Effectiveness of E-learning module versus small group teaching in pharmacology competency training for medical undergraduates

INTRODUCTION

Learning is a fundamental aspect of student life. Learning approaches can be mainly categorised into teacher-centric and learner-centric methods. Learner-centric approaches primarily promote self-directed learning (SDL), in which learners take responsibility for their own educational progress. SDL emphasises motivation, accountability and active participation from the student in achieving learning outcomes.^[1]

The evolving needs of society, advancements in scientific knowledge and pedagogical innovations have prompted the National Medical Council, India, which governs medical education to adopt a needs-based, competency-driven curriculum aimed at fostering the lifelong learning abilities of the Indian Medical Graduate.^[2] Interaction and repetition form the foundation of mastering any skill; however, opportunities for repetition are limited in traditional learning environments.^[3]

E-learning, by contrast, integrates technology and simulation, allowing learners to revisit lessons multiple times – either identically or in varied contexts – thereby reinforcing understanding and retention. According to Ellaway and Masters,^[4] ‘E-learning is a pedagogical approach that is flexible, engaging and learner-centred, promoting collaboration and communication, often asynchronously’. E-learning becomes particularly effective when aligned with curriculum objectives and supported by tools such as videos, readings, discussions and assessments.^[5]

The use of e-learning and e-modules in medical education has shown a consistently positive impact on learning outcomes across diverse learner populations.^[6] Globally, studies have documented that medical students have favourable perceptions of e-learning, with acceptance levels ranging from moderate to high. However, students have highlighted the need for better course design, enhanced interactivity and blended approaches that integrate traditional teaching methods with online learning.^[7-9]

In most medical schools, pharmacology competencies are traditionally taught through lectures, self-directed learning classes and small-group teaching (SGT) which may include tutorials or problem-based/case-based learning sessions. Despite their advantages, these approaches face challenges such as inconsistent student preparation, limited participation, insufficient critical thinking and inadequate application of knowledge to clinical contexts. Furthermore, students who miss in-person sessions often lose the opportunity to learn essential content.

Recognising these limitations, the competency-based medical education (CBME) curriculum now emphasises digital literacy and advocates for the integration of e-learning to foster self-directed learning.^[10] E-learning modules (ELMs) allow students to control their learning pace, engage with technology, enhance critical thinking and apply knowledge to real-life contexts. In addition, online learning provides flexibility in time and location, while faculty assume the role of facilitators to support understanding.^[11,12]

Based on the above merits, the present study was designed with the hypothesis that ELMs are more effective than SGT in imparting pharmacology competencies to Phase II medical undergraduates. The study aimed to compare the effectiveness of ELM and SGT in pharmacology training and to assess students’ perceptions of the E-learning approach.

MATERIALS AND METHODS

This educational interventional study was conducted in the Department of Pharmacology at a medical college in South India, following approval from the Institutional Ethics Committee (INST.EC/EC/241/2024). The study was carried out between April and August 2024.

The participants were fourth-term MBBS students who provided informed consent to participate. Out of 151 enrolled students, 126 completed both the SGT and ELM module requirements.

RESULTS

A total of 151 students were enrolled in the study, of which 126 completed all study components.

• The formative assessment scores were 8.26 ± 3.45 for the ELM method and 7.08 ± 2.81 for the SGT method, showing no statistically significant difference between the two (t = −1.26, P = 0.21) [Table 1 and Figure 1]

• The summative assessment scores (LEQ) were 6.44 ± 2.29 for the ELM method and 4.33 ± 2.45 for the SGT method, demonstrating a statistically significant difference in favour of the ELM (t = −8.15, P < 0.001) [Table 2 and Figure 2].

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Figure 1:

Boxplot depicting the distribution of formative assessment scores among two different methods of teaching.

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Figure 2:

Boxplot depicting the distribution of summative assessment scores among two different methods of teaching.

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Students’ perceptions of the ELM were evaluated across five parameters – Aptness, Content, Delivery, Activity and Assessment – using a five-point Likert scale. Approximately 80–90% of students rated each parameter above 3, indicating a high level of satisfaction with the module. Furthermore, 80% of respondents expressed that additional ELMs should be introduced in the future to further enhance their pharmacology training [Table 3].

An attitude survey comparing the SGT and ELM methods was conducted using a validated Likert-scale questionnaire. The analysis revealed no statistically significant difference between the two teaching methods overall (Z-test), except for Question 1 (P = 0.001) and Question 7 (P = 0.028), in which students expressed a preference for the SGT method over the ELM approach [Table 4 and Figure 3].

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Figure 3:

Students’ attitude survey of comparing small group teaching versus E-learning module. *SA: Strongly agree, A: Agree, NC: No comments, D: Disagree, SD: Strongly disagree.

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DISCUSSION

The present study evaluated the effectiveness of an ELM compared with SGT in pharmacology competency training for medical undergraduates. The implementation of the CBME curriculum in India emphasises student-centred, active learning methodologies over traditional teacher-focused didactic teaching.^[13]

The COVID-19 pandemic posed significant challenges to implementing CBME in its initial phase, prompting medical educators to explore innovative online learning modalities to sustain engagement. Consequently, E-learning gained tremendous relevance in medical education, with regulatory bodies in India recognising its importance and officially encouraging the integration of online modules into teaching practices.^[10]

Although academic institutions have since adopted digital methods, the transition faced initial resistance from faculty members, who expressed concerns about students’ adaptability and motivation. In this context, our study aimed to compare the learning impact, perception and attitude of medical undergraduates toward E-learning and SGT in pharmacology.

In the first phase of the study, students were exposed to both ELM and SGT sessions designed around predetermined competencies. Formative and summative assessment scores were compared to evaluate effectiveness. The formative assessment scores did not differ significantly between ELM and SGT, suggesting that both modalities were equally effective for short-term knowledge retention.

Previous studies comparing SGT with traditional didactic methods have shown that small groups enhance attention span, understanding and recall among students. In addition, such methods foster higher-order intellectual skills such as reasoning, problem-solving, listening, communication and leadership qualities, while providing a relaxed and interactive learning environment.^[14-16] These findings are consistent with our results, which demonstrated comparable short-term effectiveness and positive student attitudes toward both methods.

In contrast, the summative assessment scores in our study revealed a statistically significant improvement among students who underwent E-learning, indicating better long-term knowledge retention. Similar findings have been reported in previous research. For instance, Chauhan et al. compared asynchronous online learning with traditional teaching and found comparable post-test scores, but students favoured a combination of both – lectures followed by e-modules – for optimal learning outcomes.^[17] Thahir et al. also highlighted that blended learning, combining offline and online methods, offers a balanced and effective approach to higher education in the post-pandemic era.^[18]

A randomised controlled trial comparing ELM and SGT in teaching acute otitis media found no significant difference in diagnostic accuracy but noted a student preference for E-learning, citing flexibility and accessibility as major advantages.^[19] Similarly, a prospective comparative study evaluating E-learning versus traditional teaching in clinical reasoning found comparable effectiveness, with students recommending integration of E-modules to enrich the curriculum without creating content overload.^[20]

In psychiatry education, studies have shown that E-learning video modules outperform traditional lectures, particularly in topics such as breaking bad news and doctor–patient communication, demonstrating higher knowledge acquisition and positive perceptions among learners.^[21] Collectively, these findings support a blended learning approach, leveraging the strengths of both online and in-person modalities to maximise educational outcomes. However, further research is required to evaluate long-term knowledge retention, clinical application and scalability of E-learning across diverse educational settings.^[22]

In the present study, students rated the ELM highly for aptness, content, delivery, activity and assessment, with 80– 90% scoring each parameter above average. Approximately 80% of students recommended that more ELMs should be introduced in future pharmacology training. The key facilitating factors identified were ease of accessibility, repeatability and self-paced learning, whereas the main barriers included internet connectivity issues and variable content quality. These findings align with post-pandemic studies highlighting both the advantages and limitations of online learning.^[23-25]

Existing literature suggests that while E-learning is effective in improving knowledge acquisition and conceptual understanding, it is less effective in developing clinical and communication skills compared to face-to-face learning.^[23] Other challenges reported include technological barriers, digital literacy gaps, variable engagement levels and limited instructor readiness.^[19] Nonetheless, studies consistently report that E-learning’s flexibility and accessibility enhance self-directed learning and academic performance, especially when integrated thoughtfully within the curriculum.^[25,26]

Agarwal and Mahajan emphasised that traditional, hands-on learning remains indispensable for translating theoretical knowledge into practical patient care.^[27] Similarly, a study on medical students’ perspectives on E-learning in surgical modules concluded that the blended learning approach – combining online and in-person teaching – was most effective, a finding consistent with our observations.^[28]

Interestingly, the attitude survey in our study showed contrasting results compared to effectiveness data, while E-learning demonstrated better summative outcomes, students expressed a preference for SGT as the more effective and engaging method. This supports Mezirow’s transformative learning theory, which put forwards that deep reflection and perspective transformation promote complex knowledge processing.^[29] In addition, Boekaerts’ three-layered model suggests that successful engagement in E-learning environments depends on learners’ self-regulation skills.^[30] As Ruiz et al. noted, integrating medical education with E-learning represents a paradigm shift toward adult learning theory, where educators serve as facilitators and analysts of competency, rather than mere content deliverers.^[31]

CONCLUSION

Both ELMs and SGT serve as effective and complementary approaches in teaching pharmacology competencies to medical undergraduates. While E-learning enhances flexibility, accessibility and long-term knowledge retention, SGT remains vital for interactive learning, peer collaboration and skill development. A blended approach, integrating both modalities, may provide the most comprehensive and sustainable learning experience under the CBME framework.