Team-Based Learning in Medical School Hematology Course Improves Immediate Understanding but Not Long-Term Retention

Background: The goal of medical school hematology preclinical curricula is to prepare students not only for course exams and standardized testing but also clinical care during clerkships and beyond. While active teaching methods such as team-based learning (TBL) are associated with improved end of course exam performance, the impact on long-term retention has not been evaluated.

Methods: We assessed the impact of three different teaching approaches on short term understanding and long-term retention of hematology knowledge after a hematology pathophysiology course. Lecture material was reinforced with traditional case-based small group discussion, TBL, or no small group reinforcement. Knowledge assessments with 15 multiple choice questions were conducted prior to the course, immediately after course, and 14 months after the course at the end of the core clerkship year. Several topics covered by traditional small groups in the 2018 were switched to TBL in the 2019, and, thus, could be directly compared across the two cohorts.

Results: We recruited 70 students, 34 from the 2018 iteration of the course and 36 from the 2019, which represents 24% of eligible students. Of these, 48 students completed the final assessment (69% retention). Prior to the course, students answered 31% of questions correctly. This increased to 78% immediately after the course with significant differences across teaching methods: TBL 87%; traditional small group 78%; no small group 76% (p< 0.01). Overall knowledge declined to 70% at long-term follow up. The effect of the teaching method also dissipated and was no longer statistically significant: TBL 75%; traditional small group 67%; no small group 70%. When restricted to three topics converted from traditional small group in 2018 to TBL in 2019, the long-term benefit was not shown, with correct answers in 59% of the 2018 cohort taught through traditional small groups and 54% of the 2019 cohort taught through TBL. Long-term retention did not vary according to whether students reported re-exposure to hematology in the time since course completion.

Findings and Discussion: We found a meaningful and statistically significant increase in the understanding gained by using TBL, but this did not lead to better long-term retention. The immediate impact of improved knowledge is consistent with prior research on TBL and may be sufficient to justify its use, as improved scores on short-term testing testing has value for student well-being, generating an interest in hematology, and competitiveness for residency application. However, our findings argue against justifying the adoption of TBL on the basis of superior long-term retention. Despite this TBL may still be of long-term benefit through modeling team decision making and self-directed learning that are core features of how clinical medicine is practiced. The impact of TBL on these components of clinical efficacy and on an interest in hematology remains areas for future study.