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Enhancing a Medical Student Clerkship with Team-Based Learning Matthew N. Goldenberg, M.D., Kristina Money, M.D. and Derrick Hamaoka, M.D. Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD RATIONALE CURRICULUM INSTRUCTIONAL PROCESS Team-based learning (TBL) is an instructional strategy that has been increasingly used over the past decade in a number of educational venues including medical schools. Orientation TBL places particular value on cooperation between student team members and on using class time for active, applied learning. Pre-class Assignment At our institution, the didactic portion of the psychiatry clerkship had been conducted in a lecture-based format with little prescribed active student participation. Students traditionally rated the lectures as fair, and some cited a desire for more participatory learning. Individual Readiness Assurance Test (IRAT) Group Readiness Assurance Test (GRAT) Challenges One medical school implemented TBL in its psychiatry clerkship and published data indicating improved student satisfaction and superior standardized exam performance. Week 1 Application Exercise(s) Week 2 Week 3 Week 4 In order to increase student participation in and satisfaction with the didactic portion of our psychiatry clerkship, we have transitioned from the lecture-based format to a TBL format to teach core topics in clinical psychiatry. Week 5 PRE-CLASS ASSIGNMENTS READINESS ASSURANCE Weekly Quizzes based on reading assignments. 10-questions, multiple-choice format. Students take quiz individually first, then take same quiz as a team. Patient Voices Series 10 minutes for IRAT, 10 minutes for GRAT. Teams get instant feedback via scratch-off answer sheet. Topics Application Exercise Interviewing and Assessment Psychiatric Emergencies Mental Status Examination Videos Case-based Exercise: Suicide Risk Assessment Mood Disorders Adjustment Disorders Bereavement Med/Psych Interface: Cognitive Disorders Eating Disorders Somatoform Disorders Mood Disorders Map Case-based Exercise: Choosing an antidepressant 3Ds (Dementia, Delirium, Depression) Card Sort (from SLU) Case-based Exercise: Somatoform Disorders Case-based Exercise: Decisional Capacity PTSD Anxiety Disorders Substance Use Disorders Sleep Disorders Substance Disorder Card Sort Case-based Exercise: Combat Stress Control Case-based Exercise: Anxiety Disorders Psychotic Disorders Violence Biology of Mental Illness Evidence-Based Exercise: Managing Agitated Behavior Antipsychotic Effects Card Sort Childhood Disorders Personality Disorders Defense Mechanisms Case-based Exercise: Personality Disorders (from UTMB) APPLICATION EXERCISES 45-75 minute activities Teams work together to solve problems, accomplish tasks Various Formats: Multiple-choice questions, card sorts, product generation Open book, ungraded Examples: Mood Disorders Map Teams may challenge answers via written appeals process. Results: FUTURE DIRECTIONS Goal: Distinguish phenomenologies of various mood disorders from each other Activity: Each team is given a poster and several colored markers and is asked to draw a “mood graph,” plotting the symptom and time course of various mood disorders or related phenomena (e.g. major depressive disorder, dysthymia, bipolar disorder I and II, schizoaffective disorder, bereavement, adjustment disorder). Mood is on the y-axis (in quality), and time is on the x-axis (in years). Words or illustrations can be added to graph to differentiate some of the syndromes. Cull evaluations of the clerkship to determine student satisfaction with TBL-based instruction. Suicide Risk Assessment Examine NBME Psychiatry exam scores to determine any trends since implementation of curriculum. Use peer feedback in overall clerkship evaluation narrative. Publish and otherwise disseminate teaching materials including both readiness assurance tests and application exercises. REFERENCES/ACKNOWLEDGEMENTS Modify existing quizzes and exercises as needed and continue to develop other educational tools. Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Eds. Larry K. Michaelsen, Dean X. Parmelee, Kathryn K. McMahon , Ruth E. Levine, (2007). Incorporate TBL into other educational endeavors at institution, especially with curriculum reform efforts. Levine, Ruth et al. “Transforming a Clinical Clerkship with Team Learning,” Teaching and Learning in Medicine, 16(3), 270-275, (2004). Special thanks to the Team-Based Learning Collaborative and particularly to Ruth Levine, M.D. at UTMB for inspiring the incorporation of TBL into the psychiatry curriculum at USUHS. Goal: Identify static and dynamic risk and protective factors for suicide in clinical cases. Discuss rationale for clinical decision-making (including hospitalization) of suicidal patients. Each team is given a written case of a patient who presents with depressive symptoms and passive suicidal ideation. From the case history, they develop lists of risk and protective factors and present their lists to the class for comments/critiques. Each team is then given a series of five clinical vignettes of suicidal patients. They must list three concerning features of each presentation, and rank order the cases in terms of acuity/severity and need for hospitalization.