Mechanisms of Sickle Cell Anemia

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Team-based learning (TBL) is a well-defined instructional strategy that allows a single instructor to teach by conducting multiple small groups simultaneously in the same classroom. Learners actively participate in and out of class as they move through three phases: independent study assignments, readiness assurance testing, and group activities that force them to put knowledge into practice. Students prepare in advance by reading an assigned article. Class time is shifted away from learning facts and toward application and integration of information. The instructor retains control of content and acts as both facilitator and content expert. This TBL program is designed to supplement the first-year Molecular Basis of Medicine course covering quaternary protein structure. The session compares the impact of amino acid substation on HbA, HbS, HbF on quaternary structure and function. Protein solubility, role and rate of oxygenation, hemoglobin concentration, and rate of microvascular transient time relative to polymerization reactions are detailed to enhance appreciation as to mechanisms of disease impacted by quaternary structural defects. The TBL session features a readiness assessment test that is first taken individually and then later by teams, an applications worksheet that uses multiple-choice questions to integrate basic knowledge components into medical decision-making tasks, and a summary point review sheet that acts as a study guide for formal examination assessments used throughout the course. Included is a detailed instructor's guide to facilitate use of the materials, all of which are appended to the instructor's guide. No formal studies have been done, but the session has been used multiple times with a pediatric inpatient team made up of multiple levels of learners. Informal feedback has been uniformly positive that the case is realistic, useful, and practical.