1.1

Overview of team-based learning

TBL is a type of cooperative learning which is very structured. It has been applied gradually in nursing, medicine, and other fields since the 1970s. The TBL is an instructional strategy defined by Michaelsen et al. (2002) and organized around team activities. This method emphasizes individual and team responsiveness, group engagement, and creating motivation in group discussions. In TBL environments, small student teams work together for the entire semester, use class time to discuss, solve problems, answer questions, and apply concepts that were initially learned through individual reading assignments. Most of the learning experiences arise during in-class interactions within a team. The course materials are divided into three modules, and the students are divided into teams according to the approved guidelines listed in Table 1 . The instructor takes the role of a facilitator of teams that are formed at the beginning of the semester. Every module follows a cycle of iterative learning, repeating a series of activities consisting of (1) individual preparation through out-of-class reading of the learning materials, (2) readiness assessments through individual and team tests, (3) application of course concepts through multiple team activities. ^{, ,}

In the TBL implementation, each module begins with individual preparation. Students are divided into teams and the module materials are released to read and make study notes before class to familiarize with the course content. The readiness assessment module comprises completion of the Individual Readiness Assessment Test (IRAT) and Team Readiness Assessment Test (TRAT), which includes multiple-choice questions. This module motivates students to prepare before the class and promotes team cohesion. The preliminary IRAT is taken from the students. This test evaluates individual preparation before the test for team readiness assessment is performed. In-class scores are generated and the teams then take the same test together and have their consensus answers scored for immediate feedback. So, the TRAT is the same multiple choice test as the IRAT, which only took a second time in teams to benefit from the discussion of choosing the correct answers. All teams simultaneously reveal their answers at a designated time with the whole class for easy comparison and immediate feedback. In the third module, the testing completes the process of readiness evaluation which for each content module is a fundamental component of learning assurance. All teams work on the same case scenario and all of them solve the problems and share their knowledge both within and across teams.

1.2

Objective

This study aimed to evaluate the effect of teaching through TBL on motivation toward science learning (MTSL) in undergraduate operating room technology students. It hypothesized that the teaching through TBL could affect MTSL in these students.

2.1

Study design and participants

This is a quasi-experimental study that was conducted in the School of Nursing and Midwifery at Kashan University of Medical Sciences, Iran. This study was adhered according to the SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in EDUcation) guidelines to ensure comprehensive and transparent reporting of the findings. All operating room technology students in the 5th semester were selected through a census ( n =15). The inclusion criterion was the selection of the “Principles of Care in the Recovery Room” course for the first time and the exclusion criterion was more than one session absence in the class.

2.2

Courses design

The teaching method of TBL was implemented for the “Principles of Care in the Recovery Room” course ( Fig. 1 ). This is one of the main courses of operating room technology that was held in eight sessions according to the approved heading provided by the Iranian Ministry of Health and Medical Education. Educational content entitled: “Introduction to post-anesthesia care unit (PACU)”, “Oxygen therapy”, “Pain management”, “Fluid therapy”, “Critical care in PACU”, “Common drugs in PACU”, “Different types of shock and its management” and “Care in critical surgeries in PACU”.

The implemented TBL course.

Two two-hour preparatory sessions were held at the beginning of the semester and one week before the start of the intervention. In the first warm-up session, the research goals and different stages of the TBL method were explained to the students. Students raised some vague points about this teaching method, and the teacher clarified all of them. Also, in the second preparatory session, explanations were given to the students regarding active class participation, effective communication, and time management. These sessions provided the basis for a better implementation of the TBL method and its acceptance by the students. After that, all students were assigned to the TBL group ( n =15). They are divided into three five-member groups by the teacher in such a way that students with high and low grades are distributed randomly between three groups. For each group, one name was selected and one of the students was selected as a group leader. Also, a folder, with the name of each group, was assigned to the three groups, and appeals sheets and readiness assessment tests (IRAT and TRAT) for each session were put inside them. These folders facilitated the work of the teacher and she brought these folders into each class session and used them for each group.

Then students were provided with instructional materials including handouts, books, and PowerPoints on the subject of the first session to study them independently at home to master teacher-defined intended learning outcomes.

At the beginning of each session, students individually completed multiple-choice tests (8–10 questions) in five minutes to demonstrate their readiness without using the book and other resources. Scores are generated inside the class. Then, the three groups of students take the same test together and have their consensus answers scored for immediate feedback. The time of this part was about 15 min. In this phase, the teacher was presented with the full description of the student’s opinion. The appeal sheet could be completed by those students who objected or wrote questions and submitted to the group leader at the end of the class.

In the third phase, the instructor planned the scenario that was relevant to the discussion according to the context of each session and set out detailed questions at the highest level of the cognitive domain. Each team worked together on real-world problems for in-class applications. All three teams simultaneously announce their responses at a designated time (30 min) with the whole class for easy comparison and immediate feedback.

2.3

Data collection

The MTSL was measured by the Students’ Motivation toward Science Learning (SMTSL) questionnaire developed by Tuan et al. This questionnaire has 35 items and six subscales: self-efficacy (items 1–7), active learning strategies (items 8–15), science learning value (items 16–20), performance goal (items 21–24), achievement goal (items 25–29), and learning environment stimulation (items 30–35). The items were constituted using five-point Likert-type scales. Items on the scales are anchored at 1 = strongly disagree, 2 = disagree, 3 = no opinion, 4 = agree and 5= strongly agree. Items 2, 4–7, and 21–24 are negative and the rest of them are positive. The sum of the scores on the subscales constitutes the total score of the MTSL. A higher score reflects better MTSL. The Cronbach alpha for the entire questionnaire was 0.89 and for each subscale, alpha ranged from 0.70 to 0.89. The validity and reliability of the SMTSL questionnaire in Iran has been measured by Zare et al. The reliability of the questionnaire was calculated as 0.83 and 0.87, respectively, by calculating Cronbach’s alpha coefficients and Guttman reliability. Also, for each subscale, the alpha ranged from 0.70 to 0.89.

In this study, at the beginning and end of the semester, MTSL was measured by the SMTSL questionnaire.

2.4

Data analysis

SPSS for Windows (v. 16.0, SPSS Inc., Chicago, IL, USA) was used for data evaluation and statistical analysis. Data were summarized and presented using descriptive statistics measures such as mean, and standard deviation for quantitative variables and frequency distribution for qualitative variables. To ensure that the data were normally distributed, the Kolmogorov-Smirnov test was carried out.

The paired t -test was applied to compare the mean scores of the MTSL before and after the intervention. P < 0.05 was considered as statistically significant.

2.5

Ethical considerations

This study was approved by the Ethics Committee of the Vice Chancellor for Research, Kashan University of Medical Sciences (ethical code: IR.KAUMS.NUHEPM.REC.1396.26). All participants received the information and objectives of the study and were assured that their information would remain confidential. All participants signed an informed consent form at the first session and before the start of the intervention.