Kanwal Fatima Khalil  ( Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi, Pakistan )
Raheela Yasmin  ( Department of Medical Education, Riphah International University, Rawalpindi, Pakistan )

Team objectively structured bed side assessment (TOSBA) is one of the tools used by medical students to assess teamwork. The aim of this study was to measure the team scores and to correlate team performance scores with individual performance in final year medical students using TOSBA. It was a quasi-experimental study including 100 students, divided into 22 teams comprising of 4-6 members. TOSBA sessions were setup for module assessment of teams. Their individual and team performance scores were measured. Correlation between individual and team scores was calculated using Pearson correlatio n test. Results of the study showed seven (7) high scoring, eight (8) medium scoring and seven (7) low scoring teams. Team scores had a statistically significant correlation with individual scores (p<0.05). Reliability of the tool was 0.58 with a high convergent validity. TOSBA is a tool that can be used for individual and team assessment during clerkships.

Keywords: Team, Collaboration, Assessment

https://doi.org/10.5455/JPMA.11340

 

Introduction

 

Medical students are taught collectively but most assessments are carried out individually. Current evidence suggests that teamwork in hospitals is related to improved patient outcomes and physician well-being.¹ Few studies have assessed teamwork in under-graduate medical students. One of the studies done in Vienna on 1st year medical students elaborated that students working in teams perform well than when they work alone.² Their team scores, when compared with their final exams scores were found to be significantly higher indicating the impact of teamwork on learning.² Many tools have been developed to assess teamwork in medical students. NOTSS (Non-technical skills for surgeons), Team objectively structured clinical examination(TOSCE) and Team objectively structured bed side assessment (TOSBA).^3,4 TOSBA comprises of teams of five members who in 25- 30 minutes and perform five clinical tasks including history taking, physical examination, making a differential diagnosis, formulating an investigation and management plan and discussing patient drug treatment chart,⁴ given grades by facilitators followed by standardized verbal group feedback.⁵ Previous studies have used TOSBA for formative assessment of individuals working in teams.⁶ Role of TOSBA as a summative assessment tool has not been studied. In this study, TOSBA will be used as formative and summative assessment tools as it is used for bed side learning useful in clerkship years, its objectivity and simplicity.^4,6-8 The previous studies done in Irish Medical Schools, have shown its reliability of 0.6. The aims of this study were to measure the individual and team performance scores using TOSBA and to correlate team performance scores with individual performance scores.

 

Methods

 

It was a quasi-experimental study carried out in the Department of Pulmonology Fauji Foundation Hospital, Rawalpindi from October 2016 to June 2017, on final year medical students of Foundation University Medical College, on clerkship rotations to medical wards. It was a single institutional study aiming to get an insight into the contextual experiences of assessment. The sample size was calculated using Raosoft Sample size calculator.⁹ In a target population of 140 final year students who gave consent to participate in the study, with a confidence interval of 95% the sample size was103. Three students were absent, hence they were excluded from the study and 100 students actually participated, divided into 22 teams by simple random sampling, using lottery method on their roll numbers, each team including 4 to 6 students. Sixty three (63) female and thirty seven(37) male students participated in the study, in accordance with female gender preponderance in Pakistani Medic al Schools.¹⁰ During TOSBA, students in teams of 4-6 students followed 5 step evaluation on real patients. Every team-patient interaction lasted for 25 minutes in TOSBA. At one time, three teams were trained and assessed with a total of 5 sessions on TOSBA. The checklist of TOSBA sessions is given in Annexure 1.

For purpose of standardization, individual and teams were assessed on clinical evaluation of Respiratory System only. Five respiratory themes were identified; including Asthma/COPD, Tuberculosis, Bronchiectasis, Pneumonia and Pleural effusion and were assessed by the five components of TOSBA. Two examiners were trained to conduct TOSBA, observe and assess teams and give a constructive feedback. Students were instructed to perform one of the five tasks taking help from their team members. Each team prepared the case using five components of TOSBA for 25 minutes and presented it to the examiners in a sequential manner; one student presented history, the other student performed examination and so on. Students were awarded grades as originally described by Miller.⁶ These include P+ (Honours Achieved), P (Pass) and P- (Fail). Team scores were calculated from average of individual scores and classified as high scoring, medium scoring and low scoring teams. The final scores were calculated from the mean of individual and team scores. The data was analyzed using SPSS software version 20. Correlation of their individual scores with team scores was measured using Pearson correlation test taking pvalue of 0.05 as significant.

 

Results

 

The mean age of the students was 24.13 ±0.761. Sixtythree (63%) students were female and 37(37%) were male. The demographic characteristics of our teams are described in Table. Correlation between individual and team scores was carried out using Pearson Correlation test. Results of Pearson Correlation Test are given in table.

 

Discussion

 

The aims of this study were to measure the individual and team performance scores using TOSBA and to correlate team performance scores with students' individual performance. Reliability of TOSBA in the present study was moderate (0.58); same as in previous studies. There was statistically significant correlation between these individual and team scores, indicating that each member contribute to performance of a team. The convergent validity of the tool is high (p<0.05), indicating strong relationship between individual and team scores and strong construct validity of TOSBA. TOSBA design was elaborated in our study. All teams experienced five sessions of TOSBA, one with each theme. They had time to learn from the feedback and their peer mistakes. This advantage of TOSBA has not been described in the previous studies. In the study by Miller and colleagues, peer learning was postulated as learning from watching their peers.¹¹ However, the study does not describe the complex social interactions that are a necessary pre -requisite for peer learning. Themes of respiratory system were assessed by using TOSBA to ensure uniformity. Patients including multiple themes; respiratory, cardiovascular and neurology were used in the study by Miller.^6,11 Few later studies used one theme like a study by Deane et al obstetrics and gynaecology5 and the study by Jain; otolaryngology.¹² In our study, in addition to the individual scores measured by TOSBA, team scores were calculated by taking the mean of all individual scores in a team. This has not been described in the previous studies on TOSBA. Also, complex team interactions were not explained. In this study, students interact and their team dynamics were noted by examiners.¹³ The reliability of individual and team scores using two examiners is 0.584. In the study by Meagher and colleagues, reliability was 0.6 using 3 examiners.⁶ This indicates that two or 3 examiners does not make much difference. For purpose of standardization our study used respiratory themes only. More themes, related to other systems in medicine may be added to improve the internal consistency. Future studies need to incorporate TOSBA during clerkships for entire curriculum. There was a significant correlation between individual and team scores in TOSBA.

 

Conclusions

 

TOSBA is a valuable tool for assessing teamwork. It is feasible, moderately reliable and has a good impact on medical students. It can be used to assess individual performance and team performance.

 

Disclaimer: It is a thesis-based article.

Conflict of Interest: None.

Sources of Funding: None.

 

References

 

1. Welp A, Manser T. Integrating teamwork, clinician occupational wellbeing and patient safety - development of a conceptual framework based on a systematic review. [Online] [Cited 2016 July 19]. Available from: U RL: https :/ /do i.org/ 1 0.1 18 6 /s 1 2 91 3 -0 1 6 -1 5 35 -y.

2. Wiener H, Plass H, Marz R. Team-based learning in intensive course format for first-year medical students. Croat Med J. 2009; 50:69-76.

3. Amini M, Moghadami M, Kojuri J, Abbasi H, Abadi AAD, Molaee NA, et al. Using TOSCE (Team Objective Structured Clinical Examination) in the second national medical sciences olympiad in Iran. J Res Med Sci. 2012; 17:975-8.

4. Miller SDW, Butler MW, Meagher F, Costello RW, Mcelvaney NG. Team Objective Structured Bedside Assessment ( TOSBA ): A novel and feasible way of providing formative teaching and assessment. Med Teach. 2007; 29:156-9.

5. Deane RP, Joyce P, Murphy DJ. Team Objective Structured Bedside Assessment (TOSBA) as formative assessment in undergraduate Obstetrics and Gynaecology: a cohort study. BMC Med Educ. 2015; 15:172.

6. Meagher FM, Butler MW, Miller SDW, Costello RW, Conroy RM, McElvaney NG. Predictive validity of measurements of clinical competence using the q (TOSBA): assessing the clinical competence of final year medical students. Med Teach. 2009; 31:e545-50.

7. Deane RP, Joyce P, Murphy DJ. Team Objective Structured Bedside Assessment ( TOSBA ) as formative assessment in undergraduate Obstetrics and Gynaecology?: a cohort study. BMC Med Educ. 2015; 15:172.

8. Meagher FM, Butler MW, Miller SDW, Richard W, Conroy RM, Mcelvaney NG, et al. ce of final year medical students Predictive validity of measurements of clinical competence using Predictive validity of measurements of clinical competence using the Team Objective Structured Bedside Assessment ( TOSBA ): Assessing the clinical competence of final year medical students. J Med Teach. 2009; 31:e545-50.

9. McCrum-Gardner E. McCrum-Gardner 2010 - sample size and power calculations made simple. Inter J Therapy Rehab. 2010; 17:10-4.

10. Khan JS, Biggs JSG, Bano T, Mukhtar O, Tabasum S, Mubasshar MH. Medical colleges admission test in Punjab, Pakistan. J Ayub Med Coll Abbottabad. 2013; 25:64-7.

11. Miller SDW, Butler MW, Meagher F, Costello RW, McElvaney NG. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment. Med Teach. 2007; 29:156-9.

12. Jain S, Kumar S, Tankhiwale N. Team based objective formative assessment method for postgraduate students?: Evaluation of students' clinical performance and perceptions. JMR. 2016; 2: 47- 52.

13. Khalil K, Yasmeen R, Khalil KF, Yasmeen R. Exploring Teamwork Dynamics in Medicine Clerkship. [Online] [Cited 2017 December 15]. Available from: URL: https://doi.org/10.15694/mep.2017. 000222.