Inserting an Erroneous Element in the Answer Key of Grouped Team Readiness Assurance Test in Team-Based Learning: A Randomized Controlled Trial in Clinical Toxicology

Abstract

Purpose: Team-based learning (TBL) is an interactive instructional strategy designed to enhance student engagement. Few studies reported that TBL needs to be more interactive, concerns were raised regarding the insufficient instructor feedback, and students feel that TBL gets less attractive with time. One method of boosting students' interaction and performance is adding an element of challenge or positive stress. Therefore, we hypothesized that inserting an erroneous answer in the answer key would generate an observable improvement in the selected outcomes in terms of better satisfaction, interaction, interest in learning, better academic performance, and better development of competencies compared to traditional TBL.

Methods: This randomized controlled trial aimed to determine if inserting an erroneous element in the answer key of a grouped team readiness assurance test (GRAT) would update TBL and whether this intervention would enhance students' performance and satisfaction.

Results: A total of 55 medical students were recruited (88.7% response rate). Erroneous elements were inserted in the answer key of the experimental group and students enrolled in traditional TBL were considered as controls. Compared to the control group (p < 0.001), the experimental group revealed significantly higher academic performances in GRAT and team evaluation test (TET). Analysis of students' perception of the implemented TBL revealed better perception among the experimental group (33.7 ± 6.4) than the control group (30.1 ± 7.0). Moreover, significantly higher team dynamics were reported among the experimental group than the control group (33.0 ± 6.3 and 27.8 ± 7.6 for both groups, respectively; p = 0.005). The reported advantages were in-depth understanding, easier information retrieval, and development of problem-solving skills. Students considered time and effort as their main limitations.

Conclusion: Adding a few erroneous answers in the GRAT is well perceived by students, enhances their learning competencies and overcomes some TBL challenges.

Keywords: academic performance; instructional design; learning environment; motivation; student’s interaction; team-based learning.

Figure 1

Conceptual framework of modified team-based learning (TBL) method.

Figure 2

Grouped team readiness assurance test (GRAT) of modified team-based learning (TBL). In the step of GRAT of modified TBL, the students in the experimental group did two tasks: solving the MCQs set as a team and going through a discussion that should end up with extracting one question with an erroneous key. To do that, students should defend their choice and convince each other with that question. When reaching an agreement, students should propose the ideal answer and prepare a written agreement justifying their choice. Then teams are joined to answer all questions and represent their arguments. Taking a look at the bubble sheet depicts that the students in all teams solve the same MCQs with the same set of four distractors. Every team in the experimental group had only one question containing the wrong key. In this example, question number four was wrongly answered with option B. Compared with the control answer key, the appropriate answer is D. Inspecting the answer sheet of both teams alleviates that student answered some questions from the first trials while they could answer some other questions after two or three trials. The question number 4 was excluded from grading for both groups and no extra points were counted for it.

Figure 3

Individual Readiness Assurance Test, Grouped Team Readiness Assurance Test and Team Evaluation Test over the studied participants.