Outcomes of team based learning in teaching medical ethics: a systematic review.

backgroundThe integration of Team Based Learning (TBL) into medical ethics education has gained attention as a means of promoting active engagement, ethical reasoning, and professional development. This systematic review evaluates the characteristics, outcomes, challenges and quality of studies on TBL in teaching medical ethics across healthcare education contexts.

methodsFollowing PRISMA guideline, a systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar from 2000 to March 31, 2025. Only peer-reviewed empirical studies published in English and focusing on TBL in ethics education were included. Data were extracted on study characteristics, TBL interventions, measurement tools and outcomes. The identified outcomes were then analyzed and categorized using the Kirkpatrick framework to evaluate their hierarchical levels. Methodological quality was assessed using the MERSQI instrument. Due to heterogeneity, a narrative synthesis was conducted.

resultsThe 15 studies, involving 2,134 participants, demonstrated TBL's effectiveness in ethics education across diverse global settings. Studies originated from the United States (6), Turkey (2), Korea (2), a joint Bahrain/Ireland study (1), and single studies from the United Arab Emirates, Malaysia, Oman, and Nepal. Asia contributed 9 studies, North America 6, and Europe 1. Most studies were published between 2019 and 2025. When evaluated through the Kirkpatrick model, TBL demonstrated positive outcomes across multiple levels. Learner Reaction (Level 1) was highly favorable, with consistent reports of high satisfaction and engagement. In terms of Learning (Level 2), the intervention enhanced knowledge retention, ethical reasoning, and moral sensitivity. Furthermore, there was evidence of Behavioral change (Level 3), as students transferred learning to practice by applying ethical principles more effectively, demonstrating deeper cultural awareness, and engaging in more robust team-based decision-making. The fostering of a stronger professional identity suggests a foundational shift aligned with long-term Results (Level 4). Challenges included low pre-reading compliance, resource intensity, and ambiguous assessments. MERSQI scores ranged from 7.5 to 13.0, with an average of 10.2, indicating moderate methodological quality overall.

conclusionsTBL is an effective pedagogical approach for medical ethics education, fostering critical thinking, ethical behavior, and engagement in diverse global settings. Its interactive, learner-centered design promotes cultural and moral awareness and team-based decision-making, with high student satisfaction. Despite implementation challenges, the evidence supports its broader adoption in ethics teaching. Future research should prioritize rigorous study designs, validated assessment tools, and long-term outcome evaluation.