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

Article information

J Korean Med. 2025;46(2):132-152
Publication date (electronic) : 2025 June 1
doi : https://doi.org/10.13048/jkm.25024
Eunbyul Cho1,2,§orcid_icon, Do-Eun Lee3,§orcid_icon, Sang Yun Han4,orcid_icon, Jungtae Leem1,2,5,orcid_icon
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 2025 April 16; Revised 2025 May 16; Accepted 2025 May 22.

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
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.

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

General Characteristics of Interview Participants

Theme Analysis of the TBL Program Experience

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

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

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Article information Continued

Fig. 1

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

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%)
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.

 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.