Integrating Modified Team Learning into a Reverse Basic Medical Laboratory Course: Impact on Student Performance and Perceptions | BMC medical training


Student-centered active learning strategies, including flipped teaching and small group learning, are increasingly incorporated into health education [17]. Due to the limited studies of these strategies in courses outside of lectures, there is a need to expand the scope of their application in teaching, such as in laboratory courses. Therefore, in this study, we sought to explore the educational effects of a blended FC learning strategy with TBL in a third-grade basic medical laboratory course. Our results indicate that compared to the FC group, students in the FC-TBL group had better academic results and an overall more positive experience.

Medical laboratory courses in China, such as BMLCs, usually consist of two parts: the first consists of teacher-led lectures covering scientific concepts and experimental procedures, followed by independent student experiments. [3, 4]. We transitioned from part one to reverse teaching in 2016 and then piloted three modified TBL sessions combined with HR in the breathing block in 2020. Although there is a body of evidence that TBL has helped students learn better than traditional lectures [11, 12] [17], its comparison with reverse teaching remains uncertain. Previous research found that flipped teaching must be combined with cooperative learning to produce positive performance outcomes. [19]. Interestingly, our results also showed that the immediate learning outcomes of introducing TBL, an effective small group learning approach, into CE were vastly superior to those of flipped teaching which focused primarily on individual learning. There was a limited amount of peer interaction during class time in the FC group alone, with each student primarily receiving help and feedback from the instructor rather than their teammates. In contrast, the FC-TBL group TBL approach offers a series of group activities for the whole learning process, including experimental preparation, operation and analysis of results, allowing students to learn in a more cooperative environment. For long-term learning performance, we looked at experimental design and implementation knowledge, along with a mock study analysis in the final exam. Students in the FC-TBL group performed better on final exams in two of the three experimental sessions than those in the FC group. The sequential phases and building blocks of TBL are believed to encourage the reconsolidation of knowledge which is vital for long-term knowledge retention and transfer. [20, 21]. Our results therefore indicate that the interactive and application-oriented elements of TBL might also promote students’ knowledge retention and critical thinking in laboratory teaching.

To fully understand students’ perspectives on the newly introduced blended learning approach in our lab course, we then compared their perceptions of FC and FC-TBL. Students preferred FC-TBL for its higher engagement and motivation, more feedback from peers and teachers, and better organization and learning environment. Students believed that individuals and team members actively participated in and contributed to group activities in TBL classrooms (Table 2). They felt that “During the discussion and the experience, the team members were very engaged” and “efficiency has been increased” (Table 3). As knowledge application and problem solving are at the heart of the TBL classroom, group activities should always be closely linked to it to enhance students’ intrinsic motivation to learn. [17]. Lab lessons allow the application of knowledge, skills and reasoning, which could further increase the learning efficiency of TBL application activities combined with it [22, 23]. In the two application activities of our laboratory class, the students of the FC-TBL group first solved complex scientific problems through experiments and then discussed the results in groups, which made them more engaged and motivated. Additionally, providing clinical context in medical education can also help students better understand the content and improve student learning motivation. [24]. Students felt that providing clinical scenarios for discussion during the TBL made “the experimental results more relevant for future practice”thereby increasing their engagement in learning.

Another key feature favored by FC-TBL students was timely and helpful feedback, especially from team members (Table 2). Students also described that “different opinions can be heard” and “The group discussion was rich and fruitful” (Table 3). It has been shown that immediate feedback can improve students’ understanding of important concepts and is essential for the acquisition, application and retention of knowledge. [25, 26]. In TBL, a feedback-rich learning experience is designed based on peer interaction and instructor facilitation. Therefore, students will not be left in doubt as to their understanding of the content since feedback has been received through the readiness assurance process and during application activities. Meanwhile, students described their experience at FC as they “Rarely Asked Questions” and “no real group discussion took place” (Table 4). Insufficient engagement could undermine student learning feedback. In the FC class, the discussion in the preparation phase of the experiment and the discussion of the results after completing the experiment were based on the fact that the students worked on different problems, lacking challenges or contradictory conclusions from the experiment. same way, which could greatly weaken engagement. and student engagement.

Additionally, students rated FC-TBL higher than FC in improving interest in learning and scientific reasoning abilities (Table 2). Students found that the formal testing procedure, along with TBL’s readiness assurance process sequence, stimulated their interest in learning and inspired deep thinking. They reported that “individual responses followed by group discussions work well”and they “learned a lot from the group discussion and thought more deeply” (Table 3). In contrast, in FC, students felt they “spent a lot of time memorizing knowledge before the course but still couldn’t apply it well in the experience” (Table 4). During TBL, students build on their learning by comparing their answers to those of other team members and participating in discussions to reach consensus. In this way, the TBL format offers students the opportunity to develop teamwork abilities and critical thinking skills, which are also the main learning outcomes that laboratory courses in medical education aim to achieve. [1, 17, 27].

For the best FC features, students commented that “prepare the presentation according to the needs of the teacher” acquired knowledge “more complete and logical” (Table 4). They also suggested that FC-TBL instruction could be improved by covering more knowledge content, such as “experimental operations and statistical results” (Table 3). It is now accepted that while active learning emphasizes the transition from teaching to learning, teachers should always support learning by providing the necessary guidance [28]. In the sequential process of TBL, the instructor usually gives clarifications or a mini-lecture at the end of the readiness assurance tests to help prepare students to solve complex problems. [29]. For the lab class, based on student suggestions, in addition to enhancing discussion questions, a student-led summary step can be included after the experiment is complete, such as drawing mind maps or finding connections between key knowledge. Other recommendations, including improving the effectiveness of discussion and the relevance of pre-test learning materials, should also be included in future course enhancements.


Although our study showed positive results favoring FC with TBL blended learning, the study had some limitations. Three TBL sessions covering one block have been tested with blended teaching, which may not reflect the overall situation of the course. Further studies should be conducted to integrate the new teaching format throughout the course to better assess its effectiveness. Additionally, other learning outcomes outside of testing that TBL may also promote were not measured, such as the ability to work in a team, communicate, and problem solve. It is also possible that students gave more positive responses to the new teaching method simply because of the bias inherent in studying any new teaching method. Therefore, longitudinal studies are needed to better understand its long-term impact on learning.


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