The effects of online Team-Based Learning on undergraduate nursing students’ performance, attitudes and accountability during COVID-19 pandemic

The effects of online Team-Based Learning on undergraduate nursing students’ performance, attitudes and accountability during COVID-19 pandemic



Team-Based Learning, nursing students, distance education, COVID-19, accountability


Background and aim: The COVID-19 pandemic forced many institutions to move Team-Based Learning to an online format. The primary aim of this study is to examine the performance of undergraduate nursing students on tRAT and iRAT during online TBL. The secondary aims are to evaluate the students’ attitudes and their accountability, preferences and satisfaction with online TBL.

Methods: The study employed a one-group pretest-posttest quasi-experimental design. The primary outcome was evaluated by comparing the students’ average scores in the tRAT versus the iRAT in each online TBL session. The secondary outcomes were evaluated through the questionnaire designed by Parmelee et al. (2009) and the Team-Based Learning Student Assessment Instrument (TBL-SAI) (Mennenga, 2012).

Results: A statistically significant improvement was identified between tRAT and iRAT performances in all online TBL sessions (p<0.001). Students’ satisfaction with team experience showed a statistically significant increase (p=0.003). Participants considered the peer evaluation to be fair (p<0.001), although it didn’t encourage them to study more (p=0.028). Finally, students felt they were able to make the right decisions (p<0.001).

The mean scores for accountability (m=30±3.7) and preferences for TBL (m=51.8±6.3) were higher than their neutral values (n=24; n=48). Students’ satisfaction was neutral (m=27.8±5, n=27).


In online TBL, teamwork has improved individual performances and has been appreciated by the participants. The online TBL had a positive effect on the accountability of students who preferred it to frontal lectures.


Seemiller C, Grace, M.Generation Z: Educating and Engaging the Next Generation of Students. About Campus 2017; 22 (3): 21–26. doi:10.1002/abc.21293.

Chicca J, Shellenbarger T. Connecting with Generation Z: Approaches in Nursing Education. Teach Learn Nurs 2018; 13 (3): 180-184. doi:10.1016/j.teln.2018.03.008.

Ghezzi JFSA, Higa EFR, Lemes MA, Marin MJS. Strategies of active learning methodologies in nursing education: an integrative literature review. Rev Bras Enferm 2021: 24; 74 (1): e20200130. doi:10.1590/0034-7167-2020-0130.

Culha I. Active learning methods used in nursing education. Journal of Pedagogical Research 2019: 3 (2), 74-86. doi:10.33902/JPR.2019254174.

Ozbay O, Cinar S. Effectiveness of flipped classroom teaching models in nursing education: A systematic review. Nurse Educ Today 2021; 102, 104922. doi:10.1016/j.nedt.2021.104922.

Parmelee DX, Michaelsen L, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no. 65. Med Teach 2012; 34 (5): e275-87. doi:10.3109/0142159X.2012.651179.

Alberti S, Motta P, Ferri P, Bonetti L. The effectiveness of team-based learning in nursing education: A systematic review. Nurse Educ Today 2021; 97: 104721. doi:10.1016/j.nedt.2020.104721.

Considine J, Berry D, Allen J, Hewitt N, Oldland E, Sprogis SK, Currey J. Team-based learning in nursing education: A scoping review. J Clin Nurs 2021; 30 (7-8): 903-917. doi:10.1111/jocn.15599.

Jakobsen KV, Knetemann M. Putting Structure to Flipped Classrooms Using Team-Based Learning. International Journal of Teaching and Learning in Higher Education 2017; 29: 177-185.

Malik AS, Malik RH. Twelve tips for conducting team-based learning session online in synchronous setting. Med Teach 2021; 9: 1-8. doi:10.1080/0142159X.2021.1910642.

Arcila Hernández LM, Zamudio KR, Drake AG, Smith MK. Implementing team-based learning in the life sciences: A case study in an online introductory level evolution and biodiversity course. Ecol Evol 2020; 11 (8): 3527-3536. doi:10.1002/ece3.6863.

Wong P, Jumat MR, Lee ICJ et al. Redesigning team-based learning facilitation for an online platform to deliver preclinical curriculum: A response to the COVID-19 pandemic [version 1]. MedEdPublish 2020; 9: 135. doi:10.15694/mep.2020.000135.1.

Takizawa PA, Honan L, Brissette D, Wu BJ, Wilkins KM. Teamwork in the Time of COVID-19. FASEB Bioadv 2020; 17;3(3):175-181. doi:10.1096/fba.2020-00093.

Sannathimmappa MB, Nambiar V, Aravindakshan R, Kumar A. Are Online Synchronous Team-Based Learning (TBL) pedagogy effective?: Perspectives from a study on medical students in Oman. J Adv Med Educ Prof 2022; 10 (1): 12–21. doi:10.30476/JAMP.2021.92361.1481.

Al‐Neklawy AF, Ismail AS. Online anatomy team‐based learning using blackboard collaborate platform during COVID‐19 pandemic. Clin Anat 2022; 35: 87–93. doi:10.1002/ca.23797.

Govindarajan S, Rajaragupathy S. Online team based learning in teaching Biochemistry for first year MBBS students during COVID-19 pandemic. Biochem Mol Biol Educ 2022; 50 (1): 124-129. doi:10.1002/bmb.21598.

Clark et al. Off to On: Best Practices for Online Team-Based Learning™. Proceedings of the Team-Based Learning™ Collaborative (TBLC) conference, March 2018; San Diego, CA.

Parmelee DX, DeStephen D, Borges NJ. Medical students’ attitudes about team-based learning in a pre-clinical curriculum. Med Educ Online 2009; 14: 1. doi:10.3885/meo.2009.Res00280.

Mennenga H. Development and Psychometric Testing of the Team-Based Learning Student Assessment Instrument. Nurse Educator 2012; 37 (4): 168-172. doi:10.1097/NNE.0b013e31825a87cc.

Keshmiri F, Rahmati A, Ghafarrahimi Amin A, Faezi T. Validating and Assessing the Reaction of Medical Students Toward Team-Based Learning. Acta Med Iran 2016; 54 (12): 806-811.

Faezi ST, Moradi K, Ghafar Rahimi Amin A, Akhlaghi M, Keshmiri F. The effects of team-based learning on learning outcomes in a course of rheumatology. J Adv Med Educ Prof 2018; 6 (1): 22-30.

Ngoc PN, Cheng CL, Lin YK, Wu MS, Chu JS, Tang KP. A meta-analysis of students' readiness assurance test performance with team-based learning. BMC Med Educ 2020; 20 (1): 223. doi:10.1186/s12909-020-02139-9.

Burgess A, van Diggele C, Roberts C, Mellis C. Team-based learning: design, facilitation and participation. BMC Med Educ 2020; 20(Suppl 2): 461. doi:10.1186/s12909-020-02287-y.

Daou D, Sabra R, Zgheib NK. Factors That Determine the Perceived Effectiveness of Peer Feedback in Collaborative Learning: a Mixed Methods Design. Med Sci Educ 2020; 30 (3): 1145-1156. doi:10.1007/s40670-020-00980-7.

Göktepe N, Türkmen E, Zeybekoğlu Z, Yalçin B. Use of Team-Based Learning in a Nursing Leadership Course: An Action Research Study. Nurse Educ 2018; 43 (6): E1-E4. doi:10.1097/NNE.0000000000000500.

Burgess A, Roberts C, Lane AS, et al. Peer review in team-based learning: influencing feedback literacy. BMC Med Educ 2021; 21 (1): 426. doi:10.1186/s12909-021-02821-6.

Branson S, Boss L, Fowler D. Team-based learning: application in undergraduate baccalaureate nursing education. Journal of Nursing Education and Practice 2016; 6 (4): 59-64. doi:10.5430/jnep.v6n4p59.

Parthasarathy P, Apampa B, Manfrin A. Perception of team-based learning using the team-based learning student assessment instrument: an exploratory analysis within pharmacy and biomedical students in the United Kingdom. J Educ Eval Health Prof 2019; 16:23. doi:10.3352/jeehp.2019.16.23.

Sharma A, Janke KK, Larson A, Peter WS. Understanding the early effects of team-based learning on student accountability and engagement using a three session TBL pilot. Curr Pharm Teach Learn 2017; 9(5): 802-807. doi:10.1016/j.cptl.2017.05.024.

Nation LM, Tweddell S, Rutter P. The applicability of a validated team-based learning student assessment instrument to assess United Kingdom pharmacy students' attitude toward team-based learning. J Educ Eval Health Prof 2016; 13: 30. doi:10.3352/jeehp.2016.13.30.

Ibrahim ME. Team-based learning student assessment instrument (TBL-SAI) for assessing students acceptance of TBL in a Saudi medical school. Psychometric analysis and differences by academic year. Saudi Med J 2020; 41 (5): 542-547. doi:10.15537/smj.2020.5.25054.

Carson R, Mennenga H. Team-Based Learning and the Team-Based Learning Student Assessment Instrument (TBL-SAI): A Longitudinal Study of Master of Occupational Therapy Students' Changing Perceptions. Am J Occup Ther 2019; 73 (4): 7304205010p1-7304205010p7. doi:10.5014/ajot.2019.032623.

Teixeira Rda C; Magalhaes AB, Palacios VR, Teixeira Mde M. Physiotherapy Students' Perceptions of Team-Based Learning Using the Team-Based Learning Student Assessment. Journal of Education and Learning 2019; 8 (4): 43-51. doi:10.5539/jel.v8n4p43.

Livingston B, Lundy M, Harrington S. Physical therapy students' perceptions of team-based learning in gross anatomy using the Team-Based Learning Student Assessment Instrument. J Educ Eval Health Prof 2014; 11: 1. doi:10.3352/jeehp.2014.11.1.

Macauley K, Dirkes A. Team-Based Learning at the End of a Physical Therapy Curriculum. J Allied Health 2017; 46 (4): e67-e69.

Lochner L, Girardi S, Pavcovich A, Meier H, Mantovan F, Ausserhofer D. Applying interprofessional Team-Based Learning in patient safety: a pilot evaluation study. BMC Med Educ 2018; 18 (1): 48. doi:10.1186/s12909-018-1164-8.

Fatmi M, Hartling L, Hillier T, Campbell S, Oswald AE. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach 2013; 35 (12): e1608-e1624. doi:10.3109/0142159X.2013.849802.

Lubeck P, Tschetter L, Mennenga H. Team-based learning: an innovative approach to teaching maternal-newborn nursing care. J Nurs Educ 2013; 52(2): 112-115. doi:10.3928/01484834-20130121-02.

Chunta K, Shellenbarger T, Chicca J. Generation Z Students in the Online Environment: Strategies for Nurse Educators. Nurse Educ 2021; 46 (2): 87-91. doi:10.1097/NNE.0000000000000872.







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The effects of online Team-Based Learning on undergraduate nursing students’ performance, attitudes and accountability during COVID-19 pandemic. Acta Biomed [Internet]. 2022 Dec. 16 [cited 2024 Jun. 17];93(6):e2022346. Available from:

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