Student-led virtual team-based learning

Seb Casalotti, Honorary Clinical Teaching Fellow at the UCL Medical School, shares his experience with student-led team-based learning and includes tips for staff and student success.

Sudden suspension of on-site medical teaching during initial phases of the COVID-19 pandemic prevented lectures, ward-based and small group teaching.

It also disrupted learning from peers and the invaluable social interactions that make medical school fun. The immediate threat to continuity of training and student wellbeing created urgency for change.

Student-led approach

In response to this, a team of five recently graduated UCL Medical School students devised Student-led Online Virtual Team-based learning (SOLViT) - an 11-week programme of pub-quiz style medical teaching sessions using a team-based learning approach, for delivery to Year 5 students.

Responding to the crisis

SOLViT was developed following an evaluation of student demands on UCL online forums, which showed calls for increased interactive online teaching.

A team-based learning (TBL) format was chosen as it is an established and well-liked element of Year 5 teaching. I felt we could re-create this online and would address a need for variety in the online syllabus. 

““SOLViT speaks to the power of near-peer teaching, which can create innovative pedagogical resources and promote solidarity between students and clinicians”.

To conceptualise the project I worked closely with Dr Jonathan Cartledge, Head of Year 5 Education who has significant expertise in running TBL sessions. After developing a blueprint of the programme, I recruited four other recent graduates from my cohort to form the SOLViT team.

Together we developed a trial session which we tested on a group of twenty Year 5 students who had volunteered to help with the initial stage of the project. From the real-time feedback given by Year 5 students in this session, we were able to tailor the concept for delivery to the whole year group.

How SOLViT worked

When the country entered lockdown, Year 5 medical students had completed two of three modules. SOLViT built upon the zeitgeist of mutual-aid during the early stages of the pandemic to generate educational content via a novel mechanism. 

• Questions were written by Year 5 students who had studied the same module during the previous term.
• These questions were collated and tweaked by the SOLViT team.
• They were then sent for quality assurance by 16 medical educators (primarily Clinical Teaching Fellows and Consultants involved in medical education), who would provide insights from their own specialities.
• Quality assurance involved selecting the best questions of those produced, providing guidance on how best to explain the answers, and adding ‘clinical pearls’ to attempt to account for time on the wards lost by the Year 5 students due to the lockdown.
• These quality-assured questions were then formatted into quizzes and delivered by the SOLViT team to students studying the respective modules.

Student-created learning 

The curation of the session content and learning objectives were done by the SOLViT team, as well as all of the delivery of the sessions themselves. Where possible, a medical educator from the appropriate speciality would be on hand to answer any questions that came up. This created a system where clinician preparation time was minimised, but the content was produced with the appropriate clinical expertise.

SOLViT created an ongoing cycle of question production, where every student of the cohort contributes to producing educational material for their peers, empowering students to take control of their own learning, whilst also promoting co-design between faculty and recent graduates.

Prof Deborah Gill, Director of the MBBS programme said:

I think what they have produced is a really great example of creating connections between different year groups/student and new graduates as well as good remote pedagogy” 

Schedule of SOLViT

• We provided three online team-based learning sessions per week (one per module).
• The sessions each had 3 rounds:
  • True/false questions
  • Bonus questions
  • Knock-out cases

The sessions themselves lasted 1.5 hours each and were delivered back-to-back every Friday for each of the three modules, covering 28 topics over 11 weeks. 

We used the breakout room function on Blackboard collaborate to facilitate group discussions and socialisation, and all session preparation used software allowing for live collaborative editing, such as Google Slides. 

True/false (T/F) questions 

The T/F questions focussed on core clinical knowledge and used the review-submit-resubmit format, seen in Dr Cartledge’s existing TBL sessions. In the review-submit-resubmit format:

• The teams of students are given ten T/F questions; they submit their answers and are told how many they got right, but not which ones.
• They are then given one opportunity to re-submit making as many changes to their answers as they like.

This encourages deliberating answers and tactics, particularly as the students are able to see the scores of other teams, which might inform their decisions to change their answers or not!

Bonus round questions

For the Bonus round, we introduced a new style of questions which had not been used previously in UCL Medical School education.

These were designed to require lateral thinking and the integration of multiple pieces of knowledge, which encourages teamwork.

The questions employed gaming elements to amalgamate core clinical knowledge with elements of general knowledge and history around the topic, such as:

• dingbats
• cryptic crosswords clues
• picture quizzes and emojis

Knock-out cases

Another innovation was the use of ‘knock-out’ style clinical cases.

Here students would all put their hands up using a function on Blackboard, and would keep their hands up as long as they answered the questions correctly. The case would feature seven multiple-choice questions that the students could answer using the poll function. By the end of the case, any students left with their hands up would get points for their team!

These innovations served to gamify student learning, providing variety in the online syllabus. These elements of the teaching received overwhelmingly positive feedback from students and contributed to the atmosphere of friendly competition.

Team-based learning

Students were placed into teams which mirrored their established teaching groups, allowing peers to re-establish contact and ensuring an effective online experience. Students were encouraged to write questions on the slides during the sessions and engage in the chat-feed, which promoted a friendly vibe whilst facilitating a mode for asking questions and clarifications anonymously.

Additionally the Year 5 teams came up with fun team names, and a running leader board was kept, resulting in three winning teams at the end of the programme. Examples included:

• Quiz Witty
• The Pub Meds
• Livin’ Covida Loca!

All material produced by SOLViT is available on the Year 5 moodle pages, both as recordings of the sessions and slideshow materials. 

A year 5 student shares their experience of SOLViT:

“Picture questions, varying styles of questions, random facts. The relaxed nature of the session is actually a really nice stress relief.

The impact of SOLViT

Evaluation of the project was performed via anonymous feedback forms and live polls during the sessions.

95% of responders agreed or strongly agreed that SOLViT was relevant to their learning, improved their knowledge and provided an enjoyable means of social interaction. Attendance rates of 30-50 students per module per week mimicked that of other online sessions at the time. 

The medical educators involved were overwhelmingly positive about the contribution SOLViT had to the curriculum. It was a hugely positive experience to be able to work closely with them, and all members of the SOLViT team felt that this collaboration contributed significantly to our learning, both in term of clinical content, and methods of teaching. We would like to see SOLViT remain as an opportunity to continue student and staff co-design in the future.

Sharing the approach and broadening its use

The SOLViT team are currently working with Dr Cartledge on how the resources created can be delivered for future years. We are keen to see TBL be integrated into more parts of the curriculum, and also to see more student-led innovation be supported by the Medical School.

Problems encountered and lessons learned

Encouraging students from the year group to contribute to producing the content provided a brilliant range of questions, and was an opportunity to showcase the ingenuity of the students, particularly in the Bonus questions.

However, this methodology relies on clear instructions regarding question writing and the continued energy of the year group to write questions. We found that towards the final weeks of the 11-week programme, the quantity of question submission decreased, meaning more questions had to be written by the SOLViT team.

Running the programme required more person-hours than originally expected, with myself and one other of the SOLViT team working full time on the project, and the other three members balancing their contribution with their Foundation Interim work. To produce and deliver three unique 1.5h sessions per week took 60-80 person-hours of work for the SOLViT team and 2-4h of clinician time each week.