Team-Based Learning (TBL) is a collaborative teaching method in which students utilize course content to solve challenging problems. A modified version of TBL is used at the University of Louisville School of Medicine. Students complete questions on the Individual Readiness Assurance Test (iRAT) then gather in pre-assigned groups to retake the quiz, given time to utilize their learning resources and discuss each of the questions (Team Readiness Assurance Test-tRAT). Following this discussion, students take an Individual Summative Assessment Test (iSAT) with new questions at a similar cognitive level and content focus. While educational gains of TBL have been shown, student evaluations negatively assessed the teaching method with complaints regarding question difficulty and stress levels. Thus, during implementation of TBL in the School of Dentistry, three main changes were made: (1) The contribution of TBL to the overall grade was reduced (2) TBL questions were cognitively aligned with unit exam questions, and (3) Scratch-off, lottery response cards were used to create a fun, game-like environment. This revised TBL format, compared to the original format, resulted in similar student performance during iRAT and tRAT sessions. However, the revised, low-stress format had significantly higher scores on the iSAT (n=119-161, p <.05). Furthermore, students participating in the revised TBL format reported higher effectiveness of the learning format, higher levels of perceived fairness, and lower stress levels. These results suggest that the qualitative experience of students may be an important consideration that should be carefully evaluated during implementation of a new teaching technique.