Tohoku J. Exp. Med., 2012, 227(1)

Team-Based Learning, a Learning Strategy for Clinical Reasoning, in Students with Problem-Based Learning Tutorial Experiences

YUMIKO OKUBO,¹ NAOKO ISHIGURO,² TAIYO SUGANUMA,¹ TOSHIO NISHIKAWA,³ TOSHIO TAKUBO,⁴ NORIKO KOJIMAHARA,⁵ RIE YAGO,⁶ SHINICHI NUNODA,⁷ SHIGETAKA SUGIHARA⁸ and TOSHIMASA YOSHIOKA¹

¹Department of Medical Education, Tokyo Women's Medical University, Tokyo, Japan
²Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
³Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
⁴Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
⁵Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
⁶Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
⁷Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
⁸Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan

Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4^th year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in 2005, 2006, and 2007 (non-TBL students). Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure.

keywords —— clinical reasoning; medical education; medical students; problem-based learning; team-based learning

© 2012 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med., 2012, 227, 23-29

Correspondence; Yumiko Okubo, Department of Medical Education, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

e-mail: satoyum@research.twmu.ac.jp