Developing innovative talents with robust scientific research capabilities and effective self-learning skills stands as a crucial objective in the ongoing reforms within medical higher education in China [20]. The undergraduate phase of basic medical education represents an opportune period for nurturing students' innovative prowess and scientific acumen. Presently, laboratory course instruction serves as the primary avenue for fostering innovation and research acumen among undergraduate students in Chinese colleges and universities [20]. However, conventional experimental teaching predominantly revolves around verification experiments following teacher-led lectures, characterized by simplistic experimental procedures, fixed operations, and singular outcomes. Within traditional experimental teaching paradigms, students assume passive roles, lacking opportunities for self-exploration and innovation. Hence, the quest for novel teaching strategies in laboratory courses emerges as an imminent challenge necessitating resolution.
Previous studies have consistently shown that higher levels of learner participation and autonomy in learning activities are associated with increased feelings of value within the learning environment and heightened motivation [9, 10, 21]. In contrast to traditional instructor-centered lecture formats, FC-TBL offers participants flexible pre-class learning strategies, allowing them maximum autonomy in learning and fostering engagement through team-based learning discussions [6, 9, 10]. Additionally, the incorporation of the classroom Team Readiness Assurance Test (TRAT) and post-class reflective exchanges for FC-TBL participants empowers them to take on more active roles in the learning process. This not only enhances learning effectiveness but also further boosts participants' sense of achievement. Research conducted by Feng has underscored the efficacy of FC-TBL in enhancing learning activities within clinical laboratory immunology courses [21]. FC-TBL has been shown to improve learning effectiveness in acute-care nursing courses for nursing students [22], leading to enhanced academic performance [16]. These findings collectively suggest that the FC-TBL teaching approach positively impacts short-term learning outcomes in fundamental medical courses.
In our study, we implemented the FC-TBL teaching mode in molecular biology laboratory instruction for 55 clinical medicine students at Beihua University in 2021. Our results indicated that FC-TBL had a short-term positive impact on the learning effectiveness of molecular biology laboratory courses, enhancing students' comprehensive skills across multiple dimensions. This observation may be attributed to the collaborative nature of team-based learning, which enhances learner engagement and achievement, resulting in better preparation before class and improved problem-solving skills during and after class, thereby enhancing the effectiveness of FC. These findings are consistent with those reported by Shen [6].
Learning effectiveness encompasses enhancements in cognitive aspects as well as transformations in affective factors, including advancements in knowledge, skills, perceptions, and attitudes [23]. Current evaluations of learning impacts have predominantly concentrated on short-term effects, such as the influence on learning outcomes in courses employing specific instructional approaches and their repercussions on concurrent courses within the same academic term, as previously discussed. However, extensive research on the enduring effects of learning effectiveness—such as its influence on subsequent courses or even future professional endeavors—is notably scarce.
In a study assessing the efficacy of FC in physiology courses, it was demonstrated that FC not only elevated students' performance in physiology classes but also facilitated learning in subsequent courses like pathology, pathophysiology, pharmacology, and diagnostics [5]. Similarly, in an investigation of a comprehensive laboratory course in basic medical science, Shen discovered that FC-TBL led to improved final exam scores one month later [6]. Nevertheless, contrasting viewpoints exist, with some scholars contending that FC lacks sustained impacts and does not offer any advantage in terms of academic performance compared to alternative active learning strategies [2]. Notably, upon students' return to a traditional classroom setting, the influence of FC appeared negligible [2, 24]. These divergent findings may primarily stem from the absence of a standardized assessment framework. Variables such as the duration between assessments, evaluation criteria (e.g., exam scores, self-directed learning capabilities, communication and presentation proficiencies, creativity, analytical and problem-solving skills, etc.), and student characteristics (including diverse learning styles) can significantly influence the evaluation of long-term effects.
In the evaluation of the long-term effects of FC-TBL, our findings revealed that the retention of basic concepts and fundamental theories of molecular biology experiments did not exhibit statistically significant differences over time between the two student groups. However, the retention levels were higher in the FC-TBL group compared to the LBL group. Notably, the FC-TBL group engaged in significant self-study activities before classes, utilizing resources such as textbooks, videos, and supplementary materials. This suggests that while FC-TBL did not demonstrate a substantial positive impact on the long-term retention of foundational knowledge, the integration of pre-class self-study within the FC-TBL framework yielded satisfactory outcomes. This favorable outcome of pre-class preparation may be attributed to the reinforcing effect of the Individual Readiness Assurance Test (IRAT) and collaborative team discussions in TBL on students' comprehension of the subject matter.
The cultivation of lifelong learning skills stands as a pivotal objective in medical higher education. As aspiring clinicians poised to confront professional challenges, the acquisition of lifelong learning skills can yield enduring benefits in their future clinical and research endeavors. Regrettably, students in certain institutions may lack critical thinking, analytical prowess, and problem-solving abilities due to deficiencies in fostering innovation and practical skills. Consequently, these students are mostly trained to be qualified medical graduates rather than empowered individuals equipped with the lifelong learning capabilities. Notably, lifelong learning capabilities are essential for continual improvement and excellence in their future professional undertakings [25].
In our study, we observed that the final grades in Gene Diagnosis and Gene Therapy, Medical Biotechnology and Applications, and Introduction to Medical Science Research courses during the 7th semester were significantly higher in the FC-TBL group compared to the LBL group. Additionally, the final grade in the Hospital Infection course in the 8th semester was also superior in the LBL group. These courses necessitate a strong foundation in experimental theories of molecular biology, which are crucial for understanding clinical diagnosis and therapy, biopharmaceuticals, and the design of scientific research. The results indicate that students in the FC-TBL group exhibit enhanced abilities to construct new knowledge based on their existing understanding and effectively bridge theoretical concepts with practical applications. It is evident that the FC-TBL approach may have facilitated participants in developing essential lifelong learning skills, including critical thinking, improved analytical capabilities, and enhanced problem-solving skills. These acquired skills likely contributed to the superior performance in subsequent courses. The cultivation of lifelong learning skills through FC-TBL appears to have a positive ripple effect on students' learning outcomes in follow-up courses. By fostering a deeper understanding and application of knowledge, FC-TBL holds the potential to equip students with the necessary tools to effectively acquire and apply new knowledge in real-world contexts, thereby preparing them for continued learning and success in their future endeavors.
Furthermore, students expressed a high level of satisfaction with the FC-TBL approach. They appreciated the autonomy afforded by individual pre-class preparation and the collaborative peer-to-peer discussions during FC-TBL, noting that it enhanced their engagement and sparked their interest in learning. One student remarked, "This teaching method stimulated my interest in learning molecular biology laboratory courses" (Table 3). The efficacy of pre-class preparation was notably enhanced by the increased interest, heightened engagement, and immediate feedback received both from team members and instructors. Students highlighted the value of feedback, stating that "The feedback from the team members helped me a lot" and "I received timely feedback from teachers" and appreciated that " The course did not take up too much time outside of class " (Table 3).
Beyond enhancing student engagement, FC-TBL fostered a sense of pride and accomplishment through pre-class and in-class discussions, encouraging deeper reflection. Students expressed satisfaction with their contributions to group activities, with comments such as " I made a significant contribution to the group's activity" and " I was satisfied with my personal achievements" (Table 3). Students favored the FC-TBL approach and believed that this blended teaching method was beneficial in enhancing independent learning, teamwork skills, and practical application abilities, while also facilitating communication among peers and between students and instructors. A substantial 74.5% of students indicated that "The classroom pace is suitable for me" and expressed willingness to choose this teaching method again (Table 3).
While our study demonstrates the positive outcomes of FC-TBL instruction, there are inherent limitations in the study design that warrant consideration. Firstly, concerning the construction of the team-based learning groups, our approach primarily relied on GPA as a criterion. Each group included 1–2 high-GPA students who could assist their peers as needed. However, essential skills such as communication, presentation, and collaboration were not factored into the group composition criteria. Secondly, the assessment of the long-term impacts of FC-TBL was limited to tracking final exam results. This approach overlooked crucial factors that influence lifelong learning, such as students' self-directed learning capabilities, communication and presentation skills, creativity, as well as analytical and problem-solving skills. Moreover, the study's scope was constrained by the low number of course hours and participants exposed to FC-TBL, which could potentially diminish the assessment of its long-term effects. Additionally, factors like the type and duration of video materials used in pre-course activities were not thoroughly explored, despite their potential influence on learners' motivation to engage. Given the unique characteristics of each course, implementing and optimizing a new teaching model like FC-TBL to enhance teaching and learning quality will necessitate sustained, dedicated efforts on the part of educators over an extended period.