Team-based learning or problem-based learning: which is the best learner-centered approach for undergraduate dental students?

Introduction

Background

Medical education has undergone significant changes in recent years, compared to traditional facilitator-centered teaching methods (1). In contrast to traditional lectures, which treat students as passive information consumers, modern teaching methods strongly emphasize active learning, encouraging students to participate in group discussions, problem-solving sessions, and practical exercises (2).

Recently, various teaching methodologies have been implemented for undergraduate dental training (3). Among these, team-based learning (TBL) and problem-based learning (PBL) are two common teaching methodologies (3,4). TBL is a widely recognized approach for teaching in schools, which divides students into teams (5). It encourages students to actively participate in individual learning sessions, followed by an assessment of their readiness to work as part of a team. Each team member works in collaboration to solve a given problem (6). TBL enhances critical reasoning, problem-solving, and teamwork abilities (7,8). Whereas PBL provides students with actual cases or scenarios that require critical thinking, collaboration, and problem-solving to clarify the given problem. Students work together to discover the problem, gather facts, and formulate a solution. PBL enhances critical reasoning, problem-solving, and self-directed learning abilities (9-11).

Numerous studies have investigated the positive and the negative aspect of PBLs in medical education (12,13). In comparison with traditional learning, PBL is reported to be more advantageous as it encourages active learning, improves cooperation, communication skills, and results in long-term information retention (13,14). However, a previously conducted study revealed that it lacks structure, has unequal student participation, is dependent on the instructor’s knowledge and skills, and presents assessment challenges (4).

TBL, on the other hand, has a structured and efficient approach, facilitates accountability, and ensures active participation from all team members. It also provides immediate feedback, which aids in timely clarification and reinforcement of concepts (14). A study by Dearnley indicated several positive facts related to TBL in nursing and midwifery education. Firstly, TBL improved students’ knowledge acquisition and retention as compared to traditional lectures. Secondly, TBL was associated with increased student satisfaction and engagement in the learning process, and it enhanced teamwork skills and fostered collaborative learning among students (15). Additionally, a systematic review by Gera et al. compared the effectiveness of TBL with PBL and reported that TBL resulted in better learning outcomes for students. The positive and negative aspects of both teaching strategies were also examined in this study (16).

Research has identified that TBL and PBL both promote active learning. While both methodologies are widely adopted, direct empirical comparisons of their effectiveness in promoting conceptual learning are still relatively few. For instance, Michaelsen et al. have extensively discussed distinct features and potential benefits of TBL in relation to other active learning strategies like PBL, highlighting their respective strengths for fostering deep understanding (17). This study exhibited improved teamwork among the TBL group, increased participation, and positive attitudes toward the course (16). Similarly, the study by Burgess suggested that TBL has various advantages over PBL in the medical curriculum. As TBL promoted better learning outcomes, greater engagement and student satisfaction (18).

Nonetheless, further research and consideration of contextual factors are necessary to make informed decisions regarding the utilization of TBL and PBL in medical education. Moreover, TBL being resource effective could be managed within the allotted time as compared to PBLs, which are conducted over 3 sessions (2 hours each) (19). However, TBL requires extensive preparation by the facilitators beforehand and is quite time-consuming and sometimes difficult for one facilitator to process the entire activity (20).

Rationale and knowledge gap

In the context of medical and dental education in Pakistan, PBL has been widely adopted across numerous institutions. TBL, on the other hand, is a relatively new teaching approach that has only been implemented in a small number of academic settings. There is a dearth of comparative research between PBL and other active learning techniques like TBL because the majority of the literature currently available in Pakistan evaluates PBL’s efficacy in comparison to conventional lecture-based methodologies (13,14). Moreover, globally TBL has been employed in Medicine, Nursing, and Midwifery, and limited studies have been conducted to show efficacy of employing TBL during the pre-clinical dental years (21). Hence, a comparison between the PBL and TBL is needed to identify the more effective active learning strategy. The authors believed it was important to investigate students’ attitudes and views regarding the two methodologies, as TBL was recently implemented at our university. This comparison is crucial for developing an evidence-based curriculum that aims to improve dental education’s critical thinking and active learning capabilities.

Objectives

The objective of this study was to evaluate and compare the effectiveness of TBL and PBL in promoting active learning, critical thinking and overall academic performance among undergraduate dental students. We present this article in accordance with the STROBE reporting checklist (available at https://amj.amegroups.com/article/view/10.21037/amj-24-158/rc).

Methods

Study setting, and study type

This study was conducted at Women Medical and Dental College in Abbottabad, Pakistan, among first-year Bachelor of Dental Surgery (BDS) students to evaluate the efficacy of two different types of teaching methodologies among first-year BDS students. The study duration was from January to September 2022.

Study design

This study employed mixed-methods quasi-experimental design to evaluate and compare the effectiveness of PBL and TBL among undergraduate dental students.

Sampling technique

All students enrolled in the first year BDS program during the academic year 2022–2023 (n=45) were considered for the study, representing a purposive sampling technique (i.e., a complete cohort).

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethical Review Committee of the Women Medical and Dental College (ERC 42/2023). The students were fully informed about the study’s process of conduction. Both verbal and written informed consent were obtained from all the participants prior to their involvement.

Inclusion & exclusion criteria

All the students enrolled in the 1^st year BDS during the academic year 2022–2023 were included in the study. Students absent during any of the PBL or TBL sessions were excluded from the study.

Student group allocation and intervention flow

To facilitate active learning and maintain consistency in peer interaction, the 42 included first-year students were allocated into two independent cohorts: one assigned to the PBL curriculum track (n=21) and the other to the TBL curriculum track (n=21). Within each cohort, students were further allocated into three smaller, permanent groups, each comprising seven students, for collaborative activities. Randomisation was conducted using a lottery method: each student’s name was written on a piece of paper, and names were drawn out to form groups. This method ensured randomness while maintaining equal group sizes for both PBL and TBL activities. These group allocations remained constant throughout the study duration to maintain consistency in peer interaction and group dynamics during both the PBL and TBL sessions. Smaller groups promoted active participation and effective discussion, which are essential components of both PBL and TBL strategies. This group size aligns with educational best practices recommending teams of 5–7 members for collaborative learning (17,22). Both PBL and TBL were conducted concurrently during the study period (Figure 1).

Figure 1 Flowchart depicting methodology. BDS, bachelor of dental surgery; iRAT, individual readiness assurance test; PBL, problem-based learning; TBL, team-based learning; TMJ, temporomandibular joint; tRAT, team readiness assurance test.

Facilitator training

Facilitators for both PBL and TBL sessions underwent standardized training workshops prior to the study. These workshops, conducted by the Medical Education Department, covered the core principles of each methodology, specific roles and responsibilities of facilitators, standardized assessment rubrics (for PBL), and the guidelines for leading discussions and providing mini-lectures (for TBL). This ensured consistency in facilitation across all groups and methodologies.

Data collection tools

The data was collected using two primary instruments:

Academic performance assessments

The scores of the students during the PBL and TBL sessions were recorded using the multiple choice questions (MCQs) based tests. These quizzes were made using Google Forms especially structured for graded assessments. The data was then transferred to a spreadsheet and the scores of the students were compared. For PBL, this included a pre-test and a post-test related to the topic and for TBL, scores of team readiness assurance test (tRAT) and a post-assessment (based on group presentations).

Student feedback questionnaire

A comprehensive feedback form was administered via Google Forms, which was used to measure the student’s self-perception regarding the two teaching methodologies. The questionnaire was divided into three sections:

• Section 1 comparative effectiveness: this part contained questions that compared the two methodologies across different domains, such as their utility in promoting group discussion, helping achieve learning objectives, improving communication skills and a comprehensive topic coverage.
• Section 2 peer-evaluation and team satisfaction: this section consisted of questions related to peer-evaluation and team satisfaction. Students rated their team members on various domains (e.g., cooperativeness, handling criticism positively, equal participation, sharing points of view, completing pre-reading material) using a 5-point Likert scale, where 1 represented “strongly disagree” and 5 represented “strongly agree”.
• Section 3 open-ended feedback: the final part consisted of open-ended questions designed to identify the “best” and “worst” features of both PBL and TBL, along with suggestions for improving the teaching and learning methodologies.

Reliability of questionnaire

The feedback questionnaire underwent expert review by Medical Education specialists at the university. Following this, a pilot test was conducted on 10 students. The reliability of the questionnaire was assessed using Cronbach’s alpha. According to George and Mallery, a Cronbach’s alpha value greater than 0.9 was considered excellent, more than 0.8 was good, and greater than 0.7 was found to be acceptable (23). In this study, items demonstrating an alpha value of 0.80 or above were considered good and retained in the final version of the questionnaire, while items with values lower than 0.80 were excluded.

Conduction of PBL

Prelude for students

An introductory session was conducted for the students at the beginning of the year to familiarize them with the steps involved in the PBLs. After that, two PBL sessions were conducted, which were integrated with the four basic sciences subjects: anatomy, biochemistry, physiology, and oral biology.

Construction process

The PBL cases and objectives were meticulously designed by subject specialists from all four departments to ensure uniform integration of learning objectives based on the ongoing academic module’s curriculum. The PBL cases were then reviewed by the respective department heads, and revisions were incorporated by designated faculty members. The final assessment of the PBL case was done by the Medical Education Department and a panel of university experts via a presentation, making any necessary changes before the cases were used with students.

PBL topics

For PBL, the topics of “oral mucosa” and “bone histology, anatomy and function” were included in this research. These topics were selected for their foundational importance in the early BDS curriculum and their suitability for open-ended problem exploration.

Process of PBL

The PBL was conducted over three two-hour sessions.

Session 1

Students were provided the case scenario without prior information or reading material. They worked to solve the scenario by following the seven jumps/steps of PBL. These jumps/steps are as follows:

• Identify and clarify unfamiliar terms.
• Define the problem or problems to be discussed.
• Brainstorming possible explanations.
• Review steps 2 and 3 and arrange explanations into tentative solutions.
• Formulate learning objectives and provide a title to the case study.
• Private study between the sessions.
• Group shares results of private study.

The students were assessed based on their group dynamics, knowledge acquisition, communication skills, and time management.

A pre-test was also taken using Google Forms, which included 15 MCQs related to the topic that had to be covered in the PBL session. Steps 1–5 were completed in the first session, and the students had to evaluate, brainstorm, and derive possible explanations of difficult words and phenomena given in the scenario. After that, they had to summarize the entire case in their own words, give it a title, and formulate learning objectives for the self-study session.

Session 2 (self-study)

Students collaboratively addressed the learning objectives identified in Session 1, utilizing textbooks, research articles, and other relevant resources.

Session 3

Students discussed their findings and answers to the learning objectives, providing examples and references. They worked towards a differential diagnosis of the case and related its pathophysiology to anatomical changes. A post-test, also via Google Forms, was administered at the end of this session, with scores compared to pre-test results.

Role of facilitators

For the PBL sessions, facilitators were randomly selected from the dental college faculty, with one facilitator assigned per team. Their role was primarily passive, focusing on assessing individual and group performance during the first and third sessions. Facilitators intervened only if students deviated significantly from the case direction. The facilitators were provided with a standardized evaluation sheet, which contained information related to students’ performance in terms of attendance, participation, group dynamics, critical thinking, time management and preparation. All these key PBL parameters were scored from 1–10, with a maximum cumulative score of 50 per PBL.

Conduction of TBL sessions

Formulation of TBL session

For TBL, the topics of “histology of salivary glands” and “temporomandibular joint mechanics” were selected. One facilitator from the department was assigned to supervise the entire process of making and conducting the TBL sessions. The relevant study material was curated, and 15 MCQs were formulated to assess knowledge recall. These questions were introduced in both individual readiness assurance test (iRAT) and tRAT. The facilitator also developed scenario-based questions on the application level to judge the knowledge acquisition of the students. The questions and the scenarios were further reviewed by the department heads and the Medical Education Department. Based on their feedback, revisions and corrections were incorporated by the facilitator before implementing the TBL session.

TBL topics

For TBL sessions, the topics of “histology of salivary glands” and “temporomandibular joint mechanics” were chosen due to their conceptual frameworks, allowing for effective application through the readiness assurance process and group activities.

Process of TBL

The TBL sessions were conducted approximately 3 weeks after the last PBL to minimize any carryover effects. Students were divided into preassigned groups of 6 students. Before the scheduled TBL session, the students were provided with self-study material in the form of textbook pages and videos by the instructor. Each TBL session lasted 2.5 hours and followed these steps:

• iRAT: administered at the start via Google Forms, this 15-question MCQ test primarily focused on recall from the provided self-study material. Results were recorded in an Excel spreadsheet.
• tRAT: immediately following the iRAT, the same test was administered to teams, with collective answers submitted via Google Forms. Test marks for both iRAT and tRAT were displayed and discussed with students.
• Mini lecture and topic discussion: after the results were displayed, facilitators discussed the questions and addressed student queries through a brief mini-lecture on the topic.
• Team application (tAPP): each group received one histological slide with five relevant questions. Students prepared answers collaboratively and presented them to the entire class. Teams were marked based on their final presentation to assess knowledge acquisition. Peer feedback was also encouraged from other teams, promoting positive criticism and peer review.

Role of facilitator in the TBL session

For TBL sessions, two facilitators were selected from the department. They supervised the entire process of formulation as well as the conduct of TBL. In TBL sessions, the facilitators had an active role as they directed the students to follow the steps within the specified period and discussed their issues and queries.

Role of students in the TBL sessions

The students also had an active and interactive role in these sessions as they had to do the self-study beforehand and prepare the topics well. Moreover, the peer evaluation also encouraged their team members and classmates to participate equally in the session.

Statistical analysis

All quantitative data analyses, including descriptive statistics and inferential comparisons, were conducted using SPSS v25.0 (IBM Corp., Armonk, NY, USA). A P value ≤0.05 was considered statistically significant.

Quantitative data were examined for normality prior to inferential testing. The distribution of individual scores for continuous variables, including those used in the comparison between PBL and TBL, was assessed using the Shapiro-Wilk test. The results of individual scores for TBL iRAT (W=0.980, P=0.13), TBL tRAT (W=0.965, P=0.09), PBL pretest (W=0.989, P=0.13) and PBL posttest (W=0.978, P=0.11) indicated that the data is normally distributed. For evaluating academic performance within group comparisons were done using a paired samples t-test in the PBL cohort. For the TBL cohort, a repeated measures analysis of variance (RMANOVA) was employed to compare iRAT, tRAT and post-assessment scores. Student’s independent samples t-test was applied to compare the final post-assessment scores between the two groups.

Categorical variables were expressed as frequencies and percentages. Given the ordinal nature of the Likert-scale responses and to provide a comprehensive summary of central tendency and dispersion, both mean and median values were presented. This dual reporting allows for better interpretability of response patterns and accounts for potential skewness in ordinal data. To assess significant differences in student perceptions of PBL and TBL features, Student’s independent samples t-tests were performed for each questionnaire item, comparing the mean scores between the PBL and TBL cohorts.

Qualitative data from open-ended responses were analyzed using thematic analysis. This process involved an iterative and inductive-deductive approach, allowing for themes to emerge from the data while also being guided by the study’s specific research question regarding PBL and TBL learning experiences. The coding was performed independently by two researchers. Following initial coding, the researchers met to compare their coding frameworks, discuss discrepancies, and reach a consensus on the final codes and emergent themes. The inter-coder reliability was established through a process of discussion and consensus-building. After coding the responses, recurring themes were identified, categorized and representative quotes were included to illustrate participants’ perspectives. The qualitative analysis, including data organization, coding and theme generation, was facilitated using NVivo software (v14, QSR International Pty Ltd.).

Results

Out of 45 students, 42 students were included in the study; 3 students were excluded, as 2 of them were not present in the TBL session, and 1 student had not previously attended a PBL session.

Quantitative findings

Academic performance comparisons

Table 1 highlights the marks obtained by the students in PBL pre-test (7.11±2.5) and post-test (11.2±2.0) showing differences. Although the difference was not statistically significant (P=0.76), it could be identified that the marks obtained in the post-test were higher. The comparison of iRAT (6.5±3.2), tRAT (9.7±1.04) and post-assessment marks (13.02±1.5) in TBL showed statistically significant difference between them (P<0.001). It was noted that the lowest marks were obtained in iRAT while final assessment showed significant improvement in the marks (Table 1).

Student perceptions of teaching methodologies

A questionnaire evaluating the features of PBL and TBL was distributed among the students. Table 2 summarizes their feedback on key aspects:

• The first question was related to group discussion, a statistically significant difference was observed between TBL and PBL (P=0.003). Students reported PBL as a more effective strategy for promoting group discussions.
• When asked about time management, a statistically significant difference was observed between TBL and PBL, with TBL being a more effective time management strategy (P=0.005). Both strategies helped in achieving the learning objectives and improved communication between the students as no statistically significant differences were observed.
• While both strategies encouraged teamwork, a statistically significant difference in the students’ feedback was observed (P=0.003). Students considered PBL as more effective in encouraging teamwork.
• For independent learning, the difference was statistically significant between the two strategies (P=0.02). In comparison to PBL, students found TBL more effective in encouraging independent learning.
• A statistically significant difference was also observed when assessing whether the teaching strategy ensured uniform participation from all team members (P<0.001). It was observed that students considered PBL more effective in encouraging uniform participation from all team members. Finally, students’ perceptions of the teaching strategies being challenging (P<0.001) and motivating (P=0.02) revealed statistically significant differences between TBL and PBL, with TBL being considered more challenging and motivating.
• Both the strategies were able to cover topic contents, and no significant difference was observed between TBL and PBL in this regard. Students considered both teaching methodologies better than traditional teaching methods and wanted more of these sessions in the future.

Student satisfaction with team dynamics

Table 3 covers the questions related to students’ satisfaction with their teams in different aspects. No statistically significant differences were observed between PBL and TBL teams when asked about effective communication and co-operation between teams as well as whether the participants were able to take criticism positively and judged each other fairly.

Statistically significant difference was observed when students were asked whether team members encouraged each other to express their opinion and participated equally in the sessions (P<0.001). A statistically significant difference was also observed when enquired whether all team members paid attention during group discussions (P=0.) and fulfilled their responsibilities (P=0.04). A highly significant difference in overall team satisfaction was observed in PBL and TBL (P<0.001). It was observed that students were more satisfied with the teams in TBL.

Qualitative findings

Best and worst features of TBL and PBL

Table 4 outlines the best and worst features of TBL and PBL as described by the students.

PBL perceptions

Concerning PBL, most of the students reported that its best features included:

• Improved teamwork and leadership skills among students (81% responses) as students valued the collaborative nature of PBL. One of the students quoted: “PBL pushed us to work together and with a different team leader every time, all of us got a chance to perform and learn how to lead”.
• Learning based on clinical scenarios fostered students’ interest in the subject (85.7% responses), as the real-world application resonated strongly with students. It was quoted by one of the students that “learning through different clinical cases made the topic more interesting as it combined the learning of anatomy with its clinical application”.
• Access to resources for detailed study (71.4% responses) allowed for deeper understanding. A student commented, “Being able to go back and research after our initial discussion helped clarify a lot of points”.
• Students appreciated how PBL encouraged critical thinking and clinical relations by linking knowledge to real-world diseases (47.6% responses). One student stated, “PBL definitely improved my critical thinking and I could connect what we learned to actual diseases”.

Students also identified several worst features of PBL such as:

• Prolonged sessions and time-consumption (57.1% responses) were a common complaint by the students. One of the students expressed, “The sessions are too long and they are usually spread over the entire week, taking up a lot of our study time”.
• Students also reported a lack of interest in the second group discussion (76.2% responses). For instance, a student remarked, “Sometimes in the second session, half of the team is not interested, only a few students actively search and discuss the learning objectives”.
• Absence of pre-reading material (81% responses) was perceived to reduce the initial engagement with the scenario. This was the most frequently cited “worst feature” of PBL sessions. One of the participants had highlighted, “No pre-reading material meant it was hard to get into the scenario from start and reduced our brain-storming in the first session”.
• Students also complained about numerous learning objectives (71.4% responses) at the end of the first session. One of the students commented, “Too many learning objectives are sometimes derived at the end of the first session which makes it boring”.

TBL perceptions

Regarding the TBL sessions, participants identified the following “best features”:

• TBL is effective in teaching time management (47.6% responses). As one of the students put it, “TBL taught me how to manage my time better because we had strict deadlines”.
• The provision of pre-reading material helps to reach the conclusions in a short time (61.9% responses). A participant stated, “The pre-reading material was a great help, as it helped in quicker understanding of the topic and helped us in solving the problems faster”.
• TBL reportedly covers interesting parts of the topic (90.5% responses) and keeps the students engaged throughout the session. One student noted that, “TBL covered most of the interesting parts of the topic and helped us study smartly”.
• Final session with short presentations and use of histological slides was highly appreciated by the students as it promoted retention of key features (66.7% responses). A student commented, “I usually find it difficult to remember histological features, but the inclusion of slides in TBL sessions made it so much easier to remember key features”.

Regarding the worst features of TBL, following responses were recorded:

• Students reported that the sessions being rushed were a notable drawback of the TBL sessions (52.4% responses). For example, one student said, “The TBL sessions felt rushed as we had to do everything very quickly”.
• The inability to access resources using gadgets or textbooks was seen as a limitation to learning (85.7% responses). One of the participants said, “Access to our phones and learning resources would have been helpful in learning and retaining more points”.
• Team members were unwilling to participate in the final presentation (81% responses), which was a significant issue in the team dynamics. It was reported by one of the students, “Some team members are not interested in helping with the final presentation”.
• Another issue related to team dynamics was reported by the students as lack of interest in studying the pre-reading material (66.7% responses). One of the students remarked that, “Not everyone had done the pre-reading which was frustrating”.

Discussion

Key findings

Since the last several decades, medical curriculum in most medical schools throughout the world has changed their medical curricula from a teacher-centered to a learner-centered approach (24,25). Evidence suggests that today’s learners, who are more digitally oriented prefers active and engaging learning environments (26).

Student-centered learning strategies not only inspire learners, but also encourage peer discussion, improve communication, enhance critical thinking and problem-solving skills (27). PBL and TBL are both learner-centered approaches which use different methodologies to actively engage the students. The current study aimed to explore students’ perceptions regarding their experience for both PBL and TBL.

Comparison with similar research

Findings from the current study revealed that comparison of scores following the TBL and PBL sessions, showed significant differences. Although there was a difference in the marks obtained by students in the PBL pre-test and post-test, but these differences were not statistically significant. In contrast, the comparison of marks across different components of the TBL revealed a statistically significant difference.

In terms of students’ opinion regarding the PBL and TBL, the majority of students claimed that group discussions during PBL sessions improved their understanding of the core concepts and helped them to identify their misconceptions. Similar findings were reported in previous studies, which concluded that activating prior knowledge through group discussions positively influences learning outcomes (28). According to O’ Daniel & Rosenstein patient safety depends on having effective teamwork and excellent communication skills. Both TBL and PBL encourage effective teamwork skills in students (29). In the current study most of the participants stated that PBL sessions improved their communication skills and ability to work in team. These findings are in line with prior study by Ricotta et al., who concluded that PBL not only fosters problem-solving but also enhances knowledge acquisition, group interaction, and communication skills (30).

As compared to PBL, students stated that working in smaller groups during TBL sessions was more conducive to understanding and encouraged better understanding and student participation. The course objectives were effectively covered, and the process promoted independent learning. Similar findings from earlier studies confirm that TBL encourages students to engage in self-directed learning before formal instruction begins. TBL incorporates individual and team assessments, which collectively foster critical thinking and active participation in both group and individual contexts (8,31).

Regarding team satisfaction, most students stated that TBL improved communication among team members and provided equal opportunities to share opinions. This is consistent with literature suggesting that TBL enhances discussion and motivates students to exchange ideas with peers. Previous studies have also shown that TBL fosters greater critical thinking and collaborative learning than PBL (32). However, our students found that all team members participated equally during the PBL session as compared to TBL. These findings are in contrast with the study led by Burgess et al., where students reported working in small groups of five or six students, compared to larger groups of 10 in PBL, increased participation and peer learning (18).

Explanation of findings

Students in this study reported that they were able to share and receive constructive criticism without feeling offended and judged each other fairly. Similarly, a study by Burgess et al. noted that while students provided positive peer feedback effectively, they often hesitated to offer negative feedback. Factors contributing to this reluctance may include the difficulty of the task, fear of social discomfort, potential harm to team dynamics, or concerns about affecting a peer’s academic record (33). Farland and Beck also demonstrated that peer evaluation in TBL, when supported with proper training and mentoring, significantly improved teamwork outcomes among pharmacy students (34). Likewise, students must be trained in offering feedback, particularly related to professional conduct, which appears to be underestimated. Evidence supports that, with proper training, the practice of giving and receiving feedback is an effective learning experience that promotes self-reflection (35,36).

According to Levi and Askay, a ‘team’ is a form of group in which members collaborate to achieve a common purpose (37). The phrases ‘teams’ and ‘groups’ had been used interchangeably. PBL literature frequently uses term groups (38,39), while profession-specific literature prefers the term team working (40). Competencies to perform well in a team are divided into two categories: task-oriented skills which focus on completing the team tasks and socio-emotional skills which maintain the team process (41). Task-oriented skills involve goal setting, resource management, and decision-making, while socio-emotional skills include conflict resolution, empathy, and communication (39). Likewise, in the current study, most of the participants stated that PBL improved teamwork and developed leadership skills amongst the students. Most students found PBL encouraged habit of self-directed learning and improved their grasp on the subject. These findings are in line with the study led by Sultana et al. (42). This was because PBL scenarios had been formulated by trained faculty members who are experts in their respective fields. After receiving PBL scenarios, students solved the problems by using the internet sources, books, journals, and then actively participated in group discussions. This approach helped students develop a thorough understanding of the subject. On the other hand, our students felt that PBL sessions were quite lengthy, had lots of learning objectives and no pre-reading material was provided to them.

Regarding the best features of TBL, students stated that TBL improved their concepts, enhanced their critical learning skills. These findings are consistent with findings observed from earlier studies which showed that TBL enriched the understanding, critical thinking, and long-term retention of the knowledge as compared to other teaching methods (43,44). On the other hand, students reported that time wasn’t sufficient during the TBL session, gadgets should have been allowed and there was lack of participation from all team members.

Limitations and strengths

Firstly, this was a single-center study conducted at a private dental institution with only first-year students. These findings may not be generalizable to students in other institutions, disciplines, or academic years. Future studies should consider multi-institutional or cross-sectional designs with larger and more diverse student populations to enhance external validity.

Secondly, the study relied on self-reported data, which may be subject to social desirability bias or personal preferences influenced by prior experiences. While student perceptions are critical in evaluating educational strategies, future research should include objective performance metrics [e.g., exam results, Objective Structured Clinical Examination (OSCE) scores] to triangulate findings.

Thirdly, although both PBL and TBL sessions were integrated with basic sciences topics, no formal matching of topic complexity was performed. It is possible that some topics used in TBL could be more engaging or easier to grasp than topics used in PBL. Moreover, the duration of PBL and TBL sessions differed; PBL was conducted over multiple sessions, while TBL was completed in a single 2.5-hour session. This difference may have influenced student engagement, retention, and outcomes. Future studies should consider using validated content complexity measures or faculty-rated difficulty scales to ensure comparability between topics assigned to each teaching modality. Moreover, peer evaluation was performed in both methodologies; students may not have been adequately trained in giving and receiving feedback, especially concerning professional behaviors. This might have affected the reliability of peer feedback and team satisfaction outcomes. Future research should incorporate structured feedback training modules to improve the quality and impact of peer evaluation. Additionally, the facilitators’ teaching styles and experience levels may have influenced the learning experience. While facilitators were trained and provided with evaluation guidelines, variability in facilitation may have introduced bias. Future studies should aim to standardize facilitator training and consider inter-rater reliability of facilitator evaluations. Additionally, the division of subject topics between PBL and TBL sessions was performed without following any formal method to assess the complexity level of topic. Even though topic selection was based on curriculum content and interdisciplinary consensus, it is possible that certain topics were either more or less complex than others, potentially influencing student outcomes. Future studies should use validated content difficulty metrics or faculty ratings to ensure comparability between instructional strategies. Additionally, the duration of PBL comprised of 3 sessions while TBL had only 1 session; these differences in the number of sessions could also influence the student’s performance and engagement in different strategies used.

The exclusion of three students due to their absences during required sessions or lack of prior PBL attendance introduces a potential selection bias. The reasons for non-attending might be systematically related to student engagement or perceptions of the methodologies, implicating the findings may represent a more motivated or compliant subset of the cohort. Future studies should explore strategies for managing missing data.

Despite these limitations, this study possesses several strengths. Its mixed-methods quasi-experimental design provides a comprehensive understanding by combining quantitative and qualitative aspects. The inclusion of a complete cohort of first-year BDS students enhances the relevance of the findings to this specific educational context. Furthermore, the use of pre-tested questionnaires and rigorous qualitative analysis contributes to the internal validity of the study’s findings. The study also provides valuable insights into the practical implementation and perceived efficacy of PBL and TBL within a specific dental education curriculum.

Conclusions

This study highlights the strengths of both PBL and TBL in enhancing student learning. PBL was valued for developing clinical reasoning, communication, and teamwork, while TBL was preferred for its structured format, efficient content coverage, and improved conceptual understanding. Given the complementary benefits, a hybrid model integrating PBL’s case-based discussions with TBL’s structured pre-reading, readiness tests, and application exercises could offer a balanced and effective approach. Implementing this model in early dental education may better support knowledge retention, critical thinking, and collaborative skills essential for clinical practice.

Acknowledgments

We are grateful to our students for helping with this study.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://amj.amegroups.com/article/view/10.21037/amj-24-158/rc

Data Sharing Statement: Available at https://amj.amegroups.com/article/view/10.21037/amj-24-158/dss

Peer Review File: Available at https://amj.amegroups.com/article/view/10.21037/amj-24-158/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://amj.amegroups.com/article/view/10.21037/amj-24-158/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethical Review Committee of the Women Medical and Dental College (ERC 42/2023). The students were informed regarding the process of the conduction. Verbal and written informed consent were obtained from all individual participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Parmelee DX, Michaelsen LK. Twelve tips for doing effective Team-Based Learning (TBL). Med Teach 2010;32:118-22. [Crossref] [PubMed]
2. Haidet P, Morgan RO, O'Malley K, et al. A controlled trial of active versus passive learning strategies in a large group setting. Adv Health Sci Educ Theory Pract 2004;9:15-27. [Crossref] [PubMed]
3. Sweet M, Michaelsen LK. Team-based learning in the social sciences and humanities: Group work that works to generate critical thinking and engagement. 1st ed. New York: Routledge; 2023.
4. Michaelsen LK, Knight AB, Fink LD. Team-based learning: A transformative use of small groups in college teaching. 1st ed. New York: Routledge; 2004.
5. Burgess A, van Diggele C, Roberts C, et al. Team-based learning: design, facilitation and participation. BMC Med Educ 2020;20:461. [Crossref] [PubMed]
6. Haidet P, Levine RE, Parmelee DX, et al. Perspective: Guidelines for reporting team-based learning activities in the medical and health sciences education literature. Acad Med 2012;87:292-9. [Crossref] [PubMed]
7. Koles PG, Stolfi A, Borges NJ, et al. The impact of team-based learning on medical students' academic performance. Acad Med 2010;85:1739-45. [Crossref] [PubMed]
8. Parmelee D, Michaelsen LK, Cook S, et al. Team-based learning: a practical guide: AMEE guide no. 65. Med Teach 2012;34:e275-87. [Crossref] [PubMed]
9. Amena M. The Role of Problem Based Learning in Engaging and Empowering Omani EAP Learners: An Exploratory Study. In: Arab World English Journal (AWEJ) Proceedings of 2nd MEC TESOL Conference; 2020.
10. Hmelo-Silver CE. Problem-based learning: What and how do students learn? Educ Psychol Rev 2004;16:235-66.
11. Shuler CF. Keeping the curriculum current with research and problem-based learning. J Am Coll Dent 2001;68:20-4.
12. Vernon DT, Blake RL. Does problem-based learning work? A meta-analysis of evaluative research. Acad Med 1993;68:550-63. [Crossref] [PubMed]
13. Iqbal Z. Problem based learning (PBL) in Pakistan: a systematic review. J Rehman Med Inst 2018;4:27-33.
14. Faisal R. Problem-based learning in comparison with lecture-based learning among medical students. J Pak Med Assoc 2016;66:650-3.
15. Dearnley C, Rhodes C, Roberts P, et al. Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change. Nurse Educ Today 2018;60:75-83. [Crossref] [PubMed]
16. Gera M, Rathod U, Karra-Aly A, et al. Team Based Learning Vs Problem Based Learning in Medical Education: A Systematic Review. East J Med Sci 2024;8:1-6.
17. Michaelsen LK, Sweet M. The essential elements of team‐based learning. New Dir Teach Learn 2008;7-27.
18. Burgess A, Bleasel J, Haq I, et al. Team-based learning (TBL) in the medical curriculum: better than PBL? BMC Med Educ 2017;17:243. [Crossref] [PubMed]
19. Jabbar HA, Jarrahi AH, Vamegh MH, et al. Effectiveness of the team-based learning (TBL) strategy on medical students' performance. J Taibah Univ Med Sci 2018;13:70-6. [Crossref] [PubMed]
20. Michaelsen LK. The Essential Elements of Team-Based Learning. In: Michaelsen LK, Sweet M, Parmelee DX. Team-Based Learning: Small Group Learning's Next Big Step. 1st ed. Jossey-Bass; 2008.
21. Kachabian S, Seyedmajidi S, Tahani B, et al. Effectiveness of educational strategies to teach evidence-based dentistry to undergraduate dental students: a systematic review. Evid Based Dent 2024;25:53-4. [Crossref] [PubMed]
22. Johnson DW, Johnson RT, Smith KA. Cooperative learning: Improving university instruction by basing practice on validated theory. J Excell Coll Teach 2014;25:85-118.
23. Mallery P, George D. SPSS for windows step by step. Allyn & Bacon, Inc.; 2000.
24. Lang B, Zhang L, Lin Y, et al. Team-based learning pedagogy enhances the quality of Chinese pharmacy education: a systematic review and meta-analysis. BMC Med Educ 2019;19:286. [Crossref] [PubMed]
25. McCoy L, Pettit RK, Kellar C, et al. Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach. J Med Educ Curric Dev 2018;5:2382120518765135. [Crossref] [PubMed]
26. Ellaway R, Masters K. AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Med Teach 2008;30:455-73. [Crossref] [PubMed]
27. Serin H. A comparison of teacher-centered and student-centered approaches in educational settings. Int J Soc Sci Educ Stud 2018;5:164-7.
28. Van Blankenstein FM, Dolmans DHJM, van der Vleuten CPM, et al. Which cognitive processes support learning during small-group discussion? The role of providing explanations and listening to others. Instr Sci 2011;39:189-204.
29. Hughes RGO’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. 2008.
30. Ricotta DN, Richards JB, Atkins KM, et al. Self-Directed Learning in Medical Education: Training for a Lifetime of Discovery. Teach Learn Med 2022;34:530-40. [Crossref] [PubMed]
31. Thalib M, Corebima AD, Ghofur A. Comparison on critical thinking skill and cognitive learning outcome among students of X grade with high and low academic ability in Ternate through Reading Questioning Answering (RQA) strategy. Jurnal Pendidikan Sains 2017;5:26-31.
32. Yunikawati NA, Tuanani MAM. TBL vs. PBL: Which is More Effective Model in Economics Learning? Jurnal Pendidikan Ekonomi Dan Bisnis (JPEB 2022;10:181-92.
33. Burgess A, Roberts C, Lane AS, et al. Peer review in team-based learning: influencing feedback literacy. BMC Med Educ 2021;21:426. [Crossref] [PubMed]
34. Farland MZ, Beck DE. Collaborative Learning Teams to Longitudinally Teach and Assess Teamwork Behaviors and Attitudes. Am J Pharm Educ 2019;83:7255. [Crossref] [PubMed]
35. van de Ridder JM, Stokking KM, McGaghie WC, et al. What is feedback in clinical education? Med Educ 2008;42:189-97. [Crossref] [PubMed]
36. English R, Brookes ST, Avery K, et al. The effectiveness and reliability of peer-marking in first-year medical students. Med Educ 2006;40:965-72. [Crossref] [PubMed]
37. Levi D, Askay DA. Group dynamics for teams. 6th ed. SAGE Publications; 2020.
38. Barrows HS, Tamblyn RM. Problem-based learning: An approach to medical education. New York: Springer Publishing Company; 1980.
39. Seymour A. A qualitative investigation into how problem-based learning impacts on the development of team-working skills in occupational therapy students. J Further High Educ 2013;37:1-20.
40. Hutchings S, Hall J, Lovelady B. Teamwork: A Guide to Successful Collaboration in Health & Social Care (Speechmark Editions). Routledge; 2003.
41. Prichard JS, Stratford RJ, Hardy C. Training students to work in teams: why and how? University of Southampton; 2004.
42. Sultana A, Riaz R, Tehseen I. Comparison of problem based learning with traditional teaching as perceived by the students of Rawalpindi Medical College. RMJ 2010;35:238-41.
43. Anwar K, Kashir J, Sajid MR, et al. Implementation of structured team-based review enhances knowledge consolidation and academic performance of undergraduate medical students studying neuroscience. Adv Physiol Educ 2020;44:232-8. [Crossref] [PubMed]
44. Ozgonul L, Alimoglu MK. Comparison of lecture and team-based learning in medical ethics education. Nurs Ethics 2019;26:903-13. [Crossref] [PubMed]