Home | Register | Login | Inquiries | Alerts | Sitemap |  


Advanced Search
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

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.

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.
jkm-46-2-132f1.gif
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.
jkm-46-2-132f2.gif
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%)
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%)
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
2.2. 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
4.2. 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.
jkm-46-2-132f3.gif
jkm-46-2-132f4.gif
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.
jkm-46-2-132f5.gif
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.
jkm-46-2-132f6.gif
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.

참고문헌

1. Dent J. A., Harden R. M.(2008). A practical guide for medical teachers. Seoul. Academypress.


2. Michaelsen L. K., Parmelee D. X., McMahon K., Levine R. E.(2019). Team-Based Learning for Health Professions Education. Team-Based Learning for Health Professions Education. Seoul. Academypress.


3. Huggett K. N., Jeffries W. B.(2019). An introduction to medical teaching. Yeungnam University Publication.


4. Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Team-based learning: design, facilitation and participation. BMC Med Educ, 20, 461. https://doi.org/10.1186/s12909-020-02287-y
crossref pmid pmc pdf

5. Hrynchak, P., & Batty, H. (2012). The educational theory basis of team-based learning. Medical Teacher, 34, 796-801. https://doi.org/10.3109/0142159X.2012.687120
crossref pmid

6. Koles, P. G., Stolfi, A., Borges, N. J., Nelson, S., & Parmelee, D. X. (2010). The Impact of Team-Based Learning on Medical Students’. Academic Performance: Academic Medicine, 85, 1739-1745. https://doi.org/10.1097/ACM.0b013e3181f52bed


7. Ofstad, W., & Brunner, L. J. (2013). Team-Based Learning in Pharmacy Education. Am J Pharm Educ, 77, 70. https://doi.org/10.5688/ajpe/77470
crossref pmid pmc

8. Hur, Y., Cho, A.-R., & Kim, S. (2013). Review on the administration and effectiveness of team-based learning in medical education. Korean J Med Educ, 25, 271-277. https://doi.org/10.3946/kjme.2013.25.4.271
crossref pmid pmc

9. Parmelee, D. X., & Michaelsen, L. K. (2010). Twelve tips for doing effective Team-Based Learning (TBL). Medical Teacher, 32, 118-122. https://doi.org/10.3109/01421590903548562
crossref pmid

10. Fang, Y., Liu, L., Nie, L., Xiao, M., Lin, Q., & Guo, N., et al (2021). Application of the Hybrid CBL+TBL Method in Internal Medicine Teaching Practice of TCM Universities. Int. J. Chin. Med, 5, 48-52. https://doi.org/10.11648/j.ijcm.20210503.12
crossref

11. James, M., Baptista, A. M. T., Barnabas, D., Sadza, A., Smith, S., & Usmani, O., et al (2022). Collaborative case-based learning with programmatic team-based assessment: a novel methodology for developing advanced skills in early-years medical students. BMC Med Edu, 22, 81. https://doi.org/10.1186/s12909-022-03111-5
crossref pmid pmc pdf

12. Goolsarran, N., Hamo, C. E., Lane, S., Frawley, S., & Lu, W.-H. (2018). Effectiveness of an interprofessional patient safety team-based learning simulation experience on healthcare professional trainees. BMC Med Educ, 18, 192. https://doi.org/10.1186/s12909-018-1301-4
crossref pmid pmc pdf

13. Burgess, A., Bleasel, J., Hickson, J., Guler, C., Kalman, E., & Haq, I. (2020). Team-based learning replaces problem-based learning at a large medical school. BMC Med Educ, 20, 492. https://doi.org/10.1186/s12909-020-02362-4
crossref pmid pmc pdf

14. Alimoglu, M. K., Yardım, S., & Uysal, H. (2017). The effectiveness of TBL with real patients in neurology education in terms of knowledge retention, in-class engagement, and learner reactions. Adv Physiol Educ, 41, 38-43. https://doi.org/10.1152/advan.00130.2016
crossref pmid

15. Dickinson, B. L., Lackey, W., Sheakley, M., Miller, L., Jevert, S., & Shattuck, B. (2018). Involving a real patient in the design and implementation of case-based learning to engage learners. Adv Physiol Educ, 42, 118-122. https://doi.org/10.1152/advan.00174.2017
crossref pmid

16. Escribano, S., Juliá-Sanchis, R., García-Sanjuán, S., Congost-Maestre, N., & Cabañero-Martínez, M. J. (2021). Psychometric properties of the attitudes towards medical communication scale in nursing students. PeerJ, 9, e11034. https://doi.org/10.7717/peerj.11034
crossref pmid pmc pdf

17. Yoon, T. Y., Lee, J. K., & Oh, I. H. (2013). Changes in the clerkship in Korean medical schools: The prospect of a student internship. Korean Medl Educ Rev, 15, 75-81.
crossref pdf

18. Anderson, H., Sweeney, C., Perry, R., Vaquero, J., & Ison, H. (2020). Patient-centered team-based learning in pre-clinical curriculum supporting the application of knowledge to real-world clinical experience. Med Sci Educ, 30, 65-68. https://doi.org/10.1007/s40670-019-00872-5
crossref pmid pmc pdf

19. Cevik, A. A., ElZubeir, M., Abu-Zidan, F. M., & Shaban, S. (2019). Team-based learning improves knowledge and retention in an emergency medicine clerkship. Int J Emerg Med, 12, 6. https://doi.org/10.1186/s12245-019-0222-2
crossref pmid pmc pdf

20. Warrier, K. S., Schiller, J. H., Frei, N. R., Haftel, H. M., & Christner, J. G. (2013). Long-term gain after team-based learning experience in a pediatric clerkship. Teach Learn Med, 25, 300-305. https://doi.org/10.1080/10401334.2013.827975
crossref pmid

21. Braeckman, L., ‘TKint, L., Bekaert, M., Cobbaut, L., & Janssens, H. (2014). Comparison of two case-based learning conditions with real patients in teaching occupational medicine. Med Teach, 36, 340-346. https://doi.org/10.3109/0142159X.2014.887833
crossref pmid

22. Lim, C., Han, H., Hong, J., & Kang, Y. (2016). 2016 Competency modeling for doctor of Korean medicine & application plans. J Korean Med, 37, 101-113. https://doi.org/10.13048/jkm.16010
crossref

23. Lee, H. (2022). Modelling of the major competencies and developing of competency indicatives for Korean medicine colleges. J Teach Learn Research, 15, 57-84.


24. Joo, H. (2023). Most positive responses team-based learning applied to Korean Medicine subjects. Akomnews https://www.akomnews.com/bbs/board.php?bo_table=news&wr_id=52254


25. Reimschisel, T., Herring, A. L., Huang, J., & Minor, T. J. (2017). A systematic review of the published literature on team-based learning in health professions education. Med Teach, 39, 1227-1237. https://doi.org/10.1080/0142159X.2017.1340636
crossref pmid

26. Ivankova, N. V., Creswell, J. W., & Stick, S. L. (2006). Using Mixed-Methods Sequential Explanatory Design: From Theory to Practice. Field Methods, 18, 3-20. https://doi.org/10.1177/1525822X05282260
crossref pdf

27. Kolb, A. Y., & Kolb, D. A. (2009). Experiential learning theory: A dynamic, holistic approach to management learning, education and development. The SAGE handbook of management learning, education and development, 7, 42-68.
crossref

28. Wang, B.-R., Choi, I. Y., Kim, K.-J., & Kwon, Y. D. (2013). Use of traditional Korean Medicine by patients with musculoskeletal disorders. PLoS ONE, 8, e63209. https://doi.org/10.1371/journal.pone.0063209
crossref pmid pmc

29. Michaelsen L. K., Knight A. B., Fink L. D.(2014). Team-Based Learning: A transformative use of small groups in college teaching. Virginia. Stylus Publishing.


30. Lee, S. (2005). Dimension classification and questionnaire design criteria for reaction evaluation of educational/training programs. Journal of Educational Technology, 21, 187-214.
crossref

31. Fatmi, M., Hartling, L., Hillier, T., Campbell, S., & Oswald, A. E. (2013). The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No 30. Med Teach, 35, e1608-e1624. https://doi.org/10.3109/0142159X.2013.849802
crossref pmid

32. Zgheib, N. K., Simaan, J. A., & Sabra, R. (2011). Using team–based learning to teach clinical pharmacology in medical school: Student satisfaction and improved performance. The Journal of Clinical Pharma, 51, 1101-1111. https://doi.org/10.1177/0091270010375428
crossref pmid

33. Cho, E., Jung, H.-J., & Leem, J. (2022). Peer role-play in a College of Korean Medicine to improve senior students’ competencies in patient care and communication: A case analysis and proposal for a model. J Korean Med, 43, 49-60. https://doi.org/10.13048/jkm.22030
crossref

34. Elendu, C., Amaechi, D. C., Okatta, A. U., Amaechi, E. C., Elendu, T. C., & Ezeh, C. P., et al (2024). The impact of simulation-based training in medical education: A review. Medicine (Baltimore), 103(27), e38813. https://doi.org/10.1097/MD.0000000000038813
crossref pmid pmc

35. Jha, V., Quinton, N. D., Bekker, H. L., & Roberts, T. E. (2009). Strategies and interventions for the involvement of real patients in medical education: a systematic review. Med Educ, 43, 10-20. https://doi.org/10.1111/j.1365-2923.2008.03244.x
crossref pmid pmc

36. Sung, S.-H., Sim, H.-J., Kim, E.-G., Sung, A. D., Park, J.-Y., & Shin, B.-C., et al (2018). The utilization of medical devices by traditional Korean Medicine doctors investigated through traditional Korean Medicine clinical studies. Evid Based Complement Alternat Med, 2018, e3987019. https://doi.org/10.1155/2018/3987019
crossref pmid pmc pdf

37. Kim, J. Y., & Pham, D. D. (2019). Sasang Constitutional Medicine as a Holistic Tailored Medicine. Evid Based Complement Alternat Med, 6, 11-19. https://doi.org/10.1093/ecam/nep100
crossref pmid pmc pdf

38. Kim, T.-H., Alraek, T., Bian, Z.-X., Birch, S., Bovey, M., & Lee, J., et al (2021). Clinical reasoning in traditional medicine exemplified by the clinical encounter of Korean medicine: A narrative review. Integr Med Res, 10, 100641. https://doi.org/10.1016/j.imr.2020.100641
pmid

39. Cho, E., Lee, D.-E., Lee, D., & Jung, H.-J. (2024). Barriers and future improvements of workplace-based learning in Korean medicine clinical clerkship: perspectives of graduates. BMC Med Educ, 24, 566. https://doi.org/10.1186/s12909-024-05288-3
crossref pmid pmc pdf

TOOLS
PDF Links  PDF Links
Full text via DOI  Full text via DOI
PubReader  PubReader
Download Citation  Download Citation
  Print
Share:      
METRICS
0
Crossref
137
View
11
Download
Editorial office contact information
3F, #26-27 Gayang-dong, Gangseo-gu Seoul, 157-200 Seoul, Korea
The Society of Korean Medicine
Tel : +82-2-2658-3627   Fax : +82-2-2658-3631   E-mail : skom1953.journal@gmail.com
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Developed in M2PI