By Sonia Kolesnikov-Jessop
Team-based learning, an educational method primarily conceived for business schools, was developed in the early 1980s by Larry K. Michaelsen, now a professor of management at the University of Central Missouri in the United States. An alternative to traditional lecturing, this method uses a mix of individual and group processes to solve problems.
In recent years, some medical schools have recognized the advantage of active learning that encourages critical thinking and have started to experiment with Professor Michaelsen's techniques.
Now, the Duke-N.U.S. Graduate Medical School, in Singapore, has gone a step further, applying this method to its entire basic science education.
“Learning is both about memorizing and thinking about what you've memorized; the hardest question in education is to figure out the right balance between the two,” said Robert K. Kamei, vice dean of education at Duke-N.U.S., a partnership between Duke University, based in Durham, North Carolina, and the National University of Singapore. “We've decided to apply this teaching method to its fullest extent because we feel it's a better way for our students to learn”.
Dr. Kamei says this teaching method encourages students to think “creatively and critically,” a mindset valuable for medical practitioners and future researchers.
“What happens when you listen to a lecture is that if you don't apply it, you tend to forget it,” he said. “Our first class did extraordinarily well using this method”.
Mr. Michaelsen says traditional lecture-based teaching does a poor job of preparing students in any field for the workplace.
“For medical students the real test is being able to use content to diagnose and treat patients - and that's a very different skill than simply remembering what the content is,” he said. “The reason that team-based learning is attractive to so many medical educators is that it is a practical approach for shifting the focus of education from covering content to applying the content to solve real and meaningful problems”.
Duke-NUS has adapted Mr. Michaelsen's method slightly. It calls its variation of the method “Team LEAD,” which stands for learn, engage and develop. But the essentials of this version remain the same as Mr. Michaelsen's method.
At the start of the year, students are divided into teams, which remain the same through the year. Before each class, they are given assignments to learn independently and in their teams. In the classroom there is an initial “readiness” phase in which they are tested, individually and in their teams, through multiple-choice questions on a scratch card.
“This is a good way to teach students to work in a team, to be able to express their opinion and critically analyze what other people say,” Dr. Kamei said.
After the readiness phase, they move on to specific case studies, tackled by applying their memorized knowledge, complemented by medical literature and notes.
“Faculty does not talk, but listens to the conversations of the students, who are still working in teams," Dr. Kamei said. "The students have to explain and defend their answers because they could have found the right answer but for the wrong reasons”.
At regular intervals, as the course progresses, the students undergo peer evaluation focused on their ability to contribute to the team effort. The results of peer evaluation contribute about 10 percent to the final grade.
“This teaching method really helps students learn how to cooperate and work as a team, teaching others," Dr. Kamei said. "They can also make a direct connection between the basic science materials we asked them to learn and a relevant clinical situation”.
Duke's medical doctoral program has always been significantly different from the training provided by other medical schools, even in the United States. Duke students cover basic science in one year instead of two. They care for patients a year earlier than their peers at other medical schools and they devote a year to independent scholarship and research. The adoption of the team method is, for now, confined to its Singapore campus, which opened in 2007.
Dr. Kamei says there is some talk about using the method at the U.S. campus, but he says there could be practical difficulties.
“We could do this here in Singapore because we're starting from scratch, but it's very difficult to change the way people have been teaching their entire career,” he said. “It's a completely different way from teaching and lecturing”.
The Singapore government has committed to investing more than $350 million over seven years in Duke-N.U.S. About one-third of this money has gone into building a campus for the school, which will become operational in June. The rest of the money will pay for faculty and staff salaries, start-up research and infrastructure.
The government's support reflects its desire that Singapore become a leader in medical research and education. In 2000, the government started a program known as the biomedical sciences initiative, investing 3 billion Singapore dollars, or $2 billion, with a goal of making biomedical sciences a main part of the Singapore economy. Duke-NUS faculty and students are expected to work closely with physicians and biomedical scientists in the recently built biomedical science research and development center, known as Biopolis, which has attracted internationally reputed scientists.
Duke's medical school curriculum, which allows students to devote a year to independent scholarship and research in areas of basic and clinical sciences, was especially appealing, Dr. Kamei said.
“This model of creating a medical school to train medical scientists is an old one, but there aren't many schools doing it,” he said. “Many schools are now finding that a very small number of their students are going into research or academia and they're trying to improve that by allowing research during their school year” [5, p. 9, 12].
