The effectiveness of self-directed learning in pharmacology for second professional year medical undergraduates: Faculty and students’ perception.

INTRODUCTION

Traditionally, undergraduate medical education heavily relied on didactic lectures, offering limited opportunities for active student-teacher interaction and often lacking structured feedback mechanisms for the teaching-learning process. Theory exams and viva voce were the only methods used to assess their performance and learning ability throughout the year. With the introduction of the competency-based medical education (CBME) curriculum in 2019, the approach to medical training in India underwent a significant transformation. As outlined by the National Medical Commission (NMC), in the healthcare system, an Indian Medical Graduate (IMG) is required to competently take on multiple roles, such as that of a clinician, leader, communicator, and lifelong learner, ensuring that patient care aligns with moral, legal, and professional standards. ¹

To develop these competencies, diverse teaching and learning strategies have been integrated into the curriculum. Among them, self-directed learning (SDL) plays a critical role in nurturing students into becoming lifelong learners. SDL involves learners taking the initiative, either independently or with guidance, in identifying their learning needs, setting learning objectives, locating resources, selecting learning strategies, and assessing their learning outcomes. ²

This learner-centered approach enables students to study at their own pace and adopt strategies that suit their individual learning styles. ³ It promotes responsibility in learning, enhances practical application of knowledge, and improves communication skills and memory retention. Additionally, frameworks such as Bloom’s Taxonomy can be employed to classify and evaluate cognitive development, dividing it into 6 stages: remembering, understanding, applying, analyzing, evaluating, and creating. ⁴

By integrating SDL into the undergraduate curriculum, students develop critical thinking and independent learning skills that extend beyond graduation, supporting their growth as competent physicians or future educators. In this model, the role of the teacher shifts from a knowledge provider to a facilitator who guides students in goal-setting, resource selection, and critical analysis. ⁵

As medical science continues to evolve, it is essential for future doctors to stay updated on advances in pathophysiology, diagnostics, and treatment modalities, making lifelong learning a necessity. ⁶ Although the NMC has designated specific hours for SDL within the undergraduate curriculum, there remains uncertainty among faculty about the optimal timing (when), topics (what), and methods (how) for its effective implementation. Additionally, differing views exist regarding the facilitator’s role in the SDL process. ^1,5,7-12

This study uniquely evaluates the effectiveness of a structured SDL module within the pharmacology curriculum of 2^nd-year MBBS students under India’s CBME framework. Unlike previous studies, this intervention integrates multiple innovative components-such as trigger words, targeted video resources, and case-based discussions-spread over a defined intersession period. Furthermore, the study employs a dual-feedback approach by capturing both student and faculty perceptions, analyzed alongside cognitive gains mapped to Bloom’s Taxonomy, thus offering a more holistic understanding of SDL’s impact. The results may give insights into SDL implementation logistics, challenges, and strategies for improvement, adding contextual relevance for Indian medical institutions seeking to operationalize this educational approach.

MATERIAL AND METHODS

This prospective, interventional study was conducted following approval from the Institutional Ethics Committee (Ref. No.: JNUIMSRC/IEC/2025/26) at the Department of Pharmacology, J.N.U. Institute of Medical Sciences & Research Centre, Jaipur, Rajasthan, India. The study involved second-year undergraduate medical students from the institute, consisting of a cohort of 150 students. Participation in the study was entirely voluntary, and students were informed that non-participation would not affect their academic evaluation or standing in any manner. Before the commencement of the study, six faculty members or facilitators were oriented regarding the study design, the SDL topic, and the relevant learning materials. This orientation was conducted by the principal investigator to ensure uniformity in the facilitation process. A pre-test and post-test design was employed to assess short-term knowledge gain following the SDL session, a method commonly used in medical education research.

Intervention procedure

• Consent forms, pre-test and post-test multiple-choice questionnaires, and feedback forms were disseminated electronically via Google Forms and circulated among participants through a designated WhatsApp group. The forms were configured to allow only one submission per participant. Time limits were set as follows: 5 min for the consent form, and 25 min each for the pre-test, post-test, and feedback. Case-based questionnaires were provided to students as a Word document through the same platform.

• Two separate WhatsApp groups were created to manage communication efficiently-each group included half of the 2^nd-year undergraduate students along with assigned faculty facilitators.

• Prior to the start of the session, informed consent was obtained from all participants. Students were introduced to the selected topic through a brief PowerPoint presentation that used predominantly pictorial and schematic representations to provide background information. The presentation covered relevant concepts appropriate to the learners’ level. Following this, a pre-test was administered to assess baseline knowledge. The facilitator then shared recommended learning resources to support self-directed study. Students were also encouraged to observe relevant cases in clinical settings, where feasible, to facilitate clinical correlation.

• Students were also informed that they could seek academic support from their designated facilitators between 9:00 AM and 5:00 PM on working days, prior to the second session.

• On the 2^nd day of our study, video resources and a list of trigger words were shared with students via the designated WhatsApp group to stimulate SDL. On the 3^rd day, students received case-based questionnaires through the same platform to support continued exploration of the topic.

• During the second session, the full student batch was divided into 6 groups, each consisting of ∼25 students. Faculty facilitators, as previously assigned, were allocated to each group to guide the session. ⁹ The session was conducted in the format of SDL, with facilitators using the case-based questionnaires as the primary tool for discussion and engagement.

• Each group was further divided into smaller subgroups, with each subgroup assigned one of the five case-based questions. These subgroups were responsible for discussing their assigned question with the rest of the group, encouraging peer learning and collaborative problem-solving. Facilitators provided academic support by addressing any unresolved queries from the intersession period or those that arose during the session.

• Students brought along the recommended resource materials to reference during the session. At the conclusion of the SDL activity, the same multiple-choice questionnaire used for the pretest was re-administered as a posttest to evaluate knowledge gain. Feedback was then collected from both students and faculty facilitators to assess the effectiveness of the session and identify areas for improvement. Figure 1 depicts the methodology flowchart of the prospective interventional study evaluating SDL in Pharmacology among 2^nd-year MBBS students.

Close

Figure 1: Methodology flowchart of the prospective interventional study evaluating SDL (Self-directed learning) in pharmacology among second-year MBBS students. MCQs: Multiple-choice questions.

Export to PPT

RESULTS

Out of the 150 2^nd-year undergraduate medical students, 138 attended the initial session of the study. Among them, 116 students attended both the first and second sessions, and data from these 116 participants were included in the final analysis. The average age of the students was 19.25 ± 0.06 years (mean ± SD), comprising 43 males (37%) and 73 females (63%).

Table 1 illustrates the number of students who correctly responded to each item in the pre-test and post-test, structured based on the levels of Bloom’s Taxonomy. The mean difference in the number of correct responses between pretest and posttest was found to be 18.3, potentially indicating effective learning. A statistically significant improvement (p <0.05) was noted for questions 1, 2, 3, 5, 6, 9, and 10, which primarily assessed knowledge recall, application, analyzing and evaluation. Conversely, performance on questions 4, 7, and 8, which assessed understanding and application, showed a significant decline. Seven out of 10 questions showed significant improvement (p <0.05), indicating the intervention was effective in enhancing knowledge in these areas.

A paired t-test was conducted to compare the mean scores of the pre-test and post-test. The analysis produced a standard error of the mean difference of 1.01 and a t-value of 18.10. At a 95% confidence level, the results demonstrated a statistically significant increase in post-test scores relative to pre-test scores. These findings suggest that SDL may contribute to improvement in cognitive learning outcomes among medical undergraduates.

Feedback was collected from 116 students and 6 facilitators regarding the SDL sessions, utilizing a Likert scale to assess various aspects of the sessions.

Relevance and engagement: A significant majority of students (94%) and all the facilitators (100%) agreed or strongly agreed that the SDL sessions were aligned with the learning objectives. Additionally, 83% of students found the sessions engaging, indicating that the SDL approach made the topic more interesting to learn and encouraged critical thinking on the topic.

Understanding and clinical correlation: The sessions were effective in enhancing students’ comprehension, with 88% acknowledging improved understanding. Furthermore, 87% of students recognized a better clinical correlation of the topic through the SDL method.

Clarification and curriculum integration: Opportunities for doubt clarification were deemed sufficient by 79% of students. Moreover, 72% expressed support for incorporating the SDL method into other subject areas within the curriculum.

Table 2, which shows the students’ feedback as mean scores (X) exceeding 4 or close to 4, indicates participants generally agreed that the SDL session was aligned with the learning objectives, it encouraged critical thinking on the topic, and made the topic more interesting to learn while simultaneously allowing sufficient doubt clarification. SD <1 or ∼1 suggests moderate consistency in responses, meaning that while there was general agreement, some participants had differing views. Overall, the feedback indicates a positive reception of the SDL sessions, highlighting their effectiveness in enhancing engagement, understanding, and clinical application of the subject matter.

During the study period, 42% (51) of students (n = 116) reported encountering challenges with the SDL approach. The primary issues identified included the necessity to consult additional resources (7%), the time-intensive nature of SDL (18%), difficulties in memorizing drug dosages (11%), language barriers during discussions (<2%), and challenges in clinically correlating the topic (6%) [Table 3].

To address these challenges, students employed various strategies. A significant majority (79%, n = 51) turned to supplementary materials such as online information, case-based videos, textbooks, and notes. Additionally, 22% (n = 51) engaged in peer discussions and revisions to enhance their understanding. These adaptive approaches highlight the students’ proactive efforts to overcome obstacles and optimize their learning experience.

In response to open-ended feedback questions, students highlighted both advantages and disadvantages of the SDL approach. As shown in Graph 1, 35 students found improved interaction with peers and facilitators, and more than 20 students opined that SDL was more effective than traditional lectures. Conversely, among the 27 students who noted drawbacks, 16 cited the SDL method as being time-consuming [Graph 2].

Close

Graph 1: Advantages of SDL (Self directed learning) method- students’ perception.

Export to PPT

Close

Graph 2: Disadvantages of self-directed learning method- students’ perception. (The numbers within the pie chart indicate the frequency of student responses for each reported disadvantage).

Export to PPT

DISCUSSION

The current study aimed to assess the effectiveness of SDL among undergraduate MBBS students. While 138 students participated in the initial SDL session, only 116 were present for the second session. Consequently, the analysis was based on data from these 116 students. The slightly reduced attendance in the second session may be attributed to limited self-motivation or insufficient preparation for the topic, which could have deterred some students from participating further.

In the present study, various learning aids such as case-based questionnaires, trigger words, and topic-related videos were provided to students during the one-week intersession period to enhance engagement and reinforce learning. Contrastingly, Agrawal and Verma ⁷ (2020) shared a case-based scenario and resource materials only at the end of the first session, with a shorter intersession duration of four days. The pretest in their study was conducted a day before the second session, and no additional learning materials-such as videos, case-based exercises, or trigger words-were shared during the intersession. Moreover, unlike the current study, feedback from students and facilitators was not obtained, which is a crucial aspect for evaluating the impact and identifying areas for improvement in any new educational intervention.

Our study results revealed significant improvements in performance across most cognitive levels, particularly in domains related to remembering, application, and evaluation.

A notable increase was observed in knowledge-based (remembering) questions as the percentage of correct responses increased significantly for items such as the first-line drug class for acute migraine treatment (40-60; p = 0.0118), receptor targets of triptans (20-35; p = 0.0307), and the full form of CGRP (90-110; p = 0.0003). These findings suggest that basic factual knowledge was effectively reinforced during the SDL sessions, possibly due to repetition, accessibility of information, and focused study materials.

In the analytical domain, where students were asked to differentiate the mechanisms of action of triptans and ergot alkaloids, the improvement was also statistically significant (15-28; p = 0.0426). This indicates a positive impact of SDL in developing critical thinking and comparative analysis skills, which are essential for understanding pharmacological nuances.

The understanding-level question regarding the effectiveness of NSAIDs in migraine showed only a marginal increase (100-103; p = 0.6913), which was not statistically significant. This could be attributed to high baseline knowledge in this area or the simplicity of the question, whereas in the study by Sonar et al., ¹⁶ (2023) the number of students who correctly answered an understanding-based question significantly decreased.

Application-level questions also showed improvement, particularly for the scenario involving prophylactic drug initiation in a patient with frequent migraine episodes (30-55; p = 0.0011). However, questions regarding contraindications in patients with coronary artery disease and about the nasal spray, dosing of triptans did not yield statistically significant differences, as a higher proportion of students answered these pretest questions correctly. This outcome could be attributed to the prior sharing of the SDL topic 3 days before the pretest and the use of visual aids, such as pictorial and graphic presentations, which likely supported better retention. ⁹

The most substantial improvement was seen in the evaluation domain, where the number of students recognizing the justification for prophylactic treatment in frequent migraines increased significantly (40-82; p < 0.0001). This indicates a meaningful shift in clinical decision-making ability, which is one of the primary objectives of competency-based learning.

In our study, posttest results showed significantly improved performance in questions based on areas of testing, remembering, application, and evaluation. These concepts may have been challenging during the pretest but were better understood following the week-long intersession, use of supplementary resources, and facilitator-led case-based discussions.

The overall posttest scores showed a statistically significant improvement compared to pretest results (P <0.05), consistent with findings by Agrawal and Verma, ⁷ (2020) where the proportion of students scoring <50% decreased from 6% to 2% after discussion and with Sonar et al. ¹⁶ (2023) findings, where posttest scores showed >45% of the students answered 80% of questions correctly as compared to pretest. The second session’s small group discussions under facilitator guidance likely reinforced key concepts, while the self-directed component promoted individual learning through reading and visual aids. This combination of independent study and collaborative discussion enhanced both foundational knowledge and clinical reasoning skills among medical undergraduates.

Student feedback after the second session indicated that >75% found the SDL approach engaging, effective for understanding, and helpful in enhancing clinical relevance and doubt resolution. Additionally, 52% supported its inclusion for other topics, though 39% preferred traditional learning methods. Facilitator feedback echoed similar sentiments, with 75% agreeing that SDL made the topic more engaging and improved opportunities for student interaction and clarification.

Approximately 51 students reported challenges during the SDL sessions, including the need for additional resources, difficulty recalling drug dosages, limited clinical correlation, language barriers, and the time-intensive nature of the method. These issues were addressed independently or with facilitator support through textbooks, online videos, peer discussions, and other digital resources. Students appreciated the opportunity to express their understanding during group discussions and felt that SDL enhanced engagement, doubt resolution, and communication skills. However, only one student noted difficulty participating due to language barriers.

Although all facilitators suggested the need for additional learning resources, they rated students’ understanding as ‘good’ on the Likert scale, which is consistent with the study by Sonar et al. ¹⁶ (2023) This may be attributed to SDL’s ability to encourage critical thinking and focus on key concepts when students come prepared. Facilitators noted that the success of SDL depends heavily on student motivation and preparation, and they also acknowledged that it can be more time-consuming than traditional lectures unless well-structured and consistently implemented periodically. Only half of the facilitators expressed willingness to adopt the SDL approach for additional topics within the subject.

CONCLUSION

SDL serves as a valuable alternative learning approach to enhance cognitive development. In this study, it was applied to a single topic within the 2^nd-year MBBS curriculum. Despite the limited scope, both student and facilitator feedback indicated that SDL made the topic more engaging, improved student-teacher interaction, and fostered communication skills and clinical understanding. In addition, improvement in post-test performance suggests a positive short-term learning effect. Regular implementation across core topics may help address concerns about time consumption by gradually building students’ SDL abilities. Further research is needed to fully assess SDL’s impact on traditional teaching methods.