We examined the effects of team-based learning (TBL) versus traditional and enhanced lecture-based instruction over time (Study 1; N = 532 nursing students) and the psychometric properties of the Team Based Learning Student Assessment Instrument (TBL-SAI), a popular measure of reactions to TBL (Study 2; N = 323 nursing and medical students). Results indicated that TBL instruction resulted in higher standardized test scores than did lecture-based instruction. However, classes using enhanced lecture, a simpler active-learning strategy, had results similar to classes using TBL. Also, the results supported the expected multidimensional structure underpinning the TBL-SAI (Mennenga, 2010, 2012) as well as supported the use of a shorter yet reliable version of the TBL-SAI. Finally, results suggested that student perceptions of and reactions to TBL may play a lesser role in student outcomes than researchers expected.