Development and Refinement of Subject-Integrated Team-Based Learning with Student-Generated Questions: A Two-Year...

Team-Based Learning (TBL) has been widely adopted in undergraduate medical education; however, it is commonly implemented within individual disciplines using faculty-generated application exercises. To promote curriculum integration and active student engagement, we developed a subject-integrated TBL program incorporating student-generated questions across six basic medical science disciplines.

This article describes the development, implementation, and refinement of a subject-integrated TBL program conducted with different cohorts of second-year medical students at Nara Medical University over two consecutive academic years (2022 and 2023; 217 students in total). Following the first year, the program was refined based on faculty reflection and student feedback, with modifications to scheduling, group composition, faculty support during question generation, and program structure. Program evaluation included questionnaire responses regarding perceived mastery, understanding, difficulty, and session length. Free-text responses were analyzed using KH Coder, and relevant extracted words were classified into three categories defined a priori based on the educational design of the program.

In the second year, student evaluations shifted toward higher perceived mastery and understanding and more appropriate ratings of difficulty and session length. The proportion of students rating session difficulty as appropriate was 45.1% in 2022 and 83.3% in 2023, while the corresponding proportions for session length were 24.8% and 83.3%, respectively. Frequently occurring words were classified into three predefined categories: cooperative learning, knowledge integration, and question generation. Practical challenges identified during implementation included time allocation, uneven group participation, limited opportunities for faculty support, and variation in the difficulty of assigned themes.

This two-year implementation study identified practical considerations related to time allocation, faculty facilitation, group participation, and task design. The findings provide practical evidence from program implementation and iterative refinement and may assist educators seeking to design, implement, and refine similar horizontally integrated TBL programs in undergraduate medical education.