Team-Based Learning in the Surgery Clerkship: Impact on Student Examination Scores, Evaluations, and Perceptions

OBJECTIVE: There is little evidence for effectiveness of team-based learning (TBL) in specialties such as Surgery. We developed and instituted TBLs in surgery clerkship and compared National Board of Medical Examiners (NBME) Surgery Subject Exam scores before and after implementation. We also analyzed students' feedback for their perception of TBLs. DESIGN, SETTING, AND PARTICIPATNTS: The TBLs were transitioned into the curriculum during the 20132014 academic year. The "before" and "after" implementation periods were 2011-2013 and 2014-2016, respectively. NBME Surgery Subject Examination scores at our institution and nationally were compared using the independent samples t test. Satisfaction with the clerkship was assessed with Association of American Medical Colleges Graduate Questionnaire data. Student feedback regarding TBL was gathered at the end of each surgery rotation and were analyzed for themes, both positive and negative. RESULTS: Mean NBME score was higher at our institution than nationally, both before (77.10 +/- 8.75 vs. 75.20 +/- 8.95, p = 0.032) and after (74.65 +/- 8.0 vs. 73.10 +/- 8.55, p = 0.071) TBL implementation. The mean score decreased following TBL implementation at our medical school (77.10 +/- 8.75 vs. 74.65 +/- 8.00, p = 0.039), but it was also lower nationally (75.20 +/- 8.95 vs. 73.10 +/- 8.55, p < 0.001). Further, students were more likely to rate the surgery clerkship as "good and/or excellent" on the Association of American Medical Colleges Graduate Questionnaire after TBL implementation (84.6% vs. 73.7%). In qualitative assessment, learners stated that TBLs were informative, helpful in studying for the shelf exam, and viewed them as an opportunity for interactive learning, and thus requested more TBLs. Areas for improvement included reading materials, directions, and organization of sessions. CONCLUSIONS: Student perception of TBL into our surgery clerkship has been both positive and provided feedback for improvement. In addition, our medical school graduates have continued to assess their surgery experience as "good" or "excellent" by a large majority. Concurrently, our NBME scores remain above the national mean. We believe our medical students benefit from a well-organized TBL and its active approach to learning during the surgery clerkship with no loss of fundamental surgery knowledge. (C) 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.