TBL and Knowledge Retention: Are We Doing Enough?

By: Chris Johnson, PharmD, MEd, BCACP; Lydia Newsom, PharmD, BCPS; Jared Butler, PharmD, BCPS, DPLA

Previous Pulses posts have described the theoretical underpinnings of team-based learning (TBL) and best practices regarding pre-class preparation for educators considering implementing TBL within their courses. Faculty using TBL, as well as other pedagogies, must consider how we can improve students’ ability to retain content. This is, after all, an end goal of pharmacy education – to produce pharmacists with a well developed and dynamic knowledge base ready for patient care.

Emke et al.found that the incorporation of TBL significantly improved knowledge at the end of the course, but those benefits disappeared prior to experiential clerkships at a US medical school.1 An additional study found that long-term retention of OTC knowledge decreases in students in a TBL course compared to traditional lecture after 17 months.2 These findings indicate that TBL may improve short-term knowledge retention, but additional work needs to be done to improve long-term retention.

Frequently, knowledge retention (and exam performance) relies on the methods that students use to study content covered in class. The traditional method of massed practice (i.e., cramming) can include a number of strategies that Dunlosky describes as “less useful”: rereading, highlighting, summarization, keyword mnemonics, and imagery for text.3 Massed practice has repeatedly been shown inferior, within the realm of knowledge retention, to the strategies listed in Table 1.

Table 1. Strategies to Improve Knowledge Retention (adapted from Dunlosky)3

Category Most Effective Strategies Example
Practice Testing Aids student decisions on content that needs further practice, particularly if including instant feedback on answers. Most beneficial are practice tests that force students to recall from memory, rather than recognizing the right answer. Instructor provides practice questions for students to aid in their studying.
Distributed Practice Students review content multiple times over greater timespans. More effective than massed practice (i.e., cramming). Instructor requires an assignment at regular intervals covering previous material.
Category Promising Strategies Example
Interleaved Practice Similar to Distributed Practice, but mixes the order of the content & types of problems. Instructor can develop assignments that mix content areas & problem types for each area.
Elaborative Interrogation Encourages active processing of content through the student explaining why the content is true. Can still be beneficial when explanation is not 100% accurate. Assignments include open ended-questions that force students to explain answers.
Self-explanation Similar to Elaborative Interrogation, but students explain how new information relates to what they already know. Instructor requires regular assignments that have students explain the new content from that day’s or week’s courses.

Use of Knowledge Retention Strategies in TBL

Some strategies from Table 1 appear to be interwoven into the basic TBL structure:

  • Practice Testing: Readiness Assessment Tests (RATs) provide students the opportunity to assess what they learned from the pre-class preparation. Additionally, team RATs should include instant feedback to guide student studying.
  • Elaborative Interrogation: During the simultaneous reporting portion of a TBL session, students must explain why the answer they chose is correct.
  • In addition, questions within application activities could encourage students to discuss how the exercises connect to previous material (self-explanation).

However, as Emke, et al. and Taglieri, et al. suggest, a TBL module in isolation may not provide enough practice opportunities to improve long-term retention.1,2

Opportunities for Enhancing TBL

As many students are most familiar with and utilize massed practice for exam preparation, TBL instructors should utilize knowledge retention strategies within their course to aid in retention. This may be accomplished through weekly cumulative quizzes, longitudinal iterative cases, or regular assignments outside of class, which would create a structure of distributed practice. Some of these activities may be accomplished outside of class time to avoid encroaching on the TBL session. The inclusion of brief questions in TBL application activities that relate to previous material may also facilitate further practice. This should likely be kept brief to avoid distracting students from the topic that is the focus of the TBL session.

While it is clear that TBL has some advantages over traditional lecture, the impact on long-term knowledge retention is less clear. Pharmacy educators using TBL should research additional strategies to augment this pedagogy and enhance knowledge retention. Research into these strategies could include efficiency of their incorporation in terms of student/faculty time, ease of use, and efficacy in terms of increasing knowledge retention within TBL. How do you work to enhance the knowledge retention of students in TBL?


The authors want to acknowledge the work of the AACP Junior Faculty Learning Community Committee, especially the 2018 – 2019 committee chair, Kate Smith,PharmD, BCACP for her efforts to set up this Pulses series.


  1. Emke AR, Butler AC, Larsen DP. Effects of Team-Based Learning on short-term and long-term retention of factual knowledge. Med Teach. 2016;38(3):306-11.
  2. Taglieri C, Schnee D, Dvorkin Camiel L, et al. Comparison of long-term knowledge retention in lecture-based versus flipped team-based learning course delivery. Curr Pharm Teach Learn. 2017;9(3):391-397.
  3. Dunlosky J. Strengthening the Student Toolbox: Study Strategies to Boost Learning. Am Educat Prof J Am Fed Teachers. 2013;37(3):12–21.

Chris Johnson, PharmD, MEd, BCACP is an Assistant Professor of Pharmacy Practice at the University of Arkansas for Medical Sciences College of Pharmacy. Educational scholarship interests include underserved pharmacy practice, ambulatory care practice development, and impacts of innovative pedagogical approaches on student learning. In his free time, Chris enjoys hiking and spending time with his wife, Kati, and sons, Lincoln and Theo.

Lydia C. Newsom, PharmD, BCPS is a Clinical Assistant Professor at Mercer University College of Pharmacy. Educational scholarship interests include use of technology in the classroom and the teaching and assessment of clinical reasoning. In her free time, Lydia enjoys playing tennis, watching college football, and spending time with family and friends.

Jared Butler, PharmD, BCPS, DPLA is an Assistant Professor of Pharmacy Practice at Drake University College of Pharmacy and Health Sciences. Educational scholarship interests include team based learning in graduate education. In his free time, Jared enjoys watching and participating in sporting events, hanging out with his wife and three children, and relaxing with country music on the radio.

Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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