Natl. J. Physiol. Pharm. Pharmacol. (2025), Vol. 15(3): 218-223

Research Article

10.5455/NJPPP.2025.v15.i3.1

Evaluation of student performance: Transitioning from traditional didactic lectures to team-based learning in first-year medical education

K. O. Thejaswini¹, M. Mahantha², Arun Kumar Mohan^*2, Srinivas Pappana³, Sumali Sharma⁴ and Vivek Veeraiah⁵

¹Professor and Head, Physiology, Sri Siddhartha Institute of Medical Sciences (T Begur), Sri Siddartha Academy of Higher Education, Tumkur, India

²Associate Professor, Physiology, Sri Siddhartha Institute of Medical Sciences (T Begur), Sri Siddartha Academy of Higher Education, Tumkur, India

³Professor, Pediatrics, Sri Siddhartha Institute of Medical Sciences (T Begur), Sri Siddartha Academy of Higher Education, Tumkur, India

⁴Tutor, Physiology, Sri Siddhartha Institute of Medical Sciences (T Begur), Sri Siddartha Academy of Higher Education, Tumkur, India

⁵Department of Computer Science and Engineering, Sri Siddhartha Institute of Technology,Sri Siddartha Academy of Higher Education, Tumkur, India

*Corresponding Author: Arun Kumar Mohan. Sri Siddhartha Institute of Medical Sciences, Bengaluru, India. Email: drarunkm [at] gmail.com

Submitted: 20/12/2024 Accepted: 17/02/2025 Published: 31/03/2025

---

Abstract

Background: Medical education often relies on traditional didactic lectures that promote passive learning. Given the shift toward competency-based medical education, there is an increasing demand for active learning approaches. Team-based learning (TBL) promotes active student participation. This study aimed to compare the effects of traditional didactic lectures with TBL on the performance of first-year medical students.

Methods: A quasi-experimental design was conducted involving 119 MBBS Phase I students. Assessments were conducted using multiple-choice questions administered via Google Forms. The pre-test, post-test, and application exercise scores were used for assessment.

Results: The results indicate that both traditional didactic lectures and TBL are effective in enhancing student learning, as evidenced by the improvements in post-test scores compared to pre-test scores. In the application exercise, the average score of Group 2 TBL was 68%, significantly outperforming Group 1 (didactic lectures) with a score of 44% (p=0.000).

Conclusion: This study provides compelling evidence that TBL is superior to traditional didactic lectures in enhancing undergraduate medical education, particularly in applied physiology.

Keywords: Team-based learning, Traditional didactic lecture, Readiness assurance tests.

---

Background

Traditionally, relying on didactic teaching, this model often disengages students and hinders their development of essential clinical skills. While effective for foundational knowledge, it falls short in cultivating active learning, critical thinking, and collaborative problem-solving, which are crucial for competent medical practice (Atkinson et al. 2022). Traditional didactic lectures involve a structured presentation of the information delivered to large groups. This method is time-efficient for covering extensive materials; however, it has been criticized for its passive learning model (Huwendiek et al., 2017).

The shift toward competency-based medical education (CBME) necessitates a paradigm shift. CBME emphasizes the acquisition of specific competencies, demanding a more student-centered and interactive learning environment. To effectively implement CBME, educators must adopt innovative strategies (Suyo-Vega et al. 2024).

As the field of medical education evolves, innovative instructional methods are being proposed as alternatives to traditional lectures. One such method is team-based learning (TBL), a form of active learning that encourages collaboration among students and enhances critical thinking skills. TBL has been demonstrated to improve student engagement, knowledge retention, and application of clinical skills (Burgess et al., 2020). This method involves preclass preparation, readiness assurance testing, problem-solving activities, and immediate feedback to foster a highly interactive and student-centered learning environment. Recent studies continue to support the effectiveness of TBL in medical education, highlighting its benefits in promoting teamwork and the practical application of knowledge (Andrews-Dickert et al., 2024; Alizadeh et al., 2024).

By adopting these innovative strategies, medical educators can create a more dynamic and effective learning environment. This will not only enhance student engagement but also equip future physicians with the necessary skills to excel in a complex health care landscape.

This study aimed to compare the effectiveness of traditional didactic lectures and TBL in improving the performance of first-year medical students at the Sri Siddhartha Institute of Medical Sciences and Research Center, focusing on applied physiology. The objectives of this study were to compare the impact of traditional didactic lectures with TBL on the academic performance of first-year medical students and to evaluate the differences in knowledge retention and application between the two teaching methods through assessments.

---

Materials and Methods

The research was conducted at Sri Siddhartha Institute of Medical Sciences and Research Center situated in Bengaluru, India. The context provided an opportunity to implement both pedagogical strategies within a single academic environment. This study utilized a quasi-experimental design to compare the educational outcomes of the two teaching methodologies. The study was conducted in the Department of Physiology at Sri Siddhartha Institute of Medical Sciences and Research Center. Approval from the Institutional Ethics and Scientific Committee was obtained. The participants comprised 119 first-year MBBS students who volunteered to participate in the study, ensuring a diverse sample reflective of the medical student population.

Fig. 1. Flowchart representing the experiment.

Participants were randomly assigned to either group 1 or group 2 using simple randomization. A random number sequence was generated using the random number function in Microsoft Excel by an independent researcher who was not involved in participant recruitment or data collection. Participants were assigned to the intervention group if their assigned random number was less than 0.5 and to the control group if their random number was 0.5 or greater.

This study compared the effectiveness of traditional didactic lectures and TBL activities. The students were divided into two groups (Fig. 1).

Group 1: Traditional didactic lecture group: This group received a 30-minute lecture delivered by a subject expert professor. Pre- and post-tests, each consisting of 10 multiple-choice questions (MCQs) with four options and a single best answer, were administered before and after the lecture, respectively. Each MCQ had a 1-min time limit and was worth a mark.

Group 2: Team-based learning group: This group participated in TBL activities. The process consisted of the following steps.

Individual readiness assurance test (iRAT): An iRAT, identical in format to the pre-test (10 MCQs, four options, 1-minute time limit per question), was administered individually.

Team formation: Students were divided into teams of 5–6 members.

Team readiness assurance test (tRAT): A tRAT, similar in format to the post-test (10 MCQs, four options, 1-minute time limit per question), was administered to each team. Discussions among students were allowed.

Focused discussion: A 30-minute faculty-led discussion addressing student queries and clarifying concepts.

Application exercise: An examination with higher-order questions designed to assess application-based knowledge was administered after the group discussions.

The assessment was conducted using MCQs delivered through Google Forms. These assessments measured students’ understanding of key concepts in applied physiology both before and after the implementation of the instructional methods.

Assessment strategy

Pre-test: Administered before the teaching intervention to establish baseline knowledge. Post-test: conducted after implementing the instructional methods to evaluate knowledge retention and application. Application exercise: Higher-order questions were administered in both groups.

Fig. 2. Comparison of scores in teaching methods.

Statistical analysis

The pre-test and post-test scores in both groups were compared using the paired t-test. Data were analyzed using independent t-tests to compare the mean scores of application exercises in the two groups. A p-value of 0.05 was considered statistically significant.

---

Results

Comparison of pre-test and post-test scores (Fig . 2)

Both groups exhibited improvements in post-test scores compared to pre-test scores, indicating that the instructional methods effectively enhanced student learning. Both didactic lectures and TBL significantly improved test scores (p < 0.001). Didactic lectures resulted in a 24% improvement (47%–71%), while TBL yielded a 15% improvement (59%–74%).

Normalized gain (or Hake gain): This is a common metric in educational research that accounts for different starting points. It is calculated as follows:

Normalized gain=(Post-test %—Pre-test %) / (100%—Pre-test %)

For Group 1: (71—47) / (100—47)=24/53=0.45 (or 45%)

For Group 2: (74—59) / (100—59)=15/41=0.37 (or 37%)

Using the normalized gain, we see that Group 1 actually had a higher relative gain than Group 2.

Performance outcomes (Fig. 3)

Figure 3 illustrates the average scores on higher-order thinking questions for both the didactic lecture and TBL groups. The results revealed a statistically significant difference in performance between the two groups (p=0.000). The didactic lecture group achieved an average application exercise score of 44%, whereas the TBL group demonstrated a substantially higher average score of 68%. In comparison, the average scores on lower-order thinking questions (post-test/tRAT) were 71% and 74% for the didactic lecture and TBL groups, respectively. This represents a modest 3% increase in performance on lower-order thinking questions from the didactic lecture to the TBL group. However, the difference in performance on higher-order thinking questions between the two groups was considerably larger, with a 24% increase observed in the TBL group compared to the didactic lecture group. This suggests that TBL is significantly more effective than traditional didactic lectures in promoting higher-order thinking skills. These findings suggest that TBL might be more effective than traditional lecture-based instruction in enhancing student performance in assessments that require clinical application and critical thinking.

Fig. 3. Performance outcome in both the groups.

---

Discussion

Comparison of pre-test and post-test scores in traditional didactic lectures and team-based learning.

The results indicate that both traditional didactic lectures and TBL are effective in enhancing student learning, as evidenced by the improvements in post-test scores compared to pre-test scores. Both the didactic lecture group and the TBL group showed improvements from pre-test/iRAT to post-test/tRAT. However, given the didactic lecture group’s lower baseline knowledge (47% vs. 59%), a simple comparison of percentage point differences is misleading. When considering normalized gain, which accounts for different starting points, the didactic lecture group demonstrated a larger relative gain (45%) compared to the TBL group (37%). Further analysis using [effect size/ANCOVA] will provide a more rigorous comparison of the effectiveness of the two teaching methods.

Traditional didactic lectures offer several advantages, particularly in large classroom settings. They allow for efficient transmission of information, enabling instructors to cover a significant amount of material in a short period. This method provides a structured framework to help maintain consistent routines and clear learning objectives. Additionally, didactic lectures can be highly effective for conveying factual information, theories, and complex ideas through a well-organized, logical sequence. The use of visual aids, such as slides and handouts, further enhances understanding and retention (Rodriguez et al., 2020). Lastly, lectures offer the opportunity for personal interaction and immediate feedback, fostering a more engaging learning environment (Haidet et al., 2004).

Performance outcomes (Application exercise)

The results underscore the potential of TBL as a learner-centered, active learning methodology that not only enhances knowledge application but also fosters essential skills such as teamwork and critical analysis. By emphasizing collaborative learning, TBL encourages students to engage more deeply with the material, facilitating better understanding and retention (Burgess et al., 2020). Group 2’s higher scores on clinical and applied physiology questions may reflect the advantages of TBL’s emphasis on real-world application and problem-solving. This aligns with findings from previous studies reporting increased student engagement and satisfaction (Alamoudi et al., 2021). TBL’s structured format, which includes pre-class preparation, readiness assurance tests, and group activities, ensures active participation and continuous feedback. The active participation required in TBL sessions helps students develop critical thinking and communication skills, making it a valuable pedagogical approach in medical education (Sterpu et al., 2024).

Furthermore, studies have shown that TBL not only increases student engagement but also enhances satisfaction with the learning process. The collaborative environment created by TBL allows students to discuss and debate concepts, leading to a more profound grasp of the subject matter and improved critical thinking skills (Burgess et al., 2021). These benefits are supported by the literature that highlights the efficacy of TBL in promoting active participation and deeper learning among students. As medical education continues to evolve, integrating TBL can be a significant step toward creating a more effective and dynamic learning environment.

Strengths and limitations

The quasi-experimental design of this study has both strengths and limitations. The nonrandomized nature of the study allowed for real-world application and evaluation within a single institution. The diverse sample of 119 students from various backgrounds enhanced the generalizability of the findings. However, the relatively small sample size limits the statistical power of the results. In addition, conducting the study at a single institution may restrict the generalizability of the findings to different educational settings.

Future directions

Future research should involve longitudinal studies on varied topics and the swapping of teaching methods between groups. This could provide insights into the sustained impacts of TBL and potentially inform curriculum development across medical schools.

The continued evaluation of student performance in summative assessments could also lend credence to the findings observed in this study, expanding the understanding of the long-term benefits of active learning strategies in medical education.

---

Conclusion

This study provides compelling evidence that TBL might be a superior pedagogical approach to traditional didactic lectures in enhancing undergraduate medical education, particularly in applied physiology. The findings advocate the integration of TBL into medical curricula to develop essential clinical skills and foster a more engaged learning environment.

---

Acknowledgments

The authors gratefully acknowledge the contributions of individuals and institutions who supported this research, including technical assistance, helpful feedback, and access to resources, while not meeting authorship criteria. Their assistance was invaluable to the completion of this work.

Conflict of interest

There are no conflicts of interest to declare.

Funding

This work was conducted independently, without external financial support.

Authors contribution

A.K.M. and T.K. contributed equally to the study design, data analysis, and interpretation of results. A.K.M, T.K, S.P., M.M., and S.S. contributed equally to the data collection. A.K.M., T.K., and V.V. led the writing and critical revision of the manuscript.

Data availability

The data underlying this study are available upon reasonable request to the authors.

---

References

Alamoudi, A.A., Al Shawwa, L.A., Gad, H. and Tekian, A. 2021. Team-based learning versus traditional didactic lectures in teaching clinical biochemistry at King Abdulaziz University: learning outcomes and student satisfaction. Biochem. Mol. Biol. Educ. 49(4), 546–559; doi:10.1002/bmb.21456.

Alizadeh, M., Masoomi, R., Mafinejad, M., Parmelee, D., Khalaf, R. and Norouzi, A. 2024. Team-based learning in health professions education: an umbrella review. BMC Med. Educ. 24, 1131; doi:10.1186/s12909-024-06147-x.

Andrews-Dickert, R., Nagaraj, R., Zhan, L., Knittig, L. and Zhao, Y. 2024. Improving learning experience through implementing standardized team-based learning process in undergraduate medical education. BMC Med. Educ. 24, 1098; doi:10.1186/s12909-024-06025-6.

Atkinson, R.B., Khubchandani, J.A., Chun, M.B.J., Reidy, E., Ortega, G., Bain, P.A., Demko, C., Barreiro-Rosado, J., Kent, T.S. and Smink, D.S. 2022. Cultural competency curricula in US graduate medical education: a scoping review. J. Grad. Med. Educ. 14(1), 37–52; doi: https://doi.org/10.4300/JGME-D-21-00414.1

Burgess, A., van Diggele, C., Roberts, C. and Mellis, C. 2020. Team-based learning: design, facilitation and participation. BMC Med. Educ. 20, 461; doi:10.1186/s12909-020-02287-y.

Burgess, A., van Diggele, C., Roberts, C. and Mellis, C. 2020. Facilitating small group learning in the health professions. BMC Med. Educ. 20(Suppl 2), 457; doi: https://doi.org/10.1186/s12909-020-02282-3.

Burgess, A., Matar, E., Roberts, C., Haq, I., Wynter, L., Singer, J. and Bleasel, J. 2021. Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL). BMC Med. Educ. 21, 238; doi:10.1186/s12909-021-02638-3.

Haidet, P., Morgan, R.O., O’Malley, K., Moran, B.J. and Richards, B.F. 2004. A controlled trial of active versus passive learning strategies in a large group setting. Adv. Health Sci. Educ. Theory Pract. 9(1), 15–27.

Huwendiek, S., Ten Cate, O. and Boshuizen, H. 2017. The role of traditional teaching methods in medical education. Med. Educ. 51(10), 987–995.

Rodriguez, F., Pérez, N., Núñez, M. and Cano, F. 2020. Active versus passive learning strategies in medical education: a meta-analysis. Med. Teac. 42(3), 287–300; doi:10.1080/0142159X.2019.1703707.

Sterpu, I., Herling, L., Nordquist, J., Rotgans, J. and Acharya, G. 2024. Team-based learning (TBL) in clinical disciplines for undergraduate medical students—a scoping review. BMC Med. Educ. 24(1), 18; doi:10.1186/s12909-023-04975-x

Suyo-Vega, J.A., Fernández-Bedoya, V.H. and Meneses-La-Riva, M.E. 2024. Beyond traditional teaching: a systematic review of innovative pedagogical practices in higher education. F1000Res 13, 22; doi: https://doi.org/10.12688/f1000research.143392.2