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

  • 20 Accesses



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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2

Availability of data and materials

The datasets analysed during the current study and the full trial protocol are available from the corresponding author on reasonable request.


  1. 1.

    Parmelee D, Michaelsen LK, Cook S, Hudes PD. Team-based learning: a practical guide: AMEE guide no 65. Med Teach. 2012;34(5):e275–287.

  2. 2.

    Remington TL, Bleske BE, Bartholomew T, Dorsch MP, Guthrie SK, Klein KC, Tingen JM, Wells TD. Qualitative analysis of student perceptions comparing team-based learning and traditional lecture in a pharmacotherapeutics course. Am J Pharm Educ. 2017;81(3):55.

  3. 3.

    Jost M, Brustle P, Giesler M, Rijntjes M, Brich J. Effects of additional team-based learning on students' clinical reasoning skills: a pilot study. BMC Res Notes. 2017;10(1):282.

  4. 4.

    Ozgonul L, Alimoglu MK. Comparison of lecture and team-based learning in medical ethics education. Nurs Ethics 2017:969733017731916.

  5. 5.

    Koles PG, Stolfi A, Borges NJ, Nelson S, Parmelee DX. The impact of team-based learning on medical students' academic performance. Acad Med. 2010;85(11):1739–45.

  6. 6.

    Thomas PA, Bowen CW. A controlled trial of team-based learning in an ambulatory medicine clerkship for medical students. Teach Learn Med. 2011;23(1):31–6.

  7. 7.

    Punja D, Kalludi SN, Pai KM, Rao RK, Dhar M. Team-based learning as a teaching strategy for first-year medical students. Australas Med J. 2014;7(12):490–9.

  8. 8.

    Bouw JW, Gupta V, Hincapie AL. Assessment of students' satisfaction with a student-led team-based learning course. J Educ Eval Health Prof. 2015;12:23.

  9. 9.

    Jafari Z. A comparison of conventional lecture and team-based learning methods in terms of student learning and teaching satisfaction. Med J Islam Repub Iran. 2014;28:5.

  10. 10.

    Livingston B, Lundy M, Harrington S. Physical therapy students' perceptions of team-based learning in gross anatomy using the team-based learning student assessment instrument. J Educ Eval Health Prof. 2014;11:1.

  11. 11.

    Ghorbani N, Karbalay-Doust S, Noorafshan A. Is a team-based learning approach to anatomy teaching superior to didactic lecturing? Sultan Qaboos Univ Med J. 2014;14(1):e120–125.

  12. 12.

    Huitt TW, Killins A, Brooks WS. Team-based learning in the gross anatomy laboratory improves academic performance and students' attitudes toward teamwork. Anat Sci Educ. 2015;8(2):95–103.

  13. 13.

    Knobe M, Munker R, Sellei RM, Holschen M, Mooij SC, Rohlfing B, Niethard FU, Pape HC. Peer teaching: a randomised controlled trial using student–teachers to teach musculoskeletal ultrasound. Med Educ. 2010;44(2):148–55.

  14. 14.

    Knobe M, Sellei RM, Maus U, Mooij SC, Gradl G, Sopka S, Niethard FU, Pape HC. Undergraduate curricular training in musculoskeletal ultrasound: the impact of preexisting anatomic knowledge. Z Orthop Unfall. 2010;148(6):685–90.

  15. 15.

    Knobe M, Carow JB, Ruesseler M, Leu BM, Simon M, Beckers SK, Ghassemi A, Sonmez TT, Pape HC. Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial. BMC Med Educ. 2012;12:85.

  16. 16.

    Gradl-Dietsch G, Korden T, Modabber A, Sonmez TT, Stromps JP, Ganse B, Pape HC, Knobe M. Multidimensional approach to teaching anatomy—Do gender and learning style matter? Ann Anat. 2016;208:158–64.

  17. 17.

    Hudson JN, Tonkin AL. Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients. Med Educ. 2008;42(9):901–8.

  18. 18.

    Field M, Burke JM, McAllister D, Lloyd DM. Peer-assisted learning: a novel approach to clinical skills learning for medical students. Med Educ. 2007;41(4):411–8.

  19. 19.

    Gradl G, Buhren A, Simon M, Derntl B, Pape HC, Knobe M. Bootcamp: longitudinal gender-based surgical and clinical skills training. Unfallchirurg. 2017;120(1):46–544.

  20. 20.

    Sarabi-Asiabar A, Jafari M, Sadeghifar J, Tofighi S, Zaboli R, Peyman H, Salimi M, Shams L. The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran. Iran Red Crescent Med J. 2015;17(1):e18250.

  21. 21.

    Nuzhat A, Salem RO, Hamdan N, Ashour N. Gender differences in learning styles and academic performance of medical students in Saudi Arabia. Med Teach. 2013;35(1):S78–82.

  22. 22.

    Mooij SC, Antony P, Ruesseler M, Pfeifer R, Drescher W, Simon M, Pape HC, Knobe M. Gender-specific evaluation of student's career planning during medical study in terms of orthopaedic trauma. Z Orthop Unfall. 2011;149(4):389–94.

  23. 23.

    Kolb A, Kolb D. The kolb learning style inventory—version 3.1 2005 technical specifi cations; 2005.

  24. 24.

    Krautter M, Weyrich P, Schultz JH, Buss SJ, Maatouk I, Junger J, Nikendei C. Effects of Peyton's four-step approach on objective performance measures in technical skills training: a controlled trial. Teach Learn Med. 2011;23(3):244–50.

  25. 25.

    Gradl-Dietsch G, Menon AK, Gursel A, Gotzenich A, Hatam N, Aljalloud A, Schrading S, Holzl F, Knobe M. Basic echocardiography for undergraduate students: a comparison of different peer-teaching approaches. Eur J Trauma Emerg Surg. 2017;44:143–52.

  26. 26.

    Smith MK, David A. Kolb on experiential learning. the encyclopedia of informal education [ retrieved: May 1st 2019]

  27. 27.

    Bland JM, Altman DG. Cronbach's alpha. BMJ. 1997;314(7080):572.

  28. 28.

    Weyrich P, Celebi N, Schrauth M, Moltner A, -Koppel M, Nikendei C. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ. 2009;43(2):113–20.

  29. 29.

    Celebi N, Zwirner K, Lischner U, Bauder M, Ditthard K, Schurger S, Riessen R, Engel C, Balletshofer B, Weyrich P. Student tutors are able to teach basic sonographic anatomy effectively - a prospective randomized controlled trial. Ultraschall Med. 2012;33(2):141–5.

  30. 30.

    de Casasola G, Sanchez G, Peinado D, Gollarte A, Aceituno E, Pena Vazquez I, Torres Macho J. Teaching of clinical ultrasonography to undergraduates: students as mentors. Rev Clin Esp. 2015;215(4):211–6.

  31. 31.

    Dickerson J, Paul K, Vila P, Whiticar R. The role for peer-assisted ultrasound teaching in medical school. Clin Teach. 2017;14(3):170–4.

  32. 32.

    Chen M, Ni C, Hu Y, Wang M, Liu L, Ji X, Chu H, Wu W, Lu C, Wang S, et al. Meta-analysis on the effectiveness of team-based learning on medical education in China. BMC Med Educ. 2018;18(1):77.

  33. 33.

    Langdorf MI, Anderson CL, Navarro RE, Strom S, McCoy CE, Youm J, -Wong MF. Comparing the results of written testing for advanced cardiac life support teaching using team-based learning and the "flipped classroom" strategy. Cureus. 2018;10(5):e2574.

  34. 34.

    Wammes JD, Meade ME, Fernandes MA. The drawing effect: Evidence for reliable and robust memory benefits in free recall. Q J Exp Psychol (Hove). 2016;69(9):1752–76.

  35. 35.

    Knobe M, Holschen M, Mooij SC, Sellei RM, Munker R, Antony P, Pfeifer R, Drescher W, Pape HC. Knowledge transfer of spinal manipulation skills by student–teachers: a randomised controlled trial. Eur Spine J. 2012;21(5):992–8.

  36. 36.

    McKenzie S, Burgess A, Mellis C. Interns reflect: the effect of formative assessment with feedback during pre-internship. Adv Med Educ Pract. 2017;8:51–6.

  37. 37.

    Bosse HM, Mohr J, Buss B, Krautter M, Weyrich P, Herzog W, Junger J, Nikendei C. The benefit of repetitive skills training and frequency of expert feedback in the early acquisition of procedural skills. BMC Med Educ. 2015;15:22.

  38. 38.

    Oldland E, Currey J, Considine J, Allen J. Nurses' perceptions of the impact of team-based learning participation on learning style, team behaviours and clinical performance: an exploration of written reflections. Nurse Educ Pract. 2017;24:62–9.

  39. 39.

    Guillot A, Champely S, Batier C, Thiriet P, Collet C. Relationship between spatial abilities, mental rotation and functional anatomy learning. Adv Health Sci Educ Theory Pract. 2007;12(4):491–507.

  40. 40.

    Garg AX, Norman G, Sperotable L. How medical students learn spatial anatomy. Lancet. 2001;357(9253):363–4.

  41. 41.

    Szczepanik AM, Spieszny M, Klocek T, Szczepanik M, Goroszeniuk D, Kubisz A, Kulig J. Motor coordination assessment in practicing surgeons and medical students. Acta Chir Belg. 2010;110(3):317–22.

  42. 42.

    Bhalli MA, Khan IA, Sattar A. Learning style of medical students and its correlation with preferred teaching methodologies and academic achievement. J Ayub Med Coll Abbottabad. 2015;27(4):837–42.

  43. 43.

    Osseini SM, Amery H, Emadzadeh A, Babazadeh S. Dental students' educational achievement in relation to their learning styles: a cross-sectional study in Iran. Glob J Health Sci. 2015;7(5):152–8.

  44. 44.

    Syperda VA, Trivedi PN, Melo LC, Freeman ML, Ledermann EJ, Smith TM, Alben JO. Ultrasonography in preclinical education: a pilot study. J Am Osteopath Assoc. 2008;108(10):601–5.

  45. 45.

    Frame TR, Cailor SM, Gryka RJ, Chen AM, Kiersma ME, Sheppard L. Student perceptions of team-based learning vs traditional lecture-based learning. Am J Pharm Educ. 2015;79(4):51.

Download references


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.



Author information

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.

Correspondence to Matthias Knobe.

Ethics declarations

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 157 kb)

Supplementary file2 (SAV 124 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cremerius, C., Gradl-Dietsch, G., Beeres, F.J.P. et al. Team-based learning for teaching musculoskeletal ultrasound skills: a prospective randomised trial. Eur J Trauma Emerg Surg (2020) doi:10.1007/s00068-019-01298-9

Download citation


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