Effect of Group Size and Resource Constraints on PBL, TBL, and CBL in Healthcare Education: A Scoping Review

Introduction Active learning pedagogies used in healthcare professional education include Problem-Based Learning (PBL), Case-Based Learning (CBL), and Team-Based Learning (TBL). However, resource constraints and financial pressures have led many institutions to modify these approaches, most commonly by increasing group size. This scoping review aimed to examine how group size influences student learning outcomes. Methods We conducted a scoping review adhering to PRISMA-ScR guidelines, examining studies that examined accredited health professional education programs that compared at least two group sizes and reported on at least one learning outcome. Results Sixteen studies published between 2000 and 2025 met inclusion criteria. Both students and facilitators consistently preferred smaller groups, citing improved engagement, participation, and feedback. Evidence on academic performance was inconclusive, although extremely small groups sometimes performed worse than medium-sized groups. Larger groups were associated with decreased group cohesion and increased subgroup formation. Outside of changes to group size, programs also implemented adaptations such as transitioning from PBL to TBL, modifying facilitation strategies, and altering tutor roles to manage resource constraints. Discussion Smaller group sizes are associated with more positive learner and facilitator experiences and may therefore better support collaborative learning processes. Further research is needed to evaluate the long-term educational and professional impacts of group size and alternative strategies for addressing resource constraints in health professional education.