Educational Innovations in GME Applying Team-Based Learning in Primary Care Residency Programs to Increase Patient Alcohol Screenings and Brief Interventions Sylvia Shellenberger, PhD, J. Paul Seale, MD, Dona L. Harris, PhD, J. Aaron Johnson, PhD, Carrie L. Dodrill, PhD, and Mary M. Velasquez, PhD Abstract Purpose Educational research demonstrates little evidence of long-term retention from traditional lectures in residency programs. Team-based learning (TBL), an alternative, active learning technique, incites competition and generates discussion. This report presents data evaluating the ability of TBL to reinforce and enhance concepts taught during initial training in a National Institutes of Health–funded alcohol screening and brief intervention (SBI) program conducted in eight residency programs from 2005 to 2007 under the auspices of Mercer University School of Medicine. Method After initial training of three hours, the authors conducted three TBL booster sessions of one and a quarter hours, spaced four months apart at each site. They assessed feasibility through the amount of preparation time for faculty and staff, residents’ evaluations of their training, self-reported use of SBI, residents’ performance on individual quizzes compared with group quizzes, booster session evaluations, and levels of confidence in conducting SBI. Results After initial training and three TBL reinforcement sessions, 42 residents (63%) reported that they performed SBI and that their levels of confidence in performing interventions in their current and future practices was moderately high. Participants preferred TBL formats over lectures. Group performance was superior to individual performance on initial assessments. When invited to select a model for conducting SBI in current and future practices, all residents opted for procedures that included clinician involvement. Faculty found TBL to be efficient but labor-intensive for training large groups. Conclusions TBL was well received by residents and helped maintain a newly learned clinical skill. Future research should compare TBL to other learning methods. Acad Med. 2009; 84:340–346. Postgraduate residency programs traditionally rely on the lecture method to communicate new information to learners. Grand rounds lectures are an example. In this type of passive setting, little opportunity exists for learners to discuss material or for instructors to determine whether learning has taken place. Evidence indicates there is little long-term knowledge retention from these lectures 1 and that active learning in medical education is more effectual than passive learning. 2–6 Team-based learning (TBL), an active-learning, group-based instructional format, was first introduced in higher education in 1994. 7–8 After the theoretical basis of TBL was elucidated, some medical schools adopted this new learning method in the preclinical curriculum, 9 –13 in the clinical curriculum, 14 and in residency curriculum. 15 TBL programs derive from theory suggesting that adults learn most effectively when the basis for learning is experiential, social, and active; involves discomfort; leads to the generation of narrative; and uses both structure and freedom. Common features of TBL are that participants are accountable for individual and group learning, work in small groups to solve identical application problems, are encouraged to discuss and defend their answers, and receive immediate feedback regarding their performance. 7–8 Studies indicate that the approach changed learning, behavior, and the level of medical student satisfaction. 13–14 Residents became more engaged and stayed on task more often than during the typical lecture format, 15 and faculty viewed the model as efficient and effective. 10,12 Levine and colleagues 14 also looked at learning outcomes of students in a psychiatry clerkship. They documented that in comparing average scores of two classes, the team learning group scored significantly higher than those in the conventional didactic clerkship. 14 The Mercer University School of Medicine (MUSM) research team received a National Institutes of Health (NIH)-funded training grant from 2005 to 2007 for teaching physicians and staff to conduct screening and brief interventions (SBIs) for alcohol misuse; however, finding an appropriate instructional format for reinforcing concepts and procedures taught in initial training proved challenging. The method had to be efficient because the usual training time frame in residency programs is one hour. At the same time, the method had to engage learners to think about, discuss, and effectively use material they had covered at an initial training and during reinforcements. We developed team learning modules (called booster sessions) to reinforce the concepts taught at the initial three-hour training session, and we designed activities to involve learners, incite competition, and generate discussion. Although nurses, triage staff, residents, and faculty in family medicine participated, this report focuses on resident learning and the use of TBL as a method to reinforce and enhance the Please see the end of this article for information about the authors. Correspondence should be addressed to Dr. Shellenberger, 3780 Eisenhower Parkway, Macon, GA 31206; telephone: (478) 633-5550; fax: (478) 784-5496; e-mail: (Shellenberger.Sylvia@mccg.org). Academic Medicine, Vol. 84, No. 3 / March 2009 340