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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 98-102

Team-based learning in postgraduate midwifery education: A descriptive qualitative study

1 Department of Pharmacology, King Saud bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
2 Department of Research, College of Nursing – Jeddah, King Saud bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia

Date of Web Publication5-Nov-2019

Correspondence Address:
Dr. Nusrat Bano
King Saud bin Abdul Aziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Mail Code 6565, P. O. Box. 9515, Jeddah, 21423
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EHP.EHP_17_19

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Background: Pharmacology is perceived as a difficult course by nursing students who find it difficult to retain drug names and complex pharmacokinetic and pharmacodynamics processes. Team-based learning is a student-centered instructional design associated with improved academic outcomes. Purpose: To explore experiences of postgraduate nursing students with team-based learning in clinical pharmacology course. Methods: A descriptive qualitative design comprising of in-depth interviews was used. Study sample comprised of post graduate midwifery nursing students enrolled in clinical pharmacology course conducted with team-based learning. Content analysis following Graneheimian inductive approach was used to yield themes and subthemes. Results: Two themes emerged as 'Learning environment' and 'Intellectual process', comprising of 3-4 subthemes. Students absorbed concepts in a relaxed yet challenging environment. Intellectual process showcased improvements in knowledge retention, grasping concepts, confidence and thinking. Conclusion: Postgraduate midwifery nursing students had positive learning experiences in clinical pharmacology course conducted with team-based learning.

Keywords: Midwifery, nursing, pharmacology, postgraduate, team-based learning

How to cite this article:
Bano N, de Beer J, Omer TY. Team-based learning in postgraduate midwifery education: A descriptive qualitative study. Educ Health Prof 2019;2:98-102

How to cite this URL:
Bano N, de Beer J, Omer TY. Team-based learning in postgraduate midwifery education: A descriptive qualitative study. Educ Health Prof [serial online] 2019 [cited 2021 Jan 24];2:98-102. Available from: https://www.ehpjournal.com/text.asp?2019/2/2/98/270285

  Introduction Top

Pharmacology is a complex course which involves an understanding of drug actions and effects on the living system, comprising of cellular, molecular, and biological mechanisms.[1] Nurses require pharmacological knowledge and skills for safe drug administration and adverse effect monitoring.[2] Increasing number in reports of medication error has raised concerns about the effectiveness of pharmacological knowledge of registered nurses.[3]

Nursing students are overwhelmed with enormous course content regarding complex drug mechanisms and find it difficult to translate theoretical course knowledge into clinical practice.[4],[5] Studies have shown that traditional teaching methods comprising of didactic lectures, used in pharmacology courses lead to inadequate preparation of nursing students in clinical practice and new teaching methods are required.[6],[7],[8]

Team-based learning (TBL) is a type of flipped class learning method in which students complete preclass learning assignments in preparation of concept based application exercises in the face-to-face class sessions. TBL is associated with increased student satisfaction and higher engagement compared to traditional lectures.[9] It enhances problem-solving skills, clinical performance, and retention of knowledge in nursing students.[10] TBL is shown to improve test scores of nursing students in a pharmacology course.[11]

Most research regarding teaching and learning pharmacology are centered on undergraduate nursing education [4],[5],[6] whereas experiences of postgraduate nursing students in pharmacology course are seldom reported,[12] although preferences in learning may vary in postgraduate education.[13] In addition to this, low positive attitude toward patient safety is reported in postgraduate nursing students.[14] Their experiences in pharmacology education can directly affect their attitude in patient safety and thus important to study. Results from such studies will offer valuable insight and help curriculum developers in designing pharmacology course with effective learning outcomes.

The purpose of this study was to describe the experiences of postgraduate midwifery nursing students with TBL in clinical pharmacology module. The research question was, “What are the experiences of postgraduate midwifery nursing students with TBL in a clinical pharmacology course?” This paper primarily reports the maiden experience of the students TBL as they had no previous exposure to this instructional design.

  Methods Top

Study design, participants, and setting

A descriptive qualitative research study design was used. Eight female postgraduate students (mean age 25.03 ± 1.96), registered in clinical pharmacology course in the fall semester of midwifery master program, the academic year 2018, at the College of Nursing, King Saud bin Abdulaziz University for Health Sciences, were included after ethical approval of the study. The students were registered nurses in different local hospitals and were sanctioned leaves to complete midwifery postgraduate education. The two credit hours pharmacology course was completed over 15 weeks, allowing two consecutive contact hours per week.

Instructional design

Typical TBL unit model [15] was used in class with two permanent teams (four students each), allocated by the instructor. In the pre-class learning phase, the students were provided access to online learning content uploaded on the Blackboard Learn system® every week. The face-to-face class activities comprised of the individual readiness assessment test, group readiness assessment test, and registration of appeal followed by application exercise. [Figure 1] gives an overview of the instructional design.
Figure 1: Overview of the team-based learning process

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Data collection method, process, and analysis

Data collection commenced after course completion. Indepth face to face interviews (between 30 and 40 min) were conducted by the researchers [Table 1]. They were audio-recorded and transcribed verbatim. The accuracy of transcribed data was cross-checked and compared with the audio recordings. The inductive approach suggested by Graneheim and Lundman [16] was used for content analysis. At stage one, the transcribed interviews were read and re-read to locate experiences pertaining to TBL (body of text). In stage two, significantly similar statements which comprised of sentences, words, phrases, and clauses were highlighted and selected (meaning unit). In the third stage, significantly similar statements were summarized after categorization (condensed meaning unit). In the final stage, the summarized content was conceptualized to yield themes and subheadings (coded units).
Table 1: Guide for face-to-face interview

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Academic rigor

Trustworthiness was ensured using the criteria of credibility, transferability, dependability, and confirmability by Lincoln and Guba.[17] Credibility in this study was achieved by “member checking” in order to confirm the emerging subthemes and themes. Participants were given the opportunity to read the transcripts that were transcribed verbatim to ensure that what was captured was a true reflection of their words. Thereafter as data were analyzed, and themes emerged, participants were approached to verify whether the emerging themes are representative of their experiences as supported by interview excerpts. Transferability was achieved by providing a rich, thorough, and clear description of the study processes. Dependability was attained through scrutiny of original transcripts, highlighted sections, statements, categories, themes and subthemes, and field notes by an external reviewer. Confirmability was achieved by two independent qualitative experts that assessed the accuracy of the data, relevance or meaning. In addition, the researcher kept reflexive notes to allow an independent audit trail.[17]

  Results and Discussion Top

The purpose of this study was to explore the experiences of postgraduate nursing students with TBL in clinical pharmacology course. Data analysis resulted in two themes, which were “learning environment” and “intellectual process” [Table 2].
Table 2: Themes and subthemes of student's learning experiences with team-based learning

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Learning environment

The first main theme “learning environment” comprised three subthemes namely “relaxed,” “absorbing,” and “challenging.” The students described that learning was carried out in a calm and “relaxed” environment in the absence of any fear poised by the complexity and enormity of course content. “The learning method helped me to overcome the fear of pharmacology (Judi).”

Preclass preparation and peer support in the face-to-face class sessions resolved stress. Because I had reviewed topics on blackboard before coming to the class, I was relaxed in class (Sarah). The findings indicate that TBL improved the quality of the learning environment, that is known to directly affect the level of motivation and the academic performance in the students and reduce social anxiety.[18],[19] Everyone participated and everyone studied before coming to the class, also everyone had examples from their jobs, you know, so we had competition but no stress (Sam). This finding supports that distributed responsibilities in TBL help students to relax.[20] The students also described that a good compatible relationship with the instructor, developed during TBL, allowed them to relax. Sound and effective collaboration between faculty and student is responsible for the success of any student-centered learning method.[21] The relationship between the faculty and us was very friendly and there were no barriers. I was relaxed because of it (Helena).

The study participants described that the learning environment was “absorbing” that locked their interest, mitigated boredom, and engaged them effectively. I was deeply involved in group work and discussions. It built my teamwork skills also (Emily). In a similar study, increased engagement in TBL is reported in critical care postgraduate students.[22] We were actively involved during the whole class time and the class time (2 h) seemed short to us (Sam).

Students were not bored and they also found the learning environment to be “challenging.” We had no idea about the difficulty level of application exercises, it was challenging (Judi). The students were conscious of a certain amount of effort required from them in TBL. “To get others to agree on the right answer during discussions was most challenging because they brought examples from their job experience (Sarah).”

Experiences of students in this study are supported by a previous study showing that TBL is pleasantly received by students who are fed up from boring lectures,[23] and it fosters a competitive and challenging learning environment.[24] I was interested and I also listened to others very carefully. I was not bored (Amy). It was not at all boring….not like listening passively to a lecture (Kate).

Intellectual process

The second theme surfaced as “intellectual process” with four subthemes, “easier grasp on concepts,” “knowledge retention,” “confidence,” and “thinking.”

The students described that it was easy for them to grasp pharmacological concepts in TBL. “The learning was in discussions, and this process was easy… topics were easier to understand (Amy).” We understood things fast because of the discussions that we had in groups and the teacher always gave us more ideas to discuss (Sam).

While describing “knowledge retention,” the students verbalized their experiences as long-lasting memory of the concepts. When I studied later, it took me less time and I highlighted many things, it was easy when my eyes are on the slides and I remember like, this is what we discussed and even if it is not written, still I could recall (Amy). According to participants, knowledge retention had a positive outcome on their test performance stating that the concepts were glued to their minds which enabled them to deal with the complicated information of the course in an effective manner. We will not forget, we still remember the activities that we did in the class, it (information) is stuck in our minds (Sarah).

TBL directed a process of higher-order “thinking,” helping them to raise the quality of their arguments during discussions to reach the best possible answer. There was input from them and there were certain things on my mind, we can like confirm or discuss and reject certain ideas (and say) like this is the best one (Amy). When there was sharing of experiences, I was comparing scenarios and there was a lot of critical thinking going on (Sam).

Participants reiterated that TBL made them conscious that they were engaged in different levels of thinking. We took individual and group tests, it showed me how I should be thinking in different ways and showed me the mistake that I had made…I had to think in a different way to solve the problem (Naomi). I had to think quickly sometimes but other times we had to think in groups, slowly, carefully and deeply (Sarah).

Respondents recalled that they gradually adapted to the level of thinking of peers during the discussion, which assisted them to upstage their own level of thinking. When we worked as a group for the first time, I knew some of them were not thinking the same way I was thinking about and maybe we would not have a final solution or something, but by the next activity ….we adapted, how we accept each other, how we think together, and how we can finalize what we have to do (Sam).

The study participants described their unique classroom experience, facilitating retention of concepts due to higher-order thinking in class. This finding is in line with studies showing that TBL stimulates higher level of thinking and improves the ability to recall information in long term.[25],[26] However, contrary to this, some other studies have highlighted that knowledge retention in the long-term appears to be lower in TBL than lecture-based learning, even though TBL improves mastery of material and student engagement.[27],[28]

TBL instilled “confidence” in the students, who felt that this new-found attribute, shaped in the classroom, enabled them to apply pharmacology concepts effectively in clinical practicum. We are confident about how to address medication administration problems in practice (Sarah). I will now ask the doctor regarding the medication according to the situation and the patient. I will do it with confidence now (Helena). The students expressed that TBL in pharmacology course made them more confident about their knowledge regarding medications. Earlier studies showed similar gains in confidence of midwifery nursing students involved in TBL.[29]


This study represents the experiences of female nursing students from a single institute. Future research in a longitudinal frame is required to assess long-term knowledge retention of concepts attained by TBL in pharmacology and to assess the effectiveness of TBL on knowledge application skills in nursing practice.

  Conclusion Top

The study findings showed that the postgraduate midwifery nursing students had a positive experience with TBL in pharmacology. Pharmacological knowledge acquired in an inclusive yet challenging environment in TBL was retained easily by nursing students who felt knowledgeable, confident, and prepared to operate in clinical settings. TBL enabled students to think evaluate and formulate their arguments on scientific grounds, which improved their learning experiences in pharmacology.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2]

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