Purpose
Team-based learning (TBL) is widely used in medical education to replace lectures and promote self-directed learning. This case study evaluates the impact of transitioning a Cardiovascular Infections (CVI) topic in the Introduction to Infectious Diseases (IID) course from lectures to TBL on students' exam performance. We hypothesized that TBL would enhance student performance on related exam questions by fostering knowledge application.

Methods
CVI is the sole topic in the IID course taught during the Cardiology module. Exam grades related to CVI from 2013 onward were analyzed and normalized against overall IID course grades at the end of the second year (M2).

Results
Exam scores for CVI-related questions showed gradual improvement after transitioning to TBL, stabilizing at a high level, while overall course grades remained steady. Initially, scores dropped slightly post-transition, likely due to the need for adjustments in study materials and TBL questions. The most significant improvement coincided with the onset of the pandemic, suggesting students adapted effectively to independent learning. Notably, students performed well even when a TBL session was canceled due to a hurricane, demonstrating robust independent study skills.

Conclusion
TBL encourages collaboration and engagement through a flipped classroom model. This study provided a unique opportunity to compare student performance before and after adopting TBL for CVI. After a three-year adaptation period, students consistently performed better on relevant exam questions, indicating that TBL can enhance learning outcomes. The sharp improvement during the pandemic suggests students became adept at self-directed learning. Interestingly, high performance persisted even without group interactions, highlighting the value of well-structured independent study materials. Future research is needed to assess long-term retention of the material when group-based application of knowledge is missing.