Team-Based Learning (TBL) in a Virtual Environment

The trend of using small group learning exercises in medical school has likely transformed how students engage with learning in a fast-paced a good way. Traditionally, these small group sessions take place in a face-to-face, physical classroom or break-out room space, but that doesn’t have to be the case. 

Many ed tech resources exist that allow schools to deliver small group learning and assessment off-campus, or remotely. Many of these resources can be used in a number of collaborative ways to not only “make it happen”, but to also help make the remote experience as useful and meaningful as the on-campus, or in-person experience.

Typically, it takes time to determine what the activity will entail, start to finish, from teaching to learning to assessment as this information drives every subsequent decision you make: any materials you need to create and what technology you will use. However, if the luxury of time is not on your side, the goal is to quickly convert your existing face-to-face small group learning exercise into a virtual learning experience. The good news is that you can still follow the same “plan” with a few adjustments to how you engage with students and how students engage with the content and one another. Making this transition can be intimidating, but with a little planning and the use of available ed tech tools, conducting online small group learning can be successful.

Team-Based Learning (TBL)

Currently, it seems like Team-Based Learning (TBL) is one of the most popular forms of small group learning in medical education. Typically, this is used as a ‘flipped classroom’ approach to teaching where students prepare before class for an in-class, problem-solving activity involving several readiness “tests”. The in-class activities require students to collaborate and responsibly contribute to the learning process. We can all picture what this might look like when done in person, but it is a little harder to imagine what this might be like if it were done 100% online.

One of the greatest challenges in transitioning a face-to-face learning experience to an online experience is changing the way students collaborate and discuss things. Research shows that students who “collaboratively engage in purposeful, critical discourse and reflection will be more likely to achieve a successful educational experience” (Garrison et al 2000). So, finding a way to effectively promote the collaborative experience in an online TBL is critical. Fostering a sense of community is a very important aspect of online group activities. (9 Best Practices for Distance Ed) The use of technology can help this process evolve, but it won’t be automatic; providing synchronous and asynchronous opportunities, setting expectations, providing prompts for action, and facilitating the groups’ activities are essential.

Group (or team) activity should enhance students’ ability to work collaboratively, respectfully consider different viewpoints, explain information to educate others, advocate for others so all perspectives are considered, and collectively solve problems to determine a shared solution. To do this in an online environment requires students having the ability to engage and collaborate virtually. For medical education, DaVinci Education's Leo platform provides the ability for small groups of students to engage with one another and participate in assessments remotely, including the IRAT and GRAT assessments used in TBLs. 

The use of Small Groups in Leo allows you to break out your main student group into smaller groups for various learning activities, including TBLs. Because Leo is calendar-based, students are automatically associated with their group, which can then be used by instructors to facilitate discussions and assessments across the small groups.

The collaboration among students in small groups that normally takes place in-person can be done remotely using Leo in various ways.

Virtual Collaboration

Discussion Boards- discussions can be initiated by Course Directors, Course Coordinators, Faculty, or Students. For TBL collaboration within Small Groups, the discussion can be started within their small group event- this ensures that only members associated with that group can participate in the discussion.

Video-conferencing tool- if your school has a tool such as Zoom, it can be used for small group collaboration. Most video-conferencing tools allow you to set up virtual synchronous breakout rooms where the facilitator or moderator can join at any time to monitor and engage with the group. Links to the virtual room can be housed in Leo at either the course/section level or at the event level.

To learn more about using breakout rooms in Zoom: Getting Started with Breakout Rooms

For additional resources for using video for collaboration in small groups, visit: Using Video in the MedEd Classroom

Online Readiness Assessments

A large piece of the TBL experience are the formative readiness assessments: the individual readiness assessment test (IRAT) and the group readiness assessment test (GRAT). There are several ways in which schools currently administer these assessments in a face-to-face environment:

On paper:

  • As regular multiple choice quizzes for both the IRAT and GRAT
  • As a quiz for the IRAT and use an IF-AT scratch off card for the GRAT


  • As a multiple choice quizzes for both the IRAT and GRAT
  • As a quiz for the IRAT and use a digital scratch-off tool for the GRAT

I think we can all agree that the paper version of anything is not feasible for the online delivery of a TBL experience. So, to effectively deliver the readiness assessments online, here are some things to consider:

  • Communication modalities- synchronous and asynchronous (for example: discussion boards and video chats)
  • Timeline for taking the readiness tests- consider how this needs to be adjusted to account for online communication vs face-to-face communication. The coordination of responses among team members and instructor monitoring and facilitation can take additional time in an online TBL.

The GRAT assessment associated with Leo’s digital scratch-off tool allows you to create questions designed to accommodate group collaboration and consensus among the group, with a single team member (team leader) submitting the responses. Leo then associates each response submitted by the team leader to the other members of the group. 

As students engage in a GRAT assessment, they will receive immediate feedback for both a correct or incorrect response. If their response is incorrect, the students have the opportunity to revisit the conversation, discuss why it is incorrect, and re-engage with the content and resources for evidence of the correct answer. Once a new answer is determined, the team leader selects the new answer choice.

Here is a peek at Leo’s digital scratch-off tool in action: 

Research shows that face-to-face Team-Based Learning (TBL) is an effective way to allow students to apply their foundational knowledge through collaboration and assessment (Whitley et al, 2015). Virtual TBLs can be equally successful by adjusting how students collaborate with one another and how instructors deliver assessments.

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Clark, M. et al. (2017). Online TBL: Problems, solutions, and future directions. Presentation conducted at the meeting of the Team-Based Learning™ Collaborative in Orlando, FL.
Garrison, D.randy, et al. (2000). “Critical Inquiry in a Text-Based Environment: Computer Conferencing in Higher Education.” The Internet and Higher Education, 2(2-3), pp. 87–105., doi:10.1016/s1096-7516(00)00016-6.
Michael Dorneich-Iowa State University. (2019). Team-Based learning. (video). YouTube.
Morrison, D. (2014, August 5). 5 Tools and Strategies that Support Group Collaboration Online. Retrieved from
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Michael Dorneich-Iowa State University. (2019). Team-Based learning. (video). YouTube.
Whitley, Heather P., et al. (2015). “Practical Team-Based Learning from Planning to Implementation.” American Journal of Pharmaceutical Education, 79(10), p. 149., doi:10.5688/ajpe7910149.