A challenge encountered in the implementation of team-based learning (TBL) in a medical school biochemistry course, has been to develop clinical case-based application exercises to assure that students were making connections between biochemical and clinical concepts. We chose to add concept mapping to the application exercise because concept mapping has been shown to foster meaningful integration of basic and clinical science information as well as facilitate group and collaborative learning. The course is divided into 6 modules during which all students complete the readiness assurance process, followed by the team application exercises which focused on clinical cases. For the concept mapping exercise, teams generated a concept map relating the clinical aspects of the case to alterations in biochemical pathways. Teams used their maps to answer multiple choice questions (MCQs) that served as the basis of faculty-led discussion in a large group setting. Concept maps were graded using a rubric that provided the basis for peer feedback from another team during class and for faculty grading after class. The best maps were posted online.
Course grades are based on scores from team application exercises, concept maps, individual readiness assurance tests, team readiness assurance tests, MCQs or essay questions on block exams. MCQ block exam questions were drawn from a secure question bank. The difficulty of 72 identical questions from block exams was compared between the year with no concept mapping and the following year with concept mapping. We found that the average percentage of students answering MCQs correctly increased (65.2 to 72.7%; p<0.001) and the increase was greater for low scoring students than high scoring students (7.7 vs 4.5%; p<0.05). Also, student post-course survey results indicated an increase in time spent preparing for class (p<0.001), perceived gain of factual knowledge (p<0.001) and reported connection of basic biochemistry to medicine (p<0.01). There were no differences between the average Grade Point Average and average Medical College Admission Test scores for the two classes.
The addition of case-based concept mapping to the application exercises of a team-based learning model was associated with improved performance of first year medical students on MCQs, increased student engagement and the perception of improved knowledge and understanding.