Team-based learning (TBL) and problem-based learning (PBL) are two learning methodologies that focus on the development, execution, and completion of tasks and projects, respectively. While students form the core of both strategies’ learning, it’s crucial to remember that the establishment of objectives precedes their implementation. TBL and PBL are two separate methodologies that provide significant educational experiences for students. PBL emphasizes multidisciplinary project work that cultivates critical thinking, problem-solving, and collaborative abilities, while TBL focuses on language acquisition through the execution of specific tasks. Each method possesses distinct attributes, advantages, and factors for execution.

Eva Koritakova et al. (1) stated that both strategies, TBL and PBL, exhibit distinct advantages and disadvantages relative to one another (2). Theoretically, though, TBL offers the benefits of readiness assessment, expert availability, and the provision of introductory materials. “Learning gain was higher with TBL compared to PBL, with no difference in knowledge retention and the effect on different parameters of critical thinking skills,” according to Pakhmode et al. (3). Students perceived TBL as more advantageous for the undergraduate curriculum (3). According to Burgess et al. (4), “The students found positive aspects of their TBL experience to include the smaller group size, the use of readiness assurance tests, immediate feedback from senior clinicians, and time efficiency.” In PBL, students indicated that the varying skills of instructors, insufficient direction, and huge group size hampered their learning. “(4). TBL comprises six steps, including pre-class preparation, individual assurance test, team-based assurance test (pre-class test iRAT and tRAT), immediate feedback, clinical problem-solving discussion, and closure (4–6). It has been stated that, despite TBL’s increasing popularity, it did not lead to higher long-term retention (7). According to Nawabi et al. (8), “students reported positive aspects of the TBL experience, such as a more engaging format, collaborative learning, teamwork, and group competition.” They claimed that PBL had improved their research, presentation, and clinical reasoning abilities (8). However, PBL has the advantage of incorporating in-depth clinical reasoning into the problem-solving process. As a result, Annette Burgess et al. recommended a hybrid strategy that combines the benefits of both (4–6). Dolmans et al. (9) support a combined technique to maximize students’ learning outcomes (9). Research has demonstrated that TBL improves the performance of pharmacology students compared to those who do not attend. As a result, Nora et al. recommended the incorporation of TBL as a teaching component in the medical curriculum (10). Fujiwara et al. has proven that TBL, involving online physiology, is a useful method during epidemics such as COVID-19. It was understandable that in-person instruction was not an option. (11). Mulugeta and Zemedkun conducted a limited pilot cross-sectional study in Ethiopia, highlighting the inherent limitations of Team-Based Learning (TBL), specifically noting criticisms regarding the time required for TBL preparation and the necessity for student readiness (12). TBL effectively supplanted PBL in the first and second years of the medical curriculum, receiving favorable feedback from participants. The primary critique was inadequate facilitation by the expert, poor alignment of pre-class preparation with the Team-Based Learning (TBL) patient case, a lack of availability of the Team Readiness Assurance Test (TRAT), and excessive duration leading to fatigued students (13). Project-Based Learning (PBL) as a pedagogical approach did not yield superior information retention or academic achievement compared to traditional techniques (14). Zhao et al. have shown that “PBL combined with case-based learning (CBL) may be an effective approach for enhancing the performance and clinical skills of medical students and residents” (15). Despite their enjoyment of the activity, participants could not have a favorable opinion of the tutor’s post-PBL evaluation (16). Moreover, Saudi medical students favored problem-based learning (PBL) over lecture-based learning (LBL) due to PBL’s superior clinical reasoning capacity, clinical solving capabilities, and in-depth discussion (16). Nevertheless, there is less research comparing TBL to PBL. PBL with micro-video in burn instruction has outperformed LBL in terms of critical thinking and student satisfaction (17). “Online TBL has the potential to improve educational effectiveness for community pharmacy during the COVID-19 pandemic” (18) as opposed to PBL. Based on the findings of Sterpu et al., “TBL sessions may be advantageous in minimizing faculty workloads without compromising students’ learning outcomes” (19). “TBL resulted in improved attitudes toward obesity and self-perceived knowledge of obesity among first-year medical students at Case Western Reserve University School of Medicine (CWRU SOM),” reported Olson et al. (20). In summary, studies on TBL generally concur that positive medical attitudes and perceptions are prevalent. Nevertheless, the results of TBL-based knowledge retention and enhanced performance are contradictory (21). Our study aims to gain insight into whether TBS is a better teaching tool than PBL or not, keeping our objectives in mind.

The objective was to compare the PBL/TBL method concerning problem-solving, independent learning, engagement, and summative assessment outcomes.

The medical curriculum at the University of Tabuk is segmented into preclinical phases, including anatomy, physiology, and microbiology, where preclinical students are extensively engaged in Problem-Based Learning (PBL). Conversely, the clinical phase encompasses general surgery, medicine, obstetrics, and gynecology, where clinical students have had limited exposure to Team-Based Learning (TBL). The educators at our institution have extensive training and expertise in both TBP and PBL pedagogical approaches. TBL is renowned in medical education for its resource efficiency and student-centeredness; it was founded in 2001. A student-centered, organized TBL has basic design features and steps (22). TBL and PBL are “instructional activities involving students in doing things and contemplating what they are doing” (23), unlike standard lectures that cover one topic in one session. TBL involves large groups of 6–10 students in participatory learning. One instructor may effectively manage 20 teams using this way (24). TBL is an active method, but students learn in a controlled environment with instructor assistance (25). PBL students discover knowledge gaps and create self-study objectives. Unlike TBL, PBL demands more faculty and student self-directed study (26).

In our study, the post-test results indicated no superiority of either the TBL or BPL pedagogical strategy, as there was no statistical difference observed (p-value of 0.053 for both groups). Conversely, Smita Pakhmode indicated that “post-test results, obtained immediately following the intervention, revealed a significant learning gain in students utilizing both methods, with a statistically greater gain in TBL (p < 0.0001) relative to PBL” (3). “No statistically significant differences in knowledge retention were observed when the test was administered 2 months later in both groups.” It is important to note that our study did not assess the retention rate, as long-term retention tests were not conducted. Our study confirms the effectiveness of the loop (TBL) pedagogical strategy. The case groups utilizing TBL demonstrated enhanced knowledge acquisition through intergroup and intragroup discussions of clinical problems, as evidenced by the significant difference in pre- and post-test results (P = 0.001). We cannot underestimate the importance of having a clinically experienced teacher on site to implement iRAD, tRAD, immediate feedback, and intra-group discussion. Our study indicates that students in both case and control groups have experienced benefits from active engagement, such as enhanced problem-solving skills and overall student satisfaction. This conclusion is consistent with the findings of Sterpu et al. (21), which demonstrate that the implementation of TBL correlates with enhanced knowledge acquisition (n = 19, 39%), increased student engagement (n = 6, 12%), and greater student satisfaction (n = 31, 63%). Our study demonstrates that TBL enhances knowledge acquisition, as indicated by the comparison of pre- and post-test results, consistent with the findings of Mayel et al. (27) and Langer et al. (7). Despite numerous studies by Gong et al. (28) and Ackermann et al. (29) suggesting that the TBL has improved teamwork, our findings contradict this notion. Our study provided contrary results, with better teamwork in the control group (PBL). Conversely, TBL promotes a more scalable active-learning environment capable of accommodating bigger student populations without a corresponding increase in teacher time demands (4, 30). Our findings revealed that both the case group (TBL) and the control group (PBL) were satisfied with the overall experience, which is consistent with studies conducted by Krase et al. (31) and Thomas and Bowen (32), who discovered no differences in student satisfaction between TBL and non-TBL groups. Teaching effort and teachers’ attitudes toward TBL were the subject of numerous research studies, whereas the instructors stated that TBL was linked to a greater effort for class preparation than lecture-based instruction (12 h v. 5 h). However, we anticipated this effect because TBL was a recently developed technology. Additionally, the teachers said that using TBL made the classroom environment more active and engaging (33). However, our study did not statistically measure this factor because it fell outside our original targeting objectives. Few studies have assessed Team-Based Learning (TBL) in clinical stages, in contrast to more studies examining the role of TBL in basic science phases. Our institution extensively employs TBL methods during the preclinical phase of basic science, in contrast to minimal TBL methods during the clinical phases. This difference is explained by the fact that direct bedside teaching is the primary strategy for clinical instruction in various hospitals. Limited research has assessed the application of TBL in surgical disciplines, potentially due to the predominant instruction of surgical skills occurring in simulation environments, surgical wards, and operating theaters (34, 35). Clinical rotations are usually brief and do not allow students sufficient time to become familiar with TBL (36). Our result indicates that 91% of students were familiar with TBL, while the familiarity rate with PBL was 100%. Our study did not demonstrate the superiority of either method for measuring knowledge acquisition, despite the heavy use of PBL in our preclinical stages. Therefore, more long-term studies in our college would validate the superiority of one pedagogical strategy over the other. In the meantime, we recommend using hybrid teaching methods (traditional lectures, TBL, PBL, case-based discussion, seminars, tutorials, etc.) to evaluate our students, keeping in mind that one’s weakness can be compensated by another method. In 2006, problem-based learning (PBL) was incorporated into the medical program, introducing a well-established model of student-centered instruction in the curriculum. Increasing student enrolment from 36 first-year students in 2006 to 83 in 2025, coupled with limited teaching resources, has rendered this teaching model (PBL) unsustainable as the primary strategy for our expanding faculty. We recommend increasing the number of TBL sessions per batch during both the basic science and clinical phases, in conjunction with other pedagogical methods such as traditional lectures, seminars, tutorials, PBL, and case-based discussions (4). Furthermore, when compared to PBL, TBL retains the benefits of small group teaching and learning without requiring as many teachers (22). A notable limitation of this study is the lack of validation regarding whether all participating students engaged with the pre-class preparation material prior to attending class, as this aspect was not incorporated into our TELSON questionnaire. The absence of preparation has implications for team learning and performance, highlighting it as a critical area for further investigation (37). The literature indicates that administering the iRAT online before class enhances learning by decreasing the time required for the TBL experiment (38). However, we intentionally incorporated the iRAT into the overall exercise, despite its potential to extend the experiment’s duration from 2 to 4 h. We emphasized the inclusion of the iRAT as an integral component of TBL implementation with an expert, as our experience indicates that remote electronic questionnaires yield suboptimal response rates. The only way to guarantee that all respondents complete the iRAD and tRAD is through their actual presence in the class.

All the students used their laptops and mobile phones, as internet connectivity was stable and an electrical generator backup was available. One student mentioned that “’the iPad was used and the network was available in the building.”’ One student found using their iPad useful during the group discussion, stating, “The group discussion helped me learn how to read the question cautiously to understand what the best answer is.” The response rate in the control group (PBL) was 100%, with one student stating that “useful and advantageous technology helps us strengthen our knowledge.” One student stated that “the simulation room was comfortable” because the room was well air-conditioned and the walls had approved acoustic barriers. In contrast, one student in the control group (PBL) mentioned that “The environment was lovely, maybe somewhat cold.” Furthermore, 54% of the case group (TBL) students responded to the question by describing working with each other. In fact, one student mentioned that “I like it because we understand each other as a group.” Similar feedback was observed from the control group (PBL), as one student quoted that “I liked how we bounced ideas between each other and helped each other understand.” One student quoted that “it is my second time doing TBL, and I thoroughly enjoy this kind of learning; it makes me use my knowledge and add new information through the other options in the question.” In addition, all the students in the control group (PBL) had an encouraging experience, as one student mentioned that “the PBL classroom is a small-group, student-centered environment where students sit in a circle or U-shape to encourage discussion and collaboration.” The facilitator guides learning while students actively explore problems, share ideas, and access resources to support self-directed learning and solve the questions.

As a result, we showed that Team-Based Learning (TBL) and Problem-Based Learning (PBL) produced similar summative outcomes, with TBL providing stronger immediate knowledge acquisition. In this study, students overall valued two approaches more, with PBL being at least marginally preferred in the perception and attitude domains. The study’s findings indicate that each method possesses distinct advantages, demonstrating their mutually reinforcing roles within medical education. This study helps inform strategies of active learning to help provide problem-solving techniques, independence, and empowerment to future healthcare professionals, aligned with Vision 2030 priorities.

Despite that both TBL and PBL methodologies yielded comparable summative outcomes for both cohorts, the systemic implementation of TBL as a pedagogical tool can enhance students’ knowledge acquisition. Our study found that final-year MBBS students prefer both PBL and TBL in general, albeit that TBL enhances students’ knowledge acquisition, whereas PBL in perceptions and attitudes was marginally favored.

We advocate for the augmentation of TBL clinical sessions in general surgery, in conjunction with other conventional pedagogical methodologies, including PBL, due to the annual increase in student enrolment. The predominant instructional approach throughout the clinical stages at our medical faculty is bedside teaching in small groups. Consequently, most of our clinicians either refrain from utilizing TBL or lack familiarity with this educational approach. Consequently, we recommend promoting the involvement of newly recruited clinicians in the implementation of TBL through the organization of further workshops.

Some important constraints are the lack of long-term retention assessments, the use of self-reported questionnaire data, and the lack of validation of pre-class prep. Though a readiness assurance test was included, a lack of standard validation might affect the results. However, the study’s limitations include its restriction to female cohorts and the possibility that cultural variables influenced learner views. Moreover, the research was conducted in a single institute, which reduces external validity. Another limitation is the short follow-up duration, which was not our objective, as well as the potential for response bias. Lastly, the input of experienced educators was not solicited.