TBL: 실용 가이드 (AMEE Guide No. 65)

TBL: 실용 가이드 (AMEE Guide No. 65)

Team-based learning: A practical guide: AMEE Guide No. 65

DEAN PARMELEE1, LARRY K. MICHAELSEN2, SANDY COOK3 & PATRICIA D. HUDES1

1Wright State University, USA, 2University of Central Missouri, USA, 3Duke-NUS Graduate Medical School, Singapore

Introduction

What is team-based learning?

다양한 규모에서 활용가능하다.

Team-based learning™ (TBL) is an active learning and small group instructional strategy that provides students with opportunities to apply conceptual knowledge through a sequence of activities that includes individual work, teamwork and immediate feedback. It is used with large classes (>100 students) or smaller ones (<25 students), incorporating multiple small groups of 5–7 students each, in a single classroom. TBL is specifically characterized by three key components:

다음과 같은 특징이 있다.

• 학생이 미리 준비를 해와서 individual advance student preparation;
• iRAT과 tRAT을 수행하고 individual and team readiness assurance tests (tRATs); and
• 대부분의 수업시간은 팀 단위의 의사결정 기반 적용과제에 할애된다. the majority of in-class time devoted to decision-based application assignments done in teams.

학습자 중심, 동료평가, 즉각적 피드백, 학습에 대한 팀 단위 책임이 강조됨. 한 명의 내용전문가가 20개 이상의 팀을 운영할 수도 있음.

TBL is highly learner-centered (yet has critical faculty input) and uses grading, peer evaluation and immediate feedback to ensure individual and team accountability to promote learning and, unlike other group-based instructional approaches, one content-expert instructor can instruct 20 or more teams.

여러 국가와 분야에서 활용중

TBL is used in over 60 US and international health science professional schools, including medicine, dentistry, veterinary medicine, nursing, and allied health disciplines, at several levels of training: undergraduate, postgraduate, and continuing professional education.

제대로 활용되기만 하면 학업적 성과에 대해서는 이견이 없음.

When TBL is conducted correctly, there is little question that academic outcomes are equivalent or improved in comparison to either lecture-based formats or more traditional small group learning models (McKiernan 2003; Levine et al. 2004; Koles et al. 2005, 2010; Shellenberger et al. 2009; Zgheib et al. 2010; Thomas & Bowen 2011).

다른 그룹학습과 달리 잘 하는 학생이 고통받지 않는다(혼자 다 해야하거나, 점수를 깎이거나). 모든 사람이 그 과정에 대한 책임이 있으며, 개개인이 팀에 대해 기여하는 바가 있다. 팀이 잘 협동할수록 팀과 개인의 점수가 올라간다. 팀 내에서 동료간 학습이 이뤄진다.

Unlike typical group learning, the high performers do not suffer – by either having to do all the work or poor performers dragging their scores down. The process holds everyone accountable for their own individual work and the individual's contribution to their team. The better a team works together, the better their team and individual scores. Extensive peer teaching occurs within each team.

팀 단위 점수가 잘 못하는 학생이 누구인지 가려버리는 현상을 걱정하지만, 실제로는 TBL이 개개인의 약점에 대해 더 많은 정보를 제공하고 팀 구성원과 교수가 총괄평가 이전에 그 부족한 부분에 더 많은 도움을 줄 수 있다. 또한 개인의 역량이 과소평가되지 않는다. 투명하고 명백한 절차를 밟으며, 최종 성적은 개인과 팀의 수행능력이 합해져서 나온다.

Faculty may fear that the team scores mask the underperforming student. In reality, TBL provides more data, earlier, about an individual's weaknesses and permits team members and faculty to provide help long before a summative exam. In addition, it is not as though individual performance is mitigated – it is transparent and visible – and the final grade for a student is derived from both the individual's and the team's performance.

Why the need for this Guide?

The use of TBL in health professions education is rapidly growing for at least four key reasons: 

• 대학 집행부의 요구 One is that administrators are pushing for classes to be larger (more revenue) but want them to be taught in ways that are active, engaging, and promote positive learning outcomes.
• 인증기관의 요구 Two other reasons are that accrediting bodies are also requiring documentation that schools are: (a) employing “active learning” (Liaison Committee on Medical Education 2011) and (b) equipping students with the skills they will need to work in team-oriented environments (Interprofessional Education Collaborative Expert Panel 2011).
• 학생들은 점차 수업에 잘 들어오지 않는데, 동시에 그들이 주는 메시지는 대단히 혼란스러워서 "우리에게 시험에 무슨 문제가 나올지 하나하나 가르쳐주세요"라고 하면서 동시에 "우리는 온라인으로 배울 수 있으니 강의를 가지고 우리를 귀찮게 하지 마세요. 교수님이 우리를 잘 이끌어서 생각하고 문제해결하는 능력을 키울 수 있게 해주세요"
  Finally, faculty are frustrated that fewer and fewer students attend their lectures (especially in programs where the lectures are recorded) and students give “mixed messages” about how they want to learn: “spoon feed us with detailed lectures and notes for what is on the exams” and/or “don’t bother to lecture to us what we can learn online – bring us to class when you can guide and challenge us to think and solve problems.”

What is the purpose of this Guide?

How was TBL developed?

Michaelsen when a professor of Business at the University of Oklahoma, developed the TBL strategy in response to increasing class sizes and his discomfort with lecturing and not knowing if, what, or how his students were thinking during his presentations. In addition, he feared that if students did not have regular opportunities in class to struggle with the kinds of problems they would face in the business world, the classes would be a waste of time.

How has TBL evolved?

• During the 1990s, in the USA, TBL became known and practiced in undergraduate (college-level) business schools and within other disciples in undergraduate settings. 
• In 2001, the US Department of Education Fund for the Improvement of Postsecondary Education provided funding to the Baylor Medical College in Texas to promote TBL in health professions education through faculty development workshops, symposia and the scholarship of teaching and learning. This grant spawned the adoption of TBL at many US and international medical, nursing, veterinary, dentistry, and allied health schools over the next several years, though the amount of its use at each institution varies considerably (Thompson et al. 2007a, b). The grant also supported the creation of the TBL Collaborative – a broad-based, mostly higher education, consortium that has a resource-rich website (www.teambasedlearning.org), sponsors an annual meeting with international attendance, qualifies faculty members to conduct workshops in TBL, and promotes scholarship on its efficacy, best-practices, and innovations.

필수요소 What are the essential components of TBL?

학습자의 경험은? 

Part 1: What does the learner experience?

TBL의 각 단계는 '전향적 사고'를 하게 하는데, 학생들은 '현재'를 넘어서서 '그 다음은 무엇일까?'를 생각하는 능력 - 전향적 사고 - 를 기르게 된다.

TBL's sequence of steps is Forward Thinking; guiding students into thinking progressively and gaining the ability to look beyond the “now” and constantly asking, “what's next?”

TBL sequences the learning process for the students through the following steps, as visualized in Figure 1.

Students’ perspective

TBL recurring steps

Step 1 – Advance assignment

Out-of-class/individual. Students receive a list of learning activities, accompanied by a set of learning goals. Students study materials in preparation for the TBL session. Learning activities may include readings, videos, labs, tutorials, lectures, etc.

Step 2 – Individual readiness assurance test

In-class/individual. Each individual student completes a set (10–20) of multiple-choice questions (MCQs) that focus on the concepts they need to master in order to be able to solve the Team Application (tAPP) problems.

Step 3 – Team readiness assurance test

In-class/team. This is the same set of questions that each student has answered individually! But, now the team must answer them through a consensus-building discussion. There must be a mechanism so that the team knows as-immediately-as-possible whether or not they have selected the correct answers because they need this immediate feedback to help them improve their decision-making process.

Step 4 – Instructor clarification review

In-class/instructor. Students are given clarification from the instructor on the concepts they have been struggling with during the tRAT. At the end of the Clarification Review, students should feel confident that they are adequately prepared to solve more complex problems for the next TBL step: the Team Application.

Step 5 – tAPP – Team application (가장 중요한 단계)

In-class/team. This is the most important step! Students, in teams, are presented with a scenario/vignette that is similar to the type of problem that they will be grappling with in their careers. They are challenged to make interpretations, calculations, predictions, analyses, synthesis of given information and make a specific choice from a range of options, post their choice when other teams post theirs, then explain or defend their choice to the class if asked to do so.

The tAPP's structure follows the 4 S's principles:

• Significant problem. Students solve problems that are as realistic as possible. Problems must authentically represent the type of problem that the students are about to face in the workplace or are foundational to the next level of study. The answers must not be able to be found in any source (internet, textbook), but can only be discerned through in-depth discussion, debate, dialogue within a team.
• Same problem. Every team works on the same problem at the same time. Ideally, different teams will select different options for answers.
• Specific choice. 절대로 학생들에게 긴 문서를 만들어내도록 시켜서는 안된다. 다른 팀도 쉽게 이해할 수 있도록 팀의 결정사항을 제시해야 한다. Each team must make a specific choice through their intra-team discussion. They should never be asked to produce a lengthy document. Teams should be able to display their choice easily so that all teams can see it.
• Simultaneous report. When it is time for teams to display their specific choices to a particular question, they do so at the same time. This way, everyone gets immediate feedback on where they might stand in the posting and they are then accountable to explain and defend their decision.

Step 6 – Appeal

Out-of-class/team. A team may request that the instructor consider an alternative answer to the one designated as “best.” 문제의 기술 방식을 달리 할 수도 있고, '최선의' 답가지와 비교하여 왜 자신들의 선택도 마찬가지로 최선이 될 수 있는가를 주장할 수 있다. Appeal을 한 팀 단위로 점수를 받는다. The team must either provide a clear and usable re-write of the question if they think it was poorly worded, or a rationale with references as to why their choice was as good as the “best” chosen by the instructor. Only a team that takes the steps to write an Appeal is eligible to receive credit for a particular question.

TBL non-recurring steps

Orientation

Out-of-class/in-class/individual/team. Students read a brief article about TBL, out-of-class, in preparation for the orientation session, or the course syllabus as the first Advance Assignment. In-class, students take an individual readiness assurance test (iRAT) individually, followed by a tRAT in teams and then the tAPP that covers the essential principles of TBL. The instructor clarifies TBL concepts, including how TBL is different from students’ previous learning group experiences.

Peer evaluation

Out-of-class/individual. Each student must evaluate each of his/her teammates on their contributions to the team's success and their own learning. It is best if there is both a quantitative and a qualitative component in which they get practice with framing constructive feedback to one another. It should be done anonymously, but team members are encouraged to speak directly to one another in providing feedback.

Part 2: What does the instructor have to do?

The instructor must create a TBL module in the reverse order, using a process called Backward Design (Wiggins & McTight 1998): a three-stage design process that delays the planning of teaching and learning activities until clear and meaningful learning goals have been defined and feedback and assessment activities designed (Figure 2).

Instructor's perspective

TBL recurring steps

Step 1 – Situational factors and learning goals

학생의 사전 지식을 파악한다. 구체적이고 의미있는 학습목표를 작성한다. "이 세션이 끝나고 학생이 무엇을 할 수 있기를 바라는가?" 

Identify important Situational Factors, e.g., students’ prior knowledge. Then, write clear, specific and meaningful Learning Goals that answer the question “What do I want my students to be able to do at the end of the session that they could not do before?” Be specific with exactly how well you want them to master this – use action verbs such as identify, list, explain, calculate, compare, analyze, etc.

Step 2 – tAPP – Team application

After you have established learning goals for your TBL session, you need to create or find a problem case or scenario that is authentic and believable, the kind of brief story that your learners can relate to and know that this is the sort of situation that they will soon encounter in their profession.

이러한 사례를 찾다보면 해석이 필요한 다양한 중요한 정보가 같이 딸려오겠지만, 학생들이 압도당할 정도로 많은 정보를 제공하지는 말라.

In the health professions, such cases often come with important data that need interpretation in the context of the case. Include enough to enable them, but do not give them so much that they end up being overwhelmed. You want the learners to be able to evaluate and analyze the manifest features of your problem with the data and make decisions about the questions you pose.

책이나 인터넷에서 찾을 수 있는 질문은 하지 말라.

Never ask them a question for which the answer is in a book or can be searched and found online (students are excellent web-searchers). The solution needs to be one that they can only get to the answer through their deliberations. Of course, it is perfectly OK to include elements in the presentation or data that they do not fully understand, and they must search their resources to master.

4S원칙을 따르라.

We recommend sticking with the 4 S's principles:

• Significant problem. The problem you select and the associated question(s) must be important, authentic, and truly representative of the kind of problem students are about to encounter in their professional activities.
• 질문의 질을 더 중요하게 생각하라. 팀 적용 단계에서 너무 많이 물어보려고 하는 경향이 있다. 너무 많은 내용을 커버하려고 하지 말고, TBL의 절차를 믿으라. 
  Go for quality of questions and not quantity. There will be the tendency to try to ask too much in the Team Application, fearing that you need to “cover” so much content. Trust the process: if you design questions that really make students think and struggle with making a decision about something significant; they will master the content and key concepts.

• Same problem. All teams must be working, in class, on the same problem at the same time.
• 서로 다른 문제를 줄 경우의 문제점
  Commonly, with in-class, small group exercises, each group is given a different problem with the expectation of a sharing process at the end. This is a “killer” experience for the students for two reasons. 
• 내 발표가 끝나면 다른 사람 발표에 관심이 없다. One is because they have to endure listening to other groups present their “findings,” and once they present their own, they will not pay attention to anyone else's. 
• 서로 다른 문제를 다루면 팀 간 책임을 없애버린다. 기껏해야 예의바른 질문 한두개를 할 뿐이며, 학생들은 질문을 할 만큼 자신이 충분한 정보를 가지고 있지 않다고 생각한다. The other is that, having teams on different problems largely eliminates inter-team accountability. At best, you are likely to get a polite question or two because their motivation is low and, in addition, students are likely to feel they do not have the information they need to mount a credible challenge.

• Specific choice. 최선의 정답을 선택하고, 그것을 방어할 수 있어야 한다. 이 지점에서 딥러닝이 이루어진다. Craft questions that truly probe the “why” of a concept or use a set of data for interpretation – this separates excellent teaching from mediocre. When the learner must discern between several equally plausible options, select the BEST one and prepare to defend that decision, there is deep learning.
• 팀원이 자신의 팀의 선택에 대해서 열정적으로 방어할 때가(맞았든 틀렸든) 바로 학습이 이뤄지는 순간이다.
  With TBL, by listening in to how students are processing your questions and determining the BEST specific choice, you know how they are thinking. When a team member passionately defends her team's selection against countervailing positions, whether she is wrong or right, you know that you have a “teaching moment.”
• 어떤 교수들은 강의를 마치고 나서 박수갈채를 받으면 스스로 훌륭한 선생님이 된 것처럼 느끼지만, 그 50분 동안 어떤 순간에 학생들이 실제로 당신이 가르치는 내용에 대해 생각을 하고 있는지를 정말 알 수 있는가? 새로운 상황이나 문제에 배운 내용을 적용할 수 있을지 여부는 언제 알게 되나? 시험볼 때?
  Some instructors feel they are excellent teachers when students applaud after a lecture. But, at what point during the 50 min do you really know how students are thinking about the concept you are teaching? When do you know if they can apply that concept to a novel situation/problem? At the exam?

• Simultaneous report. A key to energizing team discussions is using procedures that make teams accountable for reaching and being prepared to defend a decision. Having teams work on the same problem is essential for intra-team accountability but it is not enough.
• 보통 교수자가 책임을 회피하는 두 가지 방법이 있다 : (1)자원자 찾기(다른 조가 리스크를 떠안기를 마냥 기다린다) (2)무작위로 부르기 (처음이라 운이 나빴네요 or 앞에 한 팀의 의견에 동의합니다.
  Instructors often reduce accountability in one of two ways. First, students discover that you have a pattern of calling for volunteers (e.g., “which team would like to give their answer?”). Students know that it is pretty safe to sit back and let the other teams risk giving what might be an incorrect answer. Second, if your practice is to randomly call on one of the teams to give their answer, students’ motivation to “get it right” is significantly reduced by their realization that, even if they do not have an answer, they have two minimally embarrassing options. If they are the “unlucky” team that gets called on first, they can say, “We haven’t had time to reach an agreement and, if they aren’t the first team to be called on, they can say, ‘We agree with team ___’ (i.e., the team that reported first).”
• 그러나 TBL에서는 모든 조가 동시에 자신들의 결정을 밝히고 그것에 대한 대응논리를 만들기 때문에 위와 같이 되지 않는다. 
  With TBL, however, teams are fully accountable because students are informed from the beginning that all of the teams will have to report their answers at the same exact moment and their task is to make a decision and be prepared to defend it. As a result, the interaction during the Team Application follows a distinct pattern. When the learners first begin grappling with the problem, there is often quiet in the room as they read and ponder individually for a few moments, then a low-grade “buzz” starts as members of teams start sharing their impressions, raise questions, and assign searching tasks to one another – in short, enjoin a strategy for making a decision within the timeline of the exercise.
• 자기 조의 최종 결론을 밝혀야 되는 순간이 오면, 모든 팀은 다른 사람이 모두 볼 수 있도록 동시에 답을 내놓는다. 
  When time is called for the posting of all decisions, teams simultaneously post their answers for all to see (e.g., by displaying a numbered or lettered card, putting up a poster, using Audience Response System “clickers,” etc.).
• 팀 내의 논의가 이뤄지는 동안 교수자는 방을 돌아다니면서 어떤 대화가 이뤄지는지 보고, 들은 내용을 기억했다가 이어지는 토론에서 활용하는 거시다. 다른 소그룹과 다르게 각 팀은 같은 문제에 대한 답을 내놓아야 하고, 다른 팀과 경쟁을 통해서 상당한 논의과 활력이 오간다. 
  If the Team Application case and questions have been written well and are tightly linked to the learning goals and the readiness assurance process (RAP), then, it is rare that a team will have questions for the instructor during the time they are trying to reach a decision. As the instructor, your task is to roam around the room and listen in on the team conversations and learn how they are processing the assignment, remember what you hear and use it in the class discussions to follow. Unlike any other small group work, the requirement that each team must make a decision on the same difficult question, and be in competition with other teams, generates a great deal of noise and animation in the classroom. The better your questions, the more lively the room becomes until the time for posting decisions.
• 각 팀의 결정이 공개되면, 교수자의 임무는 각 팀의 최종결벙을 활용해서 팀간 토론을 유도하는 것이다. 
  Once the teams’ decisions have been revealed, your job is to use the teams’ simultaneous reports as a catalyst for facilitating the inter-team discussions. What are the ways to facilitate the class discussion, generating dialogue and debate between teams? Go for the “Why?”: “Why did your team make this decision?”, “Explain your thought processes.” To a different team with a different answer: “Let's hear your rationale, why is it better than what we have just heard?” If there are many teams in the classroom, it is not necessary to get an oral defense from each team – this may bore the others and be too much like the usual small group work project sharing.

촉진기법 팁

Some facilitation tips:

• 유용한 어플
  When you call on a team to explain, select a specific student from a random list sheet or use Teacher's Pick™, an APP for the iPHONE or iPAD (http://itunes.apple.com/us/app/teachers-pick/id320221052?mt=8) – do not ask for a representative of the team to speak because the team's extravert will always do it.
• 말하는 학생은 일어나서 하도록
  Make a rule that anyone who speaks to the whole class must stand up or use a microphone, and get in the habit of moving away from the student who is speaking so that he/she will speak louder.
• 교수가 아니라 팀원한테 말하게 하라. 교수자의 결론은 최대한 아껴두라. TBL에서 학습은 교수자가 던진 질문에 의해서 프레이밍된다. 
  At first, the speaking student will try to talk to you since you asked the question. Inspire them to speak to the other teams, not you. Remember: your teaching moments are framed by the questions you ask about their decisions, their thought processes; save your own conclusions about the question until they are all in suspense about the “best” decision, then explain using what you have heard in their propositions.
• 체크리스트
  Before the session, review each of your readiness assurance test (RAT) and Team Application questions with this checklist:
• What is the key learning point from this question?
• Where would the student have been exposed to the information needed to answer it?
• What if all teams get it right? Do I move on to the next question? Do I give them a few more minutes to post what they think is the “Second Best Answer”?
• What if all teams get it wrong? How will I show them my thinking about what I selected as the right answer?

Step 3 – Individual readiness assurance test/team readiness assurance test

국가시험 수준의 우수한 MCQ가 필요함

Preparing the Team Application (tAPP) first, enables you to design RATs that truly prepares the learners for the tAPP – you know what they need to know to apply the content to meaningful problems. The questions should be in multiple-choice format (MCQ) and they should be well constructed so that their quality is equivalent to your end of course/term or licensing examination. A great source for writing effective MCQs is the National Board of Medical Examiners Item Writing Manual, downloadable at their website (www.nbme.org/publications/item-writing-manual.html).

몇 개 문항이 필요할지는 내용의 복잡성 정도와 가용 시간에 달려 있다.

How many questions you prepare depends on the amount and complexity of the content, and how much time you have in your course design for TBL. On the one hand, you do not want to overwhelm the learners with lots of MCQs where they feel they are always studying to take a test, but you and they do want to have regular assurance that they are mastering the content and that the work they have done preparing is important by being assessed.

문항은 큰 그림에 초점을 둬야 하며 세세한 내용에 대한 것이어서는 안된다.

Another key is that the questions should focus on the big ideas not the details. If they really understand the big ideas, they are prepared to learn the details when they try to use them to make the decisions that are part of the Team Application.

There are two parts to the RAT: individual and team. Learners take the iRAT at the beginning of the session, recording their decisions using a Scantron™ or Audience Response System “clickers.”

IF/AT 활용

When time is up, teams cluster and answer the exact same questions as a team, with the tRAT, making their selections on an Immediate Feedback Assessment Technique (IF-AT™) form. The IF-AT is a multiple-choice answer form with a thin opaque film covering the answer options. Instead of using a pencil to fill in a circle, students scratch off the answer as if scratching a lottery ticket. If the answer is correct, a star appears somewhere within the rectangle indicating the correct answer. Students earn partial credit for a second attempt and learn the correct response for each question while taking the tRAT. One member of a team is picked by the team to do the scratch off on the IF-AT form, and all are at rapt attention as he/she determines whether or not the team's decision on a question is the preferred one. Generally, teams will give out a small cheer when right and a light groan if wrong. If they do not get it right the first time, they will immediately re-engage on that question and make another selection, but not without careful consideration since the stakes are higher. More information about the IF-AT form is available at the Epstein Educational Enterprises website (www.epsteineducation.com).

Always structure time for the discussion of the RAT after the team process, and when you use the IF-AT, encourage teams to select the one or two questions that they would like the whole class to discuss. Although they know your designated “correct” answer from the IF-AT, if you crafted the questions well, then there should always be two to three questions that really challenged them and they will want to discuss, or even appeal (see step 6 – Appeal).

왜 IF-AT를 사용하기를 권고하는가?

We strongly recommend using the IF-AT in the tRAT. These are our reasons:

• tRTA은 각자 학습해 온 것을 설명하고 공유하게 만든다. 처음에는 투표로 하다가 나중에는 토론을 통한 합의를 이뤄나갈 것이다.
  Whether it is the very first gathering of the team or the last in a course, the tRAT forces them to share what they have learned as they each explain why they support one answer over another. Because conflict is uncomfortable, brand-new teams will initially make their choices by voting. However, with time (and the IF-AT form speeds up the learning process) they learn that voting is risky and it is more effective to share explanations first, then discuss their way to a consensus.
• 팀 응집력을 강화시켜준다. 스크래치를 긁을 때 모든 사람이 모여들 것이다.
  The IF-AT promotes team cohesion – when the team makes its decision and scratches off the selected option on the IF-AT, everyone is paying acute attention: if they have drifted apart physically during the discussion, they move back in; if they are separated by a table, they lean in – everyone wants to see and they will need to get closer to do so.
• 오답일 경우, 부분점수를 받기 위해서라도 정답을 찾는 작업에 바로 착수하게 된다.
  If a team “gets it wrong” the first time, they immediately explore why so that they can select the “right” one next, and they are motivated to do so since they will still get partial credit.
• 지나치게 주장이 강한 사람도 언젠가 틀린 답을 낼 수밖에 없고, 이 경우 그 학생은 조금 더 조심하게 될 것이다. 
  Learners who tend to be overly assertive will inevitably be wrong on one or more of the questions. When this happens, the pushy student will become more cautious and the peers will be more willing to advocate for further considerations of an answer. Or, a learner who usually “goes along” with the crowd will eventually be put on the spot and asked to defend their choice – in effect, be encouraged to participate, especially if they have been correct and not helped the team get to the right answer.

Step 4 – Advance assignment

사전학습자료는 교수자게 제공하는 Scaffolding 같은 것이다.

Prior to coming to class, the learner needs to know what he/she must read, watch or do to be prepared for class. This is where you, the instructor, provide “scaffolding” for their acquisition of the information (content). It works best to provide them, as far in advance as possible, what must be read or done and clearly identify the level of requisite mastery so that they can be successful. You should develop or select appropriate teaching and learning activities (readings, videos, labs, tutorials, lectures, etc.) for the Advance Assignment that are aligned with the iRAT/tRAT questions, are effective and sufficient for content coverage, and that include specific learning goals.

의학의 세부사항은 무한하기에 모든 내용을 주고 싶겠지만, 핵심 개념만을 찾게 해주고, 그 개념이 무엇이며 어떻게 적용하게 되는가를 알려주는 것이 좋다.

In the health sciences, there is an infinite amount of detail within many critical complex concepts. As tempting as it is to list all the content that they must learn and then test them on it in the RATs, it is far better to identify the key concepts and inform students what the concepts are and how they will be expected to apply them. For instance, autonomics is one of the most complex areas in medicine, and there are a great many agents whose names must be memorized along with how they affect different receptors. Your “scaffolding” lecture or tutorial clarifies the principles of autonomics, reviews the body's anatomic structures for sympathetic and parasympathetic systems, notes a few of the prototypical agents/transmitters, and leaves them with a handful of practice problems; the answers to be provided the next day or posted online. Memorizing the many agents that interact with the autonomic nervous system is a requisite task, like memorizing the multiplication tables, and doing so will “stick” better if done in the context of the “bigger picture” with as many practice exercises as possible.

어떻게 준비할지는 학습자가 결정한다.

Learners decide how they can best prepare: some study alone, some will form a study group, and some will use their class team as a study group. You do not have to recommend or suggest any; let them figure out what works for them as individuals and as teams.

After the first couple of TBL sessions, students will have determined how much time and energy they need to devote to the Advanced Assignment. Their scores on the iRAT, tRAT, and tAPP let them know how they are doing with the material as the course moves along.

Step 5 – Instructor clarification review

교수자가 RAT에서 어려웠던 개념을 명확히 해주는 단계. 그러나 이 부분은 강의도 아니며, 모든 개념을 리뷰해주는 것도 아니다. 

The RAP should include an instructor Clarification Review, in which students get clarification from instructor on the concepts they have been struggling with during the tRAT. At the end of the Clarification Review, students should feel confident that they are adequately prepared to solve more complex problems for the next TBL step: the Team Application. An effective Clarification Review predicts/addresses knowledge gaps (focused on the concepts that the students are struggling to understand), is neither a lecture nor a review of all concepts, and supports the development of critical thinking skills.

You should design the Clarification Review only after you have created the tAPP and RAT questions, since the purpose of the review is to better prepare students for the tAPP by addressing learning gaps identified during the tRAT.

Step 6 – Appeal

어필을 받아들이게 되면, 그 팀은 추가점수를 받게 된다. 두 가지 이유가 있다.

Teams should be able to Appeal a question in the RAP or the tAPP. If you accept their Appeal, then only that team is awarded the credit. There are two reasons for an Appeal:

• the team thinks that they were misled by the way the question was written and, to have the appeal granted, they must re-write it so that you agree that it is much clearer;
• the team is convinced that their answer is best and they can support this position through argument and/or valid source material which they reference.

어필이 들어왔을 때 생각할 시간이 필요할 수 있다.

Sometimes in the class discussion you hear an argument for an answer that is compelling, one you have not even thought about and, even though it is not normally done, you can award credit on the spot for their brilliance. More often, you need some time to process the arguments, as do the teams submitting appeals.

모든 학생들이 어필에 대한 당신의 결정을 알게 하라

Keep the turn-around time as brief as possible and let the whole class know of your decisions. If the Appeal process is done in the spirit that everyone, including the instructor, can learn more, then it encourages more discussion and deeper learning.

자신의 주장을 무한정 내세우려는 일부 학생들에 의해서 곁길로 새지 않아도 된다는 장점이 있다.

A distinct advantage of a genuine process for Appeals is that you will not be sidetracked during the class by a few students who want to argue their position ad infinitum. It will allow them and you some reflection time and opportunity to better articulate a position.

TBL non-recurring steps

Team formation

최대한 오래 같이 있을수 있는 팀을 구성하라

Ideally, create teams that can stay together as long as possible. Sometimes this means for a year, a semester, or even a 4-week clinical rotation. There are four principles for assigning students to teams:

• 스스로 팀을 짜게 하지 말라 Never let them self-select!
• "플러스 요인"이 무엇일지 고려하라 Determine what you consider to be “wealth factors” in the class, for instance, previous work experience in healthcare or having an advanced degree in a health science field like biochemistry or physiology. Distribute all such students across different teams.
• 최대한 각 팀의 구성을 다양하게 하라 Ensure that each team has as much diversity as possible. This is highly contextual and you must explore the potential characteristics in the class that represent diversity. For instance, if your school draws from a wide geographic area that includes rural and urban settings, the teams will benefit from having members from both. Gender balance, if possible, is also desirable.
• 팀 구성 단계를 투명하게 밝혀라 Make the assignment process transparent. Students should never wonder how they were assigned to a particular team.

Orientation

대부분의 학생은 TBL이 새로운 경험이므로 오리엔테이션이 필요하다.

For most students, TBL will be a new experience. The TBL Collaborative website has a link called “Orienting Students” with tips on how to introduce TBL to your students through a TBL sample session (www.teambasedlearning.org/Default.aspx?pageId=1032382). You can create the sample session using TBL content (based on a brief TBL article), or using the course syllabus as the first Advance Assignment.

가장 어려운 부분 중 하나는 학생들이 미리 준비해오도록 하는 것이다. 학생들은 '시험만 잘 보면 되지 왜 수업에 준비를 해와야하지?' 라는 의문을 가질 수 있다.

Often the biggest hurdle is student attitude about preparing for class – so many are accustomed to coming to class to be told what will be on the exam, so why prepare for a class? With TBL, they must prepare using the Advance Assignment in order to pass or do well in the course. Classroom time shifts from being a time to transmit information to problem-solving with course content that is learned largely outside of class. This becomes very clear during the Orientation session.

Peer evaluation

동료평가의 중요성에는 이견이 없다.

There is little question about the importance of our students in the health professions learning how to give and receive constructive feedback from peers since they will need this skill set in the work setting with team members from several disciplines. We recommend the development of a process that encourages students to highlight the positive behaviors of their peers and develop the skills for constructive feedback. There are several viable models for conducting peer evaluation, all of which include:

• 각각의 구성원을 팀에 대한 기여도와 개인별 학습으로 나누어 평가
  evaluation of each teammate on his/her contributions to the team's success and their own learning;
• 양적, 질적 요소 포함
  both a quantitative and qualitative component;
• 효과적인 피드백을 주는 가이드라인 제공
  guidelines on how to provide helpful feedback.
• For instance, for a qualitative query:
• “What is the single most valuable contribution this person makes to your team?”
• “What is the single most important thing this person could do to more effectively help your team?”

Grading

As with Team Formation, there are some principles for how to grade TBL:

• TBL이 전체 과정에서 반영되는 시간의 비율이 반영되어야 함. The percentage of time of a course that is devoted to TBL must be reflected in the course grade. For example, if it is a 12-week course and TBL is used for about one half of the contact hours, then it should count for about one-half of the final grade.
• TBL의 각 요소에 가중치를 두어서 Each component of TBL has a weight in the grading scheme and it will work best if the students have some responsibility in determining this within the limits you set.
• 동료평가도 포함되도록 The peer evaluation should also count as part of the TBL grade.

An example of a TBL grading scheme would be:

iRAT = 25%

tRAT = 35%

tAPP = 35%

Peer evaluation = 5%

What are the TBL critical contextual factors?

대학의 문화 Institutional culture

For TBL to be successful in a course or throughout a curriculum, it needs sanction if not support from the administrative leadership. Often, the simple support position of “classroom time needs to be used for solving problems and not just transmittal of information” goes a long way for faculty to consider using TBL.

Although there is good support in the literature for the effectiveness of TBL for a wide range of subject areas (www.teambasedlearning.org/refs), there are strong biases by faculty and administration against any active learning in the classroom. Some very experienced, and often talented, instructors grew up on the lecture-format and are wedded to it as the best way for students to learn – to be exposed to great minds such as theirs.

The administrative leadership may give in to these “sages on the stage” if they are large grant generating faculty whom they do not want to lose to the competition. In our experience, one faculty member or a small group of faculty can get started with TBL and generate both positive academic and student satisfaction outcomes within a couple of years. Students can become the best “salespersons” for having active learning in the classroom.

교수 개발 Faculty development

There are several steps that a group of faculty can take to make their transition to using TBL successful:

• 관련 워크숍 참여 Participate in several training workshops on TBL. If your aim is to have a few individuals experiment with TBL, have them attend the TBL Collaborative Annual meeting or equivalent venue. If your aim is to have a substantial part of your curriculum taught with TBL, you will need to bring one or more consultants to your campus first to introduce TBL to your faculty and later to help them refine their TBL course design and delivery.
• TBL학습 커뮤니티 개발 Once you have some pilot TBL courses up and running, establish a TBL learning community on campus or with neighboring institutions.
• TBL 전문가로서 조언을 받을 수 있는 조언자 찾기 Identify a consultant, someone experienced with TBL who can critique materials, observe initial sessions and help troubleshoot the problems that will inevitably arise.
• 모든 모듈 자료에 대해서 동료평가 받기 Peer-review all module materials, especially the MCQs in the RAP and the questions for the tAPP – this must include careful editing of the questions for grammar, syntax, and format, matching of module objectives to the materials, and framing of tAPP questions so that they will generate good, thoughtful discussions within and between teams.
• TBL의 교육과정 설계의 핵심이 되도록 하기 Ensure that TBL is an integral part of the course or curriculum design – it will flop if it is just plugged in without being well-linked to the other components (Fink 2003).
• 학생을 참여시키기 Involve students, both to introduce them to how TBL works and get constructive feedback from them after a session.

학생 참여 Student buy-in

학생들은 오리엔테이션을 받아야 한다. Wright State University Boonshoft School of Medicine 의 사례

Students must have orientation to TBL, and there are several ways to do this. 

At Wright State University Boonshoft School of Medicine (www.med.wright.edu), we have used the following:

• 제1일 First day of class, give them the article “Three Keys to Using Learning Groups Effectively” (Michaelsen 1998) to read in class, then form teams, give them a iRAT and tRAT on TBL from the article, end with a couple of application questions about TBL.
• 수업 전 Before class, ask students to study the course syllabus, i.e., grading, attendance, papers due, key topics, exam schedule. At class, conduct a TBL session on the syllabus. After this first TBL session, make time at the end to review with them the objectives for the session and ask if they feel they met the objectives through the TBL experience.

Duke-NUS의 사례

At Duke/NUS Singapore (www.duke-nus.edu.sg/web), they conduct a TBL session as part of the medical student interview process; highlighting the value and benefits of TBL, the general process, and use it a bit as a marketing tool. Once students are accepted, they participate in a series of workshops that reinforce the process, the skills for team development, review of how study habits might change, and a practice session with a review.

공간, 음향시설 Space/acoustics

TBL은 장소에 크게 구애받지 않는다. 

TBL is very adaptable to a variety of space restraints, such as fixed seating in an auditorium. However, the best space is one in which students can easily cluster in either a small circle or around a small table. We say small table because we have seen the use of larger, eight to ten seat tables and students cannot get close enough to really “team;” besides, the large tables will have space for laptops and lots of references which get in the way of good team discussions. Remember: your Team Application problems can only be solved through discussion and deliberation, not a web search!

교수의 이상적 위치는 교수가 모든 학생을 볼 수 있으면서 모든 학생이 서로를 볼 수 있는 곳이다. 

The ideal setting has a spot for the instructor in which he/she can see everyone in the classroom AND all students should be able to see each other. If a student can stand up, speak and be heard by all in the room, then you do not need an amplification system. The best amplification system has microphones at each table or cluster area; passing around a single mike can be cumbersome.

Why do we feel that TBL is an excellent instructional strategy for education in the health sciences?

What are the outcomes to date and what are important questions to answer in the future?

TBL in medical education is relatively new, and the evidence for its academic effectiveness is only beginning to grow (Nieder et al. 2005; Letassy et al. 2008; Shellenberger et al. 2009; Koles et al. 2010; Thomas & Bowen 2011).

변형된 형태를 사용하는 경우가 많다. 

One of the confounding issues in evaluating the literature to date on TBL is that authors have modified the strategy, sometimes extensively, and do not indicate this in the title. In fact, one must scrutinize the methods to learn exactly what was done, i.e., how were teams created, were the three key components used?

의학교육자들은 점차 TBL 모듈을 디자인하는 것에 능숙해지고 있다.

We feel that as medical educators become better at designing TBL modules, ensuring their integration in a course or curriculum, and clarifying what the desired academic outcomes are, the results will be very positive, especially in contrast to a pure lecture-based curriculum.

다음의 연구가 필요하다

We also feel that there are non-academic outcomes that are particularly important for future investigation:

• Does peer evaluation lead to enduring positive changes in how students collaborate?
• How does the decision-making process within a team help students make better decisions independently?
• Since there is emerging evidence for “collective intelligence” within small groups, (Woolley et al. 2010), what characteristics should we use to assign students to teams?
• Does TBL improve clinical reasoning and/or critical thinking skills? If it does, then how can we enhance this outcome?

Why is TBL unique in small group learning?

Small group learning, when done well, as described in the recent AMEE Guide 48 (Edmunds & Brown 2010) provides students with rich opportunities to explore, explain, and understand course material while learning how to communicate, collaborate, and problem-solve as they might in the workplace.

PBL과의 차이

Since PBL is probably the most commonly used small group learning strategy in medical education to date, we consider it relevant to highlight the several differences between PBL and TBL (Table 1).

What additional characteristics make TBL a good fit for healthcare professions education?

TBL의 장점

These are additional characteristics of TBL that make it unique and particularly well suited for health professions education:

• 다양한 활용도 Versatility of use. Large or small classes; single or series of sessions; whole or portions of a course; blends with lectures, labs, other learning activities; inter-professional education activities.
• 효과적 팀 구성 Effective team formation. Teams are created thoughtfully and transparently, and ideally teams stay together for as long as possible.
• 교실 밖 준비 Out-of-class preparation. The Advance Assignment informs the learner what he/she needs to master before coming to class in order to be prepared for the RAP and decision-based application assignments that follow.

Immediate feedback

Immediate feedback on both individual and team performance is inherent in the process so that students know “where they are” with respect to understanding both the content and its application. The instructor also has continuous opportunity during the class period to know how learners are thinking about the material as they grapple with using course concepts to solve real-world problems and make medical-practice decisions.

• Peer evaluation. Peer evaluation counts and, when the process is properly designed and managed, learners learn how to provide constructive feedback to peers and learn how to adjust their own behaviors to become more effective participants within their teams. This is an increasingly important component of TBL since healthcare professionals are frequently evaluated by their patients, colleagues, administrators, and other members of an allied healthcare team.
• Authentic problems. The primary emphasis of the instruction focuses on solving problems, usually based on case vignettes with realistic data and images, that are as authentic as possible, and the choices that the learners have to make force them to partake in the decision-making process that they will regularly encounter in the clinical arena.

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Med Teach. 2012;34(5):e275-87. doi: 10.3109/0142159X.2012.651179. Epub 2012 Apr 4.

Team-based learning: a practical guide: AMEE guide no. 65.

Parmelee D1, Michaelsen LK, Cook S, Hudes PD.

Author information

• 1Boonshoft School of Medicine, Wright State University, PO Box 927, Dayton, OH 45401-0927, USA. dean.parmelee@wright.edu

Abstract

Team-based learning™ (TBL) is an instructional strategy developed in the business school environment in the early 1990s by Dr Michaelsen who wanted the benefits of small group learning within large classes. In 2001, a US federal granting agency awarded funds for educators in the health sciences to learn about and implement the strategy in their educational programs; TBL was put forward as one such strategy and as a result it is used in over 60 US and international health science professional schools. TBL is very different from problem-based learning (PBL) and other small group approaches in that there is no need for multiple faculty or rooms, students must come prepared to sessions, and individual and small groups of students (teams) are highly accountable for their contributions to team productivity. The instructor must be a content-expert, but need not have any experience or expertise in group process to conduct a successful TBL session. Students do not need any specific instruction in teamwork since they learn how to be collaborative and productive in the process. TBL can replace or complement a lecture-based course or curriculum.

PMID:

 

22471941

 

[PubMed - indexed for MEDLINE]