중국 의학교육에서 TBL의 효과성에 대한 메타분석 (BMC Med Educ, 2018)

중국 의학교육에서 TBL의 효과성에 대한 메타분석 (BMC Med Educ, 2018)

Meta-analysis on the effectiveness of team-based learning on medical education in China

Minjian Chen1*, Chunhui Ni2, Yanhui Hu3, Meilin Wang1, Lu Liu4, Xiaoming Ji1, Haiyan Chu1, Wei Wu5, Chuncheng Lu1, Shouyu Wang1, Shoulin Wang1, Liping Zhao6, Zhong Li7, Huijuan Zhu4, Jianming Wang8, Yankai Xia5 and Xinru Wang5

배경

Background

방법

Methods

연구 설계

Study design

In this study, we planned and conducted meta-analysis following the guidelines of preferred reporting items for systematic review and meta-analysis protocols 2015 statement recommendations [14].

문헌 검색

Literature search

포함 기준

Inclusion criteria

자료 추출과 퀄리티 평가

Data extraction and quality assessment

통계적 풀링과 이질성 평가

Statistical pooling and evaluation of heterogeneity

민감도 분석

Sensitivity analyses

출판편향 평가

Publication bias evaluation

결과

Results

연구 특징과 퀄리티 평가

Study characteristics and quality assessment

The inclusion process of all studies is shown in Fig. 1.

Table 2 shows the methodological quality of the 13 included studies.

자료 통합

Data synthesis

The effectiveness of TBL on medical education was assessed by pooling theoretical examination scores, and the results on the learning attitude and self-directed learning skill are shown in the present study (Fig. 2, Table 3).

We found that TBL significantly increased students’ examination scores when compared with LBL in random-effects model (SMD= 2.46, 95% CI: 1.53–3.40, I2 =98.0%, Pheterogeneity < 0.001) (Fig. 2,Table3).

이질성 평가

Test of heterogeneity

Total methodological quality는 이질성의 원인이 아니다.

We used meta-regression method to explore the sources of heterogeneity. Table 4 shows that the total methodological quality could not explain the source of heterogeneity (P = 0.975).

educational classification이 원인일 수 있다.

Meta-regression analysis further showed that education classification might be a contributing factor of heterogeneity in nonrandomized group (P=0.073) (Table 5).

undergraduate students에서 heterogeneity가 크게 감소한다.

Figure 3 shows that the heterogeneity was dramatically decreased in nonrandomized studies of undergraduate students (5-year program)

TBL은 유의한 시험성적 향상을 가져온다.

we found TBL significantly increased examination scores in random-effects model (Fig. 3) (Table 5).

여학생만으로 구성된 medical college에서 heterogeneity는 없다.

There was no heterogeneity in the pooled analysis of the medical college students of only females (I2 = 9.4%, P heterogeneity = 0.332, Fig. 4, Table 5),

민감도 분석

Sensitivity analyses

When any research was removed from the model, the significant results of TBL effect on the students’ examination scores were unchanged in these models (SMD: 2. 26–2.67, 95% CI: 1.32–3.67, n = 13) (Fig. 5).

All the above results indicated that the findings were robust.

고찰

Discussion

보고서는 학생들이 TBL에 적극적으로 참여할 때 학습이 더 효과적이며, TBL은 미국에서 높은 학생 만족도를 야기한다고 밝히고 있다[33–35]. TBL은 능동적인 학습 교육학 접근법으로서, 교사와 교실의 부족 문제를 해결하기 위하여 학생-교사 비율이 허용된 중국 같은 의학교육에 적합하다[13].

Reports reveals that learning is more effective when students are actively involved in TBL, and TBL results in high student satisfaction in the USA [33–35]. TBL as an active learning pedagogical approach fits for the status of Chinese medical education, such as permission of a large student-teacher ratio to solve the problem of lack of teachers and classrooms [13].

우리는 TBL이 풀링된 분석에서 LBL 교육학에 비해 학생 이론 시험 점수, 학습 태도, 학습 능력을 향상시켰으며, 이론 시험 점수에 대한 TBL의 긍정적인 영향도 부분군 분석과 민감도 분석에서 검증되어 중국에서의 TBL 시행의 중요성을 나타냈다. 특히, TBL과 전통적인 LBL에 대한 이러한 연구 결과는 일본과 미국에서 수행된 연구[36–38]와도 비슷한데, 이는 본 연구에서 TBL의 긍정적 효과가 국가-특이적이진 않을 수 있음을 나타낸다.

We found that TBL improved student theoretical examination scores, learning attitude and learning skill compared to LBL pedagogy in the pooled analysis, and the positive effect of TBL on theoretical examination scores was also verified in sub-grouping analysis and sensitivity analysis, indicating the importance of the implement of TBL in China. Notably, these findings about TBL and traditional LBL were also supported by studies conducted in Japan and the USA [36–38], indicating the positive effectiveness of TBL in the present study may be not country-specific.

• 중국에서는 undergraduate course(5년 과정)는 이론적이고 실용적인 가르침에 초점을 맞추고 있어서, 이 과정의 학생들은 종종 learning basis를 가지고 있다. 

• 반면 medical college(3년 과정)은 실용적 가르침에 초점을 맞춘다. 

따라서 학생들의 이론적 시험 점수는 교육 수준과 긍정적으로 관련되는 것으로 나타나(계수 = 2.69, 95% CI:0.16–5.21, P = 0.041(표 4-5), learning basis와 learning objective가 의료 교육에 영향을 미칠 수 있음을 나타낸다.

In China, undergraduate course (5-year program) focuses on theoretical and practical teaching, and its students often have better learning basis, while medical college course (3-year program) focuses on practical teaching. The students’ theoretical examination scores appeared positively related to education levels (meta-regression for all studies, Coefficient = 2.69, 95% CI:0.16– 5.21, P = 0.041) (Fig. 3) (Tables 4-5), indicating the learning basis and learning objective may impact the effect of TBL on medical education.

이질성이 낮은 학부생에 대한 비랜덤화 연구(I2 = 57.5%, Pheterynthia = 0.052), 풀링된 분석(그림 3)에서 TBL이 중국의 undergraduate students에 대한 의학교육에 긍정적인 영향을 미치는 증거를 제공하였다.

in the nonrandomized studies of undergraduate students with lower heterogeneity (I2 = 57.5%, Pheterogeneity = 0.052), significant effect was observed in the pooled analysis (Fig. 3), providing the evidence about the positive effect of TBL on medical education in undergraduate students in China.

한계와 미래 연구

Limitations and future studies

중국에서는 편의상 서로 다른 학년을 비교하는 방식으로 대부분의 교육 연구가 실시되었다. 그러나, 우리는 무작위화되지 않은 이 설계가 그 결과를 손상시킬 수 있다는 것을 주목해야 한다. 이 메타 분석에서, 무작위화가 연구 결과(계수 =-4.28, 95% CI:-7.61–0.95, P =0.021)를 변화시키는 것으로 나타났으며, 무작위화된 연구 설계를 사용하여 교육적 연구 품질을 개선하는 것의 중요성을 강조했다.

In China, most educational studies were conducted based on the comparison of different classes for convenience. However, we should notice that this nonrandomized design may compromise the findings. In this meta-analysis, we observed that the randomization appeared to change the study results (meta-regression for all studies, Coefficient =−4.28, 95% CI:-7.61–0.95, P =0.021), emphasizing the importance of improving the educational study quality by using randomized study design.

LBL은 여전히 중국에서 의학 교육을 이론적으로 가르치는 데 가장 많이 사용되는 교육학이다. 따라서 어떤 새로운 교육학적 접근법의 효과성을 LBL과 참고자료로 비교해야 하는데, 이는 매우 실질적인 의미를 갖는다.

LBL is still the most commonly used pedagogy in theoretical teaching of medical education in China. Therefore, the effectiveness of any new pedagogical approach should be compared with LBL as a reference, which has a great practical significance.

이 연구는 학생 조사에 의한 학습 태도 및 숙련도 측정의 객관성뿐만 아니라 높은 인지 수준을 측정하기 보다는 암기를 테스트할 수 있는 연구들에서 이론적 시험에 여전히 제한되어 있었다.

the study was still limited in theoretical examination in those studies which might test memorization rather than measuring higher cognitive levels as well as the objectivity of measures of learning attitude and skill by student survey.

Conclusions

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BMC Med Educ. 2018 Apr 10;18(1):77. doi: 10.1186/s12909-018-1179-1.

Meta-analysis on the effectiveness of team-based learning on medical education in China.

Chen M1, Ni C2, Hu Y3, Wang M4, Liu L5, Ji X4, Chu H4, Wu W6, Lu C4, Wang S4, Wang S4, Zhao L7, Li Z8, Zhu H5, Wang J9, Xia Y6, Wang X6.

Author information

1

Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, No. 101 Longmian Road, Nanjing, 211166, China. minjianchen@njmu.edu.cn.

2

Experimental Teaching Center of Preventive Medicine, Nanjing Medical University, Nanjing, 211166, China.

3

Safety Assessment and Research Center for Drug, Pesticide and Veterinary Drug of Jiangsu Province, Nanjing Medical University, Nanjing, 211166, China.

4

Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, No. 101 Longmian Road, Nanjing, 211166, China.

5

Department of Student Affairs, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

6

Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

7

Office of School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

8

Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

9

Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

Abstract

BACKGROUND:

Team-based learning (TBL) has been adopted as a new medical pedagogical approach in China. However, there are no studies or reviews summarizing the effectiveness of TBL on medical education. This study aims to obtain an overall estimation of the effectiveness of TBL on outcomes of theoretical teaching of medical education in China.

METHODS:

We retrieved the studies from inception through December, 2015. Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Wanfang Database, Chinese Scientific Journal Database, PubMed, EMBASE and Cochrane Database were searched. The quality of included studies was assessed by the Newcastle-Ottawa scale. Standardized mean difference (SMD) was applied for the estimation of the pooled effects. Heterogeneity assumption was detected by I2 statistics, and was further explored by meta-regression analysis.

RESULTS:

A total of 13 articles including 1545 participants eventually entered into the meta-analysis. The quality scores of these studies ranged from 6 to 10. Altogether, TBL significantly increased students' theoretical examination scores when compared with lecture-based learning (LBL) (SMD = 2.46, 95% CI: 1.53-3.40). Additionally, TBL significantly increased students' learning attitude (SMD = 3.23, 95% CI: 2.27-4.20), and learning skill (SMD = 2.70, 95% CI: 1.33-4.07). The meta-regression results showed that randomization, educationclassification and gender diversity were the factors that caused heterogeneity.

CONCLUSIONS:

TBL in theoretical teaching of medical education seems to be more effective than LBL in improving the knowledge, attitude and skill of students in China, providing evidence for the implement of TBL in medical education in China. The medical schools should implement TBL with the consideration on the practical teaching situations such as students' education level.

KEYWORDS:

China; LBL; Medical education; Meta-analysis; TBL

PMID:

 

29636039

 

PMCID:

 

PMC5894173

 

DOI:

 

10.1186/s12909-018-1179-1