Team-based learning (TBL) in clinical disciplines for undergraduate medical students-a scoping review

A pre - post quasi-experimental study of team-based learning effectiveness for Vietnamese nursing students

BACKGROUND

Team-Based Learning (TBL) is a student-centered teaching strategy designed to improve problem-solving skills, knowledge, and practical abilities. Despite its increasing use in nursing education globally, limited research has explored its effectiveness in Vietnam. This study evaluates the impact of TBL on learning outcomes, accountability, preferences, satisfaction, engagement, perceptions, and attitudes of Vietnamese nursing students during the Nursing Care for Adults with Internal Medicine course.

METHODS

A quasi-experimental pre-post study was conducted with 186 fourth-year nursing students at a nursing faculty in Vietnam during the 2023-2024 academic year. TBL was implemented in the course, and data were collected using validated instruments, including the Individual Readiness Assurance Test (i-RAT), Team Readiness Assurance Test (t-RAT), Classroom Engagement Survey (CES), and Perceived Collective Efficacy (PCE) scale. Data were collected from January to April 2024 and analyzed using SPSS version 20.0.

RESULTS

The mean t-RAT scores significantly exceeded i-RAT scores, increasing from 8.17 to 9.68 (t = -19.507, p < 0.001), indicating improved group performance. Students' attitudes toward teamwork showed significant improvements across all dimensions, with higher post-TBL mean scores. CES and PCE scores also increased significantly post-TBL (31.37 ± 2.002 vs. 29.54 ± 2.186; t = -8.981, p < 0.001; 4.03 ± 0.488 vs. 3.64 ± 0.461, t = -8.667, p < 0.001). Additionally, students reported positive experiences with TBL, with average scores for accountability, preference, and satisfaction at 31.19 ± 2.975, 57.10 ± 5.279, and 36.54 ± 3.815, respectively.

CONCLUSIONS

TBL effectively enhances academic performance, teamwork attitudes, and group responsibility awareness among Vietnamese nursing students. This approach holds promise for improving nursing education in Vietnam, and educators are encouraged to expand its application to other universities and disciplines.

A Novel Online System Implementation to Enhance Team-Based Learning at a Medical School

Introduction

Team-Based Learning (TBL) is an effective learning model utilized in education to address the concerns of student active learning, participation, critical thinking and teamwork. However, faculty members must invest significant time in preparing TBL sessions, creating appropriate material and assessments, preparing paper answer sheets for group tests, and managing the logistics of student groups.

Methods

We have designed, developed and implemented a novel TBL online system at our institution by integrating the standard TBL process into a customized IT solution. The objective of this research is to identify important items in the requirements analysis based on sound pedagogy, describe the developed system while highlighting benefits and obstacles faced, and gauge user feedback of the system.

Results

The system reduces the burden on faculty by guiding in the preparation of assessments, randomizing students into groups containing students from all academic levels, allowing students to take the individual and group tests efficiently and with instant grading, providing a mechanism for answering questions in the group test in such a way that indicates to students that their answer is incorrect and then allowing them to continue discussion until they reach the correct answer and then grade the question appropriately, allowing facilitator and students to view the progress of each group in the group exams in real-time on a projected screen, and giving an immediate indication on which questions are performing poorly so that immediate discussion and feedback can occur.

Conclusion

The system has demonstrated its value in enhancing the learning experience for medical students and has received positive feedback from both facilitators and students. By continuing to innovate, TBL has the potential to play an even greater role in the education and assessment processes of medical professionals.

Validating the Turkish version of the team-based learning assessment scale: a psychometric evaluation

BACKGROUND

Team-based learning methods enhance course achievement, student success, and student satisfaction and are frequently used in nursing curricula. However, there is no valid and reliable tool for evaluating team-based learning in Türkiye. Adapting the Team-based Learning Student Assessment (TBL-SAI) into Turkish can provide a standardized and culturally appropriate evaluation tool, supporting nursing education practice and research. This study aimed to assess the validity and reliability of the Turkish version of the assessment (TBL-SAI-TR) among nursing students.

METHODS

This descriptive and psychometrics study was conducted between October and November 2022. The sample consisted of 430 nursing students. The translation-back-translation method was used to determine the language accuracy of the scale. The content validity, construct validity, item analysis, and internal consistency analysis were used as psychometrics tests of the study.

RESULTS

The Cronbach's α value of the TBL-SAI-TR was .90. The item-total correlations of the 23-item three-factor scale, validated by confirmatory factor analysis, were between .30 and .74, and the intraclass correlations were between .88 and .90.

CONCLUSION

This study showed that the TBL-SAI-TR is a valid and reliable tool for assessing team-based learning among Turkish nursing students.

Enhancing clinical reasoning skills in medical students through team-based learning: a mixed-methods study

BACKGROUND

Clinical reasoning skills are essential competencies for medical students; therefore, effective, evidence-informed teaching methodologies are needed worldwide. This study investigated the benefits of team-based learning (TBL) for developing the skills in medical students.

METHOD

A mixed-methods sequential explanatory design was used to investigate the effectiveness of TBL for medical students acquiring clinical reasoning skills. The study participants comprised 92 fourth-year medical students at Yokohama City University School of Medicine, participating in TBL sessions that covered 10 major clinical symptoms identified in the core curriculum. Each session lasted 240 min. Before and after the educational intervention, student performance was measured using the script concordance test (SCT) on a 30-point scale, and self-assessed clinical reasoning competency was measured on a 7-point Likert scale. The SCT included pre-tests and post-tests of 30 questions each, with students randomly assigned to one of two test sets. Following the quantitative evaluation, a qualitative content analysis was conducted to explore the advantages of TBL for learning clinical reasoning skills. The analytic categories were set according to the six levels of Fink's taxonomy of significant learning.

RESULT

Student performance improved significantly after the educational intervention (A test: 16.5 ± 4.4 to 18.7 ± 4.5, p = 0.019; B test: 18.1 ± 3.7 to 19.8 ± 4.4, p = 0.028). After the educational intervention, self-assessed clinical reasoning competency was significantly higher in "recalling appropriate physical examination and tests on clinical hypothesis generation," "recalling appropriate differential diagnosis from patient's chief complaint," "verbalizing points that fit/don't fit the recalled differential diagnosis appropriately," "verbalizing and reflecting appropriately on own mistakes," "selecting keywords from the whole aspect of the patient," and "practicing the appropriate clinical reasoning process" (all p < 0.001). The content analysis extracted 23 subcategories and 233 codes of the advantages of TBL for learning clinical reasoning skills, covering all six levels of Fink's taxonomy of significant learning: Foundational knowledge (7 codes); Application (40 codes); Integration (69 codes); Human dimension (89 codes); Caring (8 codes); and Learning how to learn (20 codes).

CONCLUSION

This study demonstrates that TBL supports the acquisition of critical clinical reasoning skills among medical students.

Translation and Validation of the Italian Version of the Team-Based Learning Student Assessment Instrument (TBL-SAI) in Nursing Students

Background/Objectives: Team-based learning is an educational strategy that promotes active learning and student engagement through structured team activities. It contrasts with traditional teaching models by emphasizing student preparation and collaboration. The TBL-SAI is a reliable and valid instrument designed to evaluate students' attitudes towards TBL, assessing dimensions such as accountability, preference for lecture or team-based learning, and satisfaction with TBL. Validating the TBL-SAI in different languages ensures its applicability and accuracy in diverse educational contexts, supporting the global adoption of TBL methodologies. Thus far, no Italian validation of this tool has been performed. The aim of this study is to validate the Italian version of the Team-Based Learning Student Assessment Instrument (TBL-SAI) among nursing students. Methods: A methodological-driven translation process and a cross-sectional study design were used. The study was conducted from November 2022 to March 2023 and involved 202 nursing students from the University of Modena and Reggio Emilia (Italy). Convenience sampling was employed to recruit participants who had experienced at least one TBL session during the academic year 2022/2023. The validation process included translation, back-translation, and expert panel review, followed by a pilot test to ensure clarity and comprehension. Data were collected using the self-administered TBL-SAI. The responses were analyzed using Exploratory Structural Equation Modeling (ESEM) to assess the scale's validity and McDonald's ω to evaluate internal consistency. Results: The ESEM results supported the validity of the Italian TBL-SAI, maintaining the factor structure proposed in the original instrument. The model fit indices indicated a good fit (χ2(318) = 384.097, p = 0.0065; RMSEA = 0.032; CFI = 0.974; TLI = 0.957). McDonald's ω values exceeded 0.70 for all factors, confirming adequate internal consistency. Conclusions: This study successfully validated the Italian version of the TBL-SAI, demonstrating its reliability and validity for assessing perceptions of TBL among Italian undergraduate nursing students. However, future studies should employ Confirmatory Factor Analysis to further test the proposed factor structure and explore the instrument's applicability in various educational settings. The validated TBL-SAI is recommended for use in evaluating students' attitudes towards TBL, providing actionable feedback for educators to improve teaching methods and integrate TBL methodologies effectively.

Short-term cognitive learning outcomes in team-based learning: is the permanent team important?

Assigning students to work in permanent teams is a design principle in Team-based learning (TBL). It has been assumed that a stable team composition supports the emergence of collaborative problem-solving and learning: when students became more familiar with each other, they shared more information and resolved discrepancies together, which in turn stimulated knowledge acquisition and comprehension. However, this assumption had not been probed by a randomized controlled trial with performance assessment as an outcome. In an online course for second term medical students, 50% of the students were reassigned to new teams for each of the 24 problems to be solved during four classes, thus precluding familiarity. The learning outcome was assessed shortly after the third of four classes by a domain knowledge test. Whether TBL teams were permanent or temporary did not affect the score of a domain knowledge test. As expected, participation in online TBL improved the domain knowledge test results. Overall, the permanent team seems to be less important for cognitive learning outcomes than previously assumed, but this may depend on the specific educational setting. However, team familiarity may still be important for team decision-making. As clinical reasoning in the medical workplace often involves collaborating in changing teams, future research on TBL should focus on how to utilize this format to prepare medical students for decision-making and optimal learning outcomes under these conditions.

Which novel teaching strategy is most recommended in medical education? A systematic review and network meta-analysis

AIM

There is no conclusive evidence which one is the optimal methodology for enhancing the quality and efficacy of learning for medical students. Therefore, this systematic review and network meta-analysis aims to evaluate and prioritize various teaching strategies in medical education, including simulation-based learning (SBL), flipped classrooms (FC), problem-based learning (PBL), team-based learning (TBL), case-based learning (CBL), and bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary (BOPPPS).

METHODS

We conducted a comprehensive systematic search of PubMed, Embase, Web of Science, the Cochrane Library, and some key medical education journals up to November 31, 2023. The following keywords were searched in MeSH: ("medical students") AND ("problem-based learning" OR "problem solving") AND ("Randomized Controlled Trials as Topic"). Two authors independently carried out data extraction and quality assessment from the final selection of records following a full-text assessment based on strict eligibility criteria. Pairwise and network meta-analyses were then applied to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (95%CIs) using a random-effects model. Statistical analysis was performed by R software (4.3.1) and Stata 14 software.

RESULTS

A total of 80 randomized controlled trials with 6,180 students were included in the study. Compared to LBL, CBL (SMD = 1.19; 95% CI 0.49-1.90; p < 0.05; SUCRA = 89.4%), PBL (SMD = 3.37; 95% CI 1.23-5.51; p < 0.05; SUCRA = 93.3%), and SBL (SMD = 2.64; 95% CI 1.28-4.00; p < 0.05; SUCRA = 96.2%) were identified as the most effective methods in enhancing theoretical test scores, experimental or practical test scores, and students' satisfaction scores, respectively. Furthermore, subgroup analysis indicated that CBL (SUCRA = 97.7%) and PBL (SUCRA = 60.3%) were the most effective method for enhancing learning effectiveness within clinical curricula.

CONCLUSIONS

Among the six novel teaching strategies evaluated, CBL and PBL are more effective in enhancing the quality and efficacy of learning for medical students; SBL was determined to offer a superior learning experience throughout the educational process. However, this analysis revealed only minor differences among those novel teaching strategies.

Team-based learning in health professions education: an umbrella review

BACKGROUND

Team-Based Learning (TBL) has garnered considerable attention in education research. To consolidate the existing evidence, we conducted an umbrella review with four objectives: (a) to identify TBL review characteristics, (b) to synthesize findings from previous reviews regarding TBL effectiveness and outcomes, (c) to determine which student groups benefit most, and (d) to identify the most and least researched elements.

METHODS

The Joanna Briggs Institute (JBI) methodology was followed: [1] Search strategy and literature search [2] Screening and Study Selection [3] Assessment of methodological quality [4] Data collection, and [5] Data summary. We utilized Endnote, Excel, and MAXQDA for efficient project management and analyzing data.

RESULTS

Analyzing twenty-three reviews spanning from 2013 to 2024, we found a peak in TBL research in 2022 including more than 312 unique primary studies involving more than 63,987 participants. Notably, the United States and China accounted for over 61% of the total primary articles focused on students from medicine, nursing, pharmacy, and dentistry. Evidence supports the superiority of TBL in enhancing cognitive outcomes. However, findings related to retention are mixed. Insufficient evidence exists to draw robust conclusions when comparing TBL with other active learning methods. TBL demonstrates favorable outcomes in terms of clinical performance and engagement. Non-technical skills show mixed results. Notably, TBL positively impacts self-study, learning ability, decision-making, and emotional intelligence. Faculty experiences reveal an initial increase in workload, but generally hold positive attitude. Faculty development remain limited in duration and scope. Freshmen, academically weaker students, undergraduates, Chinese female students, and nursing students appear to benefit most from TBL. Team formation and size are the most frequently studied elements.

CONCLUSION

TBL holds promise for improving learning outcomes, but ongoing investigation is essential to maximize its impact in diverse educational contexts. This umbrella review underscores the need for further research in specific areas i.e. effective pre-class learning methods and faculty workload.

Using Team-Based Learning to Teach Pharmacology within the Medical Curriculum

The primary goal of pharmacology teaching is to prepare medical students to prescribe medications both safely and efficiently. At the Utrecht University Medical School, pharmacology is integrated into the three-year bachelor's curriculum, primarily through large group sessions with limited interaction. A recent evaluation highlighted students' appreciation for pharmacology teaching, but students admitted to attending these teaching moments unprepared, resulting in passive learning. To address this, team-based learning (TBL) was implemented to facilitate learning through interaction, critical thinking, problem solving and reflection through six steps, from superficial to deeper cognitive learning. This study, conducted over two academic years, assessed students' perception and performance regarding TBL. Analysis of a digital questionnaire using a 5-point Likert scale showed high student satisfaction with TBL as a teaching methodology. However, confidence in pharmacology knowledge following TBL was moderate. TBL attendees outperformed non-attendees in pharmacology-related exam questions, indicating that TBL has a positive impact on student performance. We conclude that TBL is an engaging and effective method for pharmacology education, positively influencing student learning and performance. This method could be broadly applied for teaching pharmacology within the medical curriculum or other biomedical programs.

The outcomes of team-based learning vs small group interactive learning in the obstetrics and gynecology course for undergraduate students

INTRODUCTION

Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship.

MATERIAL AND METHODS

The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated.

RESULTS

Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction.

CONCLUSIONS

We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes.