Team-based learning for teaching musculoskeletal ultrasound skills: a prospective randomised trial

  • Cassian Cremerius
  • Gertraud Gradl-Dietsch
  • Frank J. P. Beeres
  • Björn -Christian Link
  • Lea Hitpaß
  • Sven Nebelung
  • Klemens Horst
  • Christian David Weber
  • Carl Neuerburg
  • Daphne Eschbach
  • Christopher Bliemel
  • Matthias KnobeEmail author
Original Article



The aim of this prospective randomised trial was to assess the impact of the team-based learning approach on basic musculoskeletal ultrasound skills in comparison to both peer-assisted and conventional teaching and to examine the influence of gender and learning style on learning outcomes.


In this prospective randomised trial, we randomly assigned 88 students to 3 groups: team-based learning (n = 19), peer-assisted learning (n = 36) and conventional teaching (n = 33). Pre-existing knowledge was assessed using a multiple-choice (MC) exam. Student performance after completing the course was measured using an Objective Structured Clinical Examination (OSCE) and a second MC exam. Students were asked to complete Kolb’s Learning Style Inventory and to evaluate the course.


There was a significant gain in theoretical knowledge for all students (p < 0.001). The team-based learning groups’ performance proved to be significantly superior on the OSCE (p = 0.001). As gender had no significant effect on practical or theoretical performance, learning style was linked to differences in the practical outcome. An evaluation showed overall satisfaction with the course and with the respective teaching methods.


Team-based learning proved to be superior to peer-assisted and conventional teaching of musculoskeletal ultrasound skills.


Team-based learning Peer teaching Medical education Ultrasound MSUS Objective structured clinical examination 



The authors thank all the students who participated—without their enthusiasm and willingness, this study would not have been possible. The manuscript was proofread by Scribendi Inc., 405 Riverview Drive, Suite 304, Chatham ON, Canada.

Authors contribution

GGD, CC and MK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors meet all three of the requirements for authorship. BCL, FJPB, LH, SN, CDW, CN, DE, CB and KH were highly involved in the planning and execution of this study. CC organized the project to complete his medical thesis. Furthermore, GGD, CC, BCL, FJPB, LH, CDW, CN, DE, CB and SN were highly involved in the acquisition of data and in the process of data interpretation. KH, CDW, CN and CB made a significant contribution to the analysis and interpretation of the data. Furthermore, they took part in the manuscript review process and revised it critically. In this way, they provided important intellectual content in line with the study’s execution. MK acted as the initiator of the study and was highly involved in the advancement of the conception.



Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Ethics approval

Institutional Review Board approval was granted before initiation of this study, and strict confidentiality guidelines were followed (Local Ethics Committee Reference Number EK 178/09).

Consent to participate

Participants provided informed written consent for the use of their results in this study and for publication at the time of enrolment.

Consent for publication

Written consent for publication was provided at the time of enrolment by the participants.

Supplementary material

68_2019_1298_MOESM1_ESM.docx (157 kb)
Supplementary file1 (DOCX 157 kb)
68_2019_1298_MOESM2_ESM.sav (124 kb)
Supplementary file2 (SAV 124 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Cassian Cremerius
    • 1
  • Gertraud Gradl-Dietsch
    • 2
  • Frank J. P. Beeres
    • 3
  • Björn -Christian Link
    • 3
  • Lea Hitpaß
    • 4
  • Sven Nebelung
    • 4
  • Klemens Horst
    • 5
  • Christian David Weber
    • 5
  • Carl Neuerburg
    • 6
  • Daphne Eschbach
    • 7
  • Christopher Bliemel
    • 7
  • Matthias Knobe
    • 3
    • 5
    Email author
  1. 1.Department of Diagnostic and Interventional RadiologyMarienhospital AachenAachenGermany
  2. 2.Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR ClinicUniversity of EssenEssenGermany
  3. 3.Department of Orthopaedic and Trauma SurgeryLucerne Cantonal HospitalLucerneSwitzerland
  4. 4.Department of Diagnostic and Interventional Radiology, Medical FacultyRWTH Aachen UniversityAachenGermany
  5. 5.Department of Orthopaedic Trauma, Medical FacultyRWTH Aachen UniversityAachenGermany
  6. 6.Department for General, Trauma and Reconstructive SurgeryLudwig Maximilian University MunichMunichGermany
  7. 7.Center for Orthopaedics and Trauma SurgeryUniversity Hospital Giessen and Marburg GmbHMarburgGermany

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