Team-based learning versus lecture-based instruction for chest radiograph interpretation in physician associate education: a quasi-experimental study

Chest radiograph interpretation is a foundational skill in physician associate (PA) education, and competence in diagnostic imaging is an accreditation standard. While a larger body of research on radiology education exists in undergraduate medical education, considerable variability in instructional approaches limits clear conclusions regarding the most effective method. Growing evidence supports the use of active learning strategies in radiology instruction. However, little published research specifically addresses radiology education within PA programs. Team-Based Learning (TBL), an active learning approach grounded in social constructivism that emphasizes preparation, collaboration, and application, may be well suited to teaching image interpretation. This study evaluates the effectiveness of TBL compared with traditional lecture-based instruction for chest radiograph interpretation. A mixed-methods, quasi-experimental cohort comparison using a pre–post design was conducted with two consecutive PA student cohorts at a single institution. One cohort received a 90-minute lecture-based session; another cohort participated in a 90-minute TBL session. Academic performance was assessed using validated pre- and post-tests. Student satisfaction and self-efficacy were evaluated using post-session surveys derived from the Kirkpatrick model and Bandura’s self-efficacy theory. Independent sample t-tests compared quantitative outcomes, and qualitative responses were analyzed thematically. Both cohorts demonstrated improvement in chest radiograph interpretation scores, with no statistically significant differences between groups in post-test performance or score improvement (p = 0.841). Survey results indicated favorable perceptions of both instructional approaches. The TBL cohort reported significantly higher ratings for engagement and peer interaction (p = < 0.001). Self-efficacy ratings were higher among TBL participants for selected confidence-related items (p = 0.003, p = 0.021, p = < 0.001). Qualitative responses on what contributed most to self-efficacy emphasized peer discussion in the TBL group and structured explanations in the lecture group. TBL produced academic performance comparable to lecture-based instruction while supporting greater learner engagement and confidence. These findings support TBL as a feasible instructional approach for chest radiograph interpretation in PA education.