A Narrative Review and Novel Framework for Application of Team-Based Learning in Graduate Medical Education

Abstract

Background: Team-based learning (TBL) promotes problem solving and teamwork, and has been applied as an instructional method in undergraduate medical education with purported benefits. Although TBL curricula have been implemented for residents, no published systematic reviews or guidelines exist for the development and use of TBL in graduate medical education (GME).

Objective: To review TBL curricula in GME, identify gaps in the literature, and synthesize a framework to guide the development of TBL curricula at the GME level.

Methods: We searched PubMed, MEDLINE, and ERIC databases from 1990 to 2014 for relevant articles. References were reviewed to identify additional studies. The inclusion criteria were peer-reviewed publications in English that described TBL curriculum implementation in GME. Data were systematically abstracted and reviewed for consensus. Based on included publications, a 4-element framework-system, residents, significance, and scaffolding-was developed to serve as a step-wise guide to planning a TBL curriculum in GME.

Results: Nine publications describing 7 unique TBL curricula in residency met inclusion criteria. Outcomes included feasibility, satisfaction, clinical behavior, teamwork, and knowledge application.

Conclusions: TBL appears feasible in the GME environment, with learner reactions ranging from positive to neutral. Gaps in the literature occur within each of the 4 elements of the suggested framework, including: system, faculty preparation time and minimum length of effective TBL sessions; residents, impact of team heterogeneity and inconsistent attendance; significance, comparison to other instructional methods and outcomes measuring knowledge retention, knowledge application, and skill development; and scaffolding, factors that influence the completion of preparatory work.

Figure 1

Structure of Team-Based Learning Sessions Note: Figure 1 is adapted from Parmelee and Michaelsen.³ Reproduced with permission.

Figure 2

Flow Diagram of Selection and Screening Process for Literature Review