SHORT COMMUNICATION

Team-Based Learning in a 3D Online Environment

April Richardson-Hatcher & Matthew Hazzard &

Christopher Bentley & Christena Gazave &

Thomas Greenlee & Jennifer Brueckner-Collins

Published online: 25 February 2014# International Association of Medical Science Educators 2014

Abstract Team-based learning (TBL) in a 3D online environ-ment is described here. Prehealthcare professional students en-rolled in a new regional anatomy coursemet weekly in the virtualworld of Second Life™ for synchronous TBL sessions. SecondLife™ provided an immersive online environment for effectivelytransitioning TBL components into the online domain.

Key words Team-based learning . Virtual world . SecondLife™ . Anatomy

Team-based learning is a teaching strategy that challengesstudents to be more proactive in their own education bypreparing for course material beforehand and using classroomtime to discuss and apply the material through critical thinkingstrategies [1–3]. The TBL process has been shown to be aneffective method of instruction for medical education in thetraditional classroom [3–6]. However, as more courses arebeing offered online, this style of learning may also be bene-ficial in distance education [7, 8]. Virtual worlds are attractivevenues for rich online discussion due to their ease of accessand simultaneous immersive environment that allows usersto feel like they are actually in the classroom [9–12]. We

have used the virtual world of Second Life™ to engageprehealthcare professional students in a regional anatomycourse for further preparation for their respective programs.This course was offered as a distance learning elective at theUniversity of Kentucky in the spring of 2013.

ANA 309: An Introduction to Regional Anatomy is a five-credit-hour course designed to serve as a transition betweenundergraduate systems-based anatomy and graduate level re-gional anatomy. In spring 2013, 20 students enrolled in ANA309. Research reported here has been approved by the Univer-sity of Kentucky Internal Review Board (IRB) and assignedprotocol number 12-0944-F4S. Most students (14/20 or 70 %)were seniors in college, and 16/20 (80 %) of the students hadcompleted an anatomy course before this class. Regarding pre-vious experiences with online courses, 16/20 (80 %) of studentshad taken an online course but only 3/20 (15 %) of the studentshad taken an online course with a discussion component.

In ANA 309, students independently study the course contentthrough detailed, animated online regional anatomy modulesoffered via Blackboard™ (Bb). In addition, students are provid-ed customized lists of cadaver images via McGraw Hill’s Anat-omy & Physiology Revealed 3.0 to supplement their study ofanatomical regions. The course grade is determined by fourcourse exams, 14 TBL sessions, and class participation points.Students were informed upfront that class participation pointswould be awarded according to their thoughtful participation inat least four randomly recorded sessions throughout the semester.

To begin the TBL process, students accessed the individualreadiness assurance test (iRAT) on Bb during a 4-hr time-frame prior to the virtual class each week. Students wereallotted 20 min to answer a 10 question quiz. The iRAT is aclosed-book exam so efforts were made to prevent studentsfrom looking up the answers during the online quiz. Forexample, Bb allowed for customization of the quiz by releas-ing only one question at a time, preventing the students fromreturning to a question, and automatically submitting the quizat the end of the time limit. Each question integrated severalfoundational concepts in the assigned materials so that ideally

A. Richardson-Hatcher (*) : T. GreenleeUniversity of Kentucky College of Medicine, Lexington, KY, USAe-mail: arich3@uky.edu

M. HazzardUniversity of Kentucky Information Technology, Lexington, KY,USA

C. BentleyUniversity of Kentucky College of Health Sciences, Lexington, KY,USA

C. GazaveUniversity of Kentucky Graduate School, Lexington, KY, USA

J. Brueckner-CollinsUniversity of Louisville School of Medicine, Louisville, KY, USA

Med.Sci.Educ. (2014) 24:11–14DOI 10.1007/s40670-014-0006-5

students unfamiliar with the material would not be able to lookup all the information sufficiently during the limited 20 mintime-frame.

Immediately following the iRAT, students convened virtu-ally for the remainder of the TBL session in Second Life™, aweb-based 3D virtual world. Second Life™ may be accessedvia a downloadable viewer at www.secondlife.com. A basicuser account is free. Second Life™ users interact in the virtualworld as avatars, or virtual representations of themselves. Oncea user creates an account, they are free to choose an avatar thatis easily customizable. Avatars communicate with each otherin the virtual world via instant message or voice chat. In ANA309, a tutorial on this web-based world was provided 2 weeksin advance so that each student could personalize their avatarand be prepared to attend the first day of class virtually. Inaddition, the instructor met one-on-one with the students vir-tually to check their communication and navigational skills inthe virtual environment prior to the first online session.

Following the iRAT each week, students logged into Sec-ond Life™ from their respective physical locations. The vir-tual anatomy classroom on the University of Kentucky’svirtual space or island includes a common lab space as wellas four separate rooms for the small group portion of the TBL.Upon logging into the virtual world, students met as a wholeclass for announcements in the main classroom. Oncedismissed, each group teleported to their respective roomson the island equipped with virtual quiz forms, timers, andinteractive screens for group discussion. Teleporting in thevirtual world simply involves moving to a new landmark orvirtual coordinate instantaneously. The group rooms are de-signed for the completion of the group readiness assurance test(gRAT), which is also a closed-book quiz, and for the initialdiscussion of the clinical application. One particular wall inthe group room is designated for the gRAT process. Studentsaccessed the gRAT via a virtual slide viewer that is similar to aMicrosoft Power Point™ interface equippedwith navigational

controls for referencing the slides in any order (Fig. 1). Stu-dents simultaneously communicated via instant message chat,which displayed as a running dialog that could be exported totheir local desktop. The groups were given 20 min to completethe gRAT by entering their answers on the virtual immediatefeedback assessment form (IF-AT). The virtual IF-AT includes10 questions with A–E options (Fig. 1). A green bubble indi-cates a correct response and a red bubble indicates an incorrectresponse. Students clicked the bubble that corresponded to theirgroup answer; once 10 correct answers were keyed into the IF-AT, the group score was immediately emailed to the instructorand recorded. This process mirrors the physical scratch-off IF-AT Epstein Educational Enterprise forms used for the TBL intraditional classroom settings. The virtual room also includes atimer positioned clearly on the wall so that students have avisual to reference during their discussion (Fig. 1).

Once groups completed the gRAT, their attention wasdirected to the clinical application questions displayed on theopposite wall of their virtual group room (Fig. 2). The clinicalportion of the TBL began with the private group discussion ofthe questions for 15 min. Two clinical scenarios with specificanswer choices were provided. Students were encouraged touse their atlas, books, internet, etc. to answer the questions;they were expected to reach a group consensus on thesequestions before teleporting back to the main anatomy labo-ratory. Once students returned to their group seats in thecentral anatomy room, the instructor provided the groups1 min to report their answers via a virtual letter panel posi-tioned on the top of the tables (Fig. 3). Group answers weredisplayed as large colored letters in the center of the grouptable. The instructor used a remote control to start a minutetimer, at the end of which the chosen letter displayed in thecenter of the table for simultaneous reporting (Fig. 3). Letterswere not revealed until all answers had been reported. Thissetup allowed all the students to easily see each group’sanswers, effectively imitating the simultaneous reporting in

Fig. 1 An image of the virtualgroup classrooms in SecondLife™. Slide viewers provide areference for the gRAT questions.Student avatars discussed thematerial via instant message(shown in the gray dialog box)and entered their answers in avirtual IF-AT form that recordedthe group score

12 Med.Sci.Educ. (2014) 24:11–14

the face-to-face classroom setting. The instructor used voicechat to facilitate intergroup discussion of the clinical applica-tion questions and each group justified their respective an-swers using text chat.

Second Life™ provided an efficient platform for TBL.Students quickly acclimated to the virtual nature of the classsessions. The majority of students (14/20 or 70 %) spent lessthan 30 min obtaining their avatar and learning to navigate inthe virtual world. In addition to the professor, one informationtechnology (IT) professional and one graduate student assis-tant attended each session to monitor the students. During theclass sessions, some IT assistance was needed to troubleshootany problems with avatar navigation or ability to hear theprofessor. Most issues related to this were resolved by loggingout and logging back into the virtual environment, essentiallyresetting the avatar.

Student opinion of this course and the virtual TBL wassurveyed across five different time-points during the semester.ANA 309 is currently being taught this spring semester 2014.We plan to analyze the data from spring 2013 and spring2014, and publish these results in a subsequent manuscript.

Qualitative feedback thus far indicates that students appreciatethe accessibility of the virtual environment as well as the“classroom feel” in an online course. When asked how theyfelt this course would assist with their future educationalgoals, some students replied ”I think it helped me to learnhow to better communicate with others professionally andscientifically” and “it has prepared me for further study ofanatomy in medical school, and use of technology and com-munication to learn material among classmates!”. This courseintroduces the possibility of translating interactive face-to-faceTBL sessions into an online environment. Though students mustultimately learn to interact directly with patients in their respec-tive medical disciplines, this approach to TBL offers an addition-al way for them to exercise communication skills in preparationfor further medical training, even when separated by distance.

In summary, Second Life™ provides a unique environmentfor the implementation of TBL within an upper level onlineanatomy course. Second Life™ is easily accessible. Studentscan attend class from anywhere and can experience animmersive online classroom setting where they can readilycommunicate their thoughts with one another and the

Fig. 2 The clinical applicationquestions are positioned on thewall opposite to the gRAT in thegroup rooms. Students discussedtwo clinical vignettes to applytheir foundational knowledge ofthe anatomy topic. Groupmembers were required to choosea specific answer to report andjustify to the entire classroom

Fig. 3 In the main anatomyroom, students convened at theirgroup tables for the intergroupdiscussion. Answers to theclinical vignettes were keyed intothe virtual letter panel, after whicha large, color-coded letterdisplayed in the center of thetable. The instructor facilitated thediscussion through voice chat andthe students responded in turn tothe instructor and to each other viainstant message

Med.Sci.Educ. (2014) 24:11–14 13

instructor and cultivate critical thinking skills. As a result,Second Life™ offers an efficient venue for expanding TBLin the online domain.

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