Use of case-based, problem-based and team-based learning in public health education – a scoping review

Abstract

Objectives

Active learning strategies, including case-based learning (CBL), problem-based learning (PBL) and team-based learning (TBL), have been extensively studied in clinical and basic science education; however, their application in public health programmes remains under-explored. Public health professionals address population-level challenges that differ substantially from clinical practice, making it necessary to evaluate whether these pedagogies are effective in this field. This review examines how CBL, PBL and TBL have been used in public health education and what outcomes have been reported.

Design

Scoping review was conducted using the Levac and Colquhoun framework, an adaptation of Arksey and O’Malley’s approach.

Data sources, eligibility and extraction

PubMed, Scopus and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included those involving students enrolled in undergraduate or postgraduate public health programmes, such as bachelor’s or master’s programmes in public health, epidemiology and biostatistics, global health, community medicine or health policy as well as employees working in public health-related fields. Data were extracted using a predefined template capturing study characteristics, population characteristics, student satisfaction and study objectives. All articles were thematically analysed.

Results

Overall, 22 studies were included. Of these, 11 focused on PBL, 2 on CBL, 3 on both CBL and PBL and 6 on TBL. Public health topics addressed included general public health practice (n=5), global health (n=3), health literacy or education (n=3) and occupational health or medicine (n=2); remaining studies covered leadership, nutrition, health behaviour, climate and health, ageing and mental health. Six themes emerged: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges. Key challenges for PBL included cognitive overload and implementation constraints; for CBL, inequitable participation and resource-intensive implementation; and for TBL, increased student time burden and difficulty adapting to complex simulations.

Conclusion

Active learning methods enhance critical thinking and problem-solving in public health education but face implementation barriers, including faculty training requirements and resource constraints. Future research should examine long-term outcomes and the integration of emerging technologies.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study followed the Levac and Colquhoun framework, an extension of Arksey and O’Malley’s approach, enhancing methodological rigour.

• Beyond thematic analysis, the review highlights the strengths and challenges of team-based learning, case-based learning and problem-based learning formats, offering practical insights.

• The findings may have limited applicability in low-resource educational settings due to limited representation in the included literature.

• As is typical of scoping reviews, outcomes like student satisfaction or academic performance were not quantitatively synthesised.

• Only English-language, peer-reviewed studies were included, which may introduce language and publication biases.

Introduction

The field of education is continuously evolving, with educators adopting innovative pedagogical approaches to meet the demands of modern professional practice.¹ Active learning strategies have been shown to enhance student motivation and improve retention of academic concepts compared with traditional lecture-based instruction.² Among these, case-based learning (CBL), problem-based learning (PBL) and team-based learning (TBL) have gained considerable traction in health sciences education over the past two decades.³

CBL engages students as active learners in small, cooperative groups to work through complex problems grounded in realistic scenarios.⁴ Its primary goal is to bridge theory and practice by applying knowledge to authentic cases through inquiry-based methods, preparing students for real-world professional decision-making.^{5 6} PBL, by contrast, presents students with ill-structured, open-ended problems that they must define and investigate themselves, with a facilitator playing a passive, guiding role.⁶ This approach cultivates critical thinking, self-directed learning and the ability to identify and mobilise relevant knowledge to address unfamiliar problems.⁷ TBL shares PBL’s emphasis on active engagement but is structured differently: students complete pre-class preparation, undertake individual and team readiness assurance tests and then apply their knowledge through group activities and inter-team discussion. TBL is suited to larger class formats and prioritises collaborative accountability alongside individual mastery.⁸

These three strategies differ meaningfully in their structure, facilitator role and learning objectives. PBL uses open inquiry in small groups, where students encounter unstructured problems and the facilitator remains largely passive. CBL offers more structured cases with closer facilitator involvement, reducing the risk of unfocused discussion while maintaining real-world applicability.⁹ TBL, designed for larger cohorts, uses a fixed team structure with built-in accountability mechanisms to ensure both individual preparation and team-level application.¹⁰ A comparative overview of these three modalities is provided in figure 1.

Figure 1. Comparative characteristics of CBL, TBL and PBL. CBL, case-based learning; PBL, problem-based learning; TBL, team-based learning; iRAT, individual readiness assessment test; gRAT, group readiness assessment test.

Meta-analyses have demonstrated the effectiveness of CBL, PBL and TBL in improving social skills, critical thinking and academic performance in medical, pharmacy and nursing education.¹¹,¹³ However, existing evidence is largely confined to clinical sciences, and no comprehensive review has examined their use specifically within public health education, representing a significant gap in the literature.

Public health professionals work to optimise population health through health promotion, disease surveillance, prevention and control. Unlike clinicians who manage individual patient care, public health practitioners navigate multifaceted societal challenges involving social, economic, political and environmental determinants that rarely have a single correct solution.¹⁴ These complex, systems-level problems demand pedagogical approaches that go beyond knowledge transmission. This review therefore examines how CBL, PBL and TBL have been used in public health education, and what outcomes have been reported in terms of effectiveness, student perceptions and satisfaction.

Methodology

We used the methodological framework proposed by Levac and Colquhoun,¹⁵ which is an adaptation of Arksey and O’Malley’s approach for scoping reviews.¹⁶ This framework comprises five phases: (1) identification of research questions and purpose; (2) identification of relevant studies; (3) study selection; (4) data extraction; and (5) summarising and reporting results.

Phase I: identification of research questions and purpose

The research team established the following research questions:

1. How have TBL, CBL and PBL been used in public health education?

2. What outcomes have been reported from incorporating TBL, CBL and PBL in public health education, in terms of effectiveness, student perceptions and/or satisfaction?

Phase II: identification of relevant studies

Three databases were selected by consensus: PubMed, Scopus and Google Scholar. A search strategy was developed using Boolean operators, with ‘OR’ applied to synonymous concepts and ‘AND’ used to combine distinct key concepts. Search terms included: ‘case-based learning’, ‘problem-based learning’, ‘team-based learning’, ‘public health education’, ‘public health training’, ‘community health’, ‘public health curriculum’, ‘epidemiology training’, ‘occupational health education’, and ‘community medicine’. A time restriction of 2000 to 2025 was applied; no additional filters were used. Identified studies were exported to EndNote Version 20 (Clarivate Plc, Philadelphia, Pennsylvania, USA). The complete search strategy for each database is provided in online supplemental table S1.

Operational definitions

CBL: an active pedagogy that places students at the centre of a complex problem based on real-life examples, promoting concept-based problem-solving in realistic scenarios in a small class format.¹⁷

TBL: an evidence-based collaborative strategy structured around instructional modules delivered in a three-step cycle: pre-class preparation, in-class readiness assurance testing (individual and team-based), and application-focused exercises. Teams are formed to distribute talent evenly and remain fixed for the duration of the course, engaging in consensus-building and instructor-facilitated discussion, with mechanisms ensuring accountability, team development and immediate feedback, in a large class format.¹⁸

PBL: a teaching strategy in which students are presented with an ill-structured, real-life problem. Students clarify facts, draw on prior knowledge, identify learning gaps and pursue self-directed research with facilitator guidance, in a small class format.¹⁹

Phase III: study selection

Study selection was guided by the Population, Concept and Context framework.²⁰

Population

Studies involving undergraduate or postgraduate public health students enrolled in bachelor’s or master’s programmes in public health, epidemiology and biostatistics, global health, community medicine or health policy, as well as trainees or employees working in the fields of epidemiology, occupational health or medicine, or global health were included. Studies conducted among medical, nursing, pharmacy, occupational therapy or physiotherapy students were excluded.

Concept

Use of TBL, CBL or PBL as the primary pedagogical focus of the study.

Context

Studies with or without a comparison group measuring learning effectiveness (eg, examination scores and knowledge retention), student engagement, participation, satisfaction or skill development in public health settings. All original study designs were considered including case studies, cross-sectional studies, quasi-experimental trials, randomised controlled trials, qualitative studies and mixed-methods studies. Only studies published in English with complete retrievable data were included.

Screening and study selection were performed independently by two team members (AH and MB). Discrepancies were resolved through mutual discussion and where necessary consultation with a third reviewer (JM). The screening process is summarised in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (figure 2).

Figure 2. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart.

Phase IV: data extraction

Data were extracted using a predefined Microsoft Excel template capturing study characteristics (title, author, publication year and country), population characteristics (sample size, student type and year of study) and additional variables, including study objective, student satisfaction and session topic. Extraction was performed by FM and AH and reviewed by MB; discrepancies were resolved through discussion.

Phase V: summarising the results

Studies were organised into three separate Excel sheets by learning strategy (TBL, CBL and PBL). Descriptive summaries were generated in the form of frequencies and percentages for study characteristics and narrative tables were constructed to report outcomes.

Patient and public involvement

No patient or public involvement.

Results

A total of 2515 records were identified across the three databases (PubMed: 450; Scopus: 105; and Google Scholar: 1,960). Following removal of 265 duplicate records, 2250 records were screened by title and abstract, of which 2167 were excluded. Of the 83 reports sought for full-text retrieval, 2 could not be retrieved, leaving 81 reports assessed for eligibility. A further 59 were excluded (ineligible participants: n=49; review articles: n=5; and ineligible learning methodology: n=5), yielding a final sample of 22 studies (figure 2).

Characteristics of the included studies

Among the 22 included studies, 11 used PBL only (spanning blended, simulation-based, comparative and online formats), 2 used CBL only, 3 integrated both PBL and CBL and 6 used TBL. Eight studies were conducted in the USA, four in the Netherlands, two each in Australia and Iran and one each in Belgium, Canada, China, Taiwan, Thailand, Lithuania, Austria and Vietnam; one study spanned multiple European countries. Nine studies targeted bachelor’s-level public health programmes, nine targeted master’s-level programmes and four included occupational medicine trainees or public health workers. The most common study design was mixed methods used in nine studies, followed by quasi-experimental designs in five studies and cross-sectional and qualitative designs in three studies each. Two studies used a case study design. Sample sizes ranged from 9 to 304 participants (table 1). Full study-level characteristics are provided in online supplemental table S2.

Table 1. Characteristics of the included studies (n=22).

Characteristic of the study	N (%)	References
Learning strategy
PBL only	11 (50)	23 2734
CBL only	2 (9.1)	28 30
Both PBL+CBL	3 (13.6)	29 32 33
TBL	6 (27.3)	21 2331 70 71
Country of study*
USA	8 (36.6)	23 24 26 27 32 33 36 71
The Netherlands	4 (18.2)	34 37 67 69
Australia	2 (9.1)	25 29
Iran	2 (9.1)	21 22
Other (includes Belgium, Canada, China, Taiwan, Thailand, Lithuania, Austria and Vietnam)	7 (31.8)	2830 31 35 68 70
Programme level/population
Bachelor’s	9 (40.9)	21 22 26 27 29 35 36 67 68
Master’s	9 (40.9)	2324 28 31 34 37 71
Occupational medicine/PH trainees or workers	4 (18.2)	25 30 69 70
Study design
Mixed methods study	9 (40.9)	24 26 31 34 36 37 68 70 71
Quasi-experimental study	5 (22.8)	21 22 28 32 35
Cross-sectional study	3 (13.6)	30 33 69
Qualitative study	3 (13.6)	23 25 29
Case studies	2 (9.1)	27 67

^*One study included multiple countries (online supplemental table S2)

CBL, case-based learning; PBL, problem-based learning; PH, public health; TBL, team-based learning.

Extent of implementation and outcomes

Regarding the extent of implementation, 15 studies applied the learning strategy across an entire course or programme, while 7 studies used it as a one-off session. Course-integrated studies had tendency to report more comprehensive skill development outcomes, including sustained improvements in communication, critical thinking and collaboration, whereas one-off session studies more commonly reported gains in engagement and perceived relevance without measuring longer-term competency development as summarised in table 2, with individual study details provided in online supplemental table S3.

Table 2. Implementation type, thematic focus, comparators and reported outcomes of included studies (n=22).

Characteristic of the study	N (%)	References
Implementation extent
One-off session	7 (31.8)	2529 34 37 67 69
Entire course/programme	15 (68.1)	21 2426
Public health topics
Public health practice	5 (22.7)	23 25 28 37 68
Global health	3 (13.6)	32 34
Health literacy/education	3 (13.6)	21 22 70
Occupational health/medicine	2 (9.1)	30 35
Others*	9 (40.9)	24 26 27 29 31 36 67 69 71
Comparison groups
Compared with traditional lecture	2 (9.1)	21 22
Other comparison (including online vs face-to-face PBL,  traditional PBL vs flipped PBL, PBL vs MOOC+PBL, non-simulation assignment, traditional grading vs restructured grading)	5 (22.7)	35 3767 71
No comparison	15 (68.1)	23 3468
Reported outcomes†
High student satisfaction	21 (95.4)	21 2830
Improved communication skills	12 (54.5)	21 2426 31
Improved critical thinking/problem-solving	14 (63.6)	21 2831 33 35 69
Improved collaboration	10 (45.5)	21 2325
Preference over traditional methods	15 (68.1)	21 2931
Increased intrinsic motivation	2 (9.1)	27 71
Perceived isolation in online sessions	3 (13.6)	30 35 37
Excessive workload	2 (9.1)	32 33
Extensive or poorly aligned required reading material	3 (13.6)	24 33 34
More time-consuming than traditional methods	4 (18.1)	26 35 68 70
Difficulty engaging in discussions due to inadequate preparation	2 (9.1)	24 35
Repetitive presentations across teams	2 (9.1)	24 67
Resentment toward group work in dysfunctional teams	2 (9.1)	24 33

^*Others include public health leadership, health behaviour, climate and health, ageing, mental health, public health nutrition, public health ethics, research methods and communicable diseases

^†Includes both quantitative and qualitative response summary

MOOC, Massive Open Online Courses; PBL, problem-based learning.

The public health topics addressed were diverse: five studies focused on general public health practice, three on global health, three on health literacy or education and two on occupational health or medicine. The remaining nine studies covered a range of domains, including public health leadership, health behaviour, climate and health, ageing, mental health, public health nutrition, public health ethics, research methods and communicable diseases. Across studies, student satisfaction was high, with 21 of 22 studies (95.4%) reporting positive satisfaction outcomes. Improvements were noted in critical thinking and problem-solving (14 studies; 63.6%) and communication skills (12 studies; 54.5%; table 2).

Although only two studies formally compared active learning methods with traditional lecture formats using a controlled design,^{21 22} student preference for active learning over traditional teaching was captured more broadly across the included literature. In 15 studies (68.1%), students reported a preference for CBL, PBL or TBL over conventional instruction; however, this finding was derived retrospectively through quantitative rating scales, open-ended items or qualitative methods, in which students drew on their prior experience of traditional teaching to make this judgement. Structured feedback from students was, however, infrequently obtained; most studies relied on qualitative or informal assessment methods (table 2).

Negative outcomes were also reported: perceived isolation in online sessions (3 studies; 13.6%), excessive workload (2 studies; 9.1%), poorly aligned required reading material (3 studies; 13.6%) and resentment toward group work in dysfunctional teams (2 studies; 9.1%). Structured feedback mechanisms were identified as an area requiring greater attention across all three modalities (table 2).

Thematic analysis

Six themes were identified through thematic analysis: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges (figure 3). The subthemes within each theme, along with the distribution of studies contributing to each, are detailed in online supplemental table S4 and S5. The most reported strengths and limitations of each learning format are summarised in figure 4.

Figure 3. Themes and subthemes identified during the thematic analysis. CBL, case-based learning; PBL, problem-based learning; TBL, team-based learning.

Figure 4. Key strengths and challenges identified in each format. CBL, case-based learning; PBL, problem-based learning; TBL, team-based learning.

Skill development

TBL, PBL and CBL have all demonstrated significant contributions to the development of critical and practical skills among public health students. CBL was most consistently reported within the skill development domain across the included studies. In TBL, peer learning opportunities help students deepen their understanding of complex topics through structured engagement with course materials, fostering critical thinking, collaborative problem-solving and mutual accountability.^{22 23} PBL similarly supports skill development, with particular emphasis on communication and adaptability. In settings where partnerships with local organisations and community practitioners were established, PBL was found to enhance flexibility and interdisciplinary collaboration.²⁴,²⁷ CBL complements these by focusing on the practical application of knowledge through realistic, structured case studies, including branching-tree formats built around multiple-choice questions. Students in CBL courses reported that such exercises enhanced their ability to manage ambiguity and make informed decisions in community-based contexts.^{28 29} Notably, Braeckman et al reported that postgraduate occupational medicine students, despite possessing stronger prior knowledge than undergraduates, often lacked the confidence and skills to manage complex workplace situations. Their CBL programme used practice-based cases extending beyond traditional clinical hazards to address psychosocial work factors, vulnerable groups, health promotion, rehabilitation strategies, and related legal and ethical considerations.³⁰ Across all three modalities, these methods promote self-directed learning by encouraging students to take ownership of their educational experiences, actively seek solutions and refine their analytical reasoning.

Real-world relevance

All three learning approaches emphasise the application of academic knowledge to real-world public health challenges. In TBL, students apply theoretical understanding to practical problems through case studies and group activities, gaining insight into the ethical and social dimensions of public health and preparing for professional practice.^{22 31} PBL immerses students in authentic scenarios such as rural health challenges, infectious diseases and community-based interventions, effectively connecting theory to practice.^{25 27 32} CBL integrates realistic and progressively unfolding case studies, allowing students to confront practical challenges in a stepwise manner.^{28 30} For example, Palermo et al developed cases from the firsthand experiences of authors working in remote community stores and restructuring food relief services,²⁹ while Winskell et al constructed cases using real country examples to illustrate key global health challenges and their corresponding responses.³³

Blended and online learning

While TBL is traditionally conducted in face-to-face environments, its structured format is adaptable to online and blended settings. The pre-class preparation requirement and collaborative group work align well with digital platforms, where discussions and interactive activities can be facilitated virtually. However, most included TBL studies remained focused on in-person delivery, leaving the potential of blended TBL formats relatively unexplored.^{22 23} PBL has been implemented in blended and online formats with mixed outcomes. While students appreciated the flexibility of remote access, challenges including technical difficulties, time zone differences and reduced motivation were commonly reported. In some instances, tools such as shared group calendars improved coordination and engagement in online settings.^{34 35} CBL has been successfully integrated with e-learning tools such as online case studies and multiple-choice questions, with blended approaches enriching the learning experience by combining online flexibility with hands-on practical activities in community settings.^{28 30}

Challenges

Despite their advantages, all three modalities face implementation challenges. TBL places significant workload demands on faculty, who must design, prepare and manage complex team-based sessions. Ensuring equitable participation and motivating students to complete preparatory tasks have proven difficult, and time constraints were a particular barrier for part-time students balancing work and study.^{22 23 31} PBL faces similar challenges, including resource limitations, large group sizes and variable student readiness for self-directed learning.³³ CBL challenges include limited teacher–student interaction in online settings, absence of objective long-term evaluation methods and difficulty applying case-based formats to highly technical subject matter.^{28 30}

Beyond these general implementation barriers, several challenges are specific to the public health education context. Public health problems are often structural and policy-driven, making it difficult to define a clear, bounded, solvable problem within a single teaching session.^{23 32} Students may struggle with the multilayered determinants of health, including social, economic, political and environmental factors, which rarely yield a single correct solution.³⁶ Teams may gravitate toward technically correct answers rather than engaging with questions of feasibility, political acceptability and community engagement.²³ Assessing team performance on abstract, population-level concepts is inherently more challenging than evaluating clinical reasoning. Designing cases that reflect population-level decision-making rather than individual patient management remains a persistent difficulty, and context-specific cases may not transfer readily across different sociopolitical settings. ³²Additionally, public health outcomes are often delayed, making it difficult to demonstrate clear causal relationships within the timeframe of a case-based exercise.²¹

Diversity and inclusion

Diversity is a central consideration across all three modalities, though the challenges and strategies differ. TBL benefits from diverse team compositions, which enrich learning through varied perspectives and experiences; however, barriers such as language proficiency, differences in educational background and social factors, including employment status and family responsibilities, can affect participation and engagement.³¹ PBL outcomes vary significantly across demographic and cultural contexts, underscoring the importance of context-sensitive implementation to ensure equitable learning experiences.²⁶ CBL supports diversity by creating structured environments that accommodate students with varying prior experiences and by forming interdisciplinary teams that encourage collaboration across professional and cultural boundaries.^{28 30}

Innovative approaches

Each modality integrates innovative methods to enhance engagement and learning outcomes. TBL uses individual and team readiness assurance tests, real-world case studies and group application exercises to foster active participation and practical knowledge application. PBL leverages advanced technologies including simulations, Massive Open Online Courses (MOOCs) and role-playing to create immersive learning environments, with alternative methods such as debates and mind-mapping further enriching the experience.³⁵,³⁷ CBL uses strategies such as progressively unfolding case studies that increase in complexity, challenging students to adapt and think critically. In some instances, student-authored cases have been published and disseminated globally, integrating theoretical learning with real-world professional contribution.²⁸

Discussion

This scoping review examined the use of CBL, PBL and TBL in public health education through analysis of 22 studies. Six themes were identified: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges.

CBL, TBL and PBL share several common features, including the promotion of critical thinking, collaborative problem-solving and active engagement with course material, but differ meaningfully in their structure and emphasis.⁵ CBL focuses on applying knowledge to structured, realistic scenarios and has been shown to be particularly effective in improving decision-making and critical thinking, often outperforming lecture-based methods in academic outcomes.³⁸ PBL emphasises self-directed learning and open-ended inquiry, fostering independent investigation and interdisciplinary collaboration. Students are encouraged to identify what knowledge and resources are needed to address a problem, rather than being provided solutions directly, which strengthens both analytical reasoning and communication skills.^{39 40} TBL, by contrast, prioritises collaborative accountability through structured group activities, making it particularly well suited to developing the teamwork and peer interaction skills essential to public health professional practice.⁴¹

The use of CBL, PBL and TBL in public health education holds considerable pedagogical value, though implementation is not without challenges.⁴² The effectiveness of these methods varies depending on factors such as student profile, programme level, and faculty experience and preference.^{43 44} The importance of critical thinking is central to health sciences education, and TBL and PBL have been shown to significantly enhance the ability of students to apply, analyse and evaluate complex scenarios, aligning with Bloom’s taxonomy of higher-order cognitive development.⁶ Nevertheless, the evidence base specific to public health, as distinct from medical or clinical education, and to graduate versus undergraduate levels, remains limited.⁶

Facilitators play an integral role in all three modalities, guiding discussion and ensuring that theoretical knowledge is translated into practical application. Effective facilitation requires maintaining group focus, managing team dynamics and correcting misconceptions.⁴⁵ In public health education specifically, facilitators must possess contextual knowledge to connect cases to real issues such as social determinants of health, and must be equipped to respond to the broader queries of students about policy and population-level decision-making.⁴⁶ Providing a psychologically safe environment for active participation has been consistently identified as a factor that increases student engagement and depth of understanding.⁶

The COVID-19 pandemic accelerated the adaptation of traditional PBL into modified PBL (mPBL), particularly in virtual formats. mPBL retains the core principles of PBL while incorporating additional structure, guidance and digital tools to address specific learning needs, enabling students to engage with realistic scenarios related to health service delivery in a post-pandemic context.⁴⁷ A review concluded that while mPBL improves knowledge and skills, student satisfaction remains comparatively higher with traditional teaching approaches.⁸ Studies in current review reported similar findings when PBL was delivered in an online format, with students noting reduced interaction and motivation compared with in-person delivery.^{36 37}

The pandemic also accelerated broader adoption of digital tools across all three modalities. However, maintaining interaction and engagement in online settings remains a significant challenge. Institutions seeking to implement these approaches online should consider integrating hybrid models and flipped classroom applications,⁴⁸ and should tailor cases to local health challenges.⁴⁹ Real-time teleconferencing and interactive digital platforms have demonstrated effectiveness in supporting student engagement and teamwork in online TBL and PBL.⁸ Emerging technologies, including virtual simulations, adaptive learning platforms and artificial intelligence (AI)-driven tools, are increasingly being incorporated,⁵⁰ though effective online active learning demands careful planning, adequate faculty training and manageable student-to-instructor ratios. Scalability remains a persistent concern, as maintaining quality and engagement in large virtual cohorts requires substantial resources.⁵¹ Innovative complementary methods such as concept mapping, design thinking, simulation-based learning, educational games and escape rooms have also emerged as strategies to enrich TBL and PBL delivery.⁵²

Instructor feedback and student self-assessment are integral components of active learning. TBL and PBL provide structured opportunities for formative feedback and peer-to-peer learning, both of which improve critical thinking and conceptual understanding.⁶ However, the accuracy of self-assessment varies across performance levels: mid-level performers tend to be most accurate, while high and low performers frequently overestimate or underestimate their abilities respectively.⁸ Validated self-efficacy tools and reflective writing exercises can enhance self-assessment accuracy and contribute to improved professional competency development.⁵³ Findings from this review highlight the need for structured feedback mechanisms to be built explicitly into active learning environments across all three modalities.

Implementation barriers identified in this review are consistent with those reported in the broader literature. These include high resource requirements such as funding and trained facilitators,⁵⁴ need for smaller class sizes to ensure effective learning,⁵⁵ lack of standardised assessment tools,⁵⁶ high faculty workload⁵⁷ and low student motivation, particularly in online formats. ^{58 59} These challenges are compounded in resource-limited settings, and approaches must therefore be adapted to local context and resource availability.⁶⁰

Although no studies were identified that applied AI-based modalities specifically to public health education, a systematic review by Wei et al reported a pooled student satisfaction score of 0.70 (95% CI 0.47 to 0.92) for AI-assisted PBL and CBL among medical and dental students, suggesting generally positive learner experiences with AI-supported approaches.⁶¹ Wang et al highlighted the potential of AI to enhance public health education through intelligent tutoring systems, adaptive learning platforms and learning analytics, which can provide personalised learning pathways, real-time feedback and targeted resources tailored to learner performance.⁶² For assessment, AI may contribute to automated and standardised scoring of reflective writing and readiness assurance tests, reducing faculty workload while improving consistency. Within programme management, AI-enabled tools may assist in coordinating team formation, monitoring participation and optimising resource allocation.⁶³ Future studies should explicitly explore and evaluate the integration of AI into CBL, PBL and TBL in public health education, with particular attention to implementation feasibility, student experience and learning outcomes.

Evidence from clinical and basic science education provides a useful benchmark for interpreting the findings of this review. Lu et al reported that TBL significantly improved medical student satisfaction compared with lecture-based learning, with a standardised mean difference (SMD) of 1.13 (95% CI 0.97 to 1.29).⁶⁴ Zheng et al similarly demonstrated notable enhancement in student satisfaction with PBL in surgical education, with an SMD of 2.13 (95% CI 1.11 to 3.15).⁶⁵ A meta-analysis of CBL reported an SMD of 0.79 (95% CI 0.13 to 1.44) for student satisfaction compared with other teaching methods.⁶⁶ Due to the limited number and heterogeneity of studies in public health education, a pooled effect size for satisfaction in this context has not yet been reported. However, this review found that students consistently reported high levels of satisfaction and motivation, describing their experiences as engaging, realistic and intellectually stimulating.

Beyond satisfaction, student perceptions of these learning modalities provide important insight into their acceptability and pedagogical appropriateness. Students in PBL and TBL settings generally perceived these methods as more relevant and intellectually challenging than traditional lectures, particularly at the graduate level where the complexity of real-world problem scenarios was appreciated. Perceptions were more mixed in online delivery formats, where students noted reduced peer interaction, a sense of isolation and diminished motivation compared with in-person settings.^{30 35 37} In CBL, students perceived the structured case format as realistic and well suited to developing professional judgement, though some noted that online CBL limited meaningful teacher–student interaction.^{28 30} Notably, perceptions of group work varied considerably in TBL settings: while many students valued the collaborative structure, negative perceptions emerged when team dynamics were poor, preparation was unequal across team members or workload was perceived as excessive.^{24 33} These perceptual findings have direct implications for implementation design, suggesting the need for explicit team formation strategies, clear workload expectations and structured facilitation to optimise the student experience.

Several studies in this review demonstrated particularly strong outcomes for active learning modalities. Mohebi et al and Rajati et al both found significantly higher examination scores and satisfaction in TBL groups compared with traditional lecture-based instruction (p<0.001 and p<0.021 respectively).^{21 22} Spinello et al reported that all students preferred the PBL online simulation to traditional paper-based assignments, rating it as more motivating and engaging.³⁶ Matsuda et al found significant improvements in communication and metacognitive skills across three time-points in a PBL course, with large effect sizes for key outcomes (p<0.001).²⁶ These findings are consistent with broader evidence from health sciences education. Zhao et al reported that a combined PBL–CBL approach produced significantly better learning outcomes compared with traditional teaching in the clinical context of thyroid disease education (p<0.001).⁵⁹ These findings suggest that when properly implemented, these modalities can substantially outperform conventional teaching in public health education.

Although systematic reviews have demonstrated the effectiveness of CBL, PBL and TBL in basic sciences and clinical subjects,^{7 65} their transformative potential in public health education is now becoming evident. This review systematically compiles and synthesises available evidence, providing a holistic understanding of how these modalities have been applied and adapted in public health contexts, including innovations introduced during the digital era. The included studies vary widely in design, methodology and outcomes measured, making it difficult to draw definitive conclusions. As is characteristic of scoping reviews, quality assessment, effect sizes and long-term outcomes are not reported. The applicability of findings may be limited in low-resource settings, which are insufficient representation in the included literature. Many studies relied on student self-assessments of satisfaction and skill development, which may not reflect objective learning or competency gains.

Conclusion

This scoping review provides a comprehensive synthesis of evidence on the use of CBL, PBL and TBL in public health education. Across 22 studies, six themes were identified: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges. The findings demonstrate that all three modalities hold considerable promise for public health education, enhancing critical thinking, communication, collaboration and real-world problem-solving in ways that align with the complex, systems-level demands of public health practice. Student satisfaction with these approaches was consistently high across contexts and programme levels. However, implementation remains constrained by resource requirements, faculty training needs, large class sizes and the inherent difficulty of adapting population-level problem scenarios to structured teaching formats. Future research should prioritise longitudinal studies examining the long-term impact of these modalities on professional competency and practice outcomes, the development of standardised assessment tools suited to public health education and rigorous evaluation of emerging innovations, including AI-assisted delivery and hybrid learning formats.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.