Comparison of Lecture-Based Learning vs Discussion-Based Learning in Undergraduate Medical Students.

OBJECTIVE: To compare lecture-based learning (LBL) and discussion-based learning (DBL) by assessing immediate and long-term knowledge retention and application of practical knowledge in third- and fourth-year medical students.

DESIGN: A prospective, randomized control trial was designed to study the effects of DBL. Medical students were randomly assigned to intervention (DBL) or control (LBL) groups. Both the groups were instructed regarding the management of gastroschisis. The control group received a PowerPoint presentation, whereas the intervention group was guided only by an objectives list and a gastroschisis model. Students were evaluated using a multiple-choice pretest (Pre-Test MC) immediately before the teaching session, a posttest (Post-Test MC) following the session, and a follow-up test (Follow-Up MC) at 3 months. A practical examination (PE), which tested simple skills and management decisions, was administered at the end of the clerkship (Initial PE) and at 3 months after clerkship (Follow-Up PE). Students were also given a self-evaluation immediately following the Post-Test MC to gauge satisfaction and comfort level in the management of gastroschisis.

SETTING: University of Iowa Hospitals and Clinics and the Carver College of Medicine, Iowa City, IA.

PARTICIPANTS: A total of 49 third- and fourth-year medical students who were enrolled in the general surgery clerkship were eligible for this study. Enrollment into the study was completely voluntary. Of the 49 eligible students, 36 students agreed to participate in the study, and 27 completed the study.

RESULTS: Mean scores for the Pre-Test MC, Post-Test MC, and Follow-Up MC were similar between the control and intervention groups. In the control group, the Post-Test MC scores were significantly greater than Pre-Test MC scores (8.92 ± 0.79 vs 4.00 ± 1.04, p < 0.0001), whereas the Follow-Up MC scores were significantly lower than Post-Test MC scores (7.17 ± 1.75 vs 8.92 ± 0.79, p = 0.005). In the control group, the Follow-Up MC scores were significantly greater than Pre-Test MC scores (7.17 ± 1.75 vs 4.00 ± 1.04, p < 0.0001). Analysis of variance for all control group MC examinations had a p < 0.0001. In the intervention group, the Post-Test MC scores were significantly greater than Pre-Test MC scores (8.33 ± 1.23 vs 4.60 ± 1.55, p < 0.0001), whereas the Follow-Up MC scores were significantly lower than Post-Test MC scores (7.13 ± 1.77 vs 8.33 ± 1.23, p = 0.04). In the intervention group, the Follow-Up MC scores were significantly greater than Pre-Test MC scores (7.13 ± 1.77 vs 4.60 ± 1.55, p = 0.0002). Analysis of variance for all intervention group MC examinations had a p < 0.0001. Mean scores for the Initial PE were significantly higher for the intervention group compared with the control group's score (7.47 ± 1.68 vs 5.25 ± 2.34, p = 0.008). Mean scores for the Follow-Up PE were significantly higher for the intervention group compared with the control group's score (7.87 ± 1.77 vs 5.83 ± 2.04, p = 0.005). A comparison of Initial PE vs Follow-Up PE was not significant in either group. Students in the intervention group were more comfortable in the immediate management of gastroschisis and placement of a silo and felt that the educational experience was more worthwhile than students in the control group did.

CONCLUSIONS: After a single instructional session, there was a significant difference in the students' scores between the control and the intervention groups on both administrations of the PEs. There were no significant differences between the 2 groups in any administration of the MC examinations. This seems to suggest that DBL may lead to better practical knowledge and potentially improved long-term knowledge retention when compared with LBL. Students in the DBL group also felt more comfortable with the management of gastroschisis and were more satisfied with the educational session.