NUR6023 Module 2 team-based learning session design example

Nine Teams, One Patient With Worsening Heart Failure: A Minute-by-Minute Team-Based Learning Session for Heart Failure Pharmacology, Built on the Method's Essential Elements

Student Name

American College of Education

NUR6023: Transformational Teaching in Nursing Education

Module 2 Assignment

Instructor Name

May 13, 2030

Outcomes and Setting

Pharmacology for Nursing II runs as a single three-hour weekly block for the same 64 students I taught in the first course. The heart failure week has three learning outcomes. After the session, each student should be able to explain how each major drug class prescribed when the ejection fraction is reduced, namely the renin-angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors and loop diuretics, affects the failing heart; identify the key nursing assessments and laboratory values for each class; and decide, for a patient whose condition changes, which drug to hold, which to give and whom to call. The third outcome is the one lectures have served worst, and it is where team-based learning is designed to help.

The Method and the Evidence

Team-based learning organizes a course around permanent teams. Michaelsen and Sweet (2008) identify four essential elements: teams must be properly formed and managed; students must be accountable for the quality of their individual and group work; students must receive frequent and timely feedback; and team assignments must promote both learning and team development. In practice each unit follows the same sequence: individual preparation before class, an individual readiness assurance test, the same test taken as a team with immediate feedback, a chance for teams to appeal questions, a brief clarifying talk from the instructor, and then most of class time spent on application exercises.

The nursing evidence is encouraging but not decisive. A systematic review of twelve experimental and quasi-experimental studies in undergraduate nursing found that nine produced significant results in favor of team-based learning for academic performance and skills, and that it promoted engagement and the development of communication and self-directed learning, but the results were divergent when it was compared with other teaching methods, and in the reviewers' judgment the evidence fell short of what would be needed to show that it is more effective than alternatives (Alberti et al., 2021). I read that as a reason to adopt the method carefully and evaluate it, not as a reason to avoid it. My goal is the application outcome, and the method's structure puts more class time on application than any alternative I can run in this room.

Forming and Managing the Teams

The first element starts on the first day of the course, not in the heart failure week. I will form nine teams of seven, with one team of eight, rather than letting students choose, because self-selected teams tend to cluster friends and strong students together. I will distribute the resources that matter for this course across teams: each team will have at least one student who works as a nursing assistant or medication aide, no more than one of the four licensed practical nurses in the class, and a mix of students who did well and less well in the first pharmacology course. Teams will stay together for the whole semester, sit in the same block of seats each week and complete a peer evaluation at midterm and at the end, which counts toward the grade and gives teams a way to address members who do not contribute.

Readiness Assurance

Before class, students will read the heart failure chapter and a two-page summary of current guideline-directed therapy that I will prepare. The readiness assurance tests cover that preparation. The ten items test understanding needed for the application exercise, not details. For example: which laboratory value must be checked before giving spironolactone to a patient also taking lisinopril? Which finding would make a nurse hold a scheduled dose of metoprolol succinate? Why does a modest, early fall in estimated glomerular filtration rate after an SGLT2 inhibitor is started usually not mean the drug must be stopped?

Students take the test individually for ten minutes, then immediately take the same test as a team using scratch-off answer cards, which give instant feedback because the correct answer reveals a mark; teams earn full credit for a first scratch and partial credit for later ones. Teams may then write an appeal for any question they believe was unclear, citing the reading. After the tests, I will give a clarifying talk of no more than ten minutes, limited to the items most teams missed. This is the second and third elements at work: each student is accountable for preparation, and every student learns within minutes which ideas were wrong.

The Application Exercise

Application exercises in team-based learning follow what Parmelee et al. (2012) describe as the 4S framework: a significant problem, the same problem for every team, a specific choice and simultaneous reporting. The exercise follows one patient through a hospital stay in three stages. Stage one: a 71-year-old man is admitted with worsening heart failure, weight up four kilograms in a week, taking lisinopril, metoprolol succinate, spironolactone and furosemide; his potassium is 5.6 mmol/L, and his blood pressure is 96/58. Which one of his morning medications should the nurse hold first? Stage two, the next day: after intravenous diuresis, his weight has fallen but his creatinine has risen modestly and his potassium is now 3.4; which single action is most appropriate? Stage three, at discharge: the provider adds dapagliflozin; which teaching point is most important? For each stage, teams have eight minutes to agree on one answer from four options, and all teams reveal their choices at the same moment by holding up a lettered card. I then call on teams with different answers to defend them to each other before I comment. The simultaneous reveal is where the learning happens: a team that has committed to an answer has a stake in understanding why another team chose differently.

What Could Go Wrong

Three problems are common in a first attempt at team-based learning, and the design anticipates each. The first is unprepared students. If many students skip the reading, the readiness tests will expose it, and the temptation is to lecture the content instead. I will not; the clarifying talk stays at ten minutes, and the low scores count, so that preparation becomes a habit by the third week. The second is a dominant team member. In teams with a licensed practical nurse or an experienced medication aide, others may defer to that student's answer. The simultaneous reveal and the requirement that any team member be ready to defend the team's choice when called on push against this, and the midterm peer evaluation gives quieter members a voice. The third is my own discomfort with silence. During the application exercise, the room will be noisy and I will not be teaching in the usual sense, and I expect to feel the urge to explain. My role then is to circulate, listen for reasoning errors and save them for the discussion after the reveal.

Timing, Grading and Evaluation

The three hours run as follows: ten minutes for the individual test, fifteen for the team test, ten for appeals, ten for the clarifying talk, a ten-minute break, ninety minutes for the three stages of the application exercise including discussion, and fifteen minutes for a closing summary and a one-question exit ticket. In the course grade, individual readiness tests count for 10%, team readiness tests for 10% and peer evaluation for 5%, with examinations making up the rest. To evaluate the session, I will score this cohort on the unit examination's heart failure application items and set the results against last year's lecture-taught cohort, track the gap between individual and team readiness scores as a measure of team learning, and ask students on the exit ticket to name one decision they now understand that they did not before.

References

Alberti, S., Motta, P., Ferri, P., & Bonetti, L. (2021). The effectiveness of team-based learning in nursing education: A systematic review. Nurse Education Today, 97, Article 104721. https://doi.org/10.1016/j.nedt.2020.104721

Michaelsen, L. K., & Sweet, M. (2008). The essential elements of team-based learning. New Directions for Teaching and Learning, 2008(116), 7-27. https://doi.org/10.1002/tl.330

Parmelee, D., Michaelsen, L. K., Cook, S., & Hudes, P. D. (2012). Team-based learning: A practical guide: AMEE Guide No. 65. Medical Teacher, 34(5), e275-e287. https://doi.org/10.3109/0142159X.2012.651179