The practices and strategies for implementing team-based learning in pre-clinical medical education: a systematic review

Introduction
Team-Based Learning (TBL) is increasingly adopted in medical schools to promote active learning, particularly in the foundational pre-clinical years. Despite its structured framework, variations in implementation across institutions have led to limited clarity on consistent best practices. This systematic review aims to identify and synthesise how TBL is applied globally during the first two years of pre-clinical medical education.

Methods
A comprehensive search of SCOPUS, MEDLINE, PUBMED, WEB OF SCIENCE, and ERIC databases was conducted for English-language articles published between January 2000 and October 2024. Studies were included if they described the implementation, structure, and outcomes of TBL in the first two years of pre-registration medical programs. Comparative studies were excluded. Data were extracted and synthesised across TBL’s core phases (preparation, readiness assurance, and application) and reported using PRISMA guidelines, MERSQI for quality assessment, and Kirkpatrick’s model for learning outcomes.

Results
Of 1136 articles screened, 37 studies from 15 countries met the inclusion criteria. Most focused on first-year students, with 24 using classical TBL methods and 10 employing modified approaches. TBL was primarily delivered in person and applied across individual subjects, such as anatomy, physiology, and biochemistry, as well as in integrated curricula.

Conclusion
The findings demonstrate strong adherence to TBL’s core structure, with students valuing its active, student-centred approach and educators noting its efficiency. However, TBL remains largely supplementary, with only a few institutions (primarily in Australia) using it as a primary teaching method. Most studies use TBL in conjunction with other pedagogical approaches, and TBL sessions, when delivered, were reported to be, on average, 3 h in length, with distinct phases of readiness assurance and application. Limited reporting of the use of the ‘4S’ framework in application design and peer review was noted. This gradual adoption may reflect resource constraints inherent in transitioning fully to a TBL-based curriculum, or it may indicate a preference for retaining conventional teaching methods to align with country-specific requirements. Our review identifies a need for medical schools to align curriculum design with core TBL strategies supported by curriculum governance frameworks and faculty development programs,—to enable effective and sustainable scaling of TBL across pre-clinical programs.