title: Uncover it, students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback.
abstract: BACKGROUND
  Little is known about best practices for teaching and learning leadership through Team-Based learning™ (TBL™) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework.
  
  
  METHODS
  The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n = 20 teams) and the other received only TBL (n = 19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions.
  
  
  RESULTS
  Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p = 0.6), 2 (p = 1) or 3 (p = 1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p = 0.77), 2 (p = 0.23), or 3 (p = 0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T = -8.55, p > 0.001 adjusted on baseline; T = -8.55, p > 0.001 adjusted on gender).
  
  
  CONCLUSIONS
  We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.
authors.affiliation: a Department of Medical Education , School of Medicine, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alizadeh
authors.affiliation: a Department of Medical Education , School of Medicine, Tehran University of Medical Sciences , Tehran , Iran.|b Iran Health Professions Education Research Center , Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Azim
authors.initials: A
authors.lastname: Mirzazadeh
authors.affiliation: c Wright State University Boonshoft, School of Medicine , Dayton , OH , USA.
authors.forename: Dean X
authors.initials: DX
authors.lastname: Parmelee
authors.affiliation: d Veterans Health Administration , National Center for Organization Development , Cincinnati , OH , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Peyton
authors.affiliation: e Department of Biostatistics, School of Public Health , Iran University of Medical Sciences , Tehran , Iran.|f Clinical Trial Center (CTC) , Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Janani
authors.affiliation: g Department of Anatomy , School of Medicine, Tehran University of Medical Science s, Tehran , Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Hassanzadeh
authors.affiliation: h Epidemiology and Biostatistics Department , School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Saharnaz
authors.initials: S
authors.lastname: Nedjat
mesh_terms: D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods; D005246:Feedback; D006126:Group Processes; D006801:Humans; D007492:Iran; D007857:Leadership; D007858:Learning; D018794:Problem-Based Learning; D013337:Students, Medical / Q000523:psychology*