Team-based learning is a widely accepted technique for small group, active learning, in medical courses. The nature of team-based learning allows students to discuss and explore topics in a structured way. The tasks that are set develop problem-solving skills and professional attitudes. Students are encouraged to collaborate and share knowledge to build confidence and a clinical language. There is more variability in the learning experience from team-based learning compared to lectures. However, for the student in difficulty, who may have failed an assessment, maintaining the current team-based learning environment may not yield beneficial results. Here, responses showed that a subset of students in difficulty do not utilise team-based learning to develop their learning. Students in difficulty can be less confident than other students and less willing to express their opinions within a group, particularly when there are highly achieving students dominating the session.