This article, titled “From Theory to Practice: The Impact of Team-Based Learning on Medical Students’ Communication Skills“, investigates the effectiveness of Team-Based Learning (TBL) environments in developing communication skills among medical students. Written by Elda Maria Stafuzza Gonçalves Pires, Stephanie N. E. Meeuwissen, and Hans H. C. M. Savelberg, the study addresses a critical need in modern medical education, where strong interpersonal communication skills are essential for successful interprofessional practice.
Background and Rationale: Traditionally, medical communication skills have been taught through methods like lectures, seminars, simulations, and role-playing workshops. However, previous research suggests these interventions may only yield modest short-term improvements with unclear long-term benefits. Collaborative learning environments, particularly TBL, are proposed as a more effective alternative for fostering these skills. TBL encourages cooperative interactions and shared learning experiences, promoting active engagement, critical thinking, problem-solving, and communication through peer interaction and group activities. Key elements of the TBL learning approach that can influence communication skills development include teachers’ decisions, teachers’ attitudes, students’ attitudes and traits, team characteristics, contextual factors, and formative assessment (specifically peer assessment). While TBL is widely implemented, existing studies on its benefits for communication skills present mixed findings, and its long-term effects remain largely unexplored, creating a significant research gap.
Study Aims: This study specifically aimed to answer two main questions:
- How medical students self-report their interpersonal communication skills within a TBL environment.
- To what extent students perceive a TBL environment as contributing to their communication skills development.
Methodology: The researchers conducted a primarily quantitative study with a qualitative element.
- Participants: The study involved Brazilian undergraduate medical students from one Medical School, with 307 out of 416 invited students (74%) completing both scales. The participants spanned the first seven semesters of their medical program.
- Setting: The study was conducted at the School of Medicine of Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) in São Paulo, Brazil, an institution that has employed collaborative learning, including TBL, across all subjects for almost a decade. TBL sessions follow the classic design, involving pre-class preparation, individual and team readiness assurance tests (iRAT and tRAT), and team problem-solving activities based on the 4S principles. Teams are faculty-assigned, ensuring gender diversity, and are reshuffled each semester. The program includes a formative assessment component where students self- and peer-assess team members three times per semester, providing both Likert-scale ratings and narrative feedback.
- Data Collection: Data were collected using two main scales:
- The Interpersonal Communication Competence Scale (ICCS), a validated 17-item survey measuring communication skills across five domains: Environmental Control, Self-Disclosure, Assertiveness, Interaction Management, and Immediacy.
- The Team-Based Learning Environment Scale, a 14-item scale developed by the research team to assess students’ perceptions of how six TBL environment domains influence communication skills development (teachers’ decisions, teachers’ attitudes, students’ attitudes and traits, team characteristics, contextual factors, and formative assessment).
- An open-ended question was also included to gather qualitative insights into factors contributing to or hindering communication skills development.
- Data Analysis: Quantitative data were analyzed using ANOVA to compare responses across semesters, while qualitative data from the open-ended questions were analyzed using thematic analysis.
Key Findings:
- High Self-Reported Communication Skills: Students consistently reported high scores on the Interpersonal Communication Competence Scale (ICCS), with an overall mean of 65.9 (SD 8.3) out of a possible 85. There was no significant difference in ICCS scores across the seven semesters. This suggests that the TBL environment may help maintain strong communication skills throughout the program.
- Perceived Contribution of TBL Environment Domains: Students highly valued the contribution of five out of six TBL environment domains to their communication skills development: teachers’ decisions, teachers’ attitudes, students’ attitudes and traits, team characteristics, and contextual factors, all scoring means above 4.3 (on a 5-point Likert scale).
- Formative Assessment Trend: The sixth domain, formative assessment (self- and peer-assessment), had an overall lower mean score of 3.6 (SD 0.5). Importantly, first-year students highly valued this domain, but its perceived importance showed a significant downward trend across semesters.
- Crucial Contributing Factors (Qualitative Themes): The qualitative analysis identified three main themes explaining the influence of TBL elements on communication skills:
- Teachers’ Alignment with the Educational Methodology: Students emphasized that the design and execution of classes by teachers significantly influenced the quality of team discussions and, consequently, communication skills development. Well-prepared cases that stimulated discussion and opportunities for inter-team discussions were particularly beneficial.
- Students’ Attitudes in the Teams: Students’ engagement and willingness to work as a team influenced discussion productivity and communication skills. Students also noted that working with different people each semester, despite being tiring, helped them handle interpersonal conversations. However, issues like differing motivations or lack of affinity could hinder discussions.
- Students’ Perception of Safety and Trust to Provide Feedback: The perception of safety and trust significantly influenced the quality of peer assessment, impacting communication skills development. While constructive feedback was valued, many students felt peers did not take peer assessment seriously or were reluctant to provide honest, critical feedback due to fear of conflict.
Conclusion: The study concludes that a Team-Based Learning environment can effectively maintain medical students’ communication skills. Key elements such as teachers’ alignment with the educational methodology, students’ positive attitudes within teams, and a supportive classroom atmosphere are crucial. While students self-reported high communication skills, further research is needed to explore how to improve the learning environment to support students in providing and receiving constructive peer assessment, especially given the observed downward trend in its perceived value among senior students.
Reference: Pires, E. M. S. G., Meeuwissen, S. N. E., & Savelberg, H. H. C. M. (2025). From Theory to Practice: The Impact of Team-Based Learning on Medical Students’ Communication Skills. Perspectives on Medical Education, 14(1), 74–84. https://doi.org/10.5334/pme.1595
