International Journal of Applied and Basic Medical Research

: 2017  |  Volume : 7  |  Issue : 5  |  Page : 72--77

Team-based learning strategy in biochemistry: Perceptions and attitudes of faculty and 1st-Year medical students

Namrata Chhabra1, Sahiba Kukreja2, Sarah Chhabra1, Sahil Chhabra3, Sameenah Khodabux1, Harshal Sabane4,  
1 Department of Biochemistry, S.S.R. Medical College, University of Mauritius, Réduit, Republic of Mauritius
2 Department of Biochemistry, SGRD Institute of Research and Medical Sciences, Amritsar, Punjab, India
3 Department of Anaesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
4 Department of Community Medicine, S.S.R. Medical College, University of Mauritius, Réduit, Republic of Mauritius

Correspondence Address:
Dr. Namrata Chhabra
6, Loretto Convent Street, Curepipe
Republic of Mauritius


Background: Team-based learning (TBL) strategy has been widely adapted by medical schools all over the world, but the reports regarding the perceptions and the attitudes of faculty and undergraduate medical students towards TBL approach have been conflicting. Aim: The study aimed to introduce TBL strategy in curriculum of Biochemistry after evaluating its effectiveness through perceptions and attitudes of faculty and 1st-year medical students. Materials and Methods: One hundred and fifty students of first professional M.B.B.S and five faculty members participated in the study. Their responses regarding perceptions and attitudes towards TBL strategy were collected using structured questionnaires, focus group discussions, and in-depth interviews. Data were analyzed using Wilcoxon signed-rank test, paired sample t-test, and Mann–Whitney U-test. Results: Majority of the students expressed satisfaction with team approach and reported improvement in the academic scores, learning styles, and development of problem-solving, interpersonal, and professional skills. The faculty, however, recommended a modified TBL approach to benefit all sections of the students for the overall success of this intervention. Conclusion: TBL is an effective technique to enable the students to master the core concepts and develop professional and critical thinking skills; however, for the 1st-year medical students, a modified TBL approach might be more appropriate for the effective outcomes.

How to cite this article:
Chhabra N, Kukreja S, Chhabra S, Chhabra S, Khodabux S, Sabane H. Team-based learning strategy in biochemistry: Perceptions and attitudes of faculty and 1st-Year medical students.Int J App Basic Med Res 2017;7:72-77

How to cite this URL:
Chhabra N, Kukreja S, Chhabra S, Chhabra S, Khodabux S, Sabane H. Team-based learning strategy in biochemistry: Perceptions and attitudes of faculty and 1st-Year medical students. Int J App Basic Med Res [serial online] 2017 [cited 2021 Sep 17 ];7:72-77
Available from:

Full Text


Team-based learning (TBL) strategy has been designed to provide students with both conceptual and applied knowledge. It is conducted in large group setting where the students are divided into multiple small groups. Problem-based learning shares similar features with TBL, including being conducted in small groups and promoting both active learning and problem-solving skills;[1] however, TBL is considerably less rigorous in terms of faculty resources and infrastructure.[2],[3] This type of learning can strengthen the clinical reasoning skills needed in the delivery of health care.[4]

TBL has been accepted worldwide by instructors in numerous schools of medicine, nursing, dentistry, pharmacy, and other health science disciplines, but the data regarding the effectiveness of TBL from students and faculty's perspective are insufficient, and the reports have been conflicting.

Therefore, the present study was carried out with an aim to introduce TBL strategy as a core component in biochemistry curriculum after evaluating its effectiveness through perceptions and attitudes of faculty and 1st-year medical students.

 Materials and Methods

After the approval and the ethical clearance from the Institutional Review Board, TBL was introduced as a teaching–learning strategy to teach the 1st-year medical students. TBL sessions were held twice a month and each session lasted for 2 h. Four TBL sessions were carried out to cover the topic of “Study of vitamins.” TBL modules were prepared by the “Backward design.”[5] In organizing TBL sessions, 150 students of 1st-year M.B.B.S were divided into 30 permanent teams, each comprising of 5 students. The distribution was made using the roll numbers based on alphabetical stratification system. A verbal consent was taken from the students for participation in the study. The validated questionnaires were used for collecting the responses from the students and faculty.

Each TBL session was carried out in three phases: preclass preparation, readiness assurance tests, and application of course concepts.[6]

Preclass preparations

Students were informed of the topics to be covered in the TBL sessions 2 weeks before the session. Learning objectives for each session were clearly specified by the chief investigator, and the reading material was assigned to the students which consisted of information that they needed to master to meet the learning objectives. The reading material included book chapters, learning guides, and online modules. Students were expected to review and be prepared to utilize the information during the TBL in class session.

In class team-based learning session

Individual readiness assurance test

At the onset of the session, students took the individual test (individual readiness assurance test [iRAT]) consisting of 10 multiple choice questions (MCQs). Twenty minutes of time was allotted for the completion of the test at the end of which the students were asked to submit their answer sheets.

Group or team readiness assurance test

After collecting iRAT answer sheets, students were prompted to join their teams and take the exact same test as a team. The students were given 30 min for the team readiness assurance test (tRAT). During this time, team members were encouraged to collaborate, discuss, and reach at a consensus. After the tRAT, all teams were encouraged to simultaneously report the response for each MCQ using placards. The correct answers were provided by the instructor.


Teams that did not agree or were unable to give the correct answer were allowed to appeal, and the instructor immediately clarified any misconceptions regarding their answers. The purpose of appeal was to motivate teams and clarify their understanding of the information they would need during the application phase of the TBL module.

Facilitator feedback or debriefing

The last component of readiness assurance involved a review of the RAT and discussion of any items that remained a source of confusion for the students.

Application of key concepts

The TBL session was followed by a session of application-based exercises. There were five questions based on the application of knowledge. The teams spent 30 min for discussing different options before arriving at a “specific choice” and revealing their choice to the whole class (at the same time as the other teams revealed their choices).


Every correct response in the MCQ test was awarded a score of one with no marks awarded for an incorrect response. The total score for each student was calculated weight of three components – iRAT (50%), tRAT (30%), and clinical application (20%). The weight of iRAT was deliberately kept on the higher side to provide incentive and ensure active learning among students.

Peer assessment

Peer assessment was the core component of accountability in TBL. Peer assessment was based on the validated questionnaire and was collected after the second and fourth TBL session.

Collection of feedback

Student feedback

The questionnaire-based feedback was collected from the students after the second and fourth TBL sessions to compare the differences in the perceptions and attitudes of the students regarding learning styles, behaviors, impact of team building, and professional development. The focus group discussions (FGDs) and in-depth interviews were also conducted to record their opinions.

Faculty feedback

Faculty feedback based on questionnaire, focused group discussions, reflections, and in-depth interviews was collected after the fourth TBL session.

Statistical analyses

Data were analyzed using IBM, SPSS statistic software version 24.0 for Windows (IBM Corporation, Armonk, NY, USA). The outcome of program was assessed by the student's performance and validated structured questionnaire. Confirmatory factor analysis (CFA) and Cronbach's alpha coefficient tests were used to assess the validity and reliability of the construct, respectively. The data for the pretest (iRAT) and posttest (tRAT) results were analyzed using paired sample t-test. The cutoff value for statistical significance was kept 0.05 ensuring 95% confidence in the results.

The student's performances in successive TBL sessions were analyzed using the Wilcoxon signed-rank test. Numbers and percentage responses for each of the categories of the questionnaire were calculated. Median scores for individual items on the questionnaire in the categories of objectives for the class, impact of TBL, and value of peer assessment were calculated [Table 1]. A Mann–Whitney U-test (P < 0.05) was conducted to determine if changes in attitudes about TBL occurred between the second and fourth TBL sessions [Table 1].{Table 1}


A total of 150 students and 5 faculty members participated in the study. Their responses were collected in the structured questionnaires. The validity and the internal consistency of the questionnaire were confirmed. CFA showed an adequate validity, and the internal consistency (Cronbach's alpha) for the 14-item questionnaire response was 0.973.

Overall findings of this study revealed significant improvement in the academic scores and learning abilities; development of critical thinking and professional skills; and satisfaction with team experience and peer assessment.

The academic performances of the students improved from TBL session 2 to session 4, but no statistically significant differences (P = 0.076) were observed in the results analyzed by Wilcoxon signed-rank test. In each of the TBL sessions, the iRAT and the tRAT results were analyzed statistically using the paired sample t-test. Statistically highly significant differences (P < 0.001) were observed between the iRAT and the tRAT scores in each of the sessions indicating the impact of teamwork.

Majority of the students expressed satisfaction with TBL approach. The students were more positive in session 2 whereas mixed responses were observed in session 4. The differences in the perceptions and attitudes of students toward TBL strategy in sessions 2 and 4 have been shown in [Table 1].

The content analysis of open-ended questions revealed five themes:

(i) Improvement in the learning style and attitude, (ii) team spirit and personal development, (iii) more effective use of classroom time than didactic lectures, (iv) effective technique but needs modification, and (v) less effective than didactic lectures.

FGDs were carried out involving 8–10 students in one session. The items identified through component analysis have been shown in [Table 2].{Table 2}

The students expressed positive attitude toward peer assessment and agreed to inclusion of TBL as an instructional technology in future biochemistry courses; however, they demanded more assistance from the instructors regarding clinical discussions, pre- and postsession reading materials, and assessment of application process individual as well through team efforts as in RATs.

The faculty feedback was collected through questionnaire, FGDs, and in-depth interviews. [Table 3] shows the perceptions and attitudes of faculty toward TBL approach.{Table 3}

The session of FGD was held with five faculty members of the department of Biochemistry after the last TBL session. The content analysis has been shown in [Table 4].{Table 4}

The faculty expressed a positive response for all the components of TBL module and agreed to include TBL as an effective instructional tool not only in the curriculum of Biochemistry but also in all other disciplines. The faculty, however, expressed concerns for the weaker students, who were less benefited by the TBL approach. A modified TBL approach to benefit all sections of the students for the overall success of this intervention was recommended by all the faculty members.


The study found the improvement in the academic performances of the students by TBL approach. The students enjoyed the interactive sessions and found TBL approach better than didactic lectures. Many other studies have reported similar results; Koles et al.,[7] Kolluru et al.,[8] and Vasan et al.[9] reported better academic performances and increased mastery over course contents of the students after TBL.

The analysis of the questionnaire revealed improvement in the learning styles of students [Table 1]. TBL's sequential process motivated learners to go beyond mere mastery of essential facts. TBL not only promoted total transformation of a student affecting knowledge, skills, and attitude but also helped in utilizing the classroom time in a judicious way taking the classroom discussion to a higher level. The similar results have been reported by other studies.[8],[9],[10],[11],[12],[13]

Some of the students, however, reported less effectiveness of TBL approach and preferred didactic lectures over TBL approach. Similar results have been reported by Punja et al.,[14] according to the study students generally tend to seek the comfort of attending didactic lectures that deliver information and facts in the sequence and format in which they answer their theory questions; therefore, they find this method less useful.

In our study, the students expressed more positivity in the first two sessions of TBL. The major factors identified that could sabotage the success of team-based approach were as follows:

(i) inappropriate time of introduction of TBL, (ii) less motivated or immature students, and (iii) lack of incentive to the students.

A small percentage of students demanded supplementation of didactic lectures with TBL indicating their inability to indulge in self-directed learning. Some students demanded inclusion of subjective questions as assessment in RAT and application tests so that they could prepare the contents for their semester and university examinations. A few of the students expressed their inability to solve the clinical problems and demanded elaborated clinical discussions to develop the problem-solving skills. Lower rating of TBL was mostly expressed by low achievers and slow learners.

Lower rating of TBL by underachievers has also been reported by Vasan et al.[15] According to the study, the low rating could be attributed to student's difficulty in assessing their perceived learning needs in a new learning environment of TBL.

The general attitude of the faculty was positive towards TBL. The faculty members, however, suggested modifications in TBL strategy to make it more acceptable by students. The recommendations by the faculty were as follows: supplementation of TBL with didactic lectures, use of TBL during group discussion/tutorial time for assessment of the learned topics, provision of solved exercises to the students after the completion of the session, and to avoid introduction of TBL in the first two semesters.

To summarize, TBL uses the power of small group learning within the large classroom setting. It is highly cost-effective and can be successfully employed in large classes. TBL enables the learners to become more self-directed and gain profound insights into their strengths and weaknesses as learners. TBL focuses on the application of knowledge and building of skills. The students learn to solve problems while being part of a team, similar to real practice where health professional from different disciplines works in collaboration with each other to manage medical problems. With the increasing concern on patient safety in health-care settings, TBL provides students with many opportunities to learn communicate skills and collaborate in the team setting.

Limitations of the study

Each TBL session requires 2 or more hours for the completion of all the component steps, which is usually not a dedicated time for a conventional lecture. Therefore, a careful planning is needed to introduce this technique in the curriculum.

A lecture hall was used for TBL, which was not suitable for group discussions. A dedicated space exclusively for TBL could have made the sessions more comfortable for the students.

The study was cross sectional; the future impacts on collaborative medical practice remain to be evaluated. A prospective research design to compare learning outcomes of academically similar student cohorts exposed to the TBL strategy versus another active learning method might help to produce meaningful data to draw conclusions about the effectiveness of this teaching strategy.


TBL is an effective teaching-learning strategy to address the professional competencies of the health professionals. A modified TBL strategy might be more appropriate to improve the learning outcomes and development of skills in 1st-year medical students.


We thankfully acknowledge Professor (Dr.) Bharti Uppal for her unconditional support and guidance; faculty and staff, department of biochemistry for their untiring efforts in conducting TBL sessions; and most importantly the students of first professional M.B.B.S for their cooperation and honest feedback.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Krathwohl DR. A revision of bloom's taxonomy: An overview. Theory Pract 2002;41:212-8.
2Michaelsen LK, Sweet M. The essential elements of team-based learning. New Dir Teach Learn 2008;116:7-27.
3Beatty SJ, Kelley KA, Metzger AH, Bellebaum KL, McAuley JW. Team-based learning in therapeutics workshop sessions. Am J Pharm Educ 2009;73:100.
4Michaelsen L, Sweet M, Parmalee D. Team-based learning: Small group learning's next big step. New Dir Teach Learn 2009;128;7-17.
5Wiggins G, McTighe J. Understanding by Design (Merrill Education/ASCD College Textbook Series). Alexandria, VA, USA; 1998.
6Levine R, Hudes P. How to Guide for Team-Based Learning; IAMSE Manual 1; 2013.
7Koles PG, Stolfi A, Borges NJ, Nelson S, Parmelee DX. The impact of team-based learning on medical students' academic performance. Acad Med 2010;85:1739-45.
8Kolluru S, Roesch DM, Akhtar de la Fuente A. A multi-instructor, team-based, active-learning exercise to integrate basic and clinical sciences content. Am J Pharm Educ 2012;76:33.
9Vasan NS, DeFouw DO, Compton S. Team-based learning in anatomy: An efficient, effective, and economical strategy. Anat Sci Educ 2011;4:333-9.
10Inuwa IM. Perceptions and attitudes of first-year medical students on a modified team-based learning (TBL) strategy in anatomy. Sultan Qaboos Univ Med J 2012;12:336-43.
11Chung EK, Rhee JA, Baik YH, Oh-Sun A. The effect of team-based learning in medical ethics education. Med Teach 2009;31:1013-7.
12Wiener H, Plass H, Marz R. Team-based learning in intensive course format for first-year medical students. Croat Med J 2009;50:69-76.
13Deardorff AS, Moore JA, Borges NJ, Parmelee DX. Assessing first year medical student attitudes of effectiveness of team-based learning. Med Sci Educ 2014;20:67-2.
14Punja D, Kalludi SN, Pai KM, Rao RK, Dhar M. Team-based learning as a teaching strategy for first-year medical students. Australas Med J 2014;7:490-9.
15Vasan NS, DeFouw DO, Compton S. A survey of student perceptions of team-based learning in anatomy curriculum: Favorable views unrelated to grades. Anat Sci Educ 2009;2:150-5.