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Our History Year 2000: Singapore’s initiative to be THE biomedical hub in Asia Year 2005: Agreement signed Year 2007: Pioneer class starts school Year 2011: First Class Graduates Recruiting for 6th intake in 2012

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Our Education Mission Duke-NUS Medical School

Science Knowledge Communication

Medical Practice Improve Medical Practice

Critical thinking Teamwork Creative

thinking

Leadership Professionalism & Ethics

Research

Clinical Experience

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1st year

2nd year

3rd year

4th year

1st year

2nd year

3rd year

4th year

Research Clinical

Basic Science

Clinical

Basic Science

Duke & Duke-NUS Typical US MD Program

Duke/Duke-NUS MD vs. Conventional MD

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“The learning process can be divided into the accumulation of bits of information (memory) and the movement of these bits into patterns (thinking)…

The compulsive learner is incapable of thinking. There is

always another bit to be memorized and, if they are all learned, there is little time to rearrange the bits. It is also clear that without any bits there is no thinking.

The hardest theoretic question in educational circles is

the determination of the optimum number of bits for the most effective manipulation.”

Eugene Stead, MD Chairman, Department of Medicine Duke University School of Medicine

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PLANNING THE CURRICULUM

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Students have changed

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Retention: 1st 10 mins: 70% last 10 mins: 20%

(McKeachie, 1986)

Paying attention: 40% (Pollio 1984)

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Patient care is a team effort

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15,000-17,000 medical journals!!!

15,000 to 17,000

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Forgetting curve

Hermann Ebbinghaus (1850-1909)

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Studies of Learning and Forgetting Ebbinghaus, Über das Gedächtnis (About memory), 1885

Retention, is exponentially related to time, t, and strength, S:

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Cognitive Learning Theory

• Learning is not transfer of info into an empty vessel

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What Faculty Wanted Engaged Students - Asking Questions

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Reinforcement of Content with Media

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Teams in Discussion

Teamwork, Creative and Critical Thinking

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• Efficient use of Faculty time • Duke and Local faculty partnership

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Learning as Fun

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New Instructional Strategy:

TeamLEAD (Learn, Engage, Apply, Develop)

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REALITY:

Exam

Pre-work Active Learning Homework

Wishful Thinking:

Pre-work Passive Lecture Study

TRADITIONAL

Before During After

Before During After

Exam

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Before During After

Exam Video-taped

Lecture

Team Problem Solving

Review

TeamLEAD:

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Group/Team Learning

Problem Based Learning

Collaborative Learning

Team Based Learning

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Team-Based Learning TBL© is a teacher-directed strategy for incorporating

small-group active participation in large-group educational settings.

Definition

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First Need to Form Teams…

• Principle: When forming teams, you want to ensure a distribution of resources and maximize participation of all members

• Operationalized: – Aim to identify important resources available to

individuals (background, degrees, experience) and equally distribute those individuals

– The teacher forms the teams – not students – 5-7 individuals per team

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Components of TBL Sequence of Learning

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Preparation Phase

All Possible Content

Core Principles

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Components of TBL Sequence of Learning

IRAT

GRAT

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Readiness Assurance Phase

All Possible Content

Sampling of Core for RAT

questions

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Group Readiness Assessment

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• Individual accountability promotes preparation • Group accountability promotes effective participation • Controversy stimulates discussion

Transform Groups to Teams Readiness Assurance Phase

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Components Sequence of Learning

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Application Phase

All Possible Content

Sample of Content/RAT

Application

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Elements of Effective Application • Significant Problem • Same Problem • Specific Answer • Simultaneous Reporting

• Problems that require the brainpower of the whole Team to solve

• You want the ‘why’ for their answers

• Teams teaching Teams

The 4 S’s

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Difference between Application and Readiness Assurance Questions

Lower Order Higher Order

IRAT Facts/Principles

Application Using & demonstrating knowledge & understanding

Number Questions

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Application Phase

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Backward Design

Problem to Solve, Principle to Apply in significant situation.

Where would they find the information – resources, content?

What key principles or facts do they need to know – in order to solve the problem? – how do you know they know it?

Application RATs Pre-work

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Components Sequence of Learning

R. Levine

Peer Evaluation

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“Guide on Side”

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BUT….

• There is up-front work to do. Faculty : – Need to really understand what you want students to

be able to do with this information. – Need to define the appropriate pre class learning

activities – Faculty need to design appropriate RAT and

Application Questions (which is hard work) – Focus on what drives learning behavior

• Plus Faculty have to be willing to say “I don’t know” (there is nothing more scary than well prepared student).

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And…..

• Some students will still prefer passive learning (it is hard work for them too). Faculty need to: – Prepare them for the experience – Provide sufficient time to do pre-work – Make sure the RATs and Applications are meaningful

and engaging – and they will appreciate the work • Students do prefer this type of group work over

typical small group activities – because everyone is involved.

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When would you NOT use TBL?

• When you: – Don’t expect people to actually need to apply or use

the information you are giving them – Need individual assessments (like papers) and not

promoting team collaborations. – Don’t need everyone to be at the same level of

knowledge – Are giving inspiration talks, general info – Do not have sufficient time – Or the Faculty are not willing/prepared to do upfront

work

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• “You need to lecture to “guarantee” students get all of the information,

• “Medical School is about memorization and lecturing is the best way for them to learn the material”

• Smart students can learn themselves (they don’t have to attend class – but in TBL they will be there and on time)

• Evidence doesn’t support the notion that lecturing is the best way to deliver large amounts of information to student

What we heard and what we learned:

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• Team process “over-inflates” grades of lowest performers and holds back others

• Everyone’s learning is improved • They teach each other • Teamwork and language skills improve • Reduces isolation of students

What we heard and what we learned:

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• “Students won’t learn if they have open book/internet” • It helps reinforce learning

What we heard and what we learned:

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• “I won’t know if the students ‘really’ know anything because of team work masks individual performance.”

• The power of Why? – TBL permits effective facilitation enables you to understand students’ thinking processes more effectively than any passive lecture can.

What we heard and what we learned:

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• “If they are having fun, they can’t be learning”

What we heard and what we learned:

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For more info:

• www.youtube.com/insidedukenus • http://www.tblcollaborative.org

www.duke-nus.edu.sg