Context and setting In medical education, in addition to changing pedagogy, a variety of teaching strategies are now implemented to promote active learning. Many schools have reduced the number of lectures in pre-clinical courses in favour of problem-based learning, which often includes preceptorship to actively engage students. Team Learning (TL) is another instructional strategy that promotes active, small group, interactive learning. In delivering the anatomy curriculum, we have successfully implemented TL. The TL allowed us to introduce clinical vignettes to emphasise anatomical concepts.

Why the change was necessary Under the new curriculum, initiated in August 2004, we have eliminated all anatomy lectures in favour of implementing active, student-centred teaching. To maintain the course content, we adopted a modified TL strategy to promote active learning and thereby address the lack of lectures while simultaneously maintaining effective teaching. Furthermore, we have fewer faculty available to participate in the teaching, and the TL approach requires fewer content experts to teach a large class size.

What was done A total of 170 students were divided into teams of 8. Each team received a series of assignments related to the laboratory dissection. These topics require study of assigned text materials for discussion during team encounters. The study material included basic anatomy, embryology and clinical correlations that required the application of anatomical and developmental concepts. An important component of TL is the construction of the weekly material. Effective material stimulates cognitive skills and assures deeper learning. Once a week, the teams discussed the assignments in lab by using the cadavers, radiographs, skeletons and other study aids. The faculty circulated among the teams to clarify difficult issues and to ask probing questions to further student comprehension. As each team posted their assignments on the internal website (WebCT), the faculty was able to monitor inequities in the teams' understanding. When needed, additional resources were provided to ensure uniformity of student knowledge.

Evaluation of results and impact We administer 3 departmental written examinations during the course. The first examination, covering the regions of the back, upper limbs and thorax, was administered in October, 6 weeks after the start of the course. The results of the first examination were very encouraging. A total of 90% of the multiple-choice questions (MCQs) contained clinical vignettes, which tested student knowledge, comprehension and problem-solving skills. The class average for the first examination was 77.0%. This is approximately 5% higher than the first examination score from prior years, when clinically oriented MCQ examinations were first administered. We conducted semistructured interviews, and through observation collected data on student engagement on cognitive basis and behaviour. We also collected data through student self-reporting on the nature of student–student interactions and student–faculty interactions. While the nature of student–student interactions varied, our initial experiences have been extremely satisfying, both at the level of student performance on the examination and cognitive engagement. While just in the initial phase, we have found that TL is effective and efficient and appeals to both students and faculty. We are already in the process of adopting TL on 2 other pre-clinical courses.