The past several decades have brought substantial changes in medical practice. The longstanding model of patient care by the solo practitioner is increasingly being replaced by care through collaborative teams of healthcare providers that include doctors, nurses, social workers, pharmacists and other allied health providers. The rapid pace of advancement makes the scientific base of medicine increasingly important and has reemphasized the need for physicians to think critically about medical data and facts. Thus, two important challenges of medical education are to develop the ability to work within and lead diverse teams of healthcare providers, and to acquire and logically process vast amounts of new information.

Over the past 40 years, medical education has evolved from a curriculum based almost entirely on lectures and clinical ward experiences to one in which the pre-clinical and even the clinical teaching is taught in a more active, and collaborative way. Johnson & Johnson 1-3 highlighted in their studies that cooperative learning-- defined as students working together in groups to achieve a common learning objective -- results in higher academic achievement, increased self-esteem, and greater levels of mutual support. Problem-Based Learning 4-6 and Team-Based Learning 7-9 strategies were developed and embraced by medical educators to modify their curriculum to support active, small-group, collaborative learning and systematically operationalize many of the principles of collaborative learning.

To meet the challenges of medical education in the 21st century and to achieve the results seen with collaborative learning methods, the leadership of Duke-NUS chose Cooperative Learning as our primary pedagogic delivery method for basic science education. Out of the options available for putting the practice of cooperative learning into action, we chose to start with Larry Michaelsen's TBL model 8 and have subsequently adapted it to enhance learning within our local context, timing, content, students, and faculty.

The Duke-NUS Graduate Medical School takes the innovative Duke School of Medicine curriculum as its foundation and builds onto that the best elements of Team-Based Learning. In Team-Based Learning, lectures, readings and the review of supplemental material on a given topic are completed before class. In-class activity focuses on assuring understanding, applying principles, and solving problems within student teams facilitated by faculty. Courses are run by multidisciplinary faculty teams of clinicians and scientists who are supported by education faculty with expertise in the science of learning. The classroom discussions are principally driven by student enquiry instead of faculty answers. Activities are built into the learning day that require students to make meaningful choices in order to respond to challenging questions, and students are given constant feedback from their peers and faculty on their learning. Students learn techniques for effective peer feedback and the peer evaluation process allows opportunities to practice and refine these skills. Educational technology including social media tools are integrated into all aspects of the learning experience; examples include utilizing classroom technology that facilitates interaction between students and faculty as well as converting traditional lectures into voice-annotated presentations that are reviewed prior to class sessions. This active-learning process that students are engaged in makes the knowledge acquired more relevant to the way clinicians learn and work. We call this pioneering learning method TeamLEAD (Learn, Engage, Apply, Develop) 10.

This short video provides an overview of TeamLEAD. The video contains interviews with members of the Duke-NUS senior leadership, faculty, and students as well as a chronology of the in-class activities associated with Body and Disease, a course in the first year of the MD program.

The TeamLEAD approach represents a new paradigm in medical education. I feel strongly that within the next 15 or 20 years this is how doctors will be trained because I think that it is going to become obvious that this is simply a much more effective way for students to learn. They learning more, they understand more, and we now have evidence that when they struggle with difficult concepts they retain the information, they retain the understanding, for a longer period of time.

Dr. Doyle Graham
Course Director, Body and Disease
Duke-NUS Graduate Medical School

For more information on TeamLEAD please email faculty.development@duke-nus.edu.sg.

  1. Johnson DW, Johnson RT. Learning Together and Alone; Cooperation, Competition, and Individualization. 1975.
  2. Johnson DW, Johnson RT, Smith KA. Cooperative Learning Returns to College What Evidence Is There That It Works? Change: The Magazine of Higher Learning. 1998;30(4):26-35.
  3. Johnson DW, Johnson RT, Stanne MB. Cooperative learning methods: A meta-analysis. Retrieved July. 2000;15:2007.
  4. Barrows HS. Problem-based, self-directed learning. JAMA: the journal of the American Medical Association. 1983;250(22):3077.
  5. Barrows HS. A taxonomy of problem‐based learning methods. Medical Education. 1986;20(6):481-486.
  6. Barrows HS, Tamblyn RM. Problem-based learning: An approach to medical education. Vol 1: Springer Publishing Company; 1980.
  7. Michaelsen LK, Knight AB, Fink LD. Team-based learning: A transformative use of small groups: Praeger Publishers; 2002.
  8. Michaelsen LK, Parmelee DX, McMahon KK. Team-based learning for health professions education: A guide to using small groups for improving learning: Stylus Pub Llc; 2008.
  9. Michaelsen LK, Watson W, Cragin JP, Dee Fink L. Team learning: A potential solution to the problems of large classes. Journal of Management Education. 1982;7(1):13.
  10. Krishnan K. 7th College of Physicians Lecture—The Changing Face of Medicine, Medicine–Past, Present and Future. Annals of the Academy of Medicine, Singapore. 2011;40(4):201.
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