In this study, it was found that in courses involving practical exercises for larger class sizes, the implementation of a real-time lesson response system can improve student lesson evaluations, teacher lesson delivery skills, and lesson format. In this context, teacher practical-lesson delivery skills refer to not only tool literacy for using the real-time lesson response system, but also the teacher's mode of engaging students with the lesson itself. In this study, the implementation of a real-time lesson response system not only resulted in the improvement of lesson evaluations and lesson content, but may also be considered to suggest possibilities for a new form of active learning in larger classes.