Team-based learning in thoracic surgery nursing education: a mixed-methods study of effectiveness and learning...

Team-based learning (TBL) is increasingly used as an active learning strategy in nursing education. However, evidence regarding its application in continuing education for in-service nurses in high-acuity specialty settings remains limited. This study evaluated educational outcomes and explored nurses' learning experiences within a TBL-based educational program in a thoracic surgery department.

A convergent parallel mixed-methods design incorporating a two-group randomized educational intervention was used. Eighty-eight clinical nurses who participated in the departmental continuing nursing education program were included in the quantitative component. Participants were randomly assigned to a TBL-based teaching group (n = 44) or a lecture-based teaching group (n = 44). The TBL-based teaching format included pre-class preparation, readiness testing, team discussion, evidence-based case learning, and scenario-based skills application. Educational outcomes included theoretical knowledge, practical skills, critical thinking disposition measured using the Chinese version of the Critical Thinking Disposition Inventory (CTDI-CV), and teaching feedback. Between-group comparisons were conducted using appropriate non-parametric tests, and CTDI-CV changes were analyzed using linear mixed-effects models. For the qualitative component, semi-structured interviews were conducted with 15 nurses from the TBL group, and data were analyzed using Colaizzi's seven-step method.

Nurses in the TBL group achieved higher theoretical knowledge scores than those in the lecture-based teaching group [median 93.00 (IQR 92.00-94.00) vs. 83.00 (IQR 81.75-88.00), P < 0.001, r = 0.74; Hodges-Lehmann difference 9.00 points, 95% CI 6.00 to 11.00]. Practical skills scores were also higher in the TBL group [median 95.00 (IQR 93.00-97.00) vs. 89.00 (IQR 85.75-91.25), P < 0.001, r = 0.68; Hodges-Lehmann difference 6.00 points, 95% CI 5.00 to 8.00]. A significant group-by-time interaction was observed for the CTDI-CV total score (F = 8.96, P = 0.003), indicating a greater increase over time in overall critical thinking disposition in the TBL group. Significant group-by-time interactions were also found for open-mindedness, analyticity, inquisitiveness, and cognitive maturity. Teaching feedback scores were higher in the TBL group across all six items (all P < 0.001), with large rank-based effect sizes (r = 0.65-0.91). Qualitative analysis generated four themes: transition from passive attendance to active participation, connecting clinical cases with evidence-based learning, team collaboration and shared learning, and challenges in adapting to TBL implementation.

TBL may be a feasible and acceptable approach for continuing education among thoracic surgery nurses. It was associated with higher theoretical knowledge and practical skills scores, more positive learning experiences, and greater increases over time in overall and selected aspects of critical thinking disposition. Successful implementation requires attention to preparation burden, literature-search support, question design, and facilitation in clinical teaching contexts.