European Journal of Cardiovascular Medicine

Self-directed learning (SDL) is defined as a process in which learners take the initiative—either independently or with guidance from facilitators—in identifying their learning needs, setting goals, identifying resources, selecting and implementing appropriate strategies, and evaluating their learning outcomes (1). This approach encourages autonomy, self-motivation, and reflective practice, enabling learners to adapt to new knowledge and challenges throughout their careers (1).

In medical education, SDL has emerged as a key pedagogical strategy to foster lifelong learning—an essential competency for physicians who must stay abreast of rapidly evolving medical knowledge and clinical guidelines (2). The traditional didactic lecture, though effective for structured content delivery, often positions students as passive recipients of information, limiting opportunities for active engagement, critical thinking, and deeper conceptual understanding (3).

Biochemistry, as a core subject in the first-year MBBS curriculum, helps the understanding of normal biochemical processes and their alterations in disease. The subject’s complexity and its clinical correlations require not only memorization of facts but also integration, application, and problem-solving skills. Traditional lectures may not sufficiently promote these higher-order learning outcomes, whereas SDL can bridge this gap by encouraging students to explore topics through active inquiry, collaborative discussion, and application-based exercises such as case-based learning (4).

Different SDL models have been implemented in medical education, ranging from guided individual study to problem-based learning. One effective approach involves the use of case-based scenarios supplemented with guiding questions, which direct learners to relevant resources and encourage analytical thinking (5). Such approaches not only enhance knowledge acquisition but also develop essential competencies such as self-assessment, teamwork, and communication (6).

While studies have demonstrated positive outcomes of SDL in medical education, the evidence is variable depending on student readiness, subject content, and facilitation quality (7,8). For first-year MBBS students, who are in a transitional phase from school-based to professional learning environments, evaluating the impact of SDL—both in combination with traditional lectures and as a stand-alone strategy—is particularly important. Understanding student and faculty perceptions of SDL can help in refining its implementation to maximize learning outcomes (8).

Medical educationists argue that SDL complements, and in some cases surpasses, traditional teaching methods by actively involving students in the learning process, promoting critical thinking, and fostering independent learning habits (3). One widely used approach in SDL is case-based or problem-based scenarios, where learners explore a topic with the aid of guiding questions and relevant resources (4).

SDL implementation must consider the learner’s developmental stage. According to Grow’s Staged Self-Directed Learning (SSDL) model, beginners typically fall into the dependent learner category, requiring substantial guidance, structure, and direction from faculty (5). First-year MBBS students, who are in the transition phase from school-based learning to self-regulated professional education, often rely on structured frameworks to identify learning objectives. For such learners, an initial traditional lecture may provide a conceptual scaffold, making it easier to subsequently engage in SDL (5,9). Thus, combining lecture-based teaching with SDL may offer a balanced approach by ensuring foundational knowledge while gradually fostering independence.

Given this context, the present study was undertaken to evaluate the effectiveness of SDL among first-year MBBS students in Biochemistry, comparing two approaches: (i) Traditional Lecture followed by SDL and (ii) SDL-only sessions. Additionally, student and faculty perceptions regarding SDL were explored to understand its feasibility and acceptability in early undergraduate medical education.

Aim:
To evaluate the effectiveness of self-directed learning (SDL) as a teaching-learning strategy in Biochemistry among first-year MBBS students, and to assess perceptions of students and faculty towards its implementation.

Objectives:

1. To compare the improvement in knowledge acquisition between:
• Traditional lecture followed by SDL
• SDL alone in the subject of Biochemistry among first-year MBBS students.
2. To assess students’ perceptions regarding SDL in terms of learning experience, motivation, and self-confidence using a structured Likert scale questionnaire.
3. To determine faculty perspectives on the feasibility, advantages, and challenges of implementing SDL in the MBBS Biochemistry curriculum.
4. To analyse the statistical significance of pre-test and post-test score differences in both teaching approaches.

The study was conducted at ACSR Government medical college, Nellore for a period of three months July to September 2023 on phase 1 MBBS students.  A total of 175 first-year MBBS students participated in the study. Institutional ethical committee approval was obtained.SDL session was conducted in two ways A(session 1- SDL only session) & B (session 2- Traditional lecture+SDL). A) SDL session was planned in a hybrid mode. Competency was selected , specific learning objectives were framed, Laboratory charts were posted in whatsapp group. One week later SDL session was conducted. Students were asked to present laboratory charts in one hour class. Case discussion and summary was done by the facilitator. Pre and posttest was conducted. B) One hour traditional lecture was given to students. Specific learning objectives were framed. Students were asked to work on laboratory charts. SDL session was planned the succeeding week. On the day of SDL students were randomly selected to present the laboratory charts and knowledge gaps were explained by the facilitator. Pre and post test was conducted on the same day. All participants attended both the SDL-only session (Session 1) and the Traditional Lecture + SDL session (Session 2). Informed consent was obtained from all the students. Students perception and faculty perception was noted at the end of the session through google form on a likert scale^.

Table 1: Comparison of Pre-test and Post-test Scores (Traditional Lecture + SDL vs SDL-only)

* Significant at p < 0.05

Post-test score comparison:

The mean post-test score in the Traditional Lecture + SDL group was 14.2 ± 2.1, while in the SDL-only group it was 12.5 ± 2.3. The difference in mean scores was found to be statistically significant (p = 0.02)

The Lecture + SDL group clearly outperforms SDL-only. The p-value = 0.02 indicates a statistically significant advantage of combining lectures with SDL for Phase I MBBS students.

Table No:2 Student Perception on SDL (Likert Scale)

Overall mean perception score: 4.27 ± 0.71
(On a scale of 1 = Strongly Disagree to 5 = Strongly Agree)

Figure No: 1: Student perception on SDL (%Agree/Strongly agree)

Table No : 3– Faculty Perception on SDL (Likert Scale)

Overall mean perception score: 4.22 ± 0.65

Figure No: 2 Faculty perception on SDL (%Agree/Strongly agree)

The present study evaluated the effectiveness of Self-Directed Learning (SDL) in Biochemistry among Phase I MBBS students by comparing two approaches: (i) Traditional Lecture followed by SDL and (ii) SDL-only sessions.

The results demonstrated that both groups showed significant improvement in post-test scores compared to their respective pre-test values, suggesting that SDL is an effective learning strategy for knowledge acquisition in Biochemistry. (Table No 1) However, the mean post-test scores were significantly higher in the Traditional Lecture + SDL group (14.2 ± 2.1) compared to the SDL-only group (12.5 ± 2.3), with a p-value of 0.02. This indicates that lecture-supported SDL may provide better learning outcomes for first-year MBBS students, who are still in the transition phase from dependent to self-directed learning styles.

Student perception analysis (Table No 2, Figure No 1) revealed that the majority found SDL to be engaging, interactive, and helpful for long-term retention. They reported increased motivation, better understanding of core concepts, and enhanced participation in case-based discussions. However, many students felt more comfortable when SDL was supplemented by a prior lecture, highlighting their reliance on structured guidance at this early stage of medical training.

Faculty feedback (Table No 3, Figure No 2) also emphasized the usefulness of SDL in promoting active learning, critical thinking, and collaborative discussions. Nevertheless, some faculty members observed that first-year students required more direction, orientation, and facilitation for effective SDL sessions, supporting the blended approach of combining lectures with SDL.

In the present study, both Traditional Lecture + SDL and SDL-only approaches resulted in significant improvements in post-test scores among first-year MBBS students. In our study, the combination of a Traditional Lecture followed by SDL resulted in a significantly greater improvement in knowledge scores compared to SDL-only. The mean gain of marks in the combined approach suggests that for Phase I MBBS students—who are in the early stages of transitioning to adult learning—a structured foundation provided by a lecture enhances the effectiveness of SDL.

Our findings are consistent with the scaffolding principle described by Vygotsky et al., where guided instruction before independent learning leads to better knowledge retention and application (9). Previous studies in medical education also support that novice learners benefit from instructor-led sessions before engaging in SDL activities, as it helps them frame learning objectives more effectively and reduces cognitive overload (10,8).

Student perception data further supported this observation: a clear majority agreed that SDL after lectures was more beneficial than SDL without prior instruction. Student perception results in our study revealed high levels of agreement (>80%) with statements related to improved understanding, motivation, and self-directed responsibility. This aligns with the findings of Abraham et al., who noted that while SDL is well-received, its effectiveness is maximized when learners already possess the necessary baseline concepts (1).

Faculty feedback reinforced these conclusions. In our setting, all faculty perceived SDL to be more effective when integrated after a traditional lecture, especially for foundational subjects like Biochemistry. Similar sentiments were reported by Sahoo et al., where faculty emphasized the importance of structured pre-learning before SDL in the early medical curriculum (11).

While SDL-only sessions still produced statistically significant improvement in scores, the gains were smaller. This could be due to the fact that first-year MBBS students are still adapting to self-directed approaches and may lack the ability to independently identify, prioritize, and assimilate complex concepts without initial guidance (12).

Our findings are consistent with previous research showing that SDL promotes active learning, enhances conceptual understanding, and improves long-term retention compared to purely didactic approaches (9,10). A study by Premkumar et al. reported that medical students engaged in SDL demonstrated significantly higher problem-solving skills and deeper learning strategies than those in conventional lecture-based groups (6). Similar outcomes have been noted in physiology and pharmacology teaching, where SDL improved self-assessment skills and independent learning capabilities (1,11).

Faculty perceptions, while generally positive, indicated concerns regarding feasibility, preparation time, and institutional support. These concerns echo the observations of Sahoo et al., who noted that successful SDL implementation depends heavily on faculty training, workload balance, and curriculum design support (11,13). The unanimous agreement among faculty that SDL requires more preparation time suggests that adequate time allocation and resource provision are essential for sustainable integration into the curriculum.

The slightly lower agreement for peer collaboration in our study may be attributable to the fact that SDL tasks were often completed individually rather than in large group settings, highlighting an opportunity to integrate more structured group activities in future sessions.

From a pedagogical standpoint, SDL in Biochemistry offers clear benefits: it promotes active participation, aligns with competency-based medical education (CBME) goals, and encourages lifelong learning skills (14). However, its success depends on both student readiness and faculty facilitation. First-year MBBS students, transitioning from a school-based learning style, may require orientation sessions on effective SDL strategies, as suggested by Sharma et al. (15).

The present study evaluated the effectiveness of implementing Self-Directed Learning (SDL) among Phase I MBBS students in Biochemistry through two approaches—Traditional Lecture followed by SDL and SDL-only sessions. Both approaches resulted in significant improvement in post-test scores, confirming the value of SDL in enhancing knowledge acquisition and retention. However, the Traditional Lecture + SDL group demonstrated significantly higher post-test performance (14.2 ± 2.1) compared to the SDL-only group (12.5 ± 2.3; p = 0.02), highlighting the importance of structured input before independent learning in novice learners.

Student perceptions revealed that SDL promoted active participation, deeper conceptual understanding, and confidence in self-learning. Students expressed that combining faculty-guided lectures with SDL provided clarity and direction, which was particularly valuable at the beginner stage.

Faculty perspectives aligned with these findings, emphasizing that while SDL fosters lifelong learning skills, Phase I students require scaffolding and guided facilitation to optimize learning outcomes. Faculty endorsed a blended approach, noting that it improves student engagement, critical thinking, and accountability while gradually transitioning them toward independent learning.

Limitations of the Study: This study was conducted in a single institution limiting generalizability, focussed solely on cognitive domain without assessing skills or attitudes. Time-bound SDL sessions may not reflect the extended learning cycles required for true self-directed learning

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