Getting ready to start year 4 with TBL for first year medical students in a class of 150. I have been reviewing comments from previous years in order to improve the delivery. The biggest negative comment is that it takes too long and a lot of time is spent listening to answers from questions that students already know during the application. Most students state that they like to TBL format in general but think that a lot of time is spent in the application waiting around.  I use the flag system and have also used clickers to speed up the process but still find myself spending time answering questions from students that may not have grasped some basic concepts. So the bottom third of the class benefit greatly but the top third get bored. The biggest comment is that students want the application in small groups so they can move through the material quickly rather than large group.  Does anyone have suggestion about how to navigate these type of questions?

Paula Monaghan-Nichols
University of Pittsburgh