Team-Based Learning and Undergraduate Anatomy: A Good Match

Team-Based Learning has often been used to teach anatomy and physiology courses in medical school and at other graduate schools in the health professions, but these courses are still uncommon in undergraduate programs. I have found TBL to be a perfect fit for this topic and level.

The Anatomy and Physiology courses at UMBC, like at many institutions, are a two-semester, sophomore-level biology courses taken primarily by pre-health students. The 100 or so students that enroll each semester are equally distributed among those planning careers in nursing, physical therapy, pharmacy and medicine. The TBL version of the course is divided into seven units, each of which begins with a Readiness Assessment Test (IRAT and TRAT) and ends with an application exercise. Teams are fixed and students are given required readings before class which are the basis for the RAT.

Application activities, an integral part of each module, are structured using "4S" principles and emphasize the most challenging goals for each unit. Each application activity is projected on slides to be reviewed by the teams. I have learned the following lessons about designing effective application activities which may be helpful to other faculty teaching undergraduate TBL courses:

Use relatively simple clinical applications to provide significant, specific-choice problems. For example: You're in the dentist's chair, awaiting your root canal. The dentist pauses, needle in hand. "Which cranial nerve should I block?" she asks. 

After teams use voting cards to indicate their choices, have them place the cards on stands (such as seating places at a wedding might be marked) so everyone can see and remember each team's choice. 

When facilitating team discussions choose individuals randomly during facilitation to report their team's reasoning. This prevents one or two students from becoming the team's spokesperson or spokespeople, and forces weaker or less focused students to work to understand the team's answer and reasoning.

Application exercises should be kept short. A long, complex problem can be broken up into smaller pieces. This keeps the teams on track and minimizes chatter about their weekends, as students usually have only 2-3 minutes for each problem or piece of the problem.

"Significant" doesn't always mean "Realistic." Some of my best applications-meaning, those that produce the best within-team and between-team discussion-are my "Alien Ray Gun" questions, in which a pictured cartoon alien threatens to vaporize one of various cell types within a tissue, tissues within an organ, or organs within an organ system, but kindly allows the victim to choose which. Choosing between types of T lymphocytes, for example, or whether to vaporize their stomach or colon, teams become highly invested in their answers while at the same time learning the nitty gritty functional relevance of each cell type or organ - which is, of course, the point! 

Direct competition among teams is a useful tool. Often, the times of highest enthusiasm and participation in my classroom are the ten-question "For the Pie" competitions, usually held shortly before individual exams, in which student teams compete on a series of short, tough questions to win homemade pie baked by the instructor. Although the "For The Pie" times are not advertised, students learn to predict them and often seem to study harder for them than for the actual test!

This approach has, over three years, been highly successful. The DFW rate (percent of students receiving Ds or Fs or withdraw from the course) is very low since TBL was implemented, less than 5% per year, versus 15-30% before using TBL. Student satisfaction is high, based on both official student evaluations and mid-course anonymous surveys. When compared to lecture, students give the TBL course significantly higher ratings for both how much they learned as well as the instructor's overall teaching effectiveness.

A pre-posttest is given in each semester for the TBL course. Results reveal that students more than double their knowledge each semester. Additionally, students retain more material from A&P 1 than students who took the course the same year in a lecture format.

The major benefit that TBL provides is the time to explore complex and interesting problems in class with your students. By keeping the organization and flow tight and focused while allowing for misconceptions and messiness to flow freely during facilitation, the course allows students to get confused (a state that is all too lacking in lectures) in an environment that facilitates the transformation of that confusion into new understanding - learning!

Sarah Leupen, PhD

University of Maryland