Team-Based Learning: State of the art

Team-Based Learning (TBL) has become an established pedagogy in health professions education. This page synthesizes: what is currently known about TBL’s effectiveness, how we came to this standing, and how TBL use and research might evolve in the future.

What is currently known about TBL’s effectiveness? 

Do students perform better with TBL?

Regarding academic performance, current literature suggests that participating in TBL is at least, if not more effective than other methods of teaching. TBL seems to help students who are academically poor performers more than those with a strong existing academic performance (Reimschisel et al., 2017). 

How do students react to TBL?

Research currently suggests that learners prefer TBL to more traditional forms of instruction (e.g., lectures). Reported positive aspects include the active learning style, peer learning, and application of knowledge to problem-solving with a perceived deeper understanding of content (Reimschisel et al, 2017; Burgess et al., 2020).  

How do faculty react to TBL?

Faculty generally favour TBL because of the high level of student engagement created through TBL’s structures. However, heavy additional faculty workload has been acknowledged during early TBL curriculum development of TBL. It should be noted, though, that the overall gains of implementing TBL are often reported as worthwhile. Below you'll find Sydney Medical School staff and students comment on their experiences with TBL. 

Sydney Medical School staff and students comment on their experiences with TBL:

Benefits and challenges currently reported in relation to TBL use

  • Benefits
    • Involves active learning method focused on content application and problem solving
    • Allows development of teamwork skills
    • Has been demonstrated to be effective in health professions education
    • Involves standardized teaching across large student cohorts 
    • Is faculty resource efficient.
    • Is applicable to variety of topics 
    • Allows flexibility in application question type
    • Is illustratied via published TBL modules that can be adapted to local circumstances
  • Challenges
    • Requires faculty development on backward design of modules and facilitation skills
    • Necessitates developing teaching modules with multiple components (e.g., application problems readiness assurance test, preparatory materials)
    • Requires infrastructure that allows inter- and intra-team discussion
    • Involves creating heterogeneous teams 
    • Entails implementing peer feedback process (including teaching students how to provide quality feedback to peers)
    • Requires management of intra-team conflict.

How did TBL acquire this standing?

From innovation to established method. 

TBL was originally developed during the 1970s by Professor Larry Michaelsen for use in business schools (Parmelee et al., 2012).  The application of TBL has since spread widely across disciplines, universities, and countries.  Within health professions education, the first reported use of TBL was in medicine in 2001 in the United States. By 2002, 10 medical schools in the United States reported using TBL. By 2014, 20 medical schools globally reported using TBL, including the United States, Singapore, Australia, the United Kingdom and Germany (Burgess et al., 2014).  

In 2003, nursing was the first non-medical health profession to report the use of TBL, followed by pharmacy in 2004.  Since then, TBL has rapidly gained popularity across the health professions, including pharmacy, nursing, dentistry, allied health, public health, and health sciences.  Additionally, TBL has increasingly been used in interprofessional education contexts; in 2022, a systematic review identified 12 articles reporting on interprofessional TBL, with its use reported in the United States, Australia, Italy, Hong Kong and Japan (Burgess et al., 2022).

Given this popularity, it is not surprising that health professions education researchers investigated why TBL was successful. This research resulted in the current recognition of TBL as efficient, effective, and internationally applicable. 

How might TBL use and research evolve in the future?

TBL has the capacity to evolve to continuously meet the changing needs of the health professions education in terms of knowledge, skills and values. 

Incorporating technology into TBL

Technology is increasingly being incorporated to assist in the implementation of TBL. Blended learning approaches (i.e., approaches combining face-to-face classroom instruction with online digital instruction) in TBL facilitate the use of online tools and response systems that allow for real-time analytics and feedback during the readiness assurance process, and for interactive online platforms for content delivery.  The real-time analytics of students’ and teams’ performance throughout the TBL experience allows facilitators’ ability to identify individual learner’s knowledge gaps and points of confusion. 

Technology also enables the use of TBL via synchronous online learning in various formats, including small group activities. Recent examples include the use: of WhatsApp to facilitate team communication and of large language models (e.g., ChatGPT) to enhance team discussion during problem-solving activities (Sawarkar and Sawarkar, 2024). However, the inclusion of new technology can also bring unintended consequences, like students tailoring their clinical reasoning to match answers provided by large language models (Shin et al, 2024).

Another recent trend involves taking advantage of the modular structure and flexibility of TBL to create hybrid approaches with other active-learning approaches, including self-directed learning (Kamel-ElSayed et al, 2024), simulation (Zhang et al, 2026) and PBL (Arjanto et al, 2025). This encourages faculty to see instructional methodologies not as monoliths, but as flexible resources that can be adapted to best serve the needs of the course curriculum. 

TBL for interprofessional education

Given its ability to nurture collaboration between students, there is a developing trend to use TBL as a pedagogy to engage health professional students in interprofessional education (IPE) (Burgess et al., 2022). Integrating TBL and IPE promises to generate a student-centered pedagogical approach that prepares health professional learners for future practice where they will be required to work in a collaborative team environment to provide patient care. 

The focus on clinical-problem solving is a key advantage of TBL for IPE activities, where learners from different professions can display their professional expertise when addressing the management of complex patients. It also holds the promise to encourage learners to gain a better understanding of the role of other professions represented in clinical teams.

But using HPE for IPE will also pose significant challenges. These include: 

  • the unequal distribution of students to teams, 
  • meeting the resource requirements of large groups of students (e.g. large classrooms and appropriate seating); 
  • timetabling across multiple disciplines from different courses; 
  • scheduling consecutive TBL sessions; 
  • designing patient cases that highlight the skills of multiple health professionals; 
  • the alignment of topics across multiple curricula; 
  • inequities in grading students from different courses; and 
  • limited opportunity for peer review.

For faculty from multiple professions to effectively use TBL for IPE requires not only content knowledge but also a good understanding of each professional program curriculum. These faculty members will also need to secure the support of their program leadership to ensure the long-term sustainability of these IPE efforts (especially if curricula need to be modified to align with those of other professions to enable effective TBL in IPE). The accreditation requirement of IPE activities across multiple HPE training programs may be a potent argument in ensuring such support. 

Considering how equity, diversity, and inclusion impact TBL

Current efforts to ensure equity and inclusion within teams and the role of self-confidence in taking on different team roles (Anas, 2026) can be vetted via TBL practices. TBL is well positioned to be the forum where the findings from this evolving body of research are first incorporated in HPE programs as a solid foundation to address equity and inclusion and to develop the teamwork competencies of trainees. While we have yet to see such work reported in the literature, we expect future research to attend to these issues.

Further reading

This curated list brings together articles selected by the experts for readers who want to go deeper. The notes below explain what each article contributes and why it may be useful for understanding or applying TBL in health professions education.

If you only have time to read three papers on where TBL is today, start here:

Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review.
Burgess AW, McGregor DM
Acad Med 2022 Jan;97(1):143-151

This systematic review provides a summary of the published evidence on the extent, design and practice of interprofessional TBL within the health profession degree programs, with the aim to inform IPE educators and curricula designers.  Importantly it clearly identifies the challenges associated with effective integration of IPE and TBL. Challenges include: resource requirements, timetabling, the unequal distribution of students to teams, designing patient cases that are suitable for multiple disciplines, grading inequities, and curriculum alignment.

Engaging Students in Large-Scale Interprofessional Learning Activities: Team-Based Learning (TBL) as a Pedagogical Solution.
van Diggele C, Clarke AJ, Burgess A
Clin Teach 2026 Feb;23(1):e70284

This short ‘Innovation, Implementation, Improvement’ article showcases how TBL can be used within IPE curricula to deliver a large-scale learning activity on patient safety to health professional students from five disciplines (nursing, dentistry, pharmacy, oral health and medicine). The study provides a scalable and effective framework for implementing interprofessional TBL, while highlighting both positive outcomes and areas for improvement. 

The effects of case-based, problem-based, and team-based learning on nursing students' problem-solving, self-directed learning, and communication skills: a systematic review and meta-analysis.
Zou Y, Xie W, Huang H, Liu D, Zhou Q, Yi Q, Tong X, Mao P
BMC Med Educ 2026 Jan;26(1):270

Recent meta-analysis comparing the effect of active-learning pedagogies on learner competencies. Results demonstrated that while all the active-learning approaches improve problem-solving abilities, TBL had the largest impact on communication skills.

 

References

Exploring equity and inclusion in team-based learning: A critical pedagogy perspective.
Anas S, Selway J, Otermans P
Med Teach 2026 Apr;():1-9

Integrating problem-based and team-based learning: A hybrid approach for advancing medical education pedagogy.
Arjanto P, Raya Aditama MH
J Taibah Univ Med Sci 2025 Feb;20(1):107-108

Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review.
Burgess AW, McGregor DM
Acad Med 2022 Jan;97(1):143-151

Applying established guidelines to team-based learning programs in medical schools: a systematic review.
Burgess AW, McGregor DM, Mellis CM
Acad Med 2014 Apr;89(4):678-88

Team-based learning replaces problem-based learning at a large medical school.
Burgess A, Bleasel J, Hickson J, Guler C, Kalman E, Haq I
BMC Med Educ 2020 Dec;20(1):492

Self-Directed-Team Learning (SDTL) in Medical Education.
Kamel-ElSayed S, Patino G, Lerchenfeldt S
Med Sci Educ 2024 Oct;34(5):987-989

Team-based learning: a practical guide: AMEE guide no. 65.
Parmelee D, Michaelsen LK, Cook S, Hudes PD
Med Teach 2012 ;34(5):e275-87

A systematic review of the published literature on team-based learning in health professions education.
Reimschisel T, Herring AL, Huang J, Minor TJ
Med Teach 2017 Dec;39(12):1227-1237

WhatsApp Groups as a Team-Based Learning Model for Ayurveda Undergraduate Students.
Sawarkar G, Sawarkar P
J Pharm Bioallied Sci 2024 Dec;16(Suppl 4):S3024-S3026

The Impact of Artificial Intelligence-Assisted Learning on Nursing Students' Ethical Decision-making and Clinical Reasoning in Pediatric Care: A Quasi-Experimental Study.
Shin H, De Gagne JC, Kim SS, Hong M
Comput Inform Nurs 2024 Oct;42(10):704-711

Effectiveness of integrated simulation and team-based learning in paediatric postgraduates for cardiopulmonary resuscitation training: a multiple methods study.
Zhang LD, Wang L, Li YT, Guo YY, Lin HX, Ye XT, Chen HB, Tang YL, Chen C, Xu LL
BMC Med Educ 2026 Feb;26(1):