Teaching Family Medicine Residents Brief Interventions for Alcohol Misuse

Postgraduate residency programs traditionally rely on the lecture method to communicate new information to learners. Thousand rounds lectures are an case. In this blazon of passive setting, petty opportunity exists for learners to talk over material or for instructors to determine whether learning has taken identify. Evidence indicates there is lilliputian long-term knowledge memory from these lectures¹ and that active learning in medical education is more effectual than passive learning.^2–6 Team-based learning (TBL), an active-learning, group-based instructional format, was first introduced in higher educational activity in 1994.^7–eight After the theoretical ground of TBL was elucidated, some medical schools adopted this new learning method in the preclinical curriculum,^nine–13 in the clinical curriculum,¹⁴ and in residency curriculum.¹⁵ TBL programs derive from theory suggesting that adults acquire most finer when the basis for learning is experiential, social, and active; involves discomfort; leads to the generation of narrative; and uses both construction and freedom. Common features of TBL are that participants are accountable for individual and group learning, work in small groups to solve identical awarding problems, are encouraged to discuss and defend their answers, and receive firsthand feedback regarding their performance.^seven–8 Studies indicate that the arroyo changed learning, behavior, and the level of medical pupil satisfaction.^{thirteen–14} Residents became more than engaged and stayed on task more than often than during the typical lecture format,¹⁵ and faculty viewed the model as efficient and constructive.^10,12 Levine and colleagues¹⁴ also looked at learning outcomes of students in a psychiatry clerkship. They documented that in comparing average scores of two classes, the squad learning group scored significantly college than those in the conventional didactic clerkship.¹⁴

The Mercer University School of Medicine (MUSM) inquiry team received a National Institutes of Wellness (NIH)-funded training grant from 2005 to 2007 for teaching physicians and staff to conduct screening and brief interventions (SBIs) for alcohol misuse; even so, finding an appropriate instructional format for reinforcing concepts and procedures taught in initial training proved challenging. The method had to be efficient because the usual training time frame in residency programs is one hour. At the same time, the method had to engage learners to call back about, talk over, and effectively use material they had covered at an initial training and during reinforcements. We developed squad learning modules (called booster sessions) to reinforce the concepts taught at the initial three-60 minutes training session, and we designed activities to involve learners, incite contest, and generate discussion. Although nurses, triage staff, residents, and kinesthesia in family medicine participated, this report focuses on resident learning and the utilise of TBL as a method to reinforce and raise the concepts taught to the residents during the initial training, which occurred iv months before the booster sessions began. Our hypothesis was that residents would implement SBI for alcohol misuse after training and that the TBL booster sessions would help maintain the behaviors. The outcome measure was residents' cocky-reported use of SBI for alcohol misuse at each fourth dimension point (i.east., booster session).

This purpose of this report is (1) to describe the feasibility of residency implementation of TBL by describing both the development of TBL training materials for alcohol SBI and the fourth dimension faculty members spent preparing TBL booster sessions and (2) to assess the effectiveness of our implementation of TBL, as measured by (a) residents' evaluations of their training subsequently each session, (b) residents' self-reported employ of SBI, (c) residents' performance on individual readiness assurance tests (IRATs) compared with their performance on group readiness assurance tests (GRATs), and (d) residents' levels of confidence in conducting SBI. In add-on, we depict residents' acceptance of defining SBI as part of their clinical role as demonstrated past their preferred model (i.eastward., nurse only, doc only, doctor plus nurse, or full systems involvement) for implementing SBI in their practice settings.

Clarification of the Preparation Program

Background

Though studies indicate that SBI for alcohol misuse by clinicians results in decreases in booze consumption by hazardous and harmful drinkers,^xvi–20 clinicians fail to accost problem drinking in ane third to one one-half of cases, even when they know this diagnosis.^21–25 Lack of appropriate training is a major barrier to clinicians performing SBI of booze misuse in clinical practice.^16,22,24 For clinicians who have received training, numbers of interventions seem to decline after initial preparation,²⁶ and the well-nigh effective methods of reinforcing ongoing use of SBI techniques subsequently initial grooming are not known. We designed this NIH-funded project to railroad train faculty, residents, and nursing/triage staff at eight family medicine residencies to perform SBI for alcohol misuse and to encourage the connected use of the procedure. The initial training consisted of three hours of instruction and practice in (1) conducting screening, (2) providing feedback to patients nearly their drinking, and (3) giving communication using a brochure-based intervention. We designed booster sessions to reinforce initially taught material nigh how to bear booze SBI.

A principal objective of the projection was to test the promise and feasibility of TBL activities to reinforce the continued use of resident alcohol SBI behaviors. The research team chose TBL as a model for multiple reasons. Kinesthesia members at MUSM are familiar with trouble-based learning (PBL) because the premedical curriculum is congenital on a PBL format. Therefore, faculty members are comfortable with small-group learning. Two members of the basic science faculty with item interest in TBL attended a kinesthesia development session to larn how to apply it to a PBL setting. After they institute success using the procedure during PBL sessions, MUSM sponsored a kinesthesia development program to teach all faculty the process. We decided that incorporating TBL into the current project would offering an opportunity to use the method and evaluate its effectiveness at the residency level.

The educational team (S.S., J.P.S., D.Fifty.H., C.L.D., M.M.Five.) therefore designed the booster sessions to use the typical one-hour format for family medicine teaching, with a diversity of learning activities to stimulate interest in the material presented. The team designed TBL booster sessions to reinforce textile previously taught virtually how to conduct alcohol SBI. The bones format of TBL sessions includes pocket-sized groups all working in parallel in the same room, group-based "readiness assurance" testing (i.eastward., pocket-size-group discussion and decisions on answers to questions drawn from both initial preparation and cloth to be covered during the subsequent mini-lecture), case-oriented group awarding exercises (i.due east., minor-group application of material from the initial training for use in answering questions regarding a clinical case), and simultaneous reporting (i.due east., small-group presentations of answers to multiple-selection questions to the larger group past holding upwards cards reflecting the letter of the alphabet of the selected respond).²⁷ The educational team designed tests and exercises to stimulate constructive controversy aimed at piquing interest and heightening rehearsal, retrieve, and awarding of the material.²⁷ The squad selected content both to reinforce material covered just partially in the initial preparation and to provide an opportunity for assessment of clinical cases. Because review of covered or partially covered cloth tin be boring, the team fashioned this TBL feel to incite competition, generate discussion, and stimulate peer-driven motivation to perform SBI. Nosotros held 3 booster sessions, each 1 hour and fifteen minutes in length, scheduled at four-month intervals after the initial grooming at each training site.

Preparation

Education personnel (S.S., J.P.S., C.L.D., M.M.V.) designed the TBL materials. Five kinesthesia members, including four authors (S.Due south., J.P.S., C.Fifty.D, Yard.Thousand.V.), synthetic IRAT and GRAT questions, developed a case with accompanying questions for the case analysis discussion (CAD), created a mini-presentation, and drafted questions for participants to evaluate their learning. Enquiry administration produced both small-group team folders with response cards, quizzes, and the CAD instance and speakers' folders with answer keys. Several residents and kinesthesia members and 2 mental health professionals provided peer review earlier implementation, thus serving as participants for practicing each booster session earlier we conducted it with intended learners. Their formative evaluations and suggestions led to changes. For case, on the IRAT, which is the individual pretest participant quiz, office players suggested informing participants at the start if more than one reply would be accepted every bit correct, rather than leaving them to approximate.

Bear of the sessions

Chart 1 shows the time frame and activities for a sample booster session. We divided participants into teams of 4 to eight residents. Each grouping selected a team leader, designated the "keeper of the paraphernalia" (KOP). The KOP gave an IRAT to each individual to generate a self-assessment of his or her knowledge of the fabric to be covered in the session. Subsequently participants turned in a copy of their reply sheets to session facilitators (we, the authors, who traveled to each site to comport these sessions), the pocket-sized teams discussed the IRAT and completed a GRAT. All groups answered the same questions, and the IRAT and GRAT questions were besides the aforementioned. Each KOP submitted the top sheet of a two-re-create sheet to the session facilitators. Then, the facilitator led the teams through a review of questions one at a time, with each team simultaneously showing a card with its chosen answers to the multiple-choice questions. Facilitators revealed the right answers, and all the teams discussed them. The squad with the most correct answers received prizes (e.g., sweetened popcorn, dried fruit, basics) to share. The facilitators asked squad members to justify their answers, generating recall of the material and give-and-take about the question.

Chart 1 Case Schedule for Team-Based Learning Booster Session: Session One

Another team action, the CAD, followed the large-group discussion. Within their pocket-size teams, members discussed a clinical case and answered questions. Each squad discussed the same case. Every bit in the IRAT exercise, the facilitators received one re-create of the CAD for grading before discussion; the teams used the other re-create to present their answers to each multiple-choice question during the ensuing contest. Again, the team with the about correct answers received a prize.

For both the GRAT and CAD, we adhered to the principles and practices of TBL²⁷ in that all teams dealt with the same example trouble and quiz questions, reported simultaneously, and were asked to make specific choices. Some questions had more than 1 possible answer; we allowed teams to appeal decisions and asked the team members to justify their answers. In this style, they had the opportunity both to demonstrate mastery of concepts learned and to ask about concepts that were unclear. We showed materials related to case questions after (not before or during) the competition.

Booster session one

This session focused the clinicians' attending on patients who are at run a risk because of their levels of alcohol consumption. Although these patients have not usually suffered major consequences every bit a issue of their drinking, they are drinking in a style that could lead to health problems. Patients with at-gamble drinking were a primary focus for the training project. The IRAT included questions related to

• the Unmarried Booze Screening Question ("How many times in the past twelvemonth accept you had X or more drinks in a day?" where X = 4 for women and 5 for men),
• low-risk drinking limits for men and women (no more than seven drinks per calendar week and three drinks per 24-hour interval for women; no more 14 drinks per week and iv drinks per day for men) as defined by the National Constitute for Alcohol Corruption and Alcoholism (NIAAA), and
• standard drinkable sizes (12 ounces of beer, 5 ounces of wine, and 1.v ounces of 80-proof spirits).

The CAD case described a 25-twelvemonth-old, Hispanic male structure worker with fatigue, task stresses attributable to language barriers, and family unit dilemmas related to his infirm mother in Mexico. His social history included drinking iv to six beers with friends on Fridays and Saturdays. CAD discussion questions focused on classification of his drinking, actions to take regarding his drinking, important alcohol-related risks with this detail patient, and advice for low-chance drinking. Later the IRAT and the CAD, we presented a 10-minute mini-lecture, "The Harms of At-Risk Drinking."

Booster session 2

The focal point of this session was the management of patients who are drinking at the level of possible dependence with multiple major consequences every bit a result of their drinking. The IRAT asked clinicians start to place symptoms of alcohol dependence that might pb to proposing a goal of abstinence and then to explain indications and contraindications for medications as treatment options. The CAD case presented a 57-twelvemonth-former, obese, retired school teacher with worsening gastroesophageal reflux affliction and a history of mildly elevated liver function. Afterward retirement, she began drinking more heavily. She admitted to retentivity lapses and friends' concerns about her drinking. Questions for discussion included diagnostic considerations, actions to take regarding her drinking, and medications that could be considered if she stopped drinking. After the IRAT and the CAD, a 3rd component of the booster session included a 10-minute mini-lecture, "Medication Utilize for the Treatment of Alcohol Dependence."

Booster session three

This session took place afterward i year of experience with SBI at each residency practice. Many third-twelvemonth residents were near graduation and would soon be joining practices or setting up their own practices. The IRAT included questions related to

• the Single Booze Screening Question,
• drinking limits recommended by NIAAA,
• key components of brief intervention for at-risk drinkers put forth by the U.Due south. Preventive Services Task Force (i.east., feedback regarding drinking, advice to reduce consumption, and contracting regarding futurity use), and
• methods for initial evaluation of withdrawal take a chance for patients with possible alcohol dependence (i.eastward., request patients whether they have experienced symptoms such as nausea, tremors, or hallucinations subsequently abnegation).

Nosotros designed the CAD to aid residents in thinking about their future practices and how they might integrate alcohol SBI into clinical work. The hypothetical case portrayed a 3rd-year resident in family unit medicine with a desire to contain attention to alcohol SBI in her new do. The CAD included a clarification of the practise and the professionals in her new grouping. CAD questions for the small groups to consider revolved around designing alcohol screening mechanisms for the exercise, assessing screening procedures already in place for other disorders or problems, selecting the most important tools for implementing SBI, adapting procedures and tools for patients from various backgrounds, and responding to bug that surfaced in SBI implementation. The third component of the third booster session involved a 10- to fifteen-infinitesimal mini-lecture that portrayed principles (e.g., taking a systems approach, identifying and working with the dispensary'due south power brokers, involving nurses in screening and assessment) for implementing practise change. In this component, we also described four models for how to implement SBI in primary care practice: (1) a md-only model, (two) a md-plus-nurse model, (three) a total systems involvement model, and (4) a model with interventions delegated strictly to a nurse or doctor extender.

Method

Nosotros kept notes and time records regarding the development of TBL activities. The institutional review boards for the viii sites approved the report. Nosotros used several measures to make up one's mind the effectiveness of the TBL component of the booster sessions. We recorded omnipresence at the three TBL sessions at each of the eight sites. Although nosotros encouraged nurses, triage staff, and faculty to attend these booster sessions, the master focus was on resident training. We asked all levels of residents to participate in these sessions. A pool of half-dozen members of the research team, primarily the principal investigator and coinvestigators conducted the booster sessions. Considering of the emphasis on residency training, the information reported hither from the 3 booster sessions are resident physician data merely.

Using Likert-blazon scales, we asked the residents to complete an evaluation form regarding their TBL experience. Respondents rated the relevancy of the cases, the usefulness of the small-scale-grouping and large-group discussions, and whether the specific objectives of the session were met. On the IRAT, we asked residents to list the number of outpatient alcohol brief interventions they had conducted during the previous 30 days (after booster sessions one and two) or the number of interventions they had conducted since the inception of training (after booster session iii). We also compared residents' IRAT and GRAT scores. In addition, participants stated their preferences for the TBL format or the usual didactic lectures by circling one or the other as their preferred format. At the third booster, using rulers from 1 indicating low conviction to 10 indicating high conviction, residents rated their levels of conviction in their ability to do SBI in their current and hereafter practices. A final question asked respondents to select by circling the SBI model (i.eastward., physician only, physician plus nurse, total systems program, or nurse only) they would prefer to use in their current and hereafter practices.

Results

Evolution of each of the iii booster sessions took identify during one month. Preparation time for developing IRATs and GRATs was meaning: for the three TBL sessions conducted at viii sites, four faculty members collectively spent 10 total hours developing IRATs and GRATs. We besides needed fourth dimension to develop presentations (two faculty members, 12 hours total), cases (4 faculty members, 12 hours full), and materials for the groups (two enquiry administration, two to 4 hours total for each of the TBL sessions). In addition, planning also included time prepare aside for personnel to practice using the content and materials earlier implementation with target learners (six personnel, nine hours full fourth dimension).

Among the eight residency programs, 175 of 189 residents (93%) chose to participate in the report, completed consent forms, and completed the initial 3-hour SBI training. The data on Tables 1, ii, and 3 are derived from two distinct data sets, the IRAT/GRAT data and the booster session evaluation data. As a consequence, there are different numbers of residents providing data. Not every resident who completed an IRAT/GRAT completed an evaluation form and vice versa. The n reported in each of the tables is the number of valid cases that were included in the analysis for that item tabular array. Table one depicts data gathered from TBL evaluation forms. We told project faculty to anticipate attendance of approximately l% at booster sessions considering of on-call and other clinical duties and postcall absences related to work hours regulations. Attendance by residents across the iii booster sessions was similar, with 76 (43%) attending session one, 89 (51%) in session two, and 76 (43%) in session iii. Total omnipresence at booster sessions ranged from 10 to 31 participants across private sites, with a mean attendance of 17.ane per site per session. Although resident attendance across sites did vary significantly within each booster session, attendance also varied significantly inside sites beyond booster sessions. The patterns of this variation seem random, with no i site consistently standing out every bit a poor performer. The number of residents completing evaluation forms for these sessions ranged from ii to xviii with a mean of 9.7.

Table one:

Means and Percentages of Residents Who Reported Having Performed Cursory Interventions (BI) from Iii Training Phases (Each Spaced Iv Months Autonomously)

Tabular array 2:

Participation and Average Readiness Assurance Examination (RAT) Scores from Three Training Phases (Each Spaced Four Months Apart)

Tabular array three:

Booster Information by Residents Completing Evaluation Forms from Three Grooming Phases (Each Spaced Four Months Autonomously)

Tabular array 1 besides displays clinicians' cocky-reported SBI behaviors, which we recorded only for residents who participated in the booster sessions. Results bear witness a gradual, though not meaning, increase in the number of residents reporting performance of SBI beyond booster sessions. At the third booster session, 42 (62.seven%) of residents reported performing at least one brief intervention, whereas 25 residents (37.iii%) reported no intervention activeness during the 12-calendar month study catamenia. Whereas most of the clinicians reported performing small-scale numbers of interventions (1–iv) during the study menstruum, 12 (xviii%) clinicians reported frequent intervention action (5–8 interventions, overall mean: v.99 interventions), and 8 (12%) reported very frequent intervention activity (nine–thirty interventions, overall mean: 16.88 interventions) since the inception of the grooming program.

Table 2 compares individual residents' scores with grouping scores. Group scores (GRATs) were significantly higher than IRAT scores. The overall average score when individuals completed the IRAT was 58, and, when small groups completed the GRAT, the average score was 69 (P < .001).

Table 3 shows booster evaluation information by residents and their preferred SBI model. In the cumulative evaluations of booster sessions, 138 residents (65%) rated booster sessions as excellent, and 159 (75%) preferred this format over didactic lectures. Nosotros used a Likert-type scale of 1 to five to appraise participants' views of the relevance of cases (5 indicating very relevant), usefulness of small- and large-group discussions (5 indicating very useful), and perceptions that objectives of the session were met (5 indicating objectives were very well met). The range of average responses for all iii questions was 4.4 to 4.7 (Table 3). At the third booster session, participants rated their levels of confidence in their power to deport SBI in their current and future practices on a Likert-type calibration where 10 indicated extremely confident (Table 3). Confidence in their ability to do SBI in their current practice was vii.8 (SD = one.ane) and in their hereafter practice was 7.viii (SD = 1.3). Finally, as shown in Table four, participants described the SBI model they would adopt to use in their practices as doc only (1, or 2.eight%), physician plus nurse (8, or 22.two%), and complete systems change (27, or 75.0%). No residents selected a nurse-just model.

Tabular array iv:

Resident Choices Regarding Screening and Brief Intervention Models at End of Squad-Based Learning Programme

Discussion

This study contributes to the growing body of evidence affirming the effectiveness and high acceptability of TBL in medical education. In agreement with previous research by Haidet and colleagues,¹⁵ these results reinforce the utility of TBL in the residency setting, where the constraint of the typical ane-hour didactic conference presents a particular challenge. These findings besides provide testify that TBL may aid maintain a new clinical skill. In dissimilarity to an earlier report reporting that numbers of interventions by clinicians seem to pass up after initial training,²⁶ in this projection, the number of clinicians reporting having performed SBI did not subtract. In add-on, a few residents reported frequent or very frequent carry of interventions. More than a third of the residents, nonetheless, reported performing no interventions. Residents reported at the conclusion of booster session iii and later one yr of training that their level of confidence in performing SBI in their electric current and future practices was moderately high (7.8 on a 10-point scale of confidence). Additional research is needed to determine how to train and optimize the apply of motivated residents and explore educational methods for motivating clashing or nonparticipating residents.

Participants revealed high levels of satisfaction with TBL activities and preferences for this pedagogy method over traditional lectures. Positive reactions to TBL may exist related to the novel format and/or the alter of content for each booster session. We did not assess the value of receiving prizes, which were unproblematic and inexpensive; yet, information technology is interesting to note that the kinesthesia felt the prizes added a sense of winning, just it was the sense of competition that the faculty identified as more important to the groups. Prizes added a fun aspect to the TBL.

We institute TBL to be an effective method for reinforcing and building on initial training. Group operation that included discussion of the material showed improved performance over initial private performance. Manifestly, the opportunity for discussion of the fabric and to pool knowledge resulted in enhanced performance.

We besides found TBL to be an efficient method for training big groups but labor-intensive in activity planning. For the three booster sessions combined, 1 to 4 kinesthesia spent a total of 34 hours preparing to implement TBL sessions, with an boosted 2 to 4 hours of administrative time spent preparing materials for each session. For programs considering using TBL as a educational activity method, the labor-intensity of program development and dissemination does not increase much every bit more participants join the form; the number of modest groups is simply increased—or the number of participants (with a maximum of eight) per group is increased. Two faculty members, ane kinesthesia member plus an assistant, or a sole faculty fellow member may be needed to conduct the program. For new cohorts, faculty can easily adapt and update the previously developed cases and materials, decreasing the time needed in subsequent years.

In this study, when we invited residents to select a model for conducting booze SBI in current and future practices, all opted for procedures that included clinician involvement. A surprising 75% of residents stated they would prefer a full-systems approach to implementing SBI, whereas 25% preferred a doctor-only or md-plus-nurse model. No residents stated they preferred a nurse-only model. This is encouraging because it may reflect physicians' acceptance of personal responsibleness to perform SBI and to develop systems to deport SBI in their futurity practices. This could also stand for some affect from the third TBL grooming session, which addressed principles and practices of systems change and stimulated peer-driven motivation to perform SBI.

Strengths and limitations

This multisite, prospective educational intervention targeted residents in primary care for a full year to determine whether their involvement in SBI for patients' alcohol problems could be maintained or increased. The number of residents reporting they had performed SBI grew modestly over the training yr, and residents reported moderately high levels of conviction in performing SBI at the conclusion of the grooming year. Limitations of the written report were the lack of baseline information, lack of randomization of the preparation sites or inclusion of a concurrent comparison grouping, and lack of analysis of residents who did not nourish the TBL booster sessions. This fabricated it difficult to assess the impact of the TBL component versus the impact of the entire SBI process. Another limitation was the defined nature of the TBL booster session. Designed to exist consistent across sites, the educational value of the seminars may have been enhanced if each site had the opportunity to modify the content or activities to suit its particular training program. Another limitation is that the measurement of resident interventions was based solely on resident cocky-report. Finally, just primary care residents were included in this written report, and results may not be generalizable to residents of other specialties.

Futurity research

Time to come research could compare groups exposed to TBL with a traditional didactic teaching and/or other teaching method to assess changes in resident knowledge, skills, attitudes, and behaviors. For case, investigators could design studies to determine whether learning occurred and the corporeality of retention from taking quizzes (IRATs and GRATs) versus from hearing information in a lecture. The level of competence could be assessed either through standardized patients or observation of learners conducting SBI. Self-reported levels of confidence in performing SBI could be compared beyond the pedagogy modalities. Finally, the quantity and quality of interventions with screen-positive patients could be compared across teaching strategies.

Conclusions

TBL seemed to sustain and enhance initial training in alcohol SBI. In contrast to the usual lecture format, TBL relied on competition betwixt teams along with modest-grouping and big-group discussions. Participants reported that they preferred the TBL format to the traditional lecture format. Their performance scores indicated that grouping averages (GRATs) were consistently higher than private averages (IRATs). The utility of TBL as a method for reinforcing continued use of SBI alcohol behaviors also was demonstrated in the finding that most residents reported that they were currently intervening with their patients and had confidence in their abilities to do SBI in their electric current and future practices. Furthermore, all residents chose methods for conducting SBI in their practices, in which they themselves personally conducted the screening and intervention process instead of delegating the task to staff members. Future enquiry could focus on comparisons of TBL strategies with other educational activity modalities. Longitudinal assessment of the program is warranted to decide clinicians' long-term utilise of SBI skills.

Dedication

We dedicate this report to our colleague and dear friend, Dona L. Harris. Dona was an integral part of the carry and writing of this commodity, and her vision of the possibility of using team-based learning for this projection led to its adoption. We regret to study that Dona passed away while this article was in the last stages of revision for publication. Dona devoted her extraordinary career to stimulating research, scholarship, mentoring, and leadership among faculty, especially women, at several medical schools, most recently at Mercer, but as well East Carolina Academy, the University of Michigan, and the University of Utah. Many other institutions in the U.s.a. and Russian federation sought her consultation and expertise. Special contributions include serving equally a board fellow member of the Society of Teachers of Family Medicine (STFM) and as managing director, senior adviser, and faculty member for the Public Health Service Primary Care Policy Fellowship sponsored by the Health Resources and Services Assistants of the U.South. Department of Wellness and Human Services. Among many awards, she recently received the STFM Recognition Award for outstanding leadership in advancing family unit medicine as a bailiwick and a mentoring honour from the Georgia Affiliate of the American Academy of Family Physicians. Dona was loved by students, staff, residents, faculty, and administration not simply for her academic contributions to their lives and schools simply too because she was a true-blue, caring colleague and friend.

Acknowledgments

NIAAA grant R25 AA014915-01A1 of the National Institutes of Health provided support for this commodity. The principal investigator of the project was J. Paul Seale. The coinvestigator was Mary M. Velasquez. Site coordinators for the project were Harold DuCloux, Nick Kilmer, Nick Carden, Joe Mazzola, Greg Asbury, Harry Strothers, Charles Sow, Carlos Dumas, Lisa Davis, Rebecca Gladu, and David McClellan.

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27 Michaelsen LK, Sweet K. Key principles and practices of team-based learning. In: Michaelsen LK, Parmelee DX, McMahon KK, Levine RE, eds. Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Sterling, Va: Stylus; 2008.

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© 2009 Association of American Medical Colleges

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Source: https://journals.lww.com/academicmedicine/fulltext/2009/03000/applying_team_based_learning_in_primary_care.18.aspx

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