Educational Innovations
Using a Modified Team-Based Learning Approach to Teach Nursing Students About Communicable Disease Control and Community Health Nursing Shannon Elliott, MS, RN
ABSTRACT Team-based learning (TBL) is an active learning approach that is becoming increasingly more popular in nursing education. When nurse educators flip the classroom and use methods such as TBL, students are often more engaged and are active participants in their own learning. This article outlines how a teaching team in an undergraduate nursing program used a modified TBL method to teach about community health nursing. The traditional method of TBL is described, as well as limitations of this approach and recommendations for future teaching. [J Nurs Educ. 2014;53(11):651-653.]
Received: April 7, 2014 Accepted: July 21, 2014 Posted Online: October 27, 2014 Ms. Elliott is Faculty, BSN Program, School of Health Sciences, British Columbia Institute of Technology, Burnaby, British Columbia, Canada. The author thanks Corrine Schneider and Final Jamal for their collaboration in trying a new teaching approach and for assistance with review of the manuscript. The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Shannon Elliott, MS, RN, Faculty, BSN Program, School of Health Sciences, British Columbia Institute of Technology, 3700 Willingdon Avenue, Burnaby, BC V5G 3H2, Canada; e-mail: [email protected]. doi:10.3928/01484834-20141027-01
Journal of Nursing Education • Vol. 53, No. 11, 2014
A
s nursing students proceed through a nursing program, they have a vast amount of information to learn, and nurse educators strive to find the best way to facilitate student learning of requisite content. Many nurse leaders have challenged educators to transform nursing education to enhance student learning and improve preparation for clinical practice (Benner, Sutphen, Leonard, & Day, 2010). Despite best intentions by faculty, “death by PowerPoint®” is a common experience in many nursing programs. In an attempt to provide a better method of learning, the author used a modified approach to team-based learning (TBL) to help nursing students learn about communicable disease control and community health nursing. At the British Columbia Institute of Technology (BCIT), the Bachelor of Science in Nursing (BSN) program is taught in 3 years as an accelerated program. Undergraduate nursing students complete their community health clinical course in level 5 (of 6 levels). In the 2012-2013 academic year, the community health nursing course was revised from a combined theory and clinical format to one that now focuses solely on the clinical experience. Students take two other online theory courses pertaining to community health nursing (one in level 4 and one concurrently in level 5). During the review of the community health clinical course, efforts were made to reduce duplication of content from the online community nursing courses and other courses taken earlier in the program. Only content that was deemed essential was included in the orientation sessions, which occurred during the first 2 weeks of the community health clinical course. Students attend the 2 weeks (2 days per week) of clinical orientation as a large group of approximately 90 students on campus at BCIT. One of the topics in the orientation is communicable disease control and community health nursing.
Team-Based Learning TBL is an active, small-group learning strategy that has been effectively used in large classes of up to 200 students and is part of a group of teaching strategies that flip the classroom. Flipping the classroom is a pedagogical model in which the typical lecture and homework elements of a course are reversed. Students watch prerecorded lectures or complete assigned readings, which are then followed by in-class exercises (Center for Teaching + Learning, 2010). Flipping the classroom and TBL can be used for individual classes (or topics) or for an entire course term. TBL has been used for many years in business and science and has since been introduced to health care education 651
EDUCATIONAL INNOVATIONS
(Clark, Nguyen, Bray, & Levine, 2008). TBL follows a specific format—students work in teams and learning takes place in specific phases—phase 1, preclass preparation; phase 2, readiness assurance tests; and phase 3, application of course concepts (Clark, 2013; Mennenga & Smyer, 2010). During preclass preparation, faculty members select reading assignments (textbook readings or additional assignments) and assign the students to small groups for when the class meets, ensuring that the groups are equitable in intelligence, strength, and capability. Students in this phase complete the required readings before coming to class and are expected to have a thorough understanding of the key concepts found in the required readings (Mennenga & Smyer, 2010). After the class begins, the readiness assurance process occurs. While in the classroom, students complete two tests— the Individual Readiness Assurance Test (IRAT) and the Group Readiness Assurance Test (GRAT). Each test usually consists of identical, multiple choice questions based on the preclass readings or videos selected by the teacher. The individual test is administered at the beginning of the class and the test mark is counted toward the students’ course grade. After taking the IRAT, the students complete the GRAT (also counted for test marks) in their assigned groups. While in their groups, the students debate and discuss the correct answer for each question and together decide on the best answer. The GRAT can be administered using the Immediate Feedback Assessment Technique (IF-AT) forms, which are available from http://www. epsteineducation.com/home (Mennenga, 2013). The forms are similar to a lottery ticket, where the groups scratch off their answer choice on the form provided. A star is printed beside the correct answer, which provides immediate feedback to the group if the correct answer is selected. It is not essential that the IF-AT forms be used with TBL, but the immediate feedback provided is useful (Mennenga, 2013). If the groups do not see the star, they must resume their discussion and try again to decide on the correct answer. The discussion and answering of questions continues until the correct answer is selected. The discussion between the students in their groups facilitates significant learning as they debate with each other about which answer is correct and why they believe their answer is correct. Following the completion of the GRAT, the faculty member can clarify any confusion regarding course content or the test and may have a discussion with the group or present a minilecture. The final phase of TBL is the application of course content. Students remain in their teams and complete application exercises designed by the faculty to enhance student understanding of course content and increase group cohesion. Discussion regarding application exercises can be conducted among the teams or with the entire class (Clark et al., 2008; Mennenga, 2013; Mennenga & Smyer, 2010). As with any pedagogy, there are advantages and disadvantages. The literature indicates the following advantages of TBL: improvement in student preparation (Mennenga & Smyer, 2010); student engagement (Clark et al., 2008; Lubeck, Tschetter, & Mennenga, 2013; Mennenga, 2013); team work (Clark et al., 2008; Lubeck et al., 2013); and student outcomes, such as increased engagement in the learning process and increased use of communication skills to express their arguments for an 652
answer (Clark et al., 2008). Efficient use of faculty is an obvious economic advantage of TBL, unlike other learning strategies, such as problem-based learning, as only one faculty member is required to facilitate TBL with a large group of up to 200 students (Clark, 2013; Lubeck et al., 2013). Many other authors acknowledged that the initial preparation of a course using the TBL methodology requires a significant investment of faculty time to prepare the readiness assurance tests and application exercises (Clark et al., 2008; Lubeck et al., 2013; Mennenga & Smyer, 2010). Sisk (2011) called for continued studies to demonstrate that TBL is effective in improving learning outcomes. Some students preferred the passive learning found in the traditional lecture format and resisted or had difficulty adapting to active involvement in the learning process, whereas other students voiced strong concerns over the lack of lectures and having to teach themselves (Mennenga, 2013; Lubeck et al., 2013; Sisk, 2011). Although some students had less favorable reactions to TBL, many students reacted positively to this method of teaching, recognizing that they are more engaged and enjoyed learning through group discussion (Lubeck et al., 2013; Mennenga & Smyer, 2010).
Modified TBL Approach After reviewing the literature and other resources regarding TBL, the teaching team (which consisted of three faculty members, including the author) decided to try a modified approach to TBL. The intent was to have the students teach each other, primarily through debate and discussion, while providing students with a unique way of learning the content and not having to experience death by PowerPoint. After the teaching team decided to implement this style of teaching, the team agreed on which readings the students needed to be familiar with, and an eight-question quiz was designed. Six questions were related to content in the textbook, whereas the final two questions were related to a scenario (a new mother with hepatitis A). The quiz replaced the readiness assurance tests described in the literature. Using BCIT’s online learning system—Desire2Learn—information regarding the readings and a note explaining that there would be a quiz at the start of the class based on the readings was posted on the home page for the course. Students were encouraged to check the Desire2Learn course site on a regular basis, as it is the main method for communicating with the students as a large group. Students were also informed about the readings and quiz during the introduction at the start of the orientation session. Regarding the formation of teams in TBL, the literature (Clark et al., 2008; Lubeck et al., 2013) emphasizes the importance of forming teams that ensure equal distribution of resources (i.e., intelligence, experience). However, the BCIT teaching team decided to form the student teams based on clinical groups, as these students work together for the entire term, and the modified TBL session helped to start off collegial, collaborative relationships that would hopefully continue to form within the group throughout the term. The BCIT faculty felt that the clinical groups formed were varied in terms of capabilities and experience and displayed the varied characteristics discussed in the literature. Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
The faculty administered a quiz to each student at the start of the class. After the individual quiz was completed, the students were given time to discuss and debate the results with their colleagues sitting at the same table. After the groups completed the quiz a second time (after coming to consensus on the best answers), the teaching team then facilitated a discussion among the whole group concerning the questions and answers. Each group indicated which answer they chose and whether there were any variations among the answers, and the groups defended and debated with the other groups as to why they chose their answer. After the large-group discussion, additional discussion of communicable disease control and community health nursing (specific to British Columbia) occurred. The teaching team has now taught the session twice (at the start of two terms), using the modified TBL approach, and feel that the implementation of this approach has worked well. Prior to the implementation of the modified TBL approach, students were not tested on the textbook reading, so faculty were unclear as to how many students had completed the reading and how much comprehension had occurred. On the basis of the review of both the individual and group quiz answers and group discussions (observation of the correct answers supplied by the students and groups), it was obvious that a significant number of students had completed the prereading. Most exciting has been the level of intensity observed during the group discussion portion of the modified TBL approach. Faculty circulated among the 11 to 12 tables of clinical groups to listen to the conversations and observed enthusiastic debate about the test questions. Most students have indeed been fully engaged and demonstrated a marked contrast to what has been observed in the past, namely students appearing bored while listening to a lecture on communicable disease control and community health nursing. In addition to better student preparation and student engagement, improved teamwork also appeared evident.
plement. One option would be to test student engagement and satisfaction with an orientation session that is conducted using more a traditional lecture and PowerPoint presentation and implement TBL or a modified TBL approach into the session with another group and then test both groups using the same evaluation tool for student engagement and satisfaction. Comparison of the results from the tests would provide data regarding the effectiveness of using different teaching methods in relation to student engagement and satisfaction. Clinical instructors could also implement a standardized test (verbal or written) with their clinical groups to assess student learning regarding communicable disease control and community health nursing. Initiating a discussion with their clinical groups about the experience of the modified TBL approach and asking about the students’ feelings of engagement and satisfaction would provide feedback regarding the students’ experience. Ongoing revision of this modified TBL approach is planned, incorporating better application exercises for use after the group quiz and discussion component is completed. The final recommendation for nurse educators planning to implement this modified TBL approach is to consider the amount of time required in advance of the class to complete the requisite preparation (group creation, test development, and application exercise development).
Conclusion Using a modified TBL approach to communicable disease control and community health nursing appeared to provide increased student engagement, collaboration, and problem solving. The students were enthusiastic and more involved in their learning than the more traditional pedagogy of teaching (i.e., lecturing). Students learned to work through problems by interacting and gaining knowledge from each other. This shared learning and teamwork helps to prepare nursing students to function in the real world of nursing, where they will be required to work and collaborate in teams to solve patient problems.
Limitations Sisk (2011) believed that although student engagement and satisfaction with a teaching method are important, the most meaningful outcome for testing a teaching method should be whether the students actually learn, as measured by examination scores and NCLEX–RN® scores. Because the topic of communicable disease control and community health nursing is currently part of orientation to the community clinical course at BCIT, students are not formally examined on this topic. Consequently, the impact of the modified TBL approach on students’ examination scores is undetermined. Faculty felt that students displayed a higher level of engagement and satisfaction with the learning experience than with previous lectures given via PowerPoint, but engagement and satisfaction were also not formally evaluated. Some of the benefits described in relation to the traditional format of TBL may be lost due to modifications made in this approach by the faculty.
Recommendations Using formalized methods to test learning, engagement and satisfaction will be an important next step for the faculty to im-
Journal of Nursing Education • Vol. 53, No. 11, 2014
References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Center for Teaching + Learning, University of Texas at Austin. (2010). How to flip a class. Retrieved from http://ctl.utexas.edu/ctl/teaching/ flipping_a_class/how_to_flip Clark, M. (2013, January). Employing team-based learning (TBL) in the classroom. Paper presented at Elsevier Nursing Faculty Development conference, Las Vegas, NV. Clark, M.C., Nguyen, H.T., Bray, C., & Levine, R.E. (2008). Team-based learning in an undergraduate nursing course. Journal of Nursing Education, 47, 111-117. Lubeck, P., Tschetter, L., & Mennenga, H. (2013). Team-based learning: An innovative approach to teaching maternal-newborn nursing care. Journal of Nursing Education, 52, 112-115. Mennenga, H.A. (2013). Student engagement and examination performance in a team-based learning course. Journal of Nursing Education, 52, 475-479. doi:10.3928/01484834-20130718-04 Mennenga, H.A., & Smyer, T. (2010). A model for easily incorporating team-based learning into nursing education. International Journal of Nursing Education Scholarship, 7, Article 4. doi:10.2202/1548923X.1924 Sisk, R.J. (2011). Team-based learning: Systematic research review. Journal of Nursing Education, 50, 665-669. doi:10.3928/0148483420111017-01
653
Using a Modified Team-Based Learning Approach to Teach Nursing Students About Communicable Disease Control and Community Health Nursing Shannon Elliott, MS, RN
ABSTRACT Team-based learning (TBL) is an active learning approach that is becoming increasingly more popular in nursing education. When nurse educators flip the classroom and use methods such as TBL, students are often more engaged and are active participants in their own learning. This article outlines how a teaching team in an undergraduate nursing program used a modified TBL method to teach about community health nursing. The traditional method of TBL is described, as well as limitations of this approach and recommendations for future teaching. [J Nurs Educ. 2014;53(11):651-653.]
Received: April 7, 2014 Accepted: July 21, 2014 Posted Online: October 27, 2014 Ms. Elliott is Faculty, BSN Program, School of Health Sciences, British Columbia Institute of Technology, Burnaby, British Columbia, Canada. The author thanks Corrine Schneider and Final Jamal for their collaboration in trying a new teaching approach and for assistance with review of the manuscript. The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Shannon Elliott, MS, RN, Faculty, BSN Program, School of Health Sciences, British Columbia Institute of Technology, 3700 Willingdon Avenue, Burnaby, BC V5G 3H2, Canada; e-mail: [email protected]. doi:10.3928/01484834-20141027-01
Journal of Nursing Education • Vol. 53, No. 11, 2014
A
s nursing students proceed through a nursing program, they have a vast amount of information to learn, and nurse educators strive to find the best way to facilitate student learning of requisite content. Many nurse leaders have challenged educators to transform nursing education to enhance student learning and improve preparation for clinical practice (Benner, Sutphen, Leonard, & Day, 2010). Despite best intentions by faculty, “death by PowerPoint®” is a common experience in many nursing programs. In an attempt to provide a better method of learning, the author used a modified approach to team-based learning (TBL) to help nursing students learn about communicable disease control and community health nursing. At the British Columbia Institute of Technology (BCIT), the Bachelor of Science in Nursing (BSN) program is taught in 3 years as an accelerated program. Undergraduate nursing students complete their community health clinical course in level 5 (of 6 levels). In the 2012-2013 academic year, the community health nursing course was revised from a combined theory and clinical format to one that now focuses solely on the clinical experience. Students take two other online theory courses pertaining to community health nursing (one in level 4 and one concurrently in level 5). During the review of the community health clinical course, efforts were made to reduce duplication of content from the online community nursing courses and other courses taken earlier in the program. Only content that was deemed essential was included in the orientation sessions, which occurred during the first 2 weeks of the community health clinical course. Students attend the 2 weeks (2 days per week) of clinical orientation as a large group of approximately 90 students on campus at BCIT. One of the topics in the orientation is communicable disease control and community health nursing.
Team-Based Learning TBL is an active, small-group learning strategy that has been effectively used in large classes of up to 200 students and is part of a group of teaching strategies that flip the classroom. Flipping the classroom is a pedagogical model in which the typical lecture and homework elements of a course are reversed. Students watch prerecorded lectures or complete assigned readings, which are then followed by in-class exercises (Center for Teaching + Learning, 2010). Flipping the classroom and TBL can be used for individual classes (or topics) or for an entire course term. TBL has been used for many years in business and science and has since been introduced to health care education 651
EDUCATIONAL INNOVATIONS
(Clark, Nguyen, Bray, & Levine, 2008). TBL follows a specific format—students work in teams and learning takes place in specific phases—phase 1, preclass preparation; phase 2, readiness assurance tests; and phase 3, application of course concepts (Clark, 2013; Mennenga & Smyer, 2010). During preclass preparation, faculty members select reading assignments (textbook readings or additional assignments) and assign the students to small groups for when the class meets, ensuring that the groups are equitable in intelligence, strength, and capability. Students in this phase complete the required readings before coming to class and are expected to have a thorough understanding of the key concepts found in the required readings (Mennenga & Smyer, 2010). After the class begins, the readiness assurance process occurs. While in the classroom, students complete two tests— the Individual Readiness Assurance Test (IRAT) and the Group Readiness Assurance Test (GRAT). Each test usually consists of identical, multiple choice questions based on the preclass readings or videos selected by the teacher. The individual test is administered at the beginning of the class and the test mark is counted toward the students’ course grade. After taking the IRAT, the students complete the GRAT (also counted for test marks) in their assigned groups. While in their groups, the students debate and discuss the correct answer for each question and together decide on the best answer. The GRAT can be administered using the Immediate Feedback Assessment Technique (IF-AT) forms, which are available from http://www. epsteineducation.com/home (Mennenga, 2013). The forms are similar to a lottery ticket, where the groups scratch off their answer choice on the form provided. A star is printed beside the correct answer, which provides immediate feedback to the group if the correct answer is selected. It is not essential that the IF-AT forms be used with TBL, but the immediate feedback provided is useful (Mennenga, 2013). If the groups do not see the star, they must resume their discussion and try again to decide on the correct answer. The discussion and answering of questions continues until the correct answer is selected. The discussion between the students in their groups facilitates significant learning as they debate with each other about which answer is correct and why they believe their answer is correct. Following the completion of the GRAT, the faculty member can clarify any confusion regarding course content or the test and may have a discussion with the group or present a minilecture. The final phase of TBL is the application of course content. Students remain in their teams and complete application exercises designed by the faculty to enhance student understanding of course content and increase group cohesion. Discussion regarding application exercises can be conducted among the teams or with the entire class (Clark et al., 2008; Mennenga, 2013; Mennenga & Smyer, 2010). As with any pedagogy, there are advantages and disadvantages. The literature indicates the following advantages of TBL: improvement in student preparation (Mennenga & Smyer, 2010); student engagement (Clark et al., 2008; Lubeck, Tschetter, & Mennenga, 2013; Mennenga, 2013); team work (Clark et al., 2008; Lubeck et al., 2013); and student outcomes, such as increased engagement in the learning process and increased use of communication skills to express their arguments for an 652
answer (Clark et al., 2008). Efficient use of faculty is an obvious economic advantage of TBL, unlike other learning strategies, such as problem-based learning, as only one faculty member is required to facilitate TBL with a large group of up to 200 students (Clark, 2013; Lubeck et al., 2013). Many other authors acknowledged that the initial preparation of a course using the TBL methodology requires a significant investment of faculty time to prepare the readiness assurance tests and application exercises (Clark et al., 2008; Lubeck et al., 2013; Mennenga & Smyer, 2010). Sisk (2011) called for continued studies to demonstrate that TBL is effective in improving learning outcomes. Some students preferred the passive learning found in the traditional lecture format and resisted or had difficulty adapting to active involvement in the learning process, whereas other students voiced strong concerns over the lack of lectures and having to teach themselves (Mennenga, 2013; Lubeck et al., 2013; Sisk, 2011). Although some students had less favorable reactions to TBL, many students reacted positively to this method of teaching, recognizing that they are more engaged and enjoyed learning through group discussion (Lubeck et al., 2013; Mennenga & Smyer, 2010).
Modified TBL Approach After reviewing the literature and other resources regarding TBL, the teaching team (which consisted of three faculty members, including the author) decided to try a modified approach to TBL. The intent was to have the students teach each other, primarily through debate and discussion, while providing students with a unique way of learning the content and not having to experience death by PowerPoint. After the teaching team decided to implement this style of teaching, the team agreed on which readings the students needed to be familiar with, and an eight-question quiz was designed. Six questions were related to content in the textbook, whereas the final two questions were related to a scenario (a new mother with hepatitis A). The quiz replaced the readiness assurance tests described in the literature. Using BCIT’s online learning system—Desire2Learn—information regarding the readings and a note explaining that there would be a quiz at the start of the class based on the readings was posted on the home page for the course. Students were encouraged to check the Desire2Learn course site on a regular basis, as it is the main method for communicating with the students as a large group. Students were also informed about the readings and quiz during the introduction at the start of the orientation session. Regarding the formation of teams in TBL, the literature (Clark et al., 2008; Lubeck et al., 2013) emphasizes the importance of forming teams that ensure equal distribution of resources (i.e., intelligence, experience). However, the BCIT teaching team decided to form the student teams based on clinical groups, as these students work together for the entire term, and the modified TBL session helped to start off collegial, collaborative relationships that would hopefully continue to form within the group throughout the term. The BCIT faculty felt that the clinical groups formed were varied in terms of capabilities and experience and displayed the varied characteristics discussed in the literature. Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
The faculty administered a quiz to each student at the start of the class. After the individual quiz was completed, the students were given time to discuss and debate the results with their colleagues sitting at the same table. After the groups completed the quiz a second time (after coming to consensus on the best answers), the teaching team then facilitated a discussion among the whole group concerning the questions and answers. Each group indicated which answer they chose and whether there were any variations among the answers, and the groups defended and debated with the other groups as to why they chose their answer. After the large-group discussion, additional discussion of communicable disease control and community health nursing (specific to British Columbia) occurred. The teaching team has now taught the session twice (at the start of two terms), using the modified TBL approach, and feel that the implementation of this approach has worked well. Prior to the implementation of the modified TBL approach, students were not tested on the textbook reading, so faculty were unclear as to how many students had completed the reading and how much comprehension had occurred. On the basis of the review of both the individual and group quiz answers and group discussions (observation of the correct answers supplied by the students and groups), it was obvious that a significant number of students had completed the prereading. Most exciting has been the level of intensity observed during the group discussion portion of the modified TBL approach. Faculty circulated among the 11 to 12 tables of clinical groups to listen to the conversations and observed enthusiastic debate about the test questions. Most students have indeed been fully engaged and demonstrated a marked contrast to what has been observed in the past, namely students appearing bored while listening to a lecture on communicable disease control and community health nursing. In addition to better student preparation and student engagement, improved teamwork also appeared evident.
plement. One option would be to test student engagement and satisfaction with an orientation session that is conducted using more a traditional lecture and PowerPoint presentation and implement TBL or a modified TBL approach into the session with another group and then test both groups using the same evaluation tool for student engagement and satisfaction. Comparison of the results from the tests would provide data regarding the effectiveness of using different teaching methods in relation to student engagement and satisfaction. Clinical instructors could also implement a standardized test (verbal or written) with their clinical groups to assess student learning regarding communicable disease control and community health nursing. Initiating a discussion with their clinical groups about the experience of the modified TBL approach and asking about the students’ feelings of engagement and satisfaction would provide feedback regarding the students’ experience. Ongoing revision of this modified TBL approach is planned, incorporating better application exercises for use after the group quiz and discussion component is completed. The final recommendation for nurse educators planning to implement this modified TBL approach is to consider the amount of time required in advance of the class to complete the requisite preparation (group creation, test development, and application exercise development).
Conclusion Using a modified TBL approach to communicable disease control and community health nursing appeared to provide increased student engagement, collaboration, and problem solving. The students were enthusiastic and more involved in their learning than the more traditional pedagogy of teaching (i.e., lecturing). Students learned to work through problems by interacting and gaining knowledge from each other. This shared learning and teamwork helps to prepare nursing students to function in the real world of nursing, where they will be required to work and collaborate in teams to solve patient problems.
Limitations Sisk (2011) believed that although student engagement and satisfaction with a teaching method are important, the most meaningful outcome for testing a teaching method should be whether the students actually learn, as measured by examination scores and NCLEX–RN® scores. Because the topic of communicable disease control and community health nursing is currently part of orientation to the community clinical course at BCIT, students are not formally examined on this topic. Consequently, the impact of the modified TBL approach on students’ examination scores is undetermined. Faculty felt that students displayed a higher level of engagement and satisfaction with the learning experience than with previous lectures given via PowerPoint, but engagement and satisfaction were also not formally evaluated. Some of the benefits described in relation to the traditional format of TBL may be lost due to modifications made in this approach by the faculty.
Recommendations Using formalized methods to test learning, engagement and satisfaction will be an important next step for the faculty to im-
Journal of Nursing Education • Vol. 53, No. 11, 2014
References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Center for Teaching + Learning, University of Texas at Austin. (2010). How to flip a class. Retrieved from http://ctl.utexas.edu/ctl/teaching/ flipping_a_class/how_to_flip Clark, M. (2013, January). Employing team-based learning (TBL) in the classroom. Paper presented at Elsevier Nursing Faculty Development conference, Las Vegas, NV. Clark, M.C., Nguyen, H.T., Bray, C., & Levine, R.E. (2008). Team-based learning in an undergraduate nursing course. Journal of Nursing Education, 47, 111-117. Lubeck, P., Tschetter, L., & Mennenga, H. (2013). Team-based learning: An innovative approach to teaching maternal-newborn nursing care. Journal of Nursing Education, 52, 112-115. Mennenga, H.A. (2013). Student engagement and examination performance in a team-based learning course. Journal of Nursing Education, 52, 475-479. doi:10.3928/01484834-20130718-04 Mennenga, H.A., & Smyer, T. (2010). A model for easily incorporating team-based learning into nursing education. International Journal of Nursing Education Scholarship, 7, Article 4. doi:10.2202/1548923X.1924 Sisk, R.J. (2011). Team-based learning: Systematic research review. Journal of Nursing Education, 50, 665-669. doi:10.3928/0148483420111017-01
653
