Andrew: 0:00

I saw in another team where the big reveal, precipitated an argument of the people will be like, well, that was the one I said, I was, I was going that when you just, you didn't listen to me, I had the right answer.

Mark: 0:28

Today. We're delighted to welcome Dr. Gemma Quinn. Gemma is an associate professor in clinical pharmacy and the head of school at the school of pharmacy and medical sciences at the university of Bradford. Gemma specializes in educating pharmacists. In addition to her focus on pharmacy, her work focuses on the development and implementation of team based learning as an innovative teaching strategy, particularly in healthcare education. Gemma has been actively involved in promoting TBL, a structured form of small group learning that emphasizes student engagement and accountability. She's also recognized as a consultant trainer by the team based learning collaborative TBLC, where she offers expertise and guidance on how to effectively implement TBL in educational settings. Gemma has been recognized for her contributions to the field of education. In 2017, the pharmacy curriculum team at Bradford were awarded the Collaborative Award for Teaching Excellence, and in 2023, Gemma was honored with a National Teaching Fellowship, which is one of the most prestigious awards in higher education in the UK.

Andrew: 1:31

What is team based learning?

Gemma Quinn: 1:33

team based learning is an innovative and structured way of teaching and learning that, um, offers a structure for students and requires them to work in teams to be successful. So the key thing is that it's very structured, so it's not your traditional university task of go off and work in a group and do this in your own time. It's very structured and it all happens in the classroom. so that's a brief summary. Do you want me to talk you through the structure

Andrew: 1:58

Dig, dig in for us, Gemma. We're here to talk about teams, so don't, don't spare us on the details.,

Gemma Quinn: 2:04

There's several kind of key aspects of team based learning that have to be in place for it to work properly. And we have found that if we take any of these out, it doesn't work as well. So, The first thing we do is, um, the teacher allocates teams, diverse teams. So we don't let the students choose their own teams and pick their friends. We deliberately, um, choose to form the teams so that they're made of diverse group of people. So we might use, um, academic grade, uh, gender, uh, if students are international students, if they're resitting and we divide those through all the teams. So the students are put into teams of between five and seven students in each team. have cohorts of anywhere between 200 and 250 students in our MPharm. So they're, they're split into small groups, and that's the first thing that we do is put them into teams. Um, the whole program is divided into units. So for a module that runs across a year, we might have seven or eight units in that year. And each unit, uh, um, lasts for two to three weeks. So before the unit starts, the students are given pre work and so that can be some reading, it can be watching some videos, listening to podcasts, and they do all of that individually in their own time. So that's the individual aspect to, um, to team based learning. So they do that pre work. Then right at the beginning of the unit, we do what's called a readiness assurance test. And there's two components to that. There's an individual readiness assurance test, which the students do individually. So that's taken under exam conditions and it's based on the pre work. So it's quite low level questions. Uh, they're not particularly complex, but it's checking that the students have understood the pre work. Um, and then after they've done that individual readiness assurance test, they take exactly the same test again, but in a team. So they then get into their teams, work together to undertake that test again. the traditional way, you'd use a scratch card for that. And so the team has to agree which answer they think is right. And they're looking at a multiple choice question and say, they think a is right. They scratch off a, and they get a star if it's the right answer. So they know instantly that it's the right answer or it's the wrong answer. And if it's the wrong answer, they obviously have to go back and choose. Discuss again and decide what they think is the next best answer. the students do work through all the questions in the team. So by the end of the T RAT, we call it the Team Readiness Assurance Test, they've had instant feedback on their individual test because they know what they got right and wrong and they should know what all the, all the right answers are because they've seen it from these scratch cards. they get points depending on how quickly they get the answer right. So if they get it right at first attempt, they get four points. If it takes till the third attempt, then they get one point. And. Obviously, if it takes all four, then they get zero points. So then after that, we have a process where the students are able to ask questions, clarify anything they didn't understand, they can appeal if they don't agree with the questions or the answers. and so we talk through the findings from that, that process and identify what they've actually understood and what they haven't understood. So after they've done the readiness assurance process, they then move on to application exercises. And these are much more complex questions that they do in their teams. So they, um, they, they will have a, for example, a scenario, a healthcare scenario, and they, they discuss the scenario together, and they have to make a specific choice as part of that, um, task. So all the, all the groups are working on the same task at the same time, they have to make a specific choice, um, and then they do what's called a simultaneous reveal. So they all have to hold up, um, their answer. in front of everybody else. So if you've got 150 students in a room, all the groups hold up their answer at the same time. So often it's a multiple choice question, um, and they'll hold up their answer so they can all see each other's answers. So that requires application of knowledge for the application exercises. It's, they're more complex than the questions that are asked in the readiness assurance process. and then we have, um, An inter team discussion where the facilitator will say, Oh, you know, you chose C for this. Why did you choose it? That group justifies their answer. And then we might go to someone who's chosen A and ask them why they think the other group was wrong. And we have a good 20 minutes discussion about the rationale behind their answers that they've chosen and why one answer might be wrong and the other might be right. So the majority of the classroom time actually is taken up with these application exercises, and which are the deeper level questions. then the final component to team based learning is peer evaluation. So we ask the students to evaluate each other, they evaluate everybody in their team. then we do that Bradford. We do that twice a year. So we do it formatively. That's just for feedback for the students halfway through and summatively at the end of the year where the students actually get a mark based on the that their team members give them. So that gives them some incentive as well to be good team members. So that's team based learning in

Andrew: 6:57

Well, there's lots, The overview is brilliant. So we've got a kind of what I would describe that readiness piece is about almost a sort of literacy, raising the literacy of the participants before they start of getting them conditioned into what they're going to do. Um, then they've got which they do together, uh, albeit a component of it is individual. they're into some form of kind of practical exercise, uh, then they're into a discussion and reflection, and then they're into a, almost, you could say, an evaluation and an adjourning, uh, pasture, where they're reflecting on other's performances and, and the performance of the team. There's a really nice arc to the process of, of team based learning. I first wanted to ask about this pre work. What is it that you hope, so you've got students who are coming in to engage in team based learning, what is it that you're hoping they arrive with terms of capacities and understanding so that they can get the most out of it?

Gemma Quinn: 8:09

well. guess what we're hoping they arrive with and what they do arrive with are probably two different things. Um, but I think from, from education in the UK, students are very much taught to revise for exams and to learn material and that things are the right or wrong answer. So hopefully they come in able to learn from, from material. Um, and. That's, you know, we, the traditional university would use lectures to deliver that material and there's lots of evidence that lectures don't really work. Students don't remember what they're told in lectures. Um, and so we really that that pre work is kind of is the delivery of the basic knowledge that the students need. So they need to be able to understand that basic knowledge. Um, and we do actually, we scaffold and make it, take away, we scaffold very clearly at the beginning. So in their first year, um, we tell them exactly go to this page, look at this, look at this video. And then by the time they get to the final year, which is a four year course for pharmacy, we're much less directive in the pre work. So it might be look at this guideline and pick out the key points. So we're hoping to teach them through that process to be able to read material, understand it and kind of get the knowledge in really. And so that's really about their personal learning and ability to a certain extent to revise because we do find students do revise for these exams, even though we don't really expect them to or want them to. Um, they do because it's worth saying that, um, students module marks are attached to various points of this. So they get a mark for the individual readiness assurance test and for the team readiness assurance test and for the application exercises. So they are motivated partly, partly extrinsically by the mark they're going to receive to do the best they can.

Andrew: 9:53

Can I just double check? When we're talking about the materials, both in the readiness assurance and the pre work, Is this material's technical? This is, this is material specific to study of pharmacy, as opposed to things to do with concepts of teamwork.

Gemma Quinn: 10:16

Yes, yes, it's, it's almost all related to the, the technical aspects of pharmacy that they

Andrew: 10:21

And how do students find the experience of relinquishing their, the kind of intellectual sovereignty that, that tends to be, uh, the, the, the norm in university, you know, it's like you do your studying, you, You try and log it in your head, and then you have to regurgitate it when you're assessed. And the environment that you're creating is one where that's distributed amongst other people. You're having to do this odd thing called sharing of and, um, you know, um, collaborating around about their, their, the way in which they digest the information and make sense of it. How, how do they find that?

Gemma Quinn: 11:02

they tend to actually find it quite hard. So I remember when we first put in team based learning and we just had had it in one year, had a lot of comments like I'm paying 9, 000 a year for this and you're not teaching me anything I'm having to do it all myself. Um, you know, they, they, they asked for lectures. They asked us to put lectures back in. Um, So, So, that's what they wanted. And still the first years when they first start, they do find it uncomfortable that we're not standing in a room teaching them. Um, but we have what we call staff student liaison committees and we have students from across all years in that committee. So what we see now is the first years might complain that they're, you know, that we're not teaching them anything. But the fourth years will come in and say. You just need to stick with it and you'll get it and you'll see why. So now the students kind of advocate for that themselves, that they understand that by us not standing in a room and teaching them everything we're, we're, we're teaching them how to learn for themselves. Um, so they, They do understand it in the end, but at the beginning, they do find it uncomfortable.

Mark: 12:04

Gemma, could I roll back a little bit to the beginning of this process from the student's perspective? Because you mentioned at the beginning that you do the selection, you don't let the students choose their own teams. I'm really curious how you do the selection and if there are any particular things that you found make a really positive difference, or actually a negative difference, to the outcome for the team.

Gemma Quinn: 12:27

Um, we, so we do it slightly differently in each year because obviously when we have first year students, we don't have, um, academic grades, for example, which we would have moving forward. So in the first year we do it based on gender. So we make sure that we have, um, uh, As even a gender split as we can in the teams. So pharmacy is quite female heavy. So we tend to have more, more females. So we try and split it, split it so that they're equal. um, at Bradford University, we recruit locally. So quite a lot of our students are from local schools. So we look at their postcodes. Or we actually might look sometimes at the postcode of the school they went to and try and split them up so that they're not in a group with people who they went to school with, partly because obviously they'll have formed friendships there, but also there might be, they might have people they don't like from school that they don't want to be in a group with as well. in the first year, we split according to gender and location. We split international students and we try to divide those up throughout, throughout the groups um, because they may have English, um, they may not have, um, their English might not be as good and if historically we saw that international students would very much stick together and stick with people who they could speak their own language with and then they would struggle with the language as they got through the course. So by splitting those up they, it forces them basically to speak English in the classes we also allocate resitting students you throughout all the groups. So if we've got 20 resitting students, we'll put one in each group. Um, and then also students who require any additional support, um, who have a specific learner support profile, we might those between the groups as well so that they're divided up equally. So we try to make the groups As so they've all got some diversity and all the other thing is mature students. So if we know we've got, um, somebody who's been a pharmacy technician, for example, for 15 years, they've obviously got a huge amount of experience. So we would try and, um, divide those up as well through the group. So that the idea is that the groups have got, um, yeah, diversity really of resources so that they've all, everybody in the group can contribute something different and learn something from. other people in the group. we go into second and third years, we do also add in grade average. So we try to, to, to split that evenly as well across the teams And that's,

Mark: 14:46

there are definitely two parts of that I think emphasizing the diversity is a really key part of that. selection process. Uh, Andrew will have heard this before. One of the things that I used to do, and in a very, very different setting years ago, non, a non education setting, but still team based and an almost team based learning, was running hackathons or hack days with teams. And over the years, we had different ways of selecting the teams that started with teams selecting for themselves, which meant that they were, you extremely non diverse, so in my world that meant that you had engineers sticking with engineers and marketing people sticking with marketing people, so they would recreate the groups that they had had, the in groups that they had had before the event, and we found that vastly more successful was the time where we forced, in a very similar way to you're talking about, we forced the selection process. We actually did it around archetypes, so that we said, we said to individuals, please select an archetype, you are one of these. types of characteristics, personas, and we then pre selected on that persona. So it was each team has to have one of these and we made that as diverse as possible. But obviously you're able to go much deeper into that with, um, with your selection. Do you find that there are any negative characteristics, the, so negative team characteristics, not negative individual characteristics, but if we put people that are similar in this way, it can affect a team and that might be something you would avoid.

Gemma Quinn: 16:15

Um, I think I suppose it's the students who are already struggling. If you end up with teams that have got multiple students that are struggling and they can be obviously struggling for different reasons. Um, but if there, if there's multiple people in a group who are struggling or who are not wanting to engage with the material that can have a negative effect on the group because you know, there can be three of them sitting there not doing anything, not engaging, not having done the pre work and the other three feel that that's very unfair. Um, because For the TRAC, for example, it's a team mark. So it doesn't matter who's contributed the most. It's just a team mark. Um, so that, that's, that does cause a problem if that happens. And that can happen inadvertently because obviously we don't know, can't factor that sort of characteristic in, in terms of someone who might not engage, but still do well. So they might still get an academic, a resitting the year, then we know that something has happened last year. That means they've struggled for one reason or another.

Andrew: 17:12

You're touching on an age old problem that teams experience, this is often referred to as social loafing, but what have you observed in when that happens? Because what's interesting about that whole dynamic is that you're, you're almost you're, you're You're creating a situation where those issues come to the fore from the start. So you, because of this readiness protocol you have, you, the injustices of social loafing actually come out of the woodwork very early. I love how it sits in real tension with that kind of prevailing message that a lot of students go into university with, which is like, it's my grade, I do the work, I get a grade, I get my reward, and there's this idea that it's just unfair if Anybody in any way detracts from my grade, um, which is almost a metaphor for the same tensions that exist in the working world. Right? So what do you see? How is it resolved? How bad can it get when these things happen?

Gemma Quinn: 18:27

A lot of the time it resolves itself and that's one of the, one of the things I didn't say, I don't think, is that we keep students in the same team for a whole academic year. So it's really important in team based learning that you're not changing the team. So, um, it's recommended a minimum of a semester that they're in the same team. So, so they have to go through that kind of getting to know the team and working out how they're going to work together. So there's a few things that motivate the students who are eventually going to be willing to contribute to contribute. And that is about their marks, so their individual marks and their team marks. they actually have to sit there in front of all their team members and say, I don't know, or I've got it wrong. And that actually makes them very uncomfortable or some students very uncomfortable. The fact that they can see, I have a team of six, five have done the work. I'm the only one here who hasn't put the effort in to do the work makes them. Just think, right, am I going to do it or not? Do I, am I enjoying this? Do I want to do it? And some of them at that point step up and actually think, actually, I do want to do this. I do want to take it seriously. And they do start working. So there are obviously always a couple that just don't and that carry that carry on loafing. And I suppose team based learning is not perfect, but neither is the traditional lecture system where there's a lot more

Andrew: 19:42

Neither is teamwork perfect.

Gemma Quinn: 19:44

no, no, you know, some people just are going to do that, aren't they? But doesn't happen anywhere near as often as. As you might think, so occasionally you see people who, you know, are not just obviously not taking part, but most of the time, the natural peer pressure of being in that team and knowing that your team mark contributes. So, one of the things we did, um, before COVID, we started doing it. We haven't picked it back up, but we had a league table of teams and the students asked for that. So, we had a notice board outside. that had the team numbers and who was doing the best. So they do compete, but it does introduce an element of competition. So, you know, they're like, we want our team to win. And if you're not contributing, then you're not helping the team. So there's a huge amount of peer pressure that actually means we as academics have to intervene very rarely to kind of to do anything with the team. Really, actually, they generally sort themselves out over time. So the first, the first unit or the second unit, Might not be working so well, but as they get to know each other and know where each other's strengths are, then they tend to get better at working as a team. there's another aspect is that there might be that people aren't contributing because they're shy and they just don't want to speak out. And I think what team based learning also helps them to see is actually. You know, I knew the answer to that and we chose the wrong answer. And if I'd have spoken up, we'd have got the extra marks. And so then next time they might speak up then equally their team will think, Oh, actually they don't normally speak up, but when they do, they know the answer. And so they then start asking that person, do you know the answer for this? So, so naturally over time, the team kind of evolves to work together, to work together well, so that that social loafing doesn't really happen as much. And I think. The fact that all the teamwork happens in the classroom helps that as well because you're always under the supervision. We have, you know, we have two academics in a room with 150 students. So people are walking around and they see you and, you know, if you see somebody just sit, start sitting, lolling all over the table, I would go up and kind of say, oh, you know, working hard are you today? Just some comment that generally gets them to sit up. So they are under some supervision. So I think that helps the students who are working very hard and contributing feel it's less, um, there's less opportunity to loaf.

Andrew: 22:02

So you described the idea of how students who they have this means of, of understanding and identifying that they may be slightly behind the pace in terms of technical knowledge, which identifies to them that, well, they may, they might be holding the team back or, you know, creating issues for the success of the team. Great. And they step up. Have you seen examples of where those other stronger team members recognize that? And I mean, I just use the language. in opposite, you know, they step down. I don't mean that they step down, but they, they, they hang back to try and offer assistance to, to, and they recognize that, well, we need to support those team members so that we all thrive as a team.

Gemma Quinn: 22:50

they do do that. And I think that well, so, so the better students then end up teaching the students who haven't done the work. So at that point, they're benefiting as well, because, you know, once you've taught someone something, you really have to understand it to be able to teach somebody else. So they, they do benefit from that. So they do work together and they do support each other. And I think. This is where it comes on to the teams end up being more than just a team that works together in in classes. So we see people. At year four, who are still friends and working with the teams that they had in the first year. So they become the analogy that one of my colleagues uses is that as academic tutors, we were often kind of surrogate parents and the students would come to us with problems. And actually now the team becomes surrogate siblings. So they support each other and help each other out. If I can go back to one of the things you said about it being my grade and, you know, I want to do well. One of the really compelling things about team based learning is that the team always does better than the individual, 99. 9 percent of the time, if you look at the individual readiness assurance test and the team readiness assurance test, the worst team does better than the best individual. that's a really nice lesson that even if you think you're brilliant and you don't want to work in a team and you're the best student, in a team still gets you a higher mark than if you were Which I think is a good life lesson.

Mark: 24:17

I was going to talk about outcomes, Gemma, because obviously there's a reason that you do this. And it's actually something Andrew and I have been really investigating, uh, for the work that we're doing together recently. There's, there are two elements we were looking at. One was around Henri Tajfel, which I think, Andrew, you know much more than I do, but I was also looking at the work of Johnson, Johnson and Mary Beth Stanne. And I'm not sure if that's research that you've come across, It's particularly around cooperative learning, and one of the reasons that I was looking into that, because learning definitely isn't my, um, my forte, but one of the reasons that I was looking into that is I had a hypothesis, this is something Andrew and I were discussing, that if you really subsume yourself into the team, as a team member, if you really put the team first rather than putting yourself first, then the team's outcomes are better, Which is what you're saying, but actually there was a really interesting extension to that, which is if you're part of a team, which is better than your personal outcomes, a better long term, which is probably the other way around than people would think for it because we live in quite an individualistic society where it's me, me, me a lot of the time. And I wonder if, do you, do you believe that that. Assumption that I'm proposing there, that if you really put the team first, the team outcomes are better, and there's a long term impact on the individual. Is there any evidence to suggest that that might be true?

Gemma Quinn: 25:42

It's obvious, I think, from, from the fact that because we form the diverse teams, they are forced to listen to people's point of view who might have a different point of view. So, you know, for example, if you've got a mature student in that group who has worked in pharmacy for 10 years, they will tell you something or think a different way or have a different approach to, um, to you maybe. And, and as time goes on and you kind of hear that person talking, you start to. embed those thoughts yourself. And you think, oh, what would that person say? I mean, one of the really good examples that we did recently at Staff Away Day, We categorize people's according to brain color. I don't know if you've seen that technique, but we did all our staff and we said, right, what brain color are you? And then we mix the teams into diverse brain colors. So we had some really creative people and pharmacists are very logical and they can be quite rigid. And, you know, they're typical scientists. And actually in our school, we don't have many of the creative types, by having just one of the creative type people a group with all these very rigid people. It instantly changed our approach. So we were asked something about one of the tasks was about creating a uniform for university staff. And, you know, we all went down and write, how does it work? What is it? And the creative people were like, Oh, you can, you can have one that kind of changes color according to where you are or your mood so that people know what mood you're in. And you think I would never, ever have thought of that in a million years. That's just not my, My thoughts. And so that then made me go down a different path. So I think we see it all the time and then the more you work with diverse teams, the more you understand the benefits of working with diverse teams, I think.

Mark: 27:21

Gemma, the, what I mentioned about those archetypes was actually a relatively similar thing. So the, uh, when I was selecting to those teams that had to work together and were judged, and this is very short period is the end of the day, uh, we effectively had hacker, hustler, visionary and creative. And so it's, it's acknowledging that there are quite different skill sets, capabilities, and to an extent personality types in that. And one of our guests, Dave Winsborough, who's an organizational psychologist, he, he mentioned the power of some of that psychometric testing for putting teams together. And I believe, Andrew, that Suzanne Bell did some research for the, for the Mars expedition on, um, the, on personality type in teams.

Andrew: 28:08

The research on that space is really interesting because in space exploration, it's probably one of the rare contexts where they, they have absolute dominion over selecting in for the team. You know, it's, it's the classic right stuff. Yeah. Uh, cliche, I suppose, is, well, we, we, we can, we can choose whoever we want. We only need a handful of people and we can apply whatever criteria we want to find the best crew. But, um, yeah, Suzanne Bell and, uh, A bunch of other researchers from NASA did some work and, um, looked at loads of variables in relation to team configuration and what, what matters. Uh, but the, the two really, really powerful variables that sort of were consistent across all kinds of different controls and, and, uh, scenarios was, um, individual conscientiousness. and team orientation. So a sense of bit like what you were talking about minutes ago, Gemma, with how students sort of start to recognize that the, like, you know, the kind of the tide lifts all boats, that the team outcome is always better than the individual outcome. Um, actually people in this astronauts context, those who Kind of intrinsically recognize that from the start. That was a really strong indicator of team performance overall, which, you know, when you say it like that, it sounds like common sense, but understanding the extent to which you genuinely appreciate the value of the team and you're committed to it, um, is maybe slightly more nuanced. Uh, but yeah, there, there are, uh, these kind of characteristics that make a difference, um, to, to the outcome and how you would select for performance.

Gemma Quinn: 30:11

I guess for healthcare professionals, that's really important that you understand, you know, you don't have an option of not working in a team in your job. So if you're coming through your training and you think I don't ever want to work in a team, it's better to identify that in the first year or ideally before you start and think this is not, this is not going to be for me because you can't do the job if you're not able to work in a team I

Andrew: 30:31

I'll, I'll drag us back hopefully to team based learning, but, you know, we're talking about your, your application of team based learning is preparing pharmacists for their professional roles, um, which as you say, are, uh, the, the vast majority trending to 100 percent of their, of their professional practice is going to be part of in teams. The interesting, you reverse engineer that idea of space selecting in for these things so that you have an optimal crew performance. actually it's the sort of thing you need to make sure you're providing good training for in pharmacy, right? Because you don't, you can't select in for it necessarily. People select themselves in out of their interest in pharmacy. And then, um, the extent to which they're, they're orientated towards. Teamwork maybe has to be, amplified enhanced somehow through their process of becoming a professional.

Gemma Quinn: 31:26

we're the only pharmacy course in the country that uses TBL in the way that we do across the whole program and everywhere. So we're quite well known for that. so we make sure that we when students come to us for an interview, and when they're thinking about what university they want to go to, we put them through team based learning. So we show them team based learning, partly to advertise it and say, this is what you're doing. But also so they can, if it's if it doesn't suit them, they can. Don't, you know, don't come to Bradford if you don't want to do this. So, so we are to a certain extent selecting for people who want to do team based learning before they come, but whether it's a natural they want to do or whether it's because they recognize that it's needed for the job, who knows?

Andrew: 32:06

That translates to things in healthcare would be termed as non technical skills. Tell us, a bit on that for us because, you know, you're talking about selecting in, um, but the people that you put off who still go to study pharmacy elsewhere going to have to work in teams when they qualify.

Gemma Quinn: 32:23

Yes, they are and that's, you know, that I think it's, it's key. So to me as a pharmacist. Actually, particularly these days, the technical knowledge is, you can find the technical knowledge anywhere. Anyone can find the technical knowledge. Anyone can look at what the doses of a drug are. Anyone can look up interactions. It's being able to, um, to weigh up the options, to decide which is the best option for your patient. So one of the other things the students always say is, well, what's the right answer? there isn't a right answer. Ask three different pharmacists. They'll probably do three different things. So you need to be able to look at evidence, to weigh up. the situation of your particular patient. And then pharmacists are often the only pharmacist in a team. So you might be on a ward round with doctors where you've got four or five doctors of various levels, including a consultant, a physiotherapist, occupational therapist, nurses, and you're the lone pharmacist who's got to try and persuade them not to prescribe this antibiotic or that they need to reduce the dose of a certain drug. actually, I would say the technical knowledge is is probably, I'm going to go out on a limb, the least important part of being a pharmacist, actually, it's how well are you able to articulate your decisions? How well are you able to influence other people? How well are you able to build relationships with other people off often quite quickly, but you literally might be asked that morning, right? You need to go on this ward round today with a group of doctors that you've never met. So you, so you haven't got that existing relationship where they're going to trust what you say. So, um, of those things are part of team based learning. You have to be able to, um, to say why you've made a decision and to persuade other people that, that you're right. And to listen to other people's points of view, because you might say you shouldn't use this drug in this patient. And then the consultant says, yes, but you know, they've only got three weeks left if we don't give them something. So I'm going to try it. Um, so you need to listen to other people's points of view and weigh it up. So all of that, I think is the most, Important part of being a pharmacist doesn't matter what you know, if you're not able to get anybody to do the things you need them to do

Andrew: 34:31

We have this, uh, kind of working metaphor, uh, Mark and I, that, uh, the balance between, just like you said, the balance between technical and non technical skills. the metaphor is constitution of air, in that percent of air is nitrogen. bit that's oxygen gives us life, and that would be tantamount to technical skills, which is yes, instrumentally, at the end of the day, the thing that you did or the drug that you administered. made the difference. But entire apparatus around how that found its way into the body was non technical skills. And that's the nitrogen. And you can't, get oxygen into your system without air. the vast majority of it's made up of nitrogen. So without it, you're dead anyway.

Gemma Quinn: 35:24

Yeah. And that's a good analogy. And I think if I look at, you know, pharmacists who were older, when I, before I even qualified, and I worked with the, the traditional role of a pharmacist was to stand behind a counter and, make medicines and give them out. You never quit. When I spoke to a patient, you didn't have a conversation with a patient and you just did what the doctors told you to do. so, and the role has changed so much, even since I've been qualified and in the next two years, we're going to have pharmacists graduating as independent prescribers. So they're going to be able to write those prescriptions. They have to be able to. To work in a team to be able to make sure that what they're prescribing is the right thing. And you're right, they do need that knowledge, the underpinning knowledge, but the, the team, the teamwork is, I would say probably the most important thing they

Mark: 36:09

need to have Can I can I take us back just to something that you said earlier? Um, and I want to go back and then I want to come back to this conversation, so we need to put a pin where we, right where we are now. You mentioned earlier that you keep the teams together throughout, so as for the students as they're going through their process, you, you keep the teams together. Just very quickly, what's the benefit of that, the having that long lived team that, that you see? I

Gemma Quinn: 36:33

think it's the, well, there's lots of benefits. So it's going back to that peer pressure, that caring about the people you're working with and wanting the team to do well. So if you're just in a team for a day and then we changed and you're in a different team, there will be no commitment to that team. There will be no investment. You're just, it's, it's. You know, it's just somebody else. It's another team. So by keeping them together, they develop that, that ownership and that it's their team and it's their results. They can't hide from their role in that team. Um, and it's also. They, they will go through challenges and times when it's difficult. And so, you know, we have a rule that, I mean, we literally, we never change a team once we've formed it. and so we, and we do have to talk them through some tricky times. At times. You know, we have emails from students, this student's not doing anything, this student's never there. And we try and get them to sit down and talk about it themselves. So, so it gives them a chance to. Get around those issues themselves and think about solutions for themselves like you would have to in real life. You don't get to choose who you work with. So I think it gives them that simulation really of real life that you're in this team. It has. You have to make it work. So you need to make it work

Mark: 37:45

it's incredibly few things. If I just pull out some of the things you said, there's that feeling of joint accountability. So we're in this team together. We are jointly accountable. But also, as you're talking about some of that conflict resolution, there's also a sense that you're building a knowledge of, you know, how other people perform other people's skills and capabilities. And to an extent, this is something that Andrew and I have started to call common ground. So when we talk about enduring teams, because it's really interesting that a lot of team theorists have just talked about, it's how long the teams are together. But we've also seen teams that are together for a very short period of time that have become very effective. And to an extent, that's almost part of this bigger team craft, body of, of thinking that says, it's actually how quickly the teams establish that common ground. Establish who are my team members? What are we here for? What is each other good at? So then maybe I can bring you back to that new situations. You've mentioned the really important learnings that they have as students. They're put in the situation, they can't get out of the teams. That's just like real life. But then they come forward into that clinical setting. what do those teams look like? Are they, are they enduring? So when somebody comes out of the academic setting, goes into actual practice, how long do they work with those people? Are those teams fixed? Are they consistent? Or do those teams change a lot?

Gemma Quinn: 39:09

it depends where they go. So for pharmacy, there's lots of different sectors. So there's community pharmacy sectors, primary care, and GP surgeries, basically, and then secondary care, and they're all different. And Community pharmacy teams, for example, might change quite quickly. So you might have a technician there, for example, who's been, who's been there for 15 years and it's the same tech, but you might have, um, shop staff who, who change relatively quickly. And you might have a pharmacist who's a different pharmacist every day. You know, some pharmacies are run on locums and they're coming in every day. So that, so that will change quite often. I would, in a GP, primary care setting, it probably changes less, um, because GPs are, you know, often practice partners, are there for long periods of time and the staff stay slightly longer. And then in secondary care, you probably have a core group of people who've been there a long time, but again, other people will change. And I think, There's both. So there's, in most places it's kind of a core of staff that will be a team that they're with all the time and then other people will come and go. And so they need, like, for example, like the example I gave you of the consultant ward round, a pharmacist will be part of the pharmacy team. So they might have a medical, a team of medical pharmacists that might be five or six pharmacists that cover those wards. And that that might be a team that's consistent for a couple of years. But. Then they go, they have to go on a doctor's ward round and that will change every day, potentially. I mean, doctors rotate every six months in hospital anyway. So, so there's, there's often a core team and then other people that come and go, then you've got the more peripheral of the team. So for example, a community pharmacist, if they find a mistake, if they need to correct something, they will have to ring a GP who, you know, they might speak to once every two years because they serve. 35 different surgeries. And, you know, they have to do both. They have to be part of a long term core team, but also be able to, quickly into other teams.

Mark: 41:04

Are there any specific things that you think the students learn in that team based learning setting, which particularly equip them to perform maybe, maybe more quickly, get to be more effective more quickly when they come out into the non academic setting?

Gemma Quinn: 41:18

I think literally everything they learn in that setting helps them, you know, they there's so many things they have to do So they you say that that they have to find that common ground So they're working to to work out how they can work in that team They're working thinking about how they might need to adapt how they might need to adapt to others As I say, when we do the inter team discussion, we have, so we have a big room with 160 people in, and each table will have a microphone, so each team will have a microphone, and they'll have to say, um, they'll have to use that microphone to say, we chose this because of this, um, to all 160 people in there, and because they've declared, um, their answer, that everyone can see, they can't change their mind. You know what it's like in groups if they look around and say, oh everyone else chose D, so we'll do D. They can't do that because they've declared their answer. So, so they become quite wedded to that. So they, they argue with each other and they. They start to see other people's points of view and sometimes you see the light bulb moment where you realize, Oh, we made that, that was the obvious mistake that we made. That's that we know our answer's wrong now because of what they've just said. I just think everything, everything they get from those sessions helps them hit the ground running when they go into the workplace. There is nothing, really can't think of anything they do as part of team based learning that does not help them for the workplace, every single part of it. And because. For the learning, because they've already done um, the pre work and they've got the technical knowledge there and the baseline understanding of the basics, we can go so much deeper with the application exercises because we know they've all done that pre work. So the fact we attach a mark means they all do it. So historically we used to. a thing called flipped classrooms. I don't know if you've talked about that before, but it's basically where you get the students to do the talking and the work. And we tried, before we did team based learning, we tried that where we said, okay, you're going to come to a workshop and we want you to prepare, um, the answer to this case on slides as groups before you come and you're going to come and teach the rest of your group. And that's what we did. It just didn't work because they didn't do the prep, they didn't do the pre reading, the other teams hadn't done the pre reading either, so they couldn't argue, they couldn't say you're wrong because they didn't have the underpinning knowledge. the way team based learning works builds trust. Building up to these really complex problems quite naturally. So when we first rolled out this course, we found ourselves in the third year of the course, material from the old fourth year to use with the third year, because the third year students were just at fourth year's level. They were having such complex discussions and thinking about it in much more depth. So it. It's that ambiguity as well. As I said earlier, for pharmacy, it's very rare that there's one right answer. It's rare. And students don't understand that. They've been brought up 100 percent to think what's the right answer. so by having those discussions and those conversations, it helps them to see that there often isn't one right answer. And as long as you can justify your answer, then that's, that's usually enough. You know, if you're in court and you're having to say why you've done something, as long as you've thought of the other options, then that's important. there isn't anything I don't think that doesn't prepare them for

Andrew: 44:38

That's something that jumped out to me from one of the answers you gave earlier was that example of, uh, A pharmacist might say something about a treatment plan for a patient and the doctor would say, well, we need to get this medicine into them because it gives them, it gives them two weeks of runway. And these are examples of as you talk about, essentially boils down to epistemic uncertainty, right? It's that confronting, this gap and, and the gap might be. widened or deepened by the fact that you've got different disciplinary perspectives in the problem as well. And I really like how without, without actually even labeling it, you're getting your students to experience that in a really supportive, incremental way. It's getting them, I suppose it's getting them accustomed to the discomfort of that uncertainty and recognizing that. It's not an indication that they've done something wrong. It's an indication of just arriving at the territory where you need to find a decision, which is not black and white and not, it's not a bow around it. Um, and I think that's fantastic. And I can remember it when I did the workshop myself and seeing, so there's two things I remember just on that subject about the uncertainty, which was. Um, you know, in my case, it was a workshop. So the people around in my team, we'd not met each other before. Um, so there's the kind of vulnerability of going, Well, I think this is the answer. And, and And, you know, in some of my other research where you get short lived teams together, you see that you see people falling, forming little alliances with people who they, who seem to have the same idea as they do, uh, and then the interesting thing was when you did the big reveal, you've got the affirmation for those that were the loudest voices towards, you know, that, uh, that particular answer. And what you also saw was the detractors when, you know, I saw in another team where the big reveal, precipitated an argument of the people will be like, well, that was the one I said, I was, I was going that when you just, you didn't listen to me, I had the right answer. And the thing about the question with, and I, you'll have to remind me. I remember the question because it was a group of different, different academics from different disciplines, and if I remember correctly, the question was something around what the most important things thing for students learning is, is X or Y. And that's the point is that it's not. necessarily the case that I think there was six answers, but you had, you basically had to debate whether your team thought A, B, C, D, or E. it's not the case that one of those is actually the right answer. It's what, what do you arrive at and what are you agreed upon? And all of those different features of that process are, um, you know, even for, uh, You know, very highly qualified professionals who are in the room that I was in. Wow, I'm deeply uncomfortable for a lot of them. And, and, And alien actually, properly alien. And I think, well, if you're someone who's going into a healthcare environment, uh, as a professional, and you've never done that before, the experience of the discomfort may be wrongly interpreted as doing something wrong.

Gemma Quinn: 48:26

Yeah, and I think pharmacists particularly and this is a case because pharmacists are totally focused on patient safety So, you know, we will be like you can't you can't give that dose. You can't give that drug to that person It's contraindicated or know, I'm going to refer this patient to this patient needs to go to hospital They need to be seen in hospital and then the GP doctors are trained in a much more explicit way to deal with uncertainty and manage risk. Um, because they have to allow people, you know, they have people in their GP surgery who they say, I am not going into hospital. I don't care what you say. I am not going to hospital. I don't care if I die in my chair overnight. I'm not going. And the doctor has to make a decision about what can I do to try and keep this person Alive for the next 24 hours knowing they are not going to be in hospital So a pharmacist a traditional pharmacist response will be we have to go to hospital you have to go There's no option you know people have free will and they're not going to do things and i've been in exams with Pharmacists where they've told people you have to take this medicine three times a day They are not going to they've told you they are not going to so you've got to find a way You've got to find a different drug or a different regime that means they can take it twice a day, which they can manage. And pharmacists are historically very, very uncomfortable with that. And because we've always had this kind of backdrop of, will you refer to a doctor if there's a problem? And particularly as we move forward with prescribing, pharmacists are going to have to take responsibility for their own decisions. And they're also going to have to manage risk where there is no right answer. You know, this patient, something's, Something's going to go wrong with this patient, probably. This drug, you probably don't want to give it to this patient, but we have no choice because the alternative is intravenous and they're not going into hospital to get that. So, There's all sorts of reasons that pharmacists need to become very comfortable with there not being one right answer. Um, and they are, I mean, we've selected it. When we interview people to come on the course in the past, that's one of the things we've looked for is safety. And, you know, they're not going to take risks, but actually we need to row it back a little bit. We've probably gone a bit far in the rigidity of that. We've got to now become accustomed to taking risks and to managing those risks and to knowing that there is no right answer. And I mean, these things as an academic is, is really quite challenging because I remember my first application exercises were poor, to be fair. You know, there was, they were obvious right answers and the students got the answers immediately. And then they sat around for 20 minutes chatting to each other and they're like, Oh, what's the point of that? You're right. The really clever, the really good application exercises are the ones where there is not an obvious right answer where actually you could argue for, you know, there might be some obvious wrong answers in there, but there's three or four of these that could be the right answer or that different people will think is the right answer. So if you asked a doctor, they might choose one. If you asked a nurse, they might choose another. And it does give you that understanding, like you say, of. different people will come with different viewpoints. Different healthcare professionals are coming at it with a totally, their remit is different. So they will have a different point of view. you need to be able to understand other people's points of view and know when to stand your ground and say, if you do this to this patient, you will, they will die. to say, okay, well, you know, they're in, we can do a blood test tomorrow and see if they're okay. so. It's about managing risk a lot of the time and that, that level of uncertainty and being able to, to cope with that uncomfortableness is really important.

Andrew: 52:00

that process is, is, is kind of refracted through the team prism, isn't it? Because here is about to what extent people are competitive over what the right answer is. And what you're achieving with team based learning is, is an understanding of the fact that you have to arrive at somewhere that's potentially, you know, I'm fond of saying, may arrive at an answer that none of you individually holds. you have to, through teamwork, you have to, through teamwork, agree that that's the answer that you're going with, or that's the, that's the approach that you're taking. And it doesn't represent a loss for any individual member who's contributed to that result. Um, but it's a very difficult thing to relinquish in your head if you're used to this idea of, you know, kind of competing over winning over the answer. Um, and, also when you are, as you say, standing your ground, standing your ground, not on the basis of I'm telling you why you're wrong. It's I'm telling you what I believe some of the, you know, higher risk consequences are of following this approach. wholesale and that's a different framing of right or wrong. That's about caveats and uh qualifying what what an approach might be. We're going to finish the arc here because we've talked, we've talked a bit about the the The readiness, the application of the scenarios and how that relates to professional practice. What surprises you that comes out of that retrospective reflection element at the end? What, what, what kind of surprising things have you learned by, by observing students going through that process?

Gemma Quinn: 53:43

think it's probably the complexity that they can, the level of understanding that they get by the end. As I said, we had to go and we had to use material from a pre, from the year above. The level that. You know, you see these students when they come in and they're fresh out of A levels and going back to that competitiveness, you know, they've all been competing for places in a, in a university degree. individualistic the, the, the changes that you see in them and how they come to those answers. And sometimes they come up with rationales. Sometimes they'll correct you and be like, actually, we found some new piece of information that's been published in the last six months that says your answer's wrong. And Darn it, you have as well. And that, but that's really nice when you see the students have gone to that level that they understand it so well that they can actually find a better answer than the answer we gave them. That's when it's really, it's really nice to see. And obviously, for an academic, it's so fantastic when the students come up at the end and like, we really love that, you know, we've really enjoyed it. And you can see how engaged they are, because You know, it's with a lot of professions, the university life can kind of beat out of them, the passion for the, the career they went into in the first place. So the other thing that I'm very interested in is professional identity. people tend to come into a course, you know, thinking, yeah, I want to be a pharmacist. It's great. And then they have this dip where they're like, actually not sure it's quite so great. And, you know, they see that things, they go out into practice and they see that things aren't all rosy as they might feel they get taught in the university. And I think This process gets them to have a much better understanding of what a pharmacist can do and how they can contribute and seeing students get that and then seeing them do it is really fantastic.

Mark: 55:28

There's something that I've, I've been, I've been dying to, to ask since a comment that you made earlier. And actually we can probably link it to that point about professional identity. And I'm thinking about the group identity. One of the things we've talked a lot about is the in team behavior. So how people act within, within the team. And so effectively we can see the, the growth and the improvement in, in team. collaboration. But one of the things you touched on very briefly earlier, and almost be remiss of us not to talk about the power of this, is you have that out group competitiveness. So you, you probably see it much less in practice than you do in the academic setting, and that's why I really wanted to ask it. What, what is the importance, what is the significance of the fact that you have those groups, and you have the in groups, and then you have that Competitive nature with another team. How does, how does that manifest? How powerful is it in a, as a motivation?

Gemma Quinn: 56:24

It's not a very powerful motivator actually. So I don't think they are particularly competitive. So for example, we did have these league tables since COVID because we didn't have a notice board. We've never done them again. No one's come back and said, can you reinstate, reinstate them? So they do. I think they, they use. use it more as a gauge of where they are rather than to actually compete with each other. I think they don't want to be the worst team. Um, and obviously they quite like to be the best team, but they don't really, you don't, I don't see unhealthy competitiveness at all within the teams. And I think they're all very conscious that, you know, next year they're going to be in a different team with different people. And, and then they're going to start again. So they, they, I don't think from what I see, there isn't a huge amount of competitiveness. I think the main thing that drives them is their, yeah. individual mark. So because it's kind of by the team, by the team doing well, they get a higher mark individually. So it's, they've got an eye on their individual performance as well. And remember for our course, they still have, so team based learning only constitutes 30 percent of the module. So the mark only contributes 30%. The rest is an individual written in exam and are an individual OSCE where they have to do stations and perform as a pharmacist and do consultations. So they're still. They still have to prove themselves individually. So I don't think, um, competition is a major issue, but interestingly, one of the courses that I'm trying to, to get to use team based learning, they do have a lot of competition because they have a lot of people who wanted to do medicine and didn't get in. And then they come to do our foundation year to try and get a place the following year in medicine. you know, the argument from the team is always. They hate each other. They won't talk to each other. They won't help each other. They absolutely are competing for these 20 places in medical school at the end of the year. My arguments, that is all the more reason to get them to do team based learning because they cannot sustain that. a doctor, sustain that position. That individuality doesn't work. So I think it's, it's much more about them working together to the team rather than the teams competing with each other. I think.

Andrew: 58:38

what difference does this make to students at the end of the day? Um, this is a, this is something that you've rolled out really successfully. And I think we're massive fans of, of the approach for, for a number of reasons. And I think it's, it's obvious how, how successful it's been particular for students are going on to that, um, you know, uh, environment that's really dependent on, on, on highly effective teamwork. But what about individual student outcomes at the end of the day? What, what impact does TBL have on those?

Gemma Quinn: 59:09

well, so for from for all students when we've looked at how Exam performance compares to post pre TBL and post TBL. They tend to do better in the exams post TBL We do know that um, you know If a student fails or doesn't attend two IRAs in, in, in a module, that's a very strong predictor of a failure in the final exam. So we've started to use that to try and pick up those students and support them. Um, the other thing is like, there's been a really good study done by one of my colleagues, Simon Tweddle, um, called Scale Up, that looked at the introduction of Team-based learning and what impact it made on attainment gaps and students who may not normally do as well. Um, and they found. There's normally a gender gap. Females normally do better than males. That was unchanged. So they all did better, but the gap was still there. But for ethnicity, the gap was eliminated. And for age, the gap was eliminated. So mature students tend not to do as well as, um, as fresh out of school. school students, partly because they've got extra responsibilities, that gap was eliminated. The disability attainment gap was eliminated and also, um, the participation in higher education gap was eliminated where, so where if you're a first generation university goer or from a, area where not many people go to university, you generally do poorer. All of those gaps We're eliminated with TBL. So it's a really good way to include people and for those to be able to do as well as to everybody else. It's a very inclusive way of teaching. And at the minute, we've got a PhD student who's looking at the impact on autistic students, because for a lot of those that the thought of having to sit in a team and contribute to a team and potentially talk out loud to 160 students is the most uncomfortable thing in the world that they can think of. But if you're a pharmacist, you've got to learn those skills. So we think that by practicing that in a team based learning environment where it's safe, they're building those skills. So they're uncomfortable at the beginning, but by the end of the program, they're much more used to doing that. So, it has. has a positive impact on everybody who's involved,

Andrew: 1:01:14

So it's amazing. It's like a magic, it's like a silver bullet, isn't it? It's eviscerating all of these. all of these, um, kind of exclusionary, uh, forces that, um, that, that hold particular groups back. Um, I'd also venture to say that, um, in the particular case of, of neurodiverse students, that fact that you'd have those long lived for the whole year, I would also suggest that It's the neurotypical students who are also reflecting on how they communicate and how they interact. not necessarily just a kind of assimilation effect for, um, neurodiverse students who learning the ways of the neurotypical, but I, I think there's, there's, in the way that you've described it, I would, uh, I wonder if, um, in fact, there's a recognition of Uh, how neurotypical, team members need to reflect on, on how they operate and how, and how they might adjust that to accommodate everyone in the team,

Gemma Quinn: 1:02:14

and how they can benefit from, from their particular strengths. So, you know, they might be particularly interested in a subject that they've learned all about in huge amount of detail. The neurotypical students can, learn from that So it's, it's seeing that it's mutually beneficial. And I think it does force these friendships that if, if we go right back to the beginning, if we allowed them to self select, these things would never happen. So it's, it's forcing them to see totally different points of view and

Andrew: 1:02:39

people It's great. we always like to finish with a couple of quick fires. So, uh, I'm going to start by asking you, what are your team red flags?

Gemma Quinn: 1:02:52

the thing, the time that makes you say, Oh no, is when you've got a team member who just, will not listen And who is the loudest and overrules them all every time, even when they've got the answer wrong. And I've had people, you know, I don't need peer evaluation. I don't need to reflect. Like, well, that's exactly why you need to reflect. The person who says you don't need to reflect is the exact person that does. I think it's when you see people with a lack of self awareness and understand a lack of understanding of their position in a team. That's when you think this is, you know, this is going to be problematic.

Andrew: 1:03:24

That's fascinating. Going back to that, what we mentioned about that research on, uh, astronauts and, uh, know, the traits of, of, of a team orientation and someone who's got quite an egocentric view of their role in a group, uh, your, your, your red flag is the sort of, um, antithesis of, of, of what that research find to be the most, uh, set of characteristics for team members. Fascinating. Um, it's interesting that that happens often enough that that's a red flag for you as well.

Gemma Quinn: 1:03:55

Well, to be honest, there aren't many red flags because normally the teams will work. So, you know, they might not work in the first week, but in the space of a couple of months, you don't, we don't normally have problems. So where there are red flags there, yeah, they're few and far between. So you remember them.

Andrew: 1:04:09

And do you have a resource that you would pass it on? Something that you think if someone picked it up would, would benefit them in, uh, in engaging with the world of teamwork more?

Gemma Quinn: 1:04:19

There's a book called team based learning. I can just put it here. Team based learning by Larry Mickelson. He was the inventor of team based learning and he's written basically it's a how to book on how to do team based learning so that's what we started with and then we've built up from that so absolutely that's, that's brilliant and then there's the team based, there's an organization called the team based learning collaborative that's based in America but there's a European branch as well and they've got all sorts of, they've got a website and they have a yearly team conference and online things. So lots of everything TBL, um, they are the experts and, and they've got all the material on their website. So those two things between them should be enough to get people up and running.

Andrew: 1:04:57

Great. Thank you very much. Well, it's been a pleasure talking to you, Gemma. Thank you so much for your time. And, uh, you know, as a, as someone else who works in a university, I'm kind of in awe of, uh, of how you've managed to achieve this because I, I understand just how difficult it is to to get momentum behind something that's, that's quite radically different from, from what, what students expectations are and what we generally try to do in higher education. So, you know, it's amazing what you're doing. Um, where can people find you?

Gemma Quinn: 1:05:28

the best way to get in touch with me is probably, um, email g. quinn at bradford. ac. uk. and my colleague, Simon Tweddle, as I say, we're both trainer consultants. So we are able to go out and train people how to use team based learning and offer advice and support people. So, and we run, um, Every year we run a course of what we call TBL fundamentals, which is a day course that basically teaches everybody, teaches people everything they need to know about team based learning and how to get started.

Andrew: 1:05:54

Brilliant. Well, we'll make sure we, we, uh, put those details in the show notes, but thank you again for your time. It's been fascinating talking to you.