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.