Team-Based Learning Module for Undergraduate Medical Education: A Module Focused on the Human Papilloma Virus to Increase Willingness to Vaccinate

"In light of the importance of HPV knowledge in protecting future generations against HPV-related morbidity and mortality, educational initiatives aimed at current medical students may be an avenue to enhance provider knowledge and thereby improve vaccination rates."

In recent years, undergraduate medical education in the United States (US) has undergone a shift from teacher-centred, passive learning to student-centred, active learning using clinical scenarios. Team-based learning (TBL) is one of the specific tools being used. In light of the fact that lack of strong provider recommendation may be linked to deficits in physician knowledge about human papillomavirus (HPV), and that HPV vaccination rates in the US lag behind other vaccines, primarily because of weak provider recommendations, this study assessed the effectiveness of an adapted TBL curriculum meant to teach medical students about HPV-related cancers and communication.

For the study, baseline HPV knowledge in medical students across Texas, US, was assessed by surveying all 4-year undergraduate medical schools. Students at one medical school then participated in the course described below; they were re-surveyed upon completion of the course module.

The HPV TBL exercise was a week-long learning experience. On day 1,students were introduced to the topic, objectives, and basics of HPV virology and immunology in an hour-long lecture. They subsequently watched a short video of a clinical scenario involving HPV vaccination between a patient and a physician, they were introduced to a thematic patient case on HPV-related cancers, and they were given primary literature references. During the week, more traditional lecture-style courses on the basics of immunology and microbiology were given to the students. On day 5, students were given a multiple-choice quiz, first as individuals and then in a small-group setting. They were then given 40 minutes as a small group to work through an application of 15-question multiple-choice and short-answer questions based on the patient case, during which they were allowed access to the internet, videos, and textbooks. The class reconvened after the application exercise for a clarification session on HPV immunisation, communication tools, and clinical relevance of the topic.

At baseline assessment, first-year student at the intervention site performed at the same level as first-year medical students across the state of Texas on knowledge and satisfaction with their HPV-related medical school education. After the TBL implementation, students performed significantly better than similar-year students and equal to graduating seniors on knowledge of HPV- and HPV-related cancers, and they reported significantly higher satisfaction with education measures.

In addition, students reported feeling more prepared to discuss vaccines with vaccine-hesitant patients. "Increased comfort and awareness of the need for HPV vaccination among future providers may decrease the number of missed opportunities to catch patients up on vaccinations and decrease the rate of HPV-related illness."

Furthermore, the average score for recommending vaccination in the pre-test group was 3.82 and the state at large was 4.02, which was not significantly different. Post-test, the likelihood of recommending the vaccine among those who had participated in TBL was 4.8, with 100% of participants reporting they would recommend the vaccine, compared to 58% in the pre-test. In addition, 82% of those reported they were extremely likely to recommend the vaccine vs. 41% in the pre-test.

In the statewide population, respondents who reported being hesitant or ambivalent about vaccination scored significantly lower on general and total knowledge tests for HPV than all other respondents. However, the results of this study suggest that TBL education facilitates changes in knowledge and opinion even in an "unwilling or ambivalent" cohort.

In conclusion: "The results of this study demonstrate that TBL learning is an effective method to teach general and vaccine-related HPV knowledge and patient communication skills, ultimately resulting in enhanced willingness to recommend vaccination in future practice."