Self-Directed and Lifelong Learning: the 5th “S” for TBL™ Application Exercises?

Abstract

This paper describes a pilot of an innovation to TBL™ as a means to add a fifth “S”, self-directed learning (SDL) and life-long learning (LLL), to the 4S application exercise framework. It is important for TBL™ to explicitly address SDL and LLL to enhance student learning and meet accreditation standards.

The Liaison Committee on Medical Education Standards for Accreditation of Medical Education Programs Leading to the MD degree make specific reference to the concept of “self-directed learning (SDL)” in Element 6.3, which states that medical school curricula should allow for experiences that involve “medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources” [1]. This description is very similar to Knowles’s conceptualization of SDL and also embraces the concept of lifelong learning (LLL) [2]. SDL and LLL are also the essence of one of the Accreditation Council for Graduate Medical Education core competencies: practice-based learning and improvement, which is linked to seven of the thirteen core entrustable professional activities (EPAs) for entering residency [3]. As medical schools work towards operationalizing competency-based medical education through EPAs, instructional approaches used within the undergraduate medical education space should support this effort.

Team-based learning (TBL™) is an increasingly popular instructional strategy used by health professions educational programs. While the fundamental principles of TBL™ emphasize accountability, teamwork, and learning through retrieval practice and collaboration, SDL and LLL are not explicitly addressed in the traditional 4S model for application exercise development. Our approach was to create an activity that could be incorporated into a TBL™ module as a conclusion to the application exercise to augment students’ SDL and LLL skills, called Personalized Learning and Unified Synthesis (PLUS).

We piloted TBL™-PLUS at the University of Illinois College of Medicine at Chicago in two preclinical courses—M2 Pathology and M1 Basic Immunology & Microbiology—during academic year 2016–2017. During the last 45 min of the TBL™ session, each team identifies a learning need or gap and formulates a question, performs a literature search, identifies and analyzes one or more sources with regard to strengths and weaknesses, and synthesizes the information to answer the question. One member of the team posts the team response to the discussion board on the course learning management system (Blackboard) site, and within 1–2 weeks, faculty provide feedback to the team about their information seeking and critical appraisal skills using a rubric.

Some important feedback emerged from student evaluations of TBL™-PLUS. First, students felt it gave the team an opportunity to fill a learning gap that they may not have pursued after a typical TBL™. They also felt the instructions, which included a sample team submission, were clear and straightforward. However, some students reported the purpose of the exercise was unclear as well as which specific aspects of critical appraisal were meant to be practiced. They recommended that for future sessions, we provide a short video describing the background and foreground questions, and what resources are useful to answer which type of question.

We believe that adding another “S”, SDL, and LLL, is a logical evolutionary step for the TBL™ application exercise framework to further enhance student learning and address accreditation standards across the health professions. TBL™-PLUS is one of many possible strategies that can be used to accomplish this innovation to TBL™.

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Conflict of Interest

The authors declare that they have no conflicts of interest.