Active learning by means of team-based versus traditional learning methods in undergraduate dental students: A cross-sectional pilot study

Md Zahid Hossain; Saeed Ali Alsareii; Khaled Mashoor Hyderah; M M Iqbal Hossain; Abdulrahman Aseri; Siraz D. A. A. Khan

doi:10.4103/sjoralsci.sjoralsci_9_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 9 | Issue : 2 | Page : 92-98

Active learning by means of team-based versus traditional learning methods in undergraduate dental students: A cross-sectional pilot study

Md Zahid Hossain¹, Saeed Ali Alsareii², Khaled Mashoor Hyderah¹, M M Iqbal Hossain³, Abdulrahman Aseri¹, Siraz D. A. A. Khan¹
¹ Department of Preventive Dental Sciences, College of Dentistry, Najran University, Najran, Kingdom of Saudi Arabia
² Department of Surgery, College of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
³ Department of Restorative Dental Sciences, College of Dentistry, Najran University, Najran, Kingdom of Saudi Arabia

Date of Submission	25-Feb-2022
Date of Decision	13-Apr-2022
Date of Acceptance	27-Apr-2022
Date of Web Publication	31-Aug-2022

Correspondence Address:
Dr. Md Zahid Hossain
Department of Preventive Dental Sciences, Division of Periodontics, College of Dentistry, Najran University, King Abdulaziz Road, P.O. box. 1988, Postal Code 61441, Najran
Kingdom of Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjoralsci.sjoralsci_9_22

Abstract

Introduction: Team-based learning (TBL) is gaining popularity because it allows students to achieve desired intellectual tasks through teamwork, discussion, and professionalism, in contrast to traditional (Trad) learning, which fails to keep the students' continued attention throughout the teaching session, resulting in low grades and retention rates.
Aims: Comparing the outcomes between TBL and Trad learning sessions.
Materials and Methods: A cross-sectional pilot study was carried out. Seventy-two undergraduate dental students were grouped as TBL and Trad. Each group consisted of 36 students and was made up of good, average, and below-average achievers based on their most recent exam results. The control group (Trad) received lecture-based teaching on a topic, while the case group (TBL) received discussion-based teaching on the same topic using the TBL approach. Allocated time slot for each method was equal. Following the completion of the teaching, a test was taken in the same session, consisting of 20 well-constructed multiple-choice questions (MCQs). The outcomes of the MCQ tests were subjected to item analysis. Chi-squared test was used to compare test parameters between the control and case groups using SPSS (v. 23).
Results and Discussion: Overall, the TBL groups yielded significantly higher (58.33%) learning outcomes than the Trad groups (44.4%) (P = 0.01). In general, the TBL approach showed highly significant performance results (P = 0.000) compared to Trad approach. The Cronbach's alpha for TBL and trad learning was 0.967 and 0.949, respectively, indicating an excellent reliability of our findings.
Conclusion: TBL approach has a potential to improve learning outcome by increasing knowledge and encouraging self-directed learning.

Keywords: Active learning, item analysis, Najran, teaching, team-based learning, traditional learning

How to cite this article:
Hossain MZ, Alsareii SA, Hyderah KM, Hossain M M, Aseri A, Khan SD. Active learning by means of team-based versus traditional learning methods in undergraduate dental students: A cross-sectional pilot study. Saudi J Oral Sci 2022;9:92-8

How to cite this URL:
Hossain MZ, Alsareii SA, Hyderah KM, Hossain M M, Aseri A, Khan SD. Active learning by means of team-based versus traditional learning methods in undergraduate dental students: A cross-sectional pilot study. Saudi J Oral Sci [serial online] 2022 [cited 2023 Apr 2];9:92-8. Available from: https://www.saudijos.org/text.asp?2022/9/2/92/355229

Introduction

Dental education necessitates the acquisition of specific theoretical knowledge and practicing skills to employ that knowledge effectively. Traditional (Trad) lecturing has been criticized for failing to keep learners' attention throughout classes and has been linked to less-than-optimal grades that may result from irregular, low, and inattentive attendance in the class.^[1] Historically, the average retention rate of knowledge from a classroom setting lecture in a Trad learning method is only 5%. Following that, students can retain about 10% of knowledge by reading, 20% by audiovisual, 30% by demonstration, 50% by group discussion, 75% by practicing, and 90% by teaching others.^[2] Interactive learning is well documented in dentistry curriculums around the world, specifically in clinical rotation of the students.^[3] Many advantages of this form of learning method have been presented, including the development of problem-solving abilities, critical thinking for a specific situation, and the promotion of life-long learning.^[4],[5],[6] Various educational ideas have differential influenced on teaching and learning in higher education setting during the last four decades.^[7],[8] Among these, it is evident that social learning theories contribute significantly to a better understanding of dental education. Changing trends in educational principles and practices have a significant impact on the production of competent, skilled, and self-sufficient dental professionals.

Team-based learning (TBL) is defined as “an active learning and small group instructional strategy that provides students with opportunities to apply conceptual knowledge through a sequence of activities that include individual work, team work, and immediate feedback.”^[9] Dr. Larry K. Michaelsen, a professor of management at the University of Oklahoma, USA, invented TBL in the 1980s.^[9] Later in 2001, Baylor Medical College in Texas promoted TBL in health professions education by the support from the US Department of Education.^[9] Over the time, TBL is gaining popularity in health profession education among the various learner-centered teaching modalities.^[10],[11] TBL is based on the “team” concept, with “T” standing for “together,” “E” for “everyone,” “A” for “achieves,” and “M” for “more.” TBL is useful for retaining and retrieving students' knowledge to improve their learning of fundamental concepts and their practical application.

TBL generally occurs in three phases.^[12] There are four principles in TBL approach:^[12] (i) appropriately formed and managed team groups that have a potential for maximum fruitful outcome for each of the team member; (ii) student accountability for preparation and participation in each of the learning event of the group; (iii) well-constructed readiness assurance test and team assignments by the instructor; and (iv) frequent and immediate feedback. A multiple-choice test with 10–12 questions is commonly used. These questions should focus on the key points from the subject matter. The questions might vary in complexity, with some being very specific and focused on a single concept, while others incorporate multiple concepts. In general, allow 10 min for the individual readiness assurance test (iRAT), 20 min for the team readiness assurance test (tRAT), 5–10 min for appeals, and l0–15 min for the instructor's feedback.

Rationale and aims of the study

The College of Dentistry of Najran University is relatively new and is trying to adapt to new teaching methodologies by utilizing all the available resources within its reach. To this end, the purpose of the present study was to measure the outcomes of TBL with Trad learning in three groups of undergraduate dental students at the College of Dentistry of Najran University by:

Comparing the outcomes between TBL and Trad learning sessions
Determining the reliability of the written tests using item analysis
Assessing the effectiveness of TBL in small group setting.

We hope that this pilot study allows us to determine the feasibility, duration, cost, and adverse events, as well as to enhance the study design before launching a full-scale research project to improve overall academic environment in the college.

Materials and Methods

Study design

A cross-sectional pilot study of teaching methodology was conducted on undergraduate dental students at the College of Dentistry of Najran University in the Kingdom of Saudi Arabia between January and December of 2021.

Subjects and methods

In this study, a total of 72 undergraduate dental students were enrolled from different periodontology courses. All of the participants were physically and mentally fit, and they gave their full consent to participate in the study. They were grouped as TBL and Trad. Following the strategy described,^[13],[14] each group consisted of 36 students and mixed with good, average, and below average scorers on the basis of their immediate past examination results. The students of TBL groups were subdivided into 3–4 teams, in which 3–4 students were employed in each team. Both TBL (case) and Trad learning (control) groups dealt with the same topics supervised by the same instructor/s. Students were assigned prerecorded lectures before study sessions as described.^[15] Each session was aligned with the curriculum course content, and the lectures, laboratory instruction, and clinical-based teaching were provided before the in-person study session. Both groups used separate classrooms and each in-person session lasted 1.5 h at the same time with the same facilitator. For the TBL group, iRAT (10 multiple-choice questions [MCQs]), tRAT (same MCQs as iRAT), instant feedback assessment technique (problem-solving activity), team appeals, and, finally, instructor's feedback and review occurred sequentially.^[12] The control (Trad) group received the lecture first, followed by a written test consisting of 20 well-constructed MCQs in the same session. The same written test was also taken by the TBL group in the same session with the same MCQs as used for the control group. Optical machine reader was used to evaluate the test results of each of the case and control group.

Following Sharma et al.'s model,^[16] a total of 72 undergraduate dental students were included in each of the 3 TBL and 3 Trad learning sessions:

In the first session, the total number of students was 28 (TBL1 = 14 and Trad1 = 14). The learning topic was “plaque control”
In the second session, the total number of students was 25 (TBL2 = 12 and Trad2 = 13). The learning topic was “clinical risk assessments for periodontal diseases”
In the third session, the total number of students was 19 (TBL3 = 10 and Trad3 = 9). The learning topic was “chronic periodontitis.”

Item analysis, to determine fairness of evaluating students' MCQs responses: Item analysis is the act of analyzing student responses to individual examination questions with the intention of evaluating examination quality. It is an important statistical tool to uphold test effectiveness and fairness and educators usually use this evaluating tool both consciously and unconsciously on a regular basis. This analysis tool can be used for selecting and discarding test items (questions) based on their difficulty value/difficulty factor (DF) and discrimination index (DI).^[17] The proportion or percentage of students who correctly answered the item is referred to as the DF, and it runs from 0 to 1. A low DF (≤0.20) indicates that the item is very difficult, whereas a high DF (>0.80) indicates that the item is very easy. DI is the power of an item to discriminate the students between those who scored high and those who scored low in the overall test and it ranges from −1 to +1. An item will be more discriminating if the DI value is higher. A negative DI value implies that low-achieving students choose the correct answer more frequently than high-achieving students. For high-scoring students, the item may be perplexing in some way. Both (DF and DI) are complementary, not antagonistic. Therefore, both should be considered when selecting good items. A good item has a good level of discrimination and a sufficient level of difficulty (not too difficult nor too easy).^[18]

Validity and reliability of the multiple-choice question tests

Item analysis of each of the MCQ test was performed for each of the participant groups (TBL and Trad) after completion of each session as described by Lord (1952)^[17] and Mukherjee and Lahiri.^[18] This MCQ test analysis approach reveals the level of difficulty, power of discrimination, and reliability. To determine internal consistency of this analysis approach, the reliability coefficient (Cronbach's alpha) was estimated after the number of total items had been confirmed as described previously.^[19] An optimal cutoff point of 0.70 was established to consider acceptable internal consistency.

Statistical analysis

The data obtained were coded, entered, and analyzed using the SPSS software (version 23, IBM Corp, Armonk, NY, USA). Descriptive analysis was done to summarize data as numbers and percentages. The Chi-squared test was adopted to compare MCQ test results between the case (TBL) and control (Trad learning) groups using SPSS (v. 23), with the significance level set at P < 0.05.

Results

The overall findings indicate that the TBL approach is significantly more effective for students learning compared to the Trad learning approach (P = 0.01, Chi-squared test). [Table 1] shows that out of 36 students of the TBL group, 21 (58.3%) students passed and 15 (41.7%) failed in MCQ tests. Of them, 6 (16.7%), 6 (16.7%), 6 (16.7%), and 3 (8.3%) obtained grades A, B, C, and D, respectively. On the other hand, in the Trad group, out of 36 students, 16 (44.4%) students passed and 20 (55.6%) students failed in MCQ tests. Of them, 2 (5.6%), 3 (8.3%), 6 (16.7%), and 5 (13.9%) students obtained grades A, B, C, and D, respectively.

Table 1: Overall multiple-choice questions test results of team-based learning versus traditional learning groups (n=72)

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To determine the effectiveness of TBL and Trad learning in three different learning tropics, each of the corresponding topic of TBL and Trad learning group was compared. [Table 2] shows no significant findings among any of the comparison groups.

Table 2: Individual multiple-choice questions test results of team-based learning versus traditional learning groups (n=72)

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Then, the final MCQ test results between TBL and Trad learning groups were compared by employing item analysis as described^[17],[18] and briefly outlined in the methods section. [Table 3] shows the overall item analysis results. Out of 60 MCQs in the TBL group, 22 (36.7%) MCQs fell in the good category and 8 (13.3%) and 30 (50.0%) MCQs fell in the easy and poor categories, respectively. In the Trad group, out of 60 MCQs, 17 (28.3%) MCQs fell in the good category and 13 (21.7%) and 30 (50.0%) MCQs fell in the easy and poor categories, respectively. The TBL item analysis showed a better learning outcome compared to item analyses of Trad learning (P = 0.000, Chi-squared test).

Table 3: Overall item analysis results of team-based learning versus traditional learning groups (n=60) multiple-choice questions

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Finally, this study explored the item analysis in each of the topic area and compared between TBL and Trad learning groups. [Table 4] shows individual item analysis comparison results of MCQ tests, in which TBL1 versus Trad1, TBL2 versus Trad2, and TBL3 versus Trad3 groups' item analyses showed highly significant values in each of the individual MCQ tests (P = 0.001, 0.001, and 0.000, respectively).

Table 4: Individual item analysis results of team-based learning versus traditional learning groups (n=60) multiple-choice question (20 multiple-choice question for each session)

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The reliability of the MCQ tests was valid as the Cronbach's alpha^[19] was 0.967 and 0.949 for TBL and Trad learning groups, respectively.

Discussion

Trad lecturing has been criticized for failing to keep learners' attention throughout classes and has been linked to low grades and low attendance rates.^[1] Accumulated evidence suggest that the Trad teaching approaches unable to engage all the students adequately with the forms of academic literacy required in higher education.^[20],[21] In contrast with Trad lecturing, the present study yielded significantly (P = 0.01) higher performance of learning output in TBL group. Therefore, TBL is a potentially powerful and unique type of small-group learning approach in dental schools, which is in consistent with other groups findings.^[22]

Yaduvanshi and Singh^[14] conducted a study to explore how the structured cooperative learning technique (STAD method) affected the accomplishment of low achievers, average achievers, and high achievers in 63 students of a biology class. The pretest results were used to equalize the control and case groups. The case group outperformed the control group in terms of low achievers, average achievers, and high achievers. This study included 36 students in each of the case and control groups, mixing with good, average, and below-average scorers based on their most recent examination results. The findings were in line with the latter study outcome [Table 1] and [Table 2].

In a recent qualitative assessment study, TBL and Trad classes were conducted on a cohort of 256 dental students over 3 years in six fixed prosthodontics courses by dividing the students in different groups.^[23] After completion of all the sessions, term-end tests were taken for both the groups using MCQs. Performance of TBL groups was significantly better than the Trad lecture-based teaching in their study, which is comparable to our study as we went through a qualitative assessment procedure, in which the TBL group yielded significantly (P = 0.01) higher scores than the Trad learning groups [Table 1].

Item analysis is a powerful tool for measuring the validity and reliability of a test.^[18],[24] Item analysis of written test was performed using well-constructed MCQs at the end of each session [Table 3] and [Table 4]. All of the tests were highly valid and reliable because Cronbach's alpha^[19] was 0.967 and 0.949 for TBL and Trad learning groups, respectively. Therefore, using this research method in a large number of participants has the potential to produce enough data for policy makers to decide on the teaching methodology at dental schools and other similar educational institutions.

Both TBL and Trad learning groups were taught with the same topics in this study. Each topic was delivered to all participants 1 week before the session following Burgess et al.'s study.^[15] Both groups received prerecorded lectures for essential knowledge acquisition to shift the burden of learning content during the study session.^[15] Prereading lectures would decrease in-person class time. Students' compliance with the completion of assigned prereading and preparation was poorer than expected [Table 2] and [Table 4]. Therefore, new strategies need to develop to engage students in completing assigned prereading and preparation. In addition to increase performance in examination, this prereading and preparation may significantly decrease in-person class time.

In TBL module, each session lasted for about 1.5 h. The facilitator's presence time was reduced in the class when providing similar clinical expertise in each session by utilizing TBL compared to Trad learning. As a result, TBL approach is cost savings. Despite the benefits, it should be noted that the preparation for each TBL session took time and required academic expertise of the facilitator. It also needs other resources such as online library of the institutes and access to all the relevant audiovisual facility for all the participants. Groundworks for the facilitators include preparation of multiple-choice questions and answers, creation of patient cases and clinical problem-solving activities, and PowerPoint slide presentations to guide feedback and clarify concepts. The learners would benefit more from the facilitator giving them extra time to prepare for a particular course.^[25]

A pilot study is a small-scale preliminary study used to determine feasibility, duration, cost, and adverse events, as well as to enhance the study design before launching a full-scale research project.^[24],[26] Considering pilot nature of our study, this study has some limitations:

The topics chosen for each session were influenced by the teachers because it was the first attempt of TBL teaching approach at the College of Dentistry of Najran University, which might have influenced the learning effect. Topics can be chosen by the students for future TBL sessions to minimize selection bias
Because the topic was primarily theory based, the test results of the 2^nd learning session showed that both the TBL and Trad learning groups had low grades [Table 2] and [Table 4]. Whereas, the students of both the groups performed better in the other two sessions (sessions 1 and 3) because the topics were clinic oriented. Theoretical test results may only reveal how knowledge was recalled or utilized. Therefore, considering only theory-based topics for all the three sessions may yield uniform results for all the sessions
Due to small sample size and single-institute study, we were not able to consider several confounding factors such as age, gender, race, and economic condition of the family that may influence on students' performance. In future, large multi-institute study needs to be performed to establish validity of the findings from this study
Other qualities that could be improved through TBL, such as perception, teamwork, and communication, were not well tested in our research. The theoretical assessments at the end of the session only examined short-term learning outcomes. The long-term impacts were not investigated. A well-designed longitudinal study needs to be performed to understand the long-term effects of TBL.

Conclusions

The learning goal is to adopt a 21^st-century paradigm that includes “life-long learning” by incorporating technology and improvements into today's classroom sessions. Although TBL is not extensively used in dental education in Saudi Arabia, the findings of this pilot study explored that incorporating TBL modules into student learning might be beneficial in helping students learning and apply concepts to practice later in their careers. In addition, this study showed the efficacy and feasibility of TBL in small group teaching. Students could master the knowledge and improve their self-directed learning through a team approach. It is recommended that TBL modules should be incorporated in dental education in the interest of student learning, academic enhancement, and overall professional training. Further studies to explore the long-term outcomes of TBL are necessary for the refinement of teaching policy.

Ethical policy and institutional review board statement

The Dental Ethical Committee of the College of Dentistry, Najran University, Kingdom of Saudi Arabia, approved the research project under process No. 001/21 on January 4, 2021. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient declaration of consent

All participants were the students of the College of Dentistry at Najran University, Kingdom of Saudi Arabia. They signed consent forms before participating in the study.

Acknowledgment

The authors would like to thank all the voluntary students for participating in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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