Discussion
Main findings
TBL is an established collaborative learning approach in medical education (1, 2). VaKE is a teaching approach which combines values education to knowledge acquisition. Adding a moral/ethical dilemma to the learning module stimulates the students to further seek for information by themselves in order to solve the dilemma without limiting the content of the curriculum (7). In this study we combined, for the first time, these two teaching approaches, compared and evaluated the students’ views and opinions on the TBL Vs. VaKE combined with TBL. The students who experienced the TBL+VaKE teaching approach graded it higher, statistically significant when all parameters were combined.
Interpretation
Our results are in accordance with other studies which evaluated active Vs. traditional learning approaches. Kelly et al conducted a study to compare the in-class engagement of medical students learning preclinical medical curriculum. The three types of learning approaches included in their study were problem-based learning (PBL), TBL and regular, frontal lectures. Study results showed that in PBL and TBL students’ engagement was similar but much higher than the regular lectures. The authors concluded that the observed engagement behaviors confirm the potential of team learning with greater faculty input (8). Freeman et al evaluated the results of active Vs. traditional lecturing course performance on 225 studies that reported data on examination scores or failure rates for science, technology, engineering, and mathematics (STEM). Average examination scores improved by 6% in active learning, and that students in traditional classes were 1.5 times more likely to fail than those in traditional learning (9). Theobald et al tested the hypothesis that underrepresented students in active-learning experience narrower achievements gaps than underrepresented students in traditional lecturing in STEM courses. Data from 15 studies (9,238 students) revealed that active learning reduced achievement gaps in examination scores by 33% and narrowed gaps by 45% (10). The authors called to replace traditional lecturing with active-learning course designs across the STEM disciplines. Conducting a new teaching approach, we had concerns whether or not the new methodology would impair the students’ achievements. We evaluated this issue by comparing the module’s final test results of the two approaches. We detected no change in the knowledge results in both groups’ final exams. One important and significant difference between the groups of students was that “the complexity of decision making” received higher marks in the TBL+VaKE group. This is an important observation. Indeed, obstetrics is a more complex domain then others in medicine because we have to consider two patients relating very closely to each other. These two patients have many times opposite interests and we have to work out the best solution for both. Therefore, we believe that obstetrics faculty should embrace this approach as soon as possible, since it appears to be perfectly suited for this unique domain in medicine.
Strength and limitations
This is the first study in the literature which combined TBL+VaKE in medical eduction approach of medical students. Another strength of our study is the match of our study with many other studies, comparing active Vs. passive learning approaches and concluded the same conclusions: active learning is better than passive learning. Further more, combinig the TBL to VaKE did not lower the final exam achievements, meaning - no harm done. The main limitation of our study is its small participants number.