Evaluating team-based, lecture-based, and hybrid learning methods for neurology clerkship in China: a method-comparison study

Abstract

Background: Neurology is complex, abstract, and difficult for students to learn. However, a good learning method for neurology clerkship training is required to help students quickly develop strong clinical thinking as well as problem-solving skills. Both the traditional lecture-based learning (LBL) and the relatively new team-based learning (TBL) methods have inherent strengths and weaknesses when applied to neurology clerkship education. However, the strengths of each method may complement the weaknesses of the other. Combining TBL with LBL may produce better learning outcomes than TBL or LBL alone. We propose a hybrid method (TBL + LBL) and designed an experiment to compare the learning outcomes with those of pure LBL and pure TBL.

Methods: One hundred twenty-seven fourth-year medical students attended a two-week neurology clerkship program organized by the Department of Neurology, Sun Yat-Sen Memorial Hospital. All of the students were from Grade 2007, Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University. These students were assigned to one of three groups randomly: Group A (TBL + LBL, with 41 students), Group B (LBL, with 43 students), and Group C (TBL, with 43 students). The learning outcomes were evaluated by a questionnaire and two tests covering basic knowledge of neurology and clinical practice.

Results: The practice test scores of Group A were similar to those of Group B, but significantly higher than those of Group C. The theoretical test scores and the total scores of Group A were significantly higher than those of Groups B and C. In addition, 100% of the students in Group A were satisfied with the combination of TBL + LBL.

Conclusions: Our results support our proposal that the combination of TBL + LBL is acceptable to students and produces better learning outcomes than either method alone in neurology clerkships. In addition, the proposed hybrid method may also be suited for other medical clerkships that require students to absorb a large amount of abstract and complex course materials in a short period, such as pediatrics and internal medicine clerkships.

Figure 1

Comparison of the practice test scores at the end of the clerkship. The test scores of each group are represented by a thick solid line. The comparison between the test scores of every two groups is explained with a comment on a dotted line. In the comment for each solid line, Mean stands for the mean score of the corresponding group, while SD stands for the standard deviation. Each solid line centers on Mean and stretches from (Mean – SD) to (Mean + SD). The longer the solid line is, the bigger the SD the corresponding test scores have. For each dotted line, its comment states the t-test result. If the result indicates significant difference (P < 0.05), the calculated effect size is also presented. The effect size can be either positive or negative. A positive effect size indicates positive difference in the direction of the arrow.

Figure 2

Comparison of the theoretical test scores at the end of the clerkship. Please refer to the legends of Figure 1 for the meanings of solid lines, dotted lines, and their comments.

Figure 3

Comparison of the total scores at the end of the clerkship. Please refer to the legends of Figure 1 for the meanings of solid lines, dotted lines, and their comments.