Working with other individuals toward a common goal has long been the hallmark of maturity both on individual and societal levels. While this simple activity may present as a seemingly innocuous and fundamental skill required of any future healthcare provider, it has a remarkable ability to cause extreme difficulty and frustration for a majority of medical students. The cause of this aggravation stems from a variety of factors inherent of new medical students.
Some medical students have dreamed of being physicians since their earliest memories and have dedicated a tremendous portion of their lives in that pursuit, while others have only recently elected to leave prior careers or courses of study to engage in the rewarding and trying profession of medicine. Regardless of the avenue travelled to reach this pinnacle of premedical attainment, a seat in a matriculating medical school class, the individuals driven to possess that seat have a variety of personality traits in common with the majority of their medical school cohorts. While the major traits shared among the class may be that of compassion or an affinity for solving complex problems, perhaps the most evident trait is the easily manifested “Type A” personality. While the precise definition of a “Type A” personality may vary from text to text, generally it is composed of a strong-will, extreme resolve and competitiveness, necessity for a leadership role and, particularly with medical students, an overall aura of entitlement based on the years of sacrifice already invested that are necessary to attain professional medical education, among others. As a result of this personality observed in the vast majority of any matriculating medical school class, working together with each other as a cohesive and synergistic organism proves to be the most difficult and stressful assignment of the exceptionally tumultuous and exhaustive experience that medical education is.
In consideration of the psychological makeup of a typical medical student, several useful hypotheses can be incorporated and analyzed as to exactly why team-based learning (TBL) can be surprisingly ineffective for some of the best and brightest young minds of a generation. Some of the more elementary explanations may center around a lack of previous experience with the formally structured TBL techniques or clashing of strong personality types. However, several of the fundamental flaws with TBL in the current system of medical education can be traced back to a few key aspects found in the admissions process, TBL orientation and group randomization.
The application process to medical school is a long, arduous process that requires many hours of activities like filling out applications, gathering reference letters, sending transcripts and writing personal statements. Once a prospective student’s application is reviewed and deemed worthy of an interview, the student is invited for a face-to-face analysis of professional behavior, capacity to handle pressure and communication ability. It is during these interviews that a major oversight occurs that affects not only TBL but, the professional and holistic discharging of physician duties many years after medical school has concluded. The admissions model today places an increasingly weighty significance on a potential student’s statistics; that is, the student’s science GPA, overall GPA and MCAT scores. This degradation of the admissions model is a result of the large increase in applications to medical schools and the need to quantify a student’s potential for success in medical school and residency. While statistical analysis certainly has a proper place in the assessment of potential candidates, a far larger significance must be placed on the intangibles that make up the candidates aside from numbers attained in undergraduate study. A much more stringent and thorough assessment of the individual’s personality fit for medicine and perspectives on what a physician does and the qualities that great physicians possess are essential in the decision making process that admissions officers employ. In doing so, those candidates that have juvenile, selfish or prideful intentions regarding their desire to become physicians can be weeded out. This would alleviate some of the arrogance and erroneous practice that has grown to run rampant among the young physicians of today that only wanted to become doctors to wear a white coat and give people orders.
Another aspect affecting the effectiveness of TBL lies in the initial presentation of TBL orientation. This particular type of learning is very new to most students in medical school and its introduction comes at a very inopportune time as the students are already becoming stressed and anxious over the fear of the unknown and the growing subject matter. A more effective and efficient path toward TBL proficiency may be found in starting TBL training before medical school classes begin. By starting TBL training a week earlier than the regularly scheduled classes, students have the opportunity to become comfortable with their assigned groups, work out any kinks associated with new group function and practice extensively on group problem solving techniques.
Lastly, it is imperative to assign groups as randomly as possible. While this is certainly a fundamental aspect of TBL incorporation, even a slight error in randomization can cause strain in certain groups that is both unnecessary and frustrating for each member of the group. If a group is allowed to congregate without randomization, the results will be skewed and group learning will be minimal. If the faculty attempt to organize the groups according to previous academic exposure, undergraduate GPA, MCAT scores or similar academic criteria, the learning capacity of the group as a whole will be diminished as the group will defer discussion to the most experienced student in that subject. Placing individuals in new groups that have no familiar students forces the more reserved student to speak up and be accounted for and requires the more extroverted student to restrain for the health of the entire group.
In conclusion, TBL is a dynamic and progressive learning system that has diverse and engaging learning techniques to assist medical students with some of the complex concepts they are required to learn. The inherent nature of medical students is to take control and dictate the group with little teamwork or group input involved. Avoidance of these issues can be achieved through alterations in the admissions process, restructuring of the TBL orientation sessions and thorough randomization of group selections.