Background: Fostering student engagement in low-resource learning environments is a common challenge in health professional education. Content-rich subjects, in particular, are associated with a high risk for disengagement. It is possible to enhance the student experience by incorporating principles of active learning and cognitive psychology within traditional forms of instruction. Objectives: This study explored osteopathy student perceptions of think-pair-share, a teaching strategy that combines elements of retrieval practice with cooperative learning. Furthermore, this study sought to quantify the effect of think-pair-share on self-reported engagement and academic achievement. Methods: Osteopathy students in year two of the program at Victoria University, Melbourne, Australia, were invited to participate. A pre-post design which conceptualised think-pair-share as an educational intervention was used. Twelve pathology lectures were divided into subtopics of 12–20 min duration. After each sub-topic, a short-answer question was posed to the class for consideration using the think-pair-share approach. A post-test survey assessed self-reported engagement and perceptions of the teaching strategy. Results: Seventy-six second-year osteopathy students participated. Participants reported significantly higher levels of engagement (p < 0.001) following instruction with think-pair-share. Whilst the intervention did not appear to have an impact upon final grades, the majority of learners were satisfied with the approach. Qualitative feedback on the think-pair-share strategy was largely positive: perceived benefits to learning emerged as a dominant theme. Learners also valued the collaborative nature of this teaching strategy. Conclusions: Think-pair-share is an inexpensive teaching strategy that was received well by osteopathy students. This easily implemented technique can transform a didactic lecture into a collaborative community of active learners.