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TBLC Global Newsletter Special Edition 2 • Tips for Challenges in Online TBL

Wednesday, July 1, 2020   (1 Comments)
Posted by: Cassie Chinn
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President's Message


A Message from Membership Committee Chair, Michele Clark

We are excited to be able to provide a second special edition of the TBLC Global Newsletter. Our colleagues from Asia and Europe have contributed to this issue, and they have identified common problems and challenges in delivering TBL online. I think you will find their suggestions useful and practical in helping your students have a seamless course experience.


Reflections for Online Team-based Learning

Written by Steve Cayzer

Like many of those in Higher Education, I have moved my teaching online. Since my sessions involve highly interactive teamwork and very little ‘lecturing’ this had proved a challenge. In this blog I present some reflections and learnings from my experience, in the hope it might be useful to others. My reflections cover: using the technology, team teaching, facilitating the session – and my key learning it takes longer than you think!


This is not a blog about ‘how to’ do online teaching. However, for context, my cohort is around 90 students split into 14 teams. I use a strategy called Team Based Learning but my learnings should be relevant to pretty much all online teaching.


1. Embrace the technology
For me, this is Microsoft Teams. I am not a particular fan of Microsoft technology, I hate Sharepoint for example. However, for my purposes, MS Teams works pretty well. Not least you can have private ‘channels’ for breakout team discussions which is absolutely key. Other technologies offer a similar functionality – Zoom, for example is a great tool.

One thing worth using is the notion of instant polling. In MS Teams I use Microsoft Forms which is a little temperamental but seemed to work in the end for me. The chat window is also invaluable. MS Teams allows some file sharing within the groups but I haven’t used that yet.


Another thing I used extensively is desktop recording of ‘lectures’. I use this to record video snippets (5-10 minutes each) of key concepts and post these to our online learning platform. (I use panopto desktop recorder and moodle, but other tools are available of course). I avoid the need for students to download large video files.

In any case, the learning for me was not to think of online learning as it used to be 10 years ago (or more!) but to embrace the newer technologies and affordances.

2. Students will be ahead of you (mostly)
Once I had introduced the students to MS Teams, they pretty much figured it out themselves, posting animated GIFS (I still am not sure how to do this) and getting private meetings sorted out. That said, it is worth finding a simple guide, and checking in on the teams to make sure they are using the basic technology (for example “@” tagging, or sharing a screen for discussion – and turning their microphones to mute during the breaks!).

In my experience, I didn’t have any student who couldn’t get online (but this is always a possibility). What is more likely is a student with dodgy internet access (and indeed my own wireless network cut out a couple of times). It is worth making sure there is a backup channel for these eventualities eg text messaging/mobile phones

In my sessions I am actually using 3 systems – MS TeamsMoodle and InteDashboard (a cloud based Team Based Learning system). Although I am thinking about simplifying, the students seem to handle using 3 systems at once, and they do provide a backup. (for example, I had pre-recorded the task briefings as 3 minute video snippets and made them available on moodle, in case my connection failed).

3. It takes longer than you think!
This is possibly my KEY learning. My carefully planned classroom activities needed to be adjusted and truncated, particularly in the first session, as the students adjusted to online communication with each other (and had the inevitable technical issues). I suspect this will get a bit easier in the next few sessions but I still think we probably won’t get quite as much achieved, the team communication simply takes longer online.

For reference, I had 3 activities in around 2.5 hours, the last one assessed. Each one is only meant to take 15-30 minutes of team work time (in private channels), but you need to allow time for briefing, for discussion, for wrapup and of course allow some comfort breaks. So I finished the first activity in an hour (allowing some extra facilitation time), the second in 40 minutes, and the third in 45 minutes. With breaks between each, and a final session doing a ‘concept check’, individual assignment briefing and final wrapup. I had already ditched the ‘gallery walk’ part of the class, and had to drastically reduce the second activity ‘on the fly’.

4. You need helpers
With 14 teams, I had just enough time to pop into each team channel once during the 3 hour session to check things are going OK. Fortunately I had a colleague (we were co-teaching) and 2 postgraduate helpers who were invaluable. As I said, you can pop into a team breakout discussion at any time, my technique was simply to leave a text comment if things were going OK, and only interject if the team seemed a bit lost or having difficulties with the task. My colleague was a bit more hands on and had a conversation with each team he visited. Either approach can work.

5. You need cues for participation
One thing that slightly surprised me (but shouldn’t have done) was that students are very reluctant to speak up in a large group channel – but they are happy enough to post comments, so this is worth encouraging. (if you get too many, your helpers can triage the comments for you – this didn’t happen for me, the volume was perfectly manageable). In fact some students who would never speak up in class were posting some very insightful comments, so in some ways this can even be an advantage. One student told me that my explanations were ‘clearer than in the classroom’ presumably because they come through to him with less background noise from his neighbours.

Students are much happier to speak up in their private team channels, and they will often then turn their videos on (which they wouldn’t in the main group). You will need to get students back from these private team discussions – I gave them a very specific time to return and my helpers posted comments on the team channels to bring them back again.

I also use Microsoft Forms for quick in class polls – this is really very useful to guide discussion. I ran a ‘concept check’ at the end of class, posting a number of learning outcomes to see which ones they were comfortable with. There was only one with a low number of votes, so I spent a few minutes wrapping up that concept with the class.


6. Consider asynchronous
Time in the classroom is a golden opportunity for peer learning, so I arrange my sessions to maximise that chance (this is a core principle of Team Based Learning). The same is true for online learning. So all clarifications and ‘lecturing’ should be kept to an absolute minimum. Pre learning can be recorded and posted for the students to go through in advance (I also use quizzes, online games and self assessment tests for self paced learning). Similarly, if you find yourself entering into a lengthy explanation of a concept during an online session you probably need to ask yourself whether it would be better posted as a follow up to a forum, perhaps even as a recorded video snippet. Conversely, I try to avoid too much team work done asynchronously, I think this is best kept within the timetabled slot where possible.

Online teaching takes time to learn how to do well (and I am still learning). It requires even more disciplined class scheduling/managing than in person teaching. The definition of ‘inclusive teaching’ extends to technology access and time zones. Yet for me at least, online learning offers a golden opportunity to explore new ways of teaching that supplement – and even improve – the classroom experience.


No Pandemic Panic: How a medical school moved large-group TBL online smoothly

Written by Yang Lishan and Jessica Ang

The Lee Kong Chian School of Medicine (LKCMedicine), a joint medical school between Nanyang Technological University Singapore and Imperial College London, utilises team-based learning (TBL) as its main pedagogical method for the first 2 years of the medical undergraduate curriculum (Rajalingam et al. 2018). There are up to 150 students per class, participating in roughly 70 TBL sessions per year.

Due to the Covid-19 outbreak, courses had to be moved fully online practically overnight. LKCMedicine’s success in moving to fully online TBL (eTBL) painlessly and quickly was achieved because a dedicated learning management system called LAMS, customised specifically for TBL, was already in place. Since the pandemic had occurred in the second half of the academic year, students were already familiar not just with LAMS usage, but also knew their teammates well, both important factors in the smooth transition. LAMS orientation and team development are therefore important factors to consider for the incoming cohort of freshmen should eTBL still be a requirement.

The rich face-to-face intra- and inter-team discussion in TBL is maintained through LKCMedicine’s use of teaching teams (Yang & Rajalingam, 2019). Each TBL session at LKCMedicine has a “process expert” Facilitator co-teaching alongside Content Experts (CEs; clinicians or scientists) to ensure that constructivist pedagogical practices (Fosnot & Stewart, 2005) are upheld. The Facilitator’s role is to manage the TBL process and class discussions, since most CEs only teach 1 or 2 sessions each year, and may feel overwhelmed managing discussions and toggling real-time data in LAMS for 150 students. 

LKCMedicine’s Digital Learning (DL) Team is another important support factor in eTBL. The Zoom video conferencing software had been chosen for functions which allow for close emulation to face-to-face sessions. The DL team hosts the Zoom sessions, managing features such as breakout rooms and screen-sharing.
Other factors that enable effective eTBL include:

  • Dissemination to students of step-by-step guides to technological tools’ functions and usage, and establishment of contact point for IT support, as well as ground rules for effective learning on Zoom.
  •  Having alternative (and instant) channels of communication to all stakeholders. A WhatsApp chat group is created before each session for the Facilitator, CEs and DL support staff. This provides a space for the Facilitator and CEs to discuss management of learning activities, and also allows the CEs receive technical support. The Facilitator may also use WhatsApp to contact the student class representative when necessary; for example, should any outage occur, the student representative would be able to disseminate information to the rest of the class quickly via the class’ own chat group.
  • Instructions and expectations (such as the duration breakout rooms stay open) are made known clearly before each segment of TBL.
    The feedback on the 40 eTBL sessions held so far has been positive from students and faculty. Students appreciate that their learning has not been relegated to didactic Zoom lectures, since the key features of TBL have been retained as much as possible despite the physical separation from their classmates and teachers. CEs and Facilitators have commented that the quality of student discussions in eTBL has been exceptional, as it appears to be a bastion of normalcy for them in a time of isolation.

Yang Lishan Lead for TBL Facilitation, LKCMedicine and 
Jessica Ang, Lead for Educational Development, LKCMedicine. 

Fosnot C, & Stewart R. (2005). Constructivism: a psychological theory of learning. In: Fosnot C. T., editors. Constructivism, theory, perspectives and practice. New York: Teachers College Press; p. 8–38.

Rajalingam, P., Rotgans, J. I., Zary, N., Ferenczi, M. A., Gagnon, P., & Low-Beer, N. (2018). Implementation of team-based learning on a large scale: Three factors to keep in mind. Medical teacher, 40(6), 582-588.

Yang, L., & Rajalingam, P. (2019). Are Two Teachers Better than One? Team Teaching in TBL. Medical Science Educator, 1-5.


Dedicated Administrative Support: The key to a smooth transition from in-class to online TBL

Written by Muhammad Raihan Jumat

Since its inception, Duke-NUS Medical School, Singapore, employed team-based-learning (TBL) pedagogy for its preclinical curriculum (1). In response to the COVID-19 pandemic, the university moved all its preclinical classes online. Working behind the scenes are a special group of administrators who are dedicated to making learning seamless for all participants (students and faculty). Typically these administrators, known as the MD Program Administrative Team (AT), schedule classes, train faculty, provide and maintain access to all the platforms utilized, monitor student activity, collate test responses and statistics, coordinate efforts to continually improve the process and tend to all the administrative and logistical needs of the learning process. This allows the faculty and the students to focus on learning without being burdened by the logistics of the process. 

With the sudden requirement by the university to convert to a completely online environment, faculty and students were concerned about the feasibility of transitioning and implementing TBL online so quickly. Fortunately, the AT was at hand to overcome the major logistical obstacles which could have prevented a seamless transition and execution of online TBL. 

The AT were aware of the online platforms that the university had procured and advised the leadership on their functionality. Access to these platforms by the participants was granted and maintained by the AT who also provided training to faculty on their utility. During the class, the AT provided any needed technical support. The AT identified strategies to enable students and faculty to connect if either might not have access to the online platforms. As in a face-to-face TBL, the AT continued to collate the tests responses, results, statistics and presents it to the faculty for course reviews. But in an online TBL, the AT also needs to create a separate virtual space for the faculty to discuss the performance of the students and to strategize the facilitation of the ensuing discussion.

Given the sudden push to move online, several teething inconveniences were experienced at the onset. The AT routinely collected feedback from the students and the faculty. This feedback served instrumental in modifying the format of online TBL in real time. Members of the AT, together with the educational leadership reviewed each lesson and the feedback collected to serve this purpose. Any decisions made were incorporated immediately and the AT were responsible in operationalizing these changes.

We believe a dedicated centralized administration team has always played a crucial role in the successful delivery of our TBL sessions, but even more so in bringing TBL online. Without the AT, both students and faculty would be burdened by the logistical responsibilities and this would serve as a major distraction from the learning process. Any institution interested in implementing TBL, especially on an online platform, should engage a dedicated administrative team to helm the administrative and logistical aspects of this unique learning experience. 

Kamei RK, Cook S, Puthucheary J, Starmer CF. 21 st Century Learning in Medicine: Traditional Teaching versus Team-based Learning. Medical Science Educator. 2012;22(2):57-64.


"Before we start the class, let me hear your concerns:" The importance of communication in transitioning TBL online

Written by Muhammad Raihan Jumat

Confusion, frustration and skepticism. These were the general sentiments felt by the students and faculty of Duke-NUS Medical School when all preclinical lessons were moved online abruptly in light of the restrictions imposed nationally due to the COVID-19 pandemic. All the preclinical lessons at Duke-NUS are delivered in a team-based-learning (TBL) pedagogy, known as TeamLEAD (1), and is heavily dependent on student engagement. Here we highlight the enhanced communicative efforts by the educational leadership to improve the online TBL experience.

Bringing TBL online is not a straightforward process. Creating the conditions which foster peer-to-peer learning online require the synchronization of multiple processes. Students take tests on a secure platform, participate a team discussion on a video-conferencing platform of their choice, then reconvene with the rest of the class on another video-conferencing platform. Students also submit queries on a shared online document, which is vetted by the class and the faculty. The whole process is moderated by a faculty-facilitator while logistically helmed by a dedicated team of administrators. Each TBL session is planned in advance in a process called TeamLEAD Works in Progress (TWIP). In a typical TWIP, the educational leadership meet to analyze the test statistics, student feedback, and refine elements of the TeamLEAD for the upcoming class.

Typically, feedback is collected from students after each session to gather the sentiment of the class for quality improvement and reviewed after the course has ended and during the TWIP. However, to placate and respond to the uncertainty of implementing online TBL, feedback from students and faculty were reviewed immediately post session. Additional questions were added on the feedback form regarding the online TBL format. After each class, the faculty and members of the administrative team were invited to attend an extension of the TWIP, chaired by the course director. In this meeting, the student feedback from the previous sessions are shared and the faculty also provide their insights. The feedback collected provides an assessment of the decisions made to address prior issues/concerns. This iterative process is nimble enough to detect all the pressing issues of the existing format and also robust in responding to them. In addition to the formal feedback collected after class, participants were also invited to write directly to the course director and/or administrative team anytime over the duration of the course. Any non-urgent issues detected may be reviewed in the pre-course TWIP sessions.

Navigating the transition and implementation of online TBL was a precarious undertaking. While feedback is typically collected in a face-to-face TBL, in transitioning and implementing online TBL, greater efforts were placed to improve the communication among all participants. The open communication channels created by the educational leadership was instrumental in making a smooth transition to an online environment. We will be reviewing if this should become a permanent feature of the TWIPs for all courses.

Kamei RK, Cook S, Puthucheary J, Starmer CF. 21 st Century Learning in Medicine: Traditional Teaching versus Team-based Learning. Medical Science Educator. 2012;22(2):57-64.


An Online Undergraduate TBL Course: Challenges, tips and feedback

Irene Cheng Jie Lee PhD1, Peiyan Wong PhD1,2, Sarada Bulchand PhD1*
1Duke-NUS Medical School, Singapore; 
2National University of Singapore, University, Singapore 

*Corresponding author:
Sarada Bulchand
Duke-NUS Medical School
8 College Rd, Level 3
Singapore, 169857

Duke-NUS Medical School is the first graduate medical school in South East Asia that delivers preclinical curriculum using Team-Based Learning (TBL). To recruit prospective MD students, we offer a unique, undergraduate course employing the same teaching pedagogy. This course aims to build core competencies required of medical students, including critical thinking, communication skills, and scientific research literacy. Notably, our teaching faculty are postdoctoral research fellows. As their only TBL-based teaching opportunity in Singapore, the course aids in their professional development.

The COVID-19 pandemic precipitated the digital transformation of educational activities worldwide. We were no different. After a 10-year successful run in a face-to-face class, we leveraged a TBL-enabled platform , InteDashboard™, and a video-conferencing tool, Zoom, to successfully move online. We share here our critical reflection: the challenges faced, practical tips and course feedback, on implementing an online TBL class for a cohort of 34 students. 

1. TBL faculty faced an unfamiliar educational modality: Peer-observation of sessions and training in using the virtual platform was key to building confidence and technical proficiency. Post-session debrief and feedback, from students and facilitators, helped build the community of support to ease into the process.

2. Multitasking is required in the facilitation of a virtual class: The facilitator would have to take note of a virtual raised hand, monitor the chatroom, identify inattentive students and deliver content. We alleviated this cognitive overload by having a non-content expert co-facilitate.

3. Frequent, short breakout rooms consumed time: We modified application exercises that required frequent, short team-based interactions, as breakout room implementation took more time than physical gathering in their teams. Additionally, we recommend using higher-order, multiple choice, rather than short answer type questions for the application exercise.

4. Reduced non-verbal communication: It was difficult to instantaneously gauge sentiments. However, students’ engagement rapidly grew once they understood the process. Possibly, the online setting allowed for greater freedom of expression, without the perceived judgement and the resulting nervousness that students may feel in a physical classroom. Interestingly, the reduced extraneous cues also advantaged the less TBL-experienced faculty, as being less self-conscious, they could focus on the class discussion. 

5. Maintenance of student engagement: Unsurprisingly, students’ engagement tend to decline over time. We overcame this by making it mandatory for students to be video-enabled, and using a name list to randomly call upon students. We also recommend increased levels of animation and voice modulation to break the monotony.

6. Management of student’s expectations and incorporation of their feedback: By judiciously doing so, we observed improvements in students’ feedback during the transition. End-of-course feedback showed that we met the syllabus objectives and was comparable with face-to-face iterations. A majority of the qualitative feedback received indicated that the course positively impacted the students’ interest in pursuing a MD or MD/PhD program at Duke-NUS.

Overall, our rendition of online TBL maintained the goals and purpose of the course. Our successful implementation widens Duke-NUS’s recruitment outreach to undergraduate institutions beyond Singapore. It also continues to provide professional development for postdoctoral fellows as scientist-educators.


Flattening Your Online TBL Teaching Curve

Written by Brian O'Dwyer

Since 2018, I have been collaborating with several TBLC members (Chris Burns, Sandy Cook, Annetta Dolowitz, Julie Estis, Tom Jansen, Jenn Styron and Simon Tweddell among others) to pilot a series of TBL professional development workshops online. We started after a TBLC whitepaper on online TBL best practices was created to put some of the best practices into action. To date we have conducted 44 live synchronous online TBL workshops and reached over a 1,000 TBL educators in 30+ countries on six continents. We have learned a lot during this team and climbed our own “learning curve” about how to teach with TBL online. In recent weeks I had a chance to collect my thoughts on seven applied tips to implementing the best practices in the TBLC online TBL whitepaper. Here they are:
1. Objectives: Reassess your objectives for the post-COVID world. Is this emergency remote teaching? Review? New material? For online, more specific is better.
2. Roles: Online TBL requires several roles (facilitator, content expert, web conference host, EdTech coordinator and project manager). You do not need to do all of this yourself at least initially. For early sessions, get extra help from others to cover roles like web conferencing. When you build proficiency, you may be able to build to a one to two person show. 
3. Tech stack: We have found that having one web conference technology tool and one education technology tool works best. You can drive nails and turns screws most efficiently with the right tool for the job (e.g. a hammer for nails and a screwdriver for screws). With all the moving parts of online TBL for learners and educators we find having the right tools is critical. 
4. Materials: When moving TBL online several things change and as a result, materials such as RATs and Applications may need to change as well. We have found that many things take longer online than in-person and activities need to be much more specific since clarifying misconceptions once teams have gone to virtual breakout rooms can be challenging. 
5. Preparation: Preparation is always important in TBL. In online TBL it is very important and becomes more complex as learners need to be oriented to communications and education technologies as well as the TBL method.
6. Facilitating online TBLs: Facilitating TBL in-person can require certain skills and techniques and online TBL is no different. There are a number of ways to do this such as opening “web conference” doors 15 minutes early, establishing social presence with chat introductions, time for orientation, monitoring timing carefully and being prepared and calm when something inevitability goes wrong. 
7. Debrief, evaluation and improvement: We found debriefing after each session and soliciting learner feedback was critical to improvement. Our experience grew with each TBL session as follows:

1-5: very challenging
6-10: improving but stressful
11-20: structural process and technology improvements 
21-40: refinement
40+: new normal


K SHEEBA says...
Posted Tuesday, July 7, 2020
Intedashborad is an excellent support for online TBL and without that doing online TBL is very cumbersome and tricky at times.

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