Challenge the traditional professorial approach – it works!

"My initial reaction was ‘I’m not doing that’! I won't get them to hold up red, green and yellow answer cards in a fingertip knowledge test when they’ve come to listen to a professor."

Professor and chair of neurology Henning Andersen was sceptical when, as one of the first, he restructured the traditional class lectures at graduate level and subsequently the postgraduate courses on the specialist medical education and introduced the student-activating form of instruction Team-Based Learning (TBL). Because can adults really be bothered to raise coloured answer cards and discuss cases instead of listening and taking notes as has been customary in an academic lecture tradition?

"The answer is that they most certainly can be bothered, because with Team-Based Learning they feel they’re being acknowledged. I haven’t received any negative feedback about the method. All of the students have replied that they find TBL good or very good," says Henning Andersen, who has agreed to share his experiences now that all theory on the Master’s degree programme will be modernised and class lectures will be in principle abolished from spring 2019.

Just do it!

The major reorganisation, which now includes all clinical professors, course managers and other course coordinators on the Master’s degree programme, kicked off with a pilot project for neurology and psychiatry back in 2016. This meant that Henning Andersen was already involved in restructuring most of the theoretical teaching to Team-Based Learning, which is a teacher-based but student-activating form of instruction with accountability as the most important principle.

"In connection with the process in 2016, we reduced eleven traditional lectures in the lecture theatre to the current four. Based on my experience with this, I would advise my colleagues in the other specialist areas to ‘Just do it’! And to approach the process with an open mind," says Henning Andersen.

He certainly does not share the concern that is sometimes aired by those who are sceptical about the method, which is that the taxonomic level falls in tandem with focus no longer being on the lecturer's narrow, in-depth specialised knowledge – as it is instead targeted at the problems which medical doctors meet in practical clinical situations.

Wave the red and green answer cards

In TBL, the lodestar is that the student prepares the theoretical aspects – text, video – at home, after which the teaching time is used to discuss and apply knowledge to solving specific clinical issues. Teaching typically begins with a number of rather basic questions in the subject area, of the type that are also used in e.g. a multiple-choice examination. The questions are presented on a big screen and the procedure can for example be as follows (see translation of the slide below):

Translation of the slide: Characteristic findings with polyneuropathy are: In yellow - Proximal axonopathy. In red - Distal axonopathy. In green - Glove-stocking formed sensory outcome. And in black: Shuffling gait.

When the question appears on the screen, each student must indicate his or her answers by raising an answer card which has the same colour as the contention that the student is ready to bet his or her savings on.

In the example above, the red and green reply card should be raised as both 'distal axonopathy' and 'glove-stocking formed sensory outcome' are characteristic findings with polyneuropathy – a condition in which many nerves, especially in the feet, do not function as they should. And that is certainly something students ought to know on their tenth semester.

No one can sit and catnap

On the other hand, if students instead raise the yellow or black answer card, they indirectly receive feedback that it would be a good idea to read up on the material before the next lesson. As a rule, the effect is that the students raise their game:

"They’re confronted in a completely different way than when they can sit at the back and catnap while a lecturer spends three-quarters of an hour on providing his narrow, deep knowledge from a long academic life working on neuromuscular diseases," says Henning Andersen.

In TBL teaching, the individual questions are replaced by some specific clinical cases which provide more complex, but still specific questions to be discussed in small groups, with answers submitted as described above with coloured answer cards. Time is also spent on discussing the underlying reasoning in a plenary session. Only then does the lecturer really take centre stage with his or her comments and summaries, and this is where Henning Andersen has to admit that this is somewhat of a break with the previous traditional professorial approach.

What about the most talented?

“Some lecturers find that things are less academic when much of their 'airtime’ is spent on student discussion, and I can certainly understand this. But on the plus side, TBL significantly raises the level among those at the bottom of the group, because so many more students are involved and say something. With TBL the level of the whole class – and not just the few – is raised," says Henning Andersen. Neither does he share another often heard concern that elite students go home hungry after TBL teaching.

"I sometimes hear the argument that TBL affects the most talented, understood as the two or three students who are the only ones to ask questions during traditional academic lectures. But in my experience, these very talented students come over to me afterwards and ask their supplementary questions, and I can’t see that they should benefit less when the class as a whole is actively involved in the teaching. For me it's more a question of raising the level at the lower end based on the view that the elite students will manage anyway," says Henning Andersen.

More fun for the lecturer

He and his colleagues are now ready to give the teaching in neurology another critical review with a view to – possibly – incorporating additional new tools and methods such as e.g. virtual meetings. At the same time, during the most recent semester, Neurology filmed the last traditional lectures to look into whether they could be 'edited' and used in a new way.

"But the most important message to those who might think that getting started is difficult and burdensome, is that being a lecturer is much more fun this way. And that it can snowball. I actually can't remember when I last gave a lecture where I just stood there and talked," says Henning Andersen.

Facts about the reorganisation

• The department management team at the Department of Clinical Medicine has decided that all teaching must be reorganised by the time the students begin on the Master’s degree programme in February 2019. See the following article for more information Goodbye to crowded lectures at Master’s degree level.
• The reorganisation began on 6 April this year when around 45 clinical professors, course managers and other course coordinators participated in an introductory workshop
• During the week beginning 3 September and again in the week beginning 17 September, CESU has a series of training sessions in e-learning tools targeted at lecturers on the Master’s degree programme.

Contact

Professor, Department Chair, Consultant, DMSc and PhD Henning Andersen
Department of Clinical Medicine
Department of Neurology
Email: hena@clin.au.dk
Telephone: (+45) 7846 3281

For general questions about the reorganisation, please contact:
Administrative Officer Christian Ravn Olesen
Department of Clinical Medicine
Email: crol@clin.au.dk
Telephone: (+45) 7845 9006