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AIM To test a modified team-based learning approach on undergraduate learning outcomes in an acute-care nursing course in Japan. DESIGN Mixed-methods. METHODS Students worked on three simulated cases, engaged in pre-class preparation, completed a quiz and engaged in group work. We collected data on team approach, critical-thinking disposition and time spent in self-learning at four time-points: before the intervention and after each simulated case. Data were analysed using a linear mixed model, a Kruskal-Wallis test and a content analysis. DATA SOURCES We recruited nursing students attending a mandatory course in acute-care nursing at University A. Data were collected at four time-points between April and July 2018. Data from 73 of 93 respondents were analysed. RESULTS Team approach, critical thinking and self-learning all increased significantly across the time-points. Four categories emerged from students' comments: 'achievement of teamwork', 'sense of learning efficacy', 'satisfaction with course approach' and 'issues related to course approach'. The modified team-based learning approach led to improvements in team approach and critical-thinking disposition across the course. CONCLUSION Incorporating team-based learning into the curriculum not only contributes to team building but is also effective as a teaching method to improve student learning. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The intervention led to improvements in team approach and critical-thinking disposition across the course. The educational intervention also led to more time for self-learning. Future studies should include participants from various universities and evaluate the outcomes over a longer period.