A comparison of team-based learning and lecture-based learning on clinical reasoning and classroom engagement: a cluster randomized controlled trial

Abstract

Background The lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students’ lack of ability in clinical reasoning. Team-based learning (TBL) was proposed to improve the students’ ability in clinical reasoning as it is applying a course concept of real complex scenarios. In this study, we aimed to assess and compare the effects of TBL and LBL of postpartum hemorrhage topics on the clinical reasoning and classroom engagement of midwifery students in Indonesia. Methods We conducted a cluster randomized controlled trial to compare the effects of TBL and LBL. The unit was schools and random allocation was conducted using a simple random sampling method (i.e., coin flipping). There was 1 cluster in the intervention group (n = 62 students) and 1 cluster in the control group (n = 53 students). The students in the intervention group participated in a TBL class (90 min) three times, whereas the students in the control group attended an LBL class on postpartum hemorrhage topics. The primary outcome was the clinical reasoning on postpartum hemorrhage score measured at pre-test, post-test, and 2 weeks post-test. The secondary outcome was Classroom Engagement Survey (CES) score measured after each class finished. We used an unpaired t-test to evaluate the differences between the two groups. The baseline characteristics of the participants were compared using standardized difference. Results We evaluated a total of 115 participants. Regarding the baseline characteristics, there was a small difference in the age, Grade Point Average and knowledge at pre-test between the intervention and control groups. The mean clinical reasoning on postpartum hemorrhage scores were significantly higher in the TBL students than in the LBL students at post-test (p < .001; Cohen’s d = 1.41) and 2 weeks post-test (p < .001; Cohen’s d = 1.50). The CES showed a significantly higher in the intervention group than in the control group. Conclusions TBL is an effective learning method for enhancing the clinical reasoning ability of students. This learning method allows for more independent and active learning. Having a strong background knowledge, and discussing cases comprehensively with peers can sharpen the clinical reasoning ability of students.

Team-based learning vs. lecture-based learning in nursing: A systematic review of randomized controlled trials

“…Ten studies published from 2011 to 2022 were identified for inclusion. Concerning the countries of the included studies, 4 of them were set in China ( 21 , 39 – 41 ), 2 in Indonesia ( 10 , 20 ), 2 in Korea ( 13 , 14 ), one in Iran ( 42 ), and another one in Brazil ( 11 ). A total number of 1,009 participants were enrolled, and the sample size in each study ranged from a minimum of 25 ( 11 ) to a maximum of 183 ( 13 ) students.…”

“…For educational level, eight studies were of undergraduate students ( 10 , 11 , 13 , 14 , 20 , 39 , 41 , 42 ), one was of vocational college students ( 40 ), and another one was of secondary school students ( 21 ). As for concerned topics, two studies featured in midwifery postpartum hemorrhage nursing ( 20 , 21 ), two were about surgery nursing ( 11 , 41 ), and the others were about pulmonary disease nursing ( 14 ), nursing core competency ( 13 ), emergency and intensive care nursing ( 40 ), community health care nursing ( 21 ), mental health and psychiatric disorders nursing ( 42 ), and geriatric nursing ( 39 ).…”

“…Recently, there have been a growing number of studies regarding the effectiveness of TBL in health professions {i.e., pharmacy ( 7 ), medicine ( 8 ), midwifery ( 9 ), and nursing education ( 10 – 14 ). A scoping review showed that TBL had been applied in nursing education over the last decade and reported outcomes involving students' knowledge/academic performance, student experience, satisfaction, or perceptions of TBL, student engagement, behaviors/attitudes toward TBL, and teamwork, team performance/collective efficacy ( 15 ).…”

“…However, their results were conflicted. Some researchers ( 12 , 16 – 18 ) found TBL was not superior to a traditional lecture, while others found excellent results regarding TBL ( 10 , 11 , 13 , 14 , 19 , 20 ). Among these studies, some were quasi-experimental designs ( 19 , 21 – 25 ), some were one-group pre- and post-test designs ( 26 – 30 ), and some were cross-sectional investigations ( 31 – 35 ).…”

Thriving Online: A Guide for Busy Educators

“…Online learning environments such as Google Meet, Microsoft Teams, or Zoom allow students to engage in small, face-to-face, peer learning groups. Below are three evidence-based guidelines for effective group sessions (Burgess et al, 2020;Thrall et al, 2016;Ulfa et al, 2021):…”