards design is creating a group application exercise. This should be a problem that requires students to use all of the preparatory knowledge and their team's brainpower to analyze, interpret, and then commit to a choice or a decision. Further, you should avoid the temptation to ask a series of questions as a means of ‘leading students through the thinking process.’ It is far better to require them to make a difficult choice and let them work together to master the concepts and to discover and internalize the relationships between them in the process of coming to a conclusion.

무엇을 할 수 있게 할 것이며, 그것을 어떻게 평가할지를 결정했다면 그 문제를 해결하기 위해서 수업 전에 무엇을 해와야 할지를 결정해야 한다. 또한 RAT 문제를 출제해야 한다. (이를 퀴즈라 부르지 말라)

Once you have decided what you want students to be able to do and how you will assess whether or not they can do it, the next two steps in backwards design are identifying what content elements the class must master before they are ‘ready’ to solve the problem (i.e. the information that the students need to learn outside of class to be prepared for the module) and write the questions for the readiness assurance test (RAT) (and do not call it a quiz – its purpose is readiness assurance and you should emphasize its role by the terms you use in talking about it).

심도있는 사고, 참여, 학습내용 중심 토론을 위한 학습활동을 만들라

Tip 4: Have application exercises that promote both deep thinking and engaged, content-focused discussion

TBL성공에 가장 중요한 것은 학생들에게 만들도록 한 과제가 무엇인지이다. 내용이 무엇이든 '긴 결과물을 내라'라고 하면 학생들은 그것을 서로 분담하고, 학습도 잘 안 이루어지게 되고, 부정적인 인식을 하게 된다. 잘 설계된 과제를 내면 학생들은 서로에게 배우면서 상당한 자신감을 얻게 될 것이다.

Over the years, we have come to realize that the single most important aspect of successfully implementing TBL is what your assignments require students to create. Whatever the content, if you ask them to produce a lengthy document, they will divide up the work which, in turn, will reduce learning and, all too often, will result in negative feelings about their peers and skepticism about working in a group. On the other hand, we have learned that, by using well-designed assignments, students will both learn from each other and develop a great deal of confidence in the value of working in a team.

좋은 과제는 각 단계(혼자 하기 - 팀 내에서 하기 - 팀 사이에서 하기)에서 다음의 네 가지 S를 만족하는 것이다. 

The key to designing effective assignments is ensuring that what students are asked to do is characterized by 4 S's at each of the stages in which they engage with the course content – working alone, working within their team, and working across teams (i.e. whole-class discussion). The 4 S's are:

• 실제로 중요한 문제 Significant Problem
• For a successful group application exercise, select or create a problem that the student can readily recognize as the kind of problem that will be encountered in ‘real life,’ make it Significant. In medical education, this is easy – there are an infinite number of patient cases that are rich with data to be interpreted, decisions to be made. But, there has to be a clear link between the content that underlies the exercise and its application. At the conclusion of the hypothetical module on Starling's law/physiology, you want to hear your students talking about how the basic principles of the law are applicable to understanding cardiac contractility in stress situations and how to approach interventions. In addition, the answers to these questions should never be discoverable in a text or article or lecture notes – they can only come from team members collaborating to figure them out.

• 모두에게 동일한 문제(서로 모두 같아야 하며, 따라서 학생은 문제 선택권이 없다.) Same Problem
• With TBL, all of the small groups must be working on the Same Problem. If you assign different problems to different small groups, students are not accountable to each other because you lose the benefit of having any semblance of a robust discussion (and learning!) between-group discussion of the problem. Further, if you allow groups to choose their own problem, they are not even accountable to you – unless you are willing to do the research that you hope they would do.

• 구체적 문제(이 환자에게 가장 좋은 약은? < 이 환자에게 가장 좋은 약을 썼을 때 영향을 받는 신경전달물질의 구성은?) Specific Choice
• When your assignments require students to agree on a specific choice, the only way they can accomplish the task is by working together to critically appraise a situation, examine the existing evidence, and make a professional judgment. Further, the more specific the question, the better the learning. For instance, if your module was about depression and pharmacologic interventions, a good question would be ‘Identify the set of neurotransmitters that are affected by the best drug choice for this patient’ and not ‘What would be the best drug for this patient’ because a more specific question requires a deeper analysis.

• 동시에 보고하기 Simultaneous Report
• You create an important ‘moment of truth’ when all the small groups are asked to post their responses to a question at the same time. Two things happen as soon as students realize that the choice they will be making will be open to challenges from other groups. 자신들의 의견이 다른 사람들의 공격을 받을 수 있을 것이라는 것을 깨달은 순간 다음의 일이 발생한다.
• 아군 vs 적군의 구도가 되어 그룹의 응집력이 올라간다.One is that, because of the potential of an ‘us versus them’ situation, group cohesiveness increases. 
• '정답을 내놓지 못해도' 숨을 곳이 없으므로 그룹 내 토론에 좀 더 활발히 참여하게 된다. The other is that students are far more engaged in the within-groups discussion because they realize that they would not be able to hide if they do not ‘get it right.’ 

• 각 그룹이 답을 도출한 과정을 바탕으로 하여 토론을 촉진할 수 있다.
  In addition, by engaging students exploring how they arrived at their respective answers, you can readily create a class discussion that is far more informative to you and your students than asking, ‘Somebody say what they think about thus-and-such.’

두 가지 안 좋은 점이 있다.

We have also learned two lessons – sometimes by sad experience – about the 4 S's. 

• 4S중 하나가 충족되지 않으면 토론의 강도와 그에 따른 학습이 저해된다. One is that failing to do any one of the 4 S's substantially reduces both the intensity of class discussions and the resultant learning. 
• 4S중 두 개가 충족되지 않으면, 학습은 거의 일어나지 않으며 점수를 깎이지 않으려는 것이 학생이 과제를 수행하는 유일한 이유이기 때문이다. The other is that, if you fail to do any two of the 4 S's, learning is minimal and pretty much the only reason that students are willing to complete the assignment is that it will have a negative impact on their grade.

RAP의 중요성을 과소평가하지 말라

Tip 5: Do not underestimate the importance of the RAP

RAP의 역할: 피드백, 피어티칭, 학생들의 gap 파악, 필요할 경우 강의

The RAP is designed to link students’ advance preparation to the group application exercises and provides a remarkable and powerful opportunity for individual feedback and peer teaching within the teams. In addition, the RAP lets you (and the students) know if you need to address gaps in their understanding. If the content area is particularly difficult, e.g. autonomics, odds ratios and predictive values in critical appraisal, liver pathology, then the RAP should be separated in time from the group application exercise so that the instructor can give corrective feedback and/or provide additional input before they begin to tackle the group application exercise. However, you do not have to cover everything – only what you (and the students) know they need help with.

RAP가 잘 이뤄지면 다음과 같은 장점이 있다.

The RAP, when done well, unfailingly produces five priceless outcomes even though it typically uses only a fraction of the overall class time (usually about 25–30%) for any given unit of instruction. These are:

• Effective and efficient content coverage.
• Development of real teams and students’ interpersonal and teamwork skills.
• Students gain an experience-based insight about the value of diverse input.
• Development of students’ self-study and life-long learning skills.
• Class time during which you can provide the content expertise to ensure that students develop critical thinking skills.

99.9% 이상 팀 내에서 가장 점수가 높은 학생의 점수보다 팀 점수가 더 높으며, 가장 낮은 점수를 받은 팀의 점수도 전체 반에서 가장 높은 점수를 받은 학생의 점수보다 높다.

In addition, data from the RAP provides data that definitively answers the question of whether or not individuals are likely to be held back by working in teams. Based on data from the past 23 years of using TBL (Michaelsen and Parmelee, unpublished), teams will score higher than their own very best member 99.9+% of the time1 and the most common outcome is that the worst team score will be higher than the highest individual score in an entire class.

종종 발생하는 실수에는 다음과 같은 것들이 있다.

Unfortunately, we have seen some instructors miss out on part or all of these valuable outcomes because they have, for whatever reason, decided to: 

• (1) skip either the individual or the group component – or both; 
• (2) use questions that are merely designed see if the students did the reading, e.g. asking ‘picky’ or meaningless questions unrelated to the objectives of the module; and 
• (3) view this process as a way of getting another assessment for their course grade. The RAP is not just another ‘quiz’ and neither instructors nor students will reap its many potential benefits if it is treated as such.

왜 TBL을 사용하는지, 이전 그룹 학습과 어떻게 다른지에 대해 학생들에게 설명하기

Tip 6: Orient the class to why you are using TBL and how it is different from previous experience they may have had with learning groups

대부분은 경험도 없고, 있더라도 형편없이 설계된 과제를 해야 했을 것이다. 혹은 잘 참여하지 않는 그룹원들을 데리고 뭐든 해보려고 고군분투 했었을 것이다.

Most students will not have had a classroom experience like TBL. In fact, the majority of their experience with group work will have been struggling to complete poorly designed assignments that forced them into the uncomfortable position of having to choose between doing more than their fair share or risk getting a bad grade and/or having to deal with difficult group members just to get anything done at all.

이러한 걱정은 실제하는 것이며, 왜 TBL을 사용하며 어떻게 TBL이 설계되었는지를 제대로 이해시키지 못하면 학생들의 적극적 참여를 이끌어내기 어려울 것이다. 최소한 교과목의 목표를 제시해야 하며, TBL에서는 전통적인 방법과 어떻게 다르게 그 목표를 달성하게 될 것인지를 설명해야 한다.

These concerns are real and must be addressed or you will have a difficult time getting student buy-in unless students understand both why you are using TBL and how TBL is designed to avoid the problems that they, all too often, have come to expect are a normal outcome from doing group work. At a minimum, you need to outline your course objectives and provide an explanation of how they would be achieved in a traditionally taught course versus how you will achieve them by using TBL. 

학생들의 TBL에 대한 이해를 도와주기 위해서는..

Other suggestions to help them understand and accept TBL include: 

(1) giving a practice RAT (many use the course syllabus as the ‘subject matter’ for the test); 

(2) engaging them in the process of determining the grading system for the course (Michaelsen et al. 2004) and, throughout the course; and 

(3) reminding them about the benefits they are experiencing along the way.

TBL의 핵심으로서 '책임'을 강조하기

Tip 7: Highlight accountability as the cornerstone of TBL

TBL의 성공에는 학생, 팀, 교수의 책임이 중요하다.

The cornerstone of success of TBL is that the natural outcome of its processes is that individuals, teams, and the instructor are immediately and clearly accountable for behaving in ways that promote learning. 

• Students are accountable for coming to class, preparing before they come, and investing time and effort working in their team. 
• The instructor is accountable for providing students with the cognitive foundation they will need to be ready to tackle the kinds of problems they will face in medical practice and giving them opportunities to practice developing their application skills.

학생의 책임: TBL이 온전히 적용되면 대부분의 학생들은 사전 준비를 하고, 교실로 와서, 서로 생산적인 방법으로 활동하게 된다. 그 결과 처음에는 회의적이었던 학생들고 TBL을 수용하게 된다 "각자 열심히 준비해와서 그룹 활동을 열심히 하면 그 만한 보람이 있다"

When TBL is fully employed, the vast majority of students are prepared, come to class, and engage each other in productive ways as they work together. As a result, even the students who start out with a skeptical attitude because of past negative experiences with learning groups will eventually embrace TBL – ‘Finally, hard work as an individual and hard work as a group pays off.’

교수의 책임: 일부 학생들은 교수가 다른 수업에서 하듯 '가르치지' 않는다는 인상을 받기 시작할 것이다. 만약 교수가 여기서 책임을 다하지 않으면(4S의 활용, 학생에게 TBL의 장점에 대해 충분히 설명하기) 그러한 의심이 더 커지고 분노를 느낄 것이다.

As for the accountability of the instructor, some students will inevitably start out with the impression that he/she is not ‘teaching’ as in other classes, i.e. using lectures to state what will be on the final exam, and, worse, we (the students) are having to do all the work. Further, if the instructor is not following through with his/her side of the bargain – doing a good job of: (1) providing students with the opportunity to practice using well-designed applications assignments (i.e. using the 4 S's) and (2) reminding students of the benefits that they are getting – then the doubts and the resentment are likely to persist.

오답에 대한 의견을 말할 수 있는 기회 주기

Tip 8: Providing a fair appeals process will inspire further learning

문제가 혼란스럽게 기술되었거나(따라서 학생은 문제가 기술된 방식을 지적할 수 있고), 내용 해석에 대한 의견이 다를 수 있다(근거를 제시하여 의견을 제시할 수 있다.) 문제제기는 팀 단위로만 가능하고, 그에 따른 보상도 팀 단위로 들어간다.

Inevitably, some students will disagree with your selection of a best answer on a RAT question. They will do so on one of two bases: the question was written in such as way that they were confused or they feel you made an error in your interpretation of the content. The appeals process (Michaelsen 2008, p.24) provides the opportunity, preferably while they are still in class, to either re-write a question that they feel was poorly written or articulate, in writing, why they feel their answer was better, using references if appropriate. Accept appeals from a team only; award credit to the appealing team(s) only and to the individual scores of the members of those teams.

장점

The appeals process provides a number of benefits. 

• One is that it motivates students to do a focused re-study of the exact material that gave them the most trouble. 
• Another is that, the process of trying to put together a successful appeal requires to think deeply about both the specific ideas and the overall context within which they reside. 
• Finally, students can often re-write your questions so that indeed they are better!

학생들의 상호 동료평가 활용

Tip 9: Peer evaluation is a challenge to get going, but it can enhance the accountability of the process

다음과 같은 장점이 있음.

There are several ways to set up a peer evaluation process for the course, and it may take some trial and error to find the one that fits well with your institution or course's culture (Levine RE 2008, Chapter 9). There are, however, numerous benefits from putting forth the effort. 

• One of the most important is that, when you use peer evaluations, students are accountable to the members of their team. 
• Another is that a well-designed peer evaluation process enables students to learn how to give constructive feedback to one another and to gratefully receive constructive feedback from peers – an invaluable competency for future practice.

사전 준비에 대해서 명확히 하기

Tip 10: Be clear and focused with the advanced preparation

TBL에 대해서 교수자가 사전에 공부할 부분을 정해줘서 학생이 스스로 무엇을 공부해야 하는가 알아낼 기회를 뺏는다는 비판이 있지만, TBL에서 사전 준비란 RAP의 '개인별 파트'에 대해서만 도움이 되도록 하는 것이다.

A criticism of TBL is that the instructor identifies the learning needs for the students, thereby robbing them of the opportunity to explore the potential domain of the content and make some judgments about what they need to know. Based on past experience, when you are specific about what you want them to master before a TBL module, including posting action-oriented objectives such as ‘Be able to articulate how dopamine affects sodium channels at the receptor level,’ you invite them to go beyond doing the minimum of preparation since that will only help for the individual part of the RAP. They learn quickly that for their team to be really successful in the group work, they must master the advance assignment assiduously and devote additional effort to exploring the content domain. Tying the TBL objectives to the course objectives is essential.

팀 구성의 요령

Tip 11: Create the teams thoughtfully

세 가지 원칙이 있다.

We have three principles to guide the process of getting a class into teams: 

• (1) make the process transparent so all students know how they ended up in a particular team, even if the process is totally random; 
• (2) distribute what you define as ‘resources’ for a team as evenly as possible, for instance, a beginning class of medical students might have several students who have advanced degrees in one of the basic medical sciences, so you want to assign them to different teams; and 
• (3) strive for the teams to have a diverse composition, i.e. gender balance, rural or urban backgrounds, science/nonscience majors. Letting a class know that teams that have diversity within, however defined, will have unique strengths to draw upon in the challenging modules ahead.

작은 예산으로 효과를 내기

Tip 12: Several low-budget ‘props’ facilitate the implementation of a good module

One does not need to spend several thousands of Euros for the latest audience response system or any high-definition technology to get a well-constructed TBL module to work. We recommend using IFAT™ response forms for the group readiness assurance because students will hover over the scratch-off card, talk with each other, make eye contact, and be passionate about whether or not the correct answer is going to emerge. They receive immediate feedback, let one another know things like ‘You were right! Next time make us listen to you!’ Prepare folders for each team, color code the components to make the sequence of activities clear, collect everything so that you do not have to start ‘de nova’ every year – a good module is a treasure. Buy or build flagpoles to demarcate the position of teams; laminate the lettered cards for simultaneous responses. Require students to stand and face the class when speaking – you will not need a roving microphone once they learn to be quiet when someone is speaking.

결론 Conclusions

We are grateful to have been invited to provide these 12 TIPS. Over the past few years, we have provided many faculty development workshops and consultations, around the world, to introduce medical educators to TBL and assist them with its implementation in a variety of settings. In most cases, TBL has produced a positive transformation of the classroom experience for both the students and the instructor. Sometimes, however, we hear comments from faculty such as: ‘I tried it a few times, but gave up because the students didn’t like it,’ or ‘Does one have to use all the components? The GRAT sounds like a waste of time.’ Unfortunately, whenever we ask about the details of a less-than-successful attempt, we almost always learn that one or more of the components had been omitted or altered substantially. The strategy has been well tested and works, but works best when all of the components are included in the design and implementation.

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Med Teach. 2010;32(2):118-22. doi: 10.3109/01421590903548562.

Twelve tips for doing effective Team-Based Learning (TBL).

Parmelee DX1, Michaelsen LK.

Author information

• 1Academic Affairs, Boonshoft School of Medicine, Wright State University, Dayton, OH 45401-0927, USA. dean.parmelee@wright.edu

Abstract

Team-based learning (TBL) in medical education has emerged over the past few years as an instructional strategy to enhance active learning and critical thinking - even in large, basic science courses. Although TBL consistently improves academic outcomes by shifting the instructional focus from knowledge transmission to knowledge application, it also addresses several professional competencies that cannot be achieved or evaluated through lecture-based instruction. These 12 tips provide the reader with a set of specific recommendations which, if followed, will ensure the successful design and implementation of TBL for a unit of study.

PMID:

 

20163226

 

[PubMed - indexed for MEDLINE]