Implementation and Evaluation of Modified Team-Based Learning Involving a Real Patient in Korean Medicine Education: A Mixed-Method Study

Eunbyul Cho; Do-Eun Lee; Sang Yun Han; Jungtae Leem; Cho, Eunbyul; Lee, Do-Eun; Han, Sang Yun; Leem, Jungtae

doi:10.13048/jkm.25024

JKM > Volume 46(2); 2025 > Article

Cho, Lee, Han, and Leem: Implementation and Evaluation of Modified Team-Based Learning Involving a Real Patient in Korean Medicine Education: A Mixed-Method Study

Original Article

The Journal of Korean Medicine 2025; 46(2): 132-152.

Published online: June 1, 2025

DOI: https://doi.org/10.13048/jkm.25024

Implementation and Evaluation of Modified Team-Based Learning Involving a Real Patient in Korean Medicine Education: A Mixed-Method Study

Eunbyul Cho¹^{, 2}^{, §}

, Do-Eun Lee³^{, §}

, Sang Yun Han⁴^{, *}

, Jungtae Leem¹^{, 2}^{, 5}^{, *}

¹Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

²Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Republic of Korea

³Department of Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

⁴College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea

⁵Department of Il-won Integrated Medicine, Wonkwang University Korean Medicine Hospital, Iksan, Republic of Korea

Correspondence to: Sang Yun Han, College of Korean Medicine, Daejeon University, #62 Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea, Tel: +82-42-280-2634, E-mail: gobesthan@gmail.com

Correspondence to: Jungtae Leem, College of Korean Medicine, Wonkwang University, #460 Iksan-daero, Iksan 54538, Republic of Korea, Tel: +82-63-8506914, E-mail: julcho@naver.com

§ These authors contributed equally to this work.

Received April 16, 2025 Revised May 16, 2025 Accepted May 22, 2025

Abstract

Objectives

Team-based learning (TBL) expands in healthcare education to enhance students’ competency in self-directed learning, effective communication, collaboration, clinical reasoning, and problem-solving in clinical settings. This study investigated students’ perspectives in Korean Medicine (KM) regarding their clinical experience with a real patient in a pilot TBL module using a mixed-methods approach.

Methods

A 3-hour TBL session was conducted with 36 final-year KM students divided into eight groups of 4–5 students each. The students conducted a medical interview and performed physical examinations and clinical reasoning for the patient with neck pain. Students were then surveyed regarding their satisfaction with TBL, relevance of the program’s objectives and content, and suggestions for program improvement. Four students from different teams were interviewed to explore their experiences in the TBL class, and a qualitative thematic analysis was conducted.

Results

Eleven students (31%) completed questionnaires. All students found TBL to be beneficial and satisfactory and considered it highly pertinent to their future duties. Interacting with a real patient facilitated learning, as students identified their weaknesses. Through team-based care, students actively engaged in discussions about clinical reasoning and treatment plans, thereby expanding their perspectives on patient care through their peers. The group activities reflected the characteristics of traditional medical practice, in which diagnosis and treatment might be timely completed in primary care, with multiple therapeutic approaches available for the same diagnosis. The students proposed promoting pre-learning, modifying group composition methods, extending class time, and modifying feedback methods using post-it notes to improve the TBL module.

Conclusion

Group practice with a real patient facilitates self-directed learning and expands students’ understanding of clinical reasoning and perspectives on patient care through live discussions. The pilot TBL module should be included in KM curricula to ensure students’ sufficient experience in decision-making and communication before practicing individually as licensed healthcare providers.

Keywords: clinical practice, real patient, student reaction, team-based learning, mixed-methods research

Supplementary materials

jkm-46-2-132-Supplementary-Table-1.pdf

jkm-46-2-132-Supplementary-Table-2.pdf

jkm-46-2-132-Supplementary-Table-3,4.pdf

jkm-46-2-132-Supplementary-Table-5.pdf

Fig. 1

Comparison of traditional and modified team-based learning (TBL) processes. The modified TBL incorporates real patient interaction and emphasizes clinical application through rotational group questioning for physical examination and review of systems. Time allocations are shown for each phase.

RAT, readiness assurance test.

Fig. 2

Schematic diagram of team-based learning with a real patient and actual classroom setup. Students who want to ask questions to the patient (represented by purple in the figure) take turns coming to the patient’s bed, asking questions, and then returning to the group.

P, poster presentation used for group discussion, is shown in the photo on the right.

Table 1

Students’ Reactions to the TBL Program (N=11)

Categories	Questions	Strongly disagree	Disagree	Agree	Strongly agree
Program objectives and content	The TBL contents met the stated objectives.	0 (0%)	0 (0%)	3 (27.3%)	8 (72.7%)
	The lesson content was effectively organized.	0 (0%)	0 (0%)	4 (36.4%)	7 (63.6%)
	The lesson content was difficult.	0 (0%)	3 (27.3%)	8 (72.7%)	0 (0%)

Program materials	The materials used were appropriate for the purpose of the course.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)
	The handouts for teaching and learning (manuals) were organized in an easy-to-understand manner.	0 (0%)	0 (0%)	7 (63.6%)	4 (36.4%)
	There were clear instructions for using the program materials.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)

Teaching methods and media use	The visual aids helped me understand the lesson content.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)
Teaching methods and media use	The teaching method was effective in learning the lesson content.	0 (0%)	0 (0%)	7 (63.6%)	4 (36.4%)

Teachers and learning facilitators	The teacher presented the lesson clearly.	0 (0%)	0 (0%)	4 (36.4%)	7 (63.6%)
	The teacher responded appropriately to the learners’ questions.	0 (0%)	0 (0%)	3 (27.3%)	8 (72.7%)
	The teacher controlled the classroom situation well.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)

Teaching and learning activities	Teaching and learning activities were relevant to the lesson objectives.	0 (0%)	0 (0%)	4 (36.4%)	7 (63.6%)
	Group discussions helped students exchange ideas.	0 (0%)	0 (0%)	8 (72.7%)	3 (27.3%)
	The assignments helped me understand the program content.	0 (0%)	0 (0%)	4 (36.4%)	7 (63.6%)

Timing and duration of the program	The duration of the class was sufficient to learn the program content.	0 (0%)	1 (9.1%)	6 (54.5%)	4 (36.4%)
	The timing of the class was appropriate for the program objectives.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)
	There was enough time allotted for practicing the lesson content.	0 (0%)	5 (45.5%)	6 (54.5%)	0 (0%)

Education, training environment	The classroom environment was conducive to learning.	0 (0%)	1 (9.1%)	6 (54.5%)	4 (36.4%)
	Environmental conditions (e.g., comfort, temperature, and noise) were conducive to learning.	0 (0%)	0 (0%)	8 (72.7%)	3 (27.3%)
	The space for classroom activities was adequate.	0 (0%)	0 (0%)	6 (54.5%)	5 (45.5%)

Expectations for learning transfer	The training program is related to the job (KM doctor).	0 (0%)	0 (0%)	2 (18.2%)	9 (81.8%)
Overall evaluation	The TBL program was overall beneficial.	0 (0%)	0 (0%)	3 (27.3%)	8 (72.7%)
Overall evaluation	I am overall satisfied with the TBL program.	0 (0%)	0 (0%)	4 (36.4%)	7 (63.6%)

Data are presented as frequency (%).

Table 2

General Characteristics of Interview Participants

Participant	Sex	Age	Experience of real patient care	Previous TBL experience
A	Female	24	No	No
B	Male	26	No	No
C	Male	24	No	No
D	Male	24	Yes^*	No

* Approximately 30 patients in medical outreach from the community.

Table 3

Theme Analysis of the TBL Program Experience

Theme	Subtheme
1. Motivation: Being aware of the gap between what should and cannot do
2. Expanding perspectives through team practice	2.1. Heated debate on clinical reasoning
2. Expanding perspectives through team practice	2.2. Learning different approaches on patient care
3. Difficulty setting a specific treatment plan
4. Strategies for patient-involved TBL	4.1. More opportunities to interact with patients with various diseases
4. Strategies for patient-involved TBL	4.2. Facilitating team learning activities

Table 4

Data Convergence Matrix on the Effectiveness and Future Improvements of the Pilot TBL Program

Topic	Quantitative data	Qualitative data	Data convergence label
Students’ perceptions of the teaching method	All respondents agreed that the teaching method was closely related to the learning objectives.	Interview Theme 1: Motivation: Being aware of the gap between what should and cannot do “After the TBL, one member in our group brought acupuncture, and we got together in a room or something, and we practiced the needles on each other. Yes, we were naturally motivated to do it that way.” (Participant 2) Interview Theme 2: Expanding perspectives through team practice “There were a lot of different perspectives, even on the same diagnosis.” (Participant 4) “I thought, ‘Why would I suspect this disease? It doesn’t matter at all.’ But after listening to the group member’s explanation, it was helpful because I thought, ‘Ah, I should check this out.’” (Participant 2)	Confirm
Difficulties during TBL	Eight respondents found the pilot TBL content challenging, while three disagreed.	Interview “We listed several diagnoses, like strain and sprain of cervical spine, rotator cuff tendinitis, this and that, but I was actually not sure.” (Participant 1) “It was challenging to create treatment plans because I had not really thought about the treatment duration, for example, whether I can apply taping to this patient or if I’m going to do wet cupping, the appropriate amount, the number of points to target, and the cup size to use. So it was difficult to decide on the details, but also whether it’s appropriate to do wet cupping here, target points, and I think it was the most difficult to determine whether it’s appropriate, even though I looked up clinical cases and publications and textbooks.” (Participant 3)	Mixed
Lack of time	Five out of 11 respondents responded that the time allotted for practicing the content (activity during the TBL) was insufficient.	Open answers from survey “Probably the time they set for real clinical practice, but it’s not enough.” (Respondent 2) Interview “Time was tight when we set treatment plans. We had to conduct clinical reasoning, pattern identification, planning treatment with evidence. So, we relied on a group member who was confident.” (Participant 2)	Confirm

TBL, team-based learning.

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