Purpose/Hypothesis : This study compared the effect of team-based learning (TBL) versus traditional lecturing (TL) in two physical therapy courses on musculoskeletal disorders of the spine.Number of Subjects : 70 DPT students.Materials/Methods : Two consecutive cohorts of 2nd year doctorate of physical therapy students were taught a 4-credit course on the lumbar spine and pelvis (LSP) and a 3-credit course on the cervico-thoracic (CT) region. The first cohort was taught using traditional in class lecturing, while the 2nd cohort was taught utilizing TBL for 8 modules over the 16-week semester Ð one TBL module every 2 weeks. The TBL principles of equal team allocation, readiness assurance, immediate feedback, sequencing of in-class problem solving, attention to the four S structure, incentive grading and peer review were employed in the TBL sessions. The same midterm and final exam questions were used for both cohorts for both courses. To check for grade inflation, from the use of team scores, term grades were calculated with and without team activities. A follow-up survey questioned the second cohort of students on their views of the TBL learning experience.Results : There was no difference between cohorts in the baseline characteristics of either cumulative GPA or science and math GPA. The TBL cohort performed better on the mid-term and final exams in both courses. The same cumulative final exam scores increased 5.3% in the LSP course and 11.3% in the CT course (both p<0.0001). Practical exam scores also improved in both courses.The team Readiness Assurance Test (RAT) scores were 20% higher than the individual RAT scores. However, even though the team-scored activities accounted for 30% of the course grade, the use of team scores only inflated the final course grade by an average of less than 1%, for both courses. Despite the higher grades, survey responses were mixed as to the value of TBL. There were also mixed responses as to which component of TBL was most effective - flipping the classroom or working in teams.Conclusions : Incorporating TBL resulted in a significant increase in individual performance. The team scores did not inflate students grades. Student acknowledgement that they were better learning the material was balanced by the "complaint" that they had to work harder. Both flipping the classroom and working in teams seemed to contribute to the higher academic performance.Clinical Relevance : The incorporation of TBL into two musculoskeletal courses resulted in much higher grades than in ten years previously teaching the same material. It remains to be seen whether an improvement in long-term learning has also occurred.