Background/Purpose: Medical education curricula have evolved to more interactive approaches. Fully interactive, team-based learning (TBL) is a flipped classroom model that has been well studied at the pre-graduate level. The impact of TBL in post graduate populations, especially on Rheumatology specific topics, has not been well explored (Reimschisel et al, Medical Teacher, 2017). How TBL compares to a more moderately interactive session is also not clear. The major aim of this study was to evaluate the efficacy of TBL versus a moderately interactive teaching approach and traditional lecture in increasing rheumatology specific topic competency in medical trainees.

Methods: Three 1-hour sessions on various rheumatology topics: a didactic, a moderately interactive lecture and a TBL session were performed. Three knowledge based multiple choice questions were administered pre and post each session. For the moderately interactive session, the group was asked open ended questions at regular intervals. For TBL, a pre-reading assignment was given and participants completed individual readiness assurance tests and group application exercises.  Pre and post rotation surveys assessing learning preferences and to what degree the sessions enhanced comfort with diagnosis and treatment were completed. Comfort was measured on a 5-point Likert scale (1: not comfortable and 5: very comfortable). Paired and independent samples t-tests were used for analyses.

Results: There were 29 participants in the lecture, 27 in the moderately interactive and 46 in the TBL group. The majority were medical residents PGY 1-3. For the lecture, there were decreases in post test scores (1.7±0.6 vs 0.8±0.8, p < 0.001), though comfort with diagnosis (3.2±0.8 vs 4.0±0.7, p < 0.001) and treatment (2.5±0.7 vs 3.5±0.8, p < 0.001) improved. For the moderately interactive, there were improvements in test scores (0.8±0.8 vs 1.32±0.8, p = 0.049), comfort with diagnosis (2.9±0.7 vs 3.9 ±0.9, p < 0.001) and treatment (2.5±1.0 vs 3.5±1.0, p = 0.011). For TBL, there were improvements in test scores (1.0±0.6 vs 2.1±0.8, p < 0.001), comfort with diagnosis (2.7±1.0 vs 3.3±1.0, p = 0.001) and treatment (2.3±0.9 vs 3.2±1.1, p < 0.001).  When comparing changes in test scores between groups, there were significant differences between TBL and lecture (p < 0.001), TBL and moderately interactive (p = 0.019) and between moderately interactive and lecture (p < 0.001). All increases in comfort went from uncomfortable or neutral to comfortable ranges and there were no significant differences in change in comfort between groups. The majority of residents preferred mixed learning formats.

Conclusion: Though residents prefer mixed learning models and all formats subjectively increased comfort with diagnosis and treatment, this study shows that TBL yields a significantly greater increment in rheumatology specific knowledge than moderately interactive and non-interactive sessions. Interestingly, knowledge scores after traditional lecture-based teaching actually decreased. Post graduate curricula should reflect the trends seen in pre-graduate education, by utilizing interactive small group formats.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/time-to-bridge-the-gap-in-rheumatology-education-interactive-team-based-learning-is-most-effective-in-increasing-internal-medicine-residents-knowledge/