Interactional dynamics in interprofessional team-based learning: Effects of learning design and environments on teamwork

Abstract

Preparing health professionals from different disciplines and institutions to work collaboratively in managing complex health and social care problems is a challenge for undergraduate curriculum designers. The context of this study is an Inter-professional education (IPE) initiative in Hong Kong implemented in 2016-17 that uses team-based learning (TBL) to bring together teachers and students from twelve health and social care programmes across two universities (total n= 1060 students; 41 faculty members) in a challenging, novel learning environment. Each of the six instructional units (IUs) was designed around a clinical topic aimed at engaging students from complementary disciplines. Before the face-to-face part of a 3-4-hour IU, students were given pre-class materials to study (e.g. journal papers, book chapters, videos). On the day of the IU, all students (200 to 500, depending on the IU) gathered in a large hall, where they sat with their pre-assigned team-members to form inter-professional teams. All the student teams synchronously engaged in the team-based learning (TBL) process: individual readiness assurance test (iRAT); team readiness assurance test (tRAT); appeal; feedback; and application exercise (AE). Tasks were completed synchronously on a purpose-built online platform. Team discussions were facilitated by three to nine disciplinary experts in each IU. This study adopts interactional analysis to address the research question, how do newly formed inter-professional groups synchronously engage with both face-to face and online learning processes in a large-scale multi-group TBL environment? Data were collected under ethical clearance (Hong Kong West Institutional Review Board) and included overhead video recordings, synchronous online learning analytics, student peer evaluations. Following review of the overhead videos of all six IUs, the 4th IU on ‘Fractures’ (with 437 students and nine disciplinary experts) was selected for in-depth analysis for the observed richness of group interactions. Two groups were identified for contrastive analysis. Group A had seven students from five disciplines and Group B had six students from four disciplines. Interactional analysis of the overhead camera recordings examined group engagement with peers and their material environment (moveable chairs, mobile devices etc.) across the 3-hour time course. Analysis was anchored to significant transition points within the TBL process. At these points in time, graphic representations of the physical configurations and actions of participants, associated talk and timed synchronous online activity were drawn upon for interpretive analysis. Findings indicated how group engagement patterns were linked to the instructional design of both the overall 3-hour TBL session and the discrete tasks within the TBL process. In comparison with Group A, Group B online data indicated more evenly distributed peer evaluations, more time spent on individual tasks but less time on group tasks. In terms of face-to-face dynamics, interactionally, Group B was more cohesive in terms of group physical orientation. Peer evaluations combined with interactional analysis indicated how one student (nursing) in Group A adopted a defined leadership role. Overall, findings support the literature on the power of task and social processes in the developing cohesion of work groups with implications for future inter-professional collaboration in healthcare.