. 2019 Oct 15;19:369. doi: 10.1186/s12909-019-1795-4

Table 3.

Participants’ responses regarding perceptions of their experiences that related to “Mutual engagement”

MUTUAL ENGAGEMENT: joint activities that promote collaboration and development of learning relationships
Structure and steps in TBL promoted student preparation and collaboration The specific in-class steps of TBL, including the pre-reading, the individual and team test and a series of problem solving activities encouraged students to work together. Students were made accountable for their learning both individually and as a group, thus promoting team development. Facilitators felt the structure of TBL helped ensure that students come to class prepared to engage in joint activities.	“Doing the test you might go through by yourself, not get all the questions right, you’ve got other people’s brains to bounce off, it’s more the way that it is – because both of them are guided in a manner but I feel like TBL’s much more guided around, knowledge and learning where I found PBL was very guided around time.” (student) “TBL is very structured. There is pre-reading that is compulsory for the students, and they do it because they are assessed as soon as they come into the room. They do an individual test, and then the team does the same test. There is a lot of accountability on the students, a lot of competitiveness, so they are really doing a proper flipped class room, they actually do come along prepared”. (facilitator)
All students in one large class-room space Staff and students felt having all groups of students in one large room facilitated intra and inter-team collaboration, creating a relaxed, safe environment and collegial atmosphere for student learning.	“I think the experiences I’ve had about why TBL works so well is the organization – you’ve got to have the right space for students to work in small groups, but also mix with each other…..they have an opportunity to share in a safe space, which is fantastic”. (facilitator) “…..the fact that it was in this big room, we were collaborating still, the competition wasn’t too serious, but it added an element of pressure or motivation to the group dynamic”. (student) “..if you’re struggling with something like drawing the mechanism, it’s just not working, you look immediately to your left and you have a good example of how you could do it and in PBL - you’re locked in a room in this big corridor it’s completely isolating. We lean across and discuss, and the tutors would ask people their different thoughts, there was that sharing as well….like cross group learning”. (student)
Small group size of TBL teams The small size of the TBL groups (five students per team) compared to PBL groups (10 students per team) motivated students to prepare for the class and contribute to discussions.	“PBL is just excruciating that where same people talk every week, the same people are quiet every week and there’s nothing that changes that, but I think in TBL even if someone’s a person who’s inclined to be quiet and inclined to, kind of, shy away from their opinion, just the environment of the room makes people change … because it’s much more collaborative, it’s much more friendly ..much more stimulating”. (student)
Use of testing prompted students to prepare In TBL, individual accountability and effective teamwork was fostered by the individual and teams tests. Testing at the beginning of class was an important influence in ensuring students came to class prepared. The team test in TBL promoted friendly competition between teams, and active discussion within teams.	“I think there was the competitive edge, as bad as it sounds, no one wants to be the loser. There’s the whole thing if you didn’t watch the lectures and people look at you.. get the vibe. You turn around to your friend and joking be like, ‘yeah, you better prepare for next week mate, we’ve got to win’”. (student) “People had to explain what they thought was right or wrong, and I think this is a really good way of getting people to work together as they will do in the future in the medical profession”. (student)

MUTUAL ENGAGEMENT: joint activities that promote collaboration and development of learning relationships

Structure and steps in TBL promoted student preparation and collaboration

The specific in-class steps of TBL, including the pre-reading, the individual and team test and a series of problem solving activities encouraged students to work together. Students were made accountable for their learning both individually and as a group, thus promoting team development.

Facilitators felt the structure of TBL helped ensure that students come to class prepared to engage in joint activities.

“Doing the test you might go through by yourself, not get all the questions right, you’ve got other people’s brains to bounce off, it’s more the way that it is – because both of them are guided in a manner but I feel like TBL’s much more guided around, knowledge and learning where I found PBL was very guided around time.” (student)

“TBL is very structured. There is pre-reading that is compulsory for the students, and they do it because they are assessed as soon as they come into the room. They do an individual test, and then the team does the same test. There is a lot of accountability on the students, a lot of competitiveness, so they are really doing a proper flipped class room, they actually do come along prepared”. (facilitator)

All students in one large class-room space

Staff and students felt having all groups of students in one large room facilitated intra and inter-team collaboration, creating a relaxed, safe environment and collegial atmosphere for student learning.

“I think the experiences I’ve had about why TBL works so well is the organization – you’ve got to have the right space for students to work in small groups, but also mix with each other…..they have an opportunity to share in a safe space, which is fantastic”. (facilitator)

“…..the fact that it was in this big room, we were collaborating still, the competition wasn’t too serious, but it added an element of pressure or motivation to the group dynamic”. (student)

“..if you’re struggling with something like drawing the mechanism, it’s just not working, you look immediately to your left and you have a good example of how you could do it and in PBL - you’re locked in a room in this big corridor it’s completely isolating. We lean across and discuss, and the tutors would ask people their different thoughts, there was that sharing as well….like cross group learning”. (student)

Small group size of TBL teams

The small size of the TBL groups (five students per team) compared to PBL groups (10 students per team) motivated students to prepare for the class and contribute to discussions.

“PBL is just excruciating that where same people talk every week, the same people are quiet every week and there’s nothing that changes that, but I think in TBL even if someone’s a person who’s inclined to be quiet and inclined to, kind of, shy away from their opinion, just the environment of the room makes people change … because it’s much more collaborative, it’s much more friendly ..much more stimulating”. (student)

Use of testing prompted students to prepare

In TBL, individual accountability and effective teamwork was fostered by the individual and teams tests. Testing at the beginning of class was an important influence in ensuring students came to class prepared. The team test in TBL promoted friendly competition between teams, and active discussion within teams.

“I think there was the competitive edge, as bad as it sounds, no one wants to be the loser. There’s the whole thing if you didn’t watch the lectures and people look at you.. get the vibe. You turn around to your friend and joking be like, ‘yeah, you better prepare for next week mate, we’ve got to win’”. (student)

“People had to explain what they thought was right or wrong, and I think this is a really good way of getting people to work together as they will do in the future in the medical profession”. (student)