Evaluating active learning strategies among physiotherapy students: a comparison of note- taking and multiple-choice question writing on summative examination performance

Evaluating active learning strategies among physiotherapy students: a comparison of note- taking and multiple-choice question writing on summative examination performance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating active learning strategies among physiotherapy students: a comparison of note- taking and multiple-choice question writing on summative examination performance Magdalena Wrzesińska, Jarosław Rakoczy, Katarzyna Weronika Binder-Olibrowska, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6964393/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background The education of health professionals plays a crucial role in developing the competence-based learning that is essential for their future practice. Increased student engagement and participation has been shown to significantly enhance academic achievement compared to passive knowledge integration during lectures or tutorials. However, the effectiveness of different learning strategies can vary depending on the individual and the context. This study investigated the impact of note-taking and generating multiple-choice questions (MCQs) on physiotherapy students' performance in summative examinations, as well as their preferences for using these methods. Methods A cluster-randomised controlled crossover study was conducted among first-year undergraduate physiotherapy students enrolled in a psychology course at a Polish medical university. The study included 173 students (116 females, 57 males), aged 18–23 years. Following the psychology module, students completed a homework assignment, either a written note or an MCQ, which was subsequently reviewed by instructors. These materials were intended to support students’ preparation for the final psychology examination. The effectiveness of each method as a tool for knowledge consolidation was evaluated using summative exam scores. Additionally, students provided qualitative feedback on their preferred learning method via an open-ended question. Results There was no statistically significant difference at the 5% level in students’ summative exam performance between the two learning methods. Overall, students expressed a preference for note-taking over the MCQ format, citing greater familiarity due to its use during their secondary education. However, students who began the learning process with the MCQ method demonstrated a slightly higher preference for that approach. Conclusions Given the diversity of student preferences, the integration of note-taking and MCQ learning methods may optimise the educational experience in psychology training in the psychotherapy course. Further research should investigate their equivalence, taking into account students' choice of learning method. Note-taking Multiple-Choice Question MCQ Physiotherapy Academic Performance Figures Figure 1 Background The education and training of health professionals is important in developing the competence-based learning necessary for their future professional practice. It has been shown that additional student engagement and participation can lead to better achievement of academic goals compared to their passive role in the integration of knowledge during lectures or tutorials [ 1 ]. Note-taking (NT) and multiple-choice questions (MCQs) are used in health educational settings [ 2 ]. Although the effectiveness of both learning strategies can vary depending on the individual and the context, some research suggests that both NT and composing MCQs can be effective in different ways [ 3 – 6 ]. NT can help students remember information, especially when they are encouraged to review and revise their notes [ 7 ]. Taking notes during and after class is a complex cognitive task that involves interrelated cognitive processes: attention, encoding, selection, organisation, elaboration (adding additional information to the note in order to fully understand the material) and reviewing. By developing these skills, students can improve their ability to learn and retain information from their classes [ 8 – 9 ]. Composing MCQs can also enhance learning by encouraging students to think more deeply about the material and to anticipate potential exam questions [ 10 ]. However, Fiorella and Mayer [ 11 ] found that students who generated questions during learning performed better on subsequent tests than those who simply took notes. This suggests that the active process of generating questions may lead to deeper processing and better understanding of the material. Moreover, creating MCQs also involves complex cognitive skills such as analysis, synthesis, and evaluation. It requires students to collect and synthesise information about the topic from multiple sources before generating each MCQ [ 4 ]. In this way, students can identify gaps in their knowledge and improve their higher-order thinking skills. While students might readily recognise the immediate advantages of answering MCQs, they may overlook the enduring cognitive benefits of formulating them. Hence, incorporating MCQ composition as a post-class activity can foster enhanced cognitive engagement and ultimately bolster their educational outcomes [ 6 ]. The scientific literature on learning strategies used by Polish students of medical school mainly refers to students of medicine. Some studies have shown that taking their own notes, highlighting key information, annotating in the text were the most common learning methods used during the remote learning period of pandemic [ 12 ]. Additionally the potential of MCQs as a learning technique has been evaluated among Polish students of medical faculties over the past decade [ 13 – 14 ]. However, the evaluation of using different educational methods among students of physiotherapy is not commonly described in the studies. This is perhaps odd as physiotherapists are integral members of the interdisciplinary health‑care team and their education involves acquisition and development of a large amount of knowledge, skill, and competences by fostering critical thinking process, synthesis, and making inferences [ 15 ]. To maintain high academic standards and quality of learning among different groups of students, it is necessary to offer a variety of teaching materials and resources adjusted to the preferences of students to facilitate them to achieve their educational goals [ 15 – 16 ]. In order to provide evidence on the effectiveness of using different study methods in a group of physiotherapy students, research was undertaken to compare the effects of using NT and MCQs as homework assignments on the final exam performance of physiotherapy students in a psychology course, and to present and discuss students' opinions on both methods. The main research questions are: Is there a significant difference in first-year Polish physiotherapy students' summative examination performance who use NT vs MCQ creation in their homework assignments? Which of the two methods is preferred by these students? Methods Participants First-year students of physiotherapy from the Medical University of Lodz in Poland who took part in the psychology course were enrolled. The study group consisted of 173 participants (116 women and 57 men). Participants' ages ranged from 18 to 23 years (mean: 19.1 years; standard deviation: 0.69 years). Students were divided into 14 dean groups (DGs). Each DGs consisted of 8 to 15 students. The study was conducted from October 2022 to February 2023. The research was conducted in accordance with the ethical principles set out in the Helsinki Declaration. The local Institutional Review Board gave an opinion that informed consent was not needed, in line with national regulations. Ethical opinion for the study was gained from the Bioethical Committee of the Medical University of Lodz (RNN/218/22/KE). During the first lecture, the objectives of the project were explained, and all students were briefly informed of procedures. Each person could ask questions to the instructors and had the opportunity to withdraw from the study at any time. Informed consent to participate in the study was obtained from all participants. Setting and study design To assess the impact of preparing online notes and MCQs as post-seminar assignments on students' final test exam performance, a cluster-randomised controlled crossover study was conducted. All respondents participated in the psychology course taught by three academic teachers. The course consisted of 12 online lectures and six in person seminars. Data was only analysed from seminar material because this part of the course was obligatory. At the first lecture, students were instructed on how to prepare homework to pass each of the six seminars. Post-seminar home assignments consisted of creating one MCQ or writing a 100–300 word note on the course content. The aim of the tasks was to evaluate the knowledge provided during classes as a way of preparation for the exam planned after completing the psychology course. Both tasks were to be completed and evaluated by teachers. Each of the 14 DGs were randomly assigned to one of the two arms of the study (Fig. 1 ). In Arm A, students created an MCQ after the first class and a note after the second seminar with each teacher. In Arm B, the assignments were reversed. In DGs assigned to Arm A there were 91 participants, whereas in DGs assigned to Arm B there were 82. For the exam, the teachers created nine questions (six MCQs and three short answer questions) for each of the topics taught. In total, 27 questions were created for the topics from seminar 1 of each teacher, which constituted one part of the exam - Test 1 (T1). Similarly, Test 2 (T2), which tested knowledge of the topics discussed in seminar 2 of each teacher, consisted of 27 questions. The exam comprised 69 questions in total : 27 questions each for T1 and T2 split between each of the three teachers, and 15 questions relating to lecture topics (T3). To assess the impact of NT and MCQ tasks on students' exam performance, T1 (N = 87) and T2 (N = 81) were included in the analysis. Students attitudes towards learning methods were collecting by using an on-line survey after the final exam, and 134 (77.5%) students completed it. Students had the possibility to answer to the following question: “Being able to choose only one of these two methods to support learning, which of the methods would you choose: NT or MCQs?” and students were then asked to justify their choice. All given answers were independently read by two independent judges (KBO and JR) who manually identified themes and categories independently. A uniform coding frame was developed after common discussions and second independence category assignment was done by the same person. Finally, any discrepancies in the assignment of individual survey participant responses to the pre-agreed categories were identified and reconciled through common discussion. Data Analysis The statistical analyses were performed using Statistica v. 13 (TIBCO Software Inc.). To determine the required sample size for this cluster-randomised controlled trial, an initial power analysis was executed via G*Power. Assuming an effect size d = 0.3, the software’s estimation yielded a sample size of 90 under the premise of individual randomisation, set at α = 0.05 and β = 0.8. Acknowledging the clustered structure of our research design, adjustments were necessary to accommodate for intra-cluster correlation. As such, the final adjusted sample size deemed necessary for the study was established. To compare student performance, the significance of T1 and T2 scores between the study arms was determined using the Mann-Whitney U test. To ensure a consistent and comparative evaluation of the examination data, results from the two sections of the examination test (T1 and T2) were standardized using Z-scores. Comparisons of standardized T1 and T2 scores within the same study arm were assessed using the Wilcoxon signed-rank test. Additionally, to compare the frequency of the revision method preferences in the post-survey, the chi-square test was employed. Results The effect of NT and MCQ creation on student exam performance 168 students took the final exam (116 women). In the intra-group analysis for Arm A, contrasting T1 with T2 revealed no statistically significant differences (p = 0.142). Similarly, for Arm B's intra-group evaluation, the differences between the tests were not statistically significant (p = 0.111). In the inter-group assessment of T1, distinguishing between Arm A and Arm B, there were no significant differences detected (p = 0.161). Likewise, the inter-group analysis for T2 also demonstrated no significant variance between the two arms (p = 0.296) (Table 1 ). Table 1 Standardised scores of both parts of the exam test (T1 and T2) in both arms of the study (N = 168). Inter-group comparisons: Mann-Whitney U; intra-group comparisons: Wilcoxon T. Arm T1 T2 Me IQR Min Max Me IQR Min Max A (N=87) -0.07 1A 1.15 -2.76 2.23 -0.11 2A 1.31 -2.07 2.83 B (N=81) 0.31 1B 1.15 -2.38 3.00 -0.11 2B 1.31 -2.40 1.85 Total -0.07 1.15 -2.76 3.00 -0.11 1.47 -2.40 2.83 1A/2A T=1567.00; p=0.142 1B/2B T=1322.00; p=0.111 1A/1B U=3081.50; p=0.161 2A/2B U=3193.50; p=0.296 Student perceptions of NT vs MCQ creation 134 (77.5%) students completed the post-course survey. Significantly more students would prefer notes when being able to choose only one between NT or MCQ to support learning (N = 116, 86.6% vs. N = 18, 13.4%; z = 8.379; p < 0.001). However, those who prepared MCQ as their first post-classes task (Arm A) were more likely to appreciate this method than students from Arm B (19% vs. 7%; χ² = 4.28; p = 0.039; phi = 0.19). The predominant rationale for selecting NT was the students' belief that this is a more effective form of learning that covers a broader range of knowledge and allows for better assimilation, comprehension and repetition of information in less time than MCQ preparation. Another argument in favour of NT was its evaluation as a student-friendly method; students admitted that they prefer notes because it is a known method, easier to do and implement in learning, and less tiring than creating an MCQ. In contrast, those who chose MCQs as their preferred method of learning argued that it was more interesting, less monotonous, and more creativity-inducing than the NT. Students pointed out other advantages of the MCQs - that they are more effective than notes in terms of exam preparation. Participants highlighted the efficiency of repetitive memory stimulation that reinforces knowledge on a specific topic, noting its advantage in time-saving when compared to the traditional process of NT (Table 2 ). Table 2 Themes for choosing NT vs MCQ creation with number of exemplar quotes. The reason for preference Students’ quotes Opinions on MCQ Interesting & creative form of learning “Composing questions was more enjoyable for me because I could be creative and get into the role of a therapist” “Is more interesting and less monotonous than taking classic class notes” Effectiveness of the method “This is an innovative and, in my opinion, more effective method of learning [than NT], because it stimulates our creativity, we can imagine life situations that fit the issue, and based on this we can make conclusions and remember the issue in the long run.” “Creating questions was a better way for me to repeat the material after class” “They make me think typically in terms of the exam” “A question is created shorter (than NT) and contains condensed knowledge on a given topic” Opinions on NT Effectiveness of the method “The notes force us to create such a “mental shortcut” on the issues, which not only can be used for learning, but the very reading of such content makes us often able to add the rest on our own, which we associate from the class or from another source.” “For me, creating notes is a longer [than MCQ], but consequently a more effective way of learning. “More knowledge in less effort.” “[notes] seem to me to activate the student's attention and memory more.” “By NTs, I remember more and repeat the material more. NT is useful for further study for an exam.” Student-friendly method “I have been choosing this form for many years and perhaps it is a matter of habit and convenience.” “I learn more easily when I can use my own form of language and not come up with false answers (distractions) that I could accidentally remember.” “Can be easily shared with others” Discussion Transitioning into the nuanced cognitive strategies in writing, it becomes clear that NT predominantly aligns as a "knowledge telling" strategy. In contrast, composing MCQs, especially those accompanied by clinical vignettes or real-life scenarios, tends to activate the more intricate "knowledge transforming" strategy [ 17 ]. This study found no significant difference in students’ of physiotherapy exam performance whether notes or MCQ creation was used as a summarising of knowledge obtained during seminars. Students generally preferred NT over question creation as a learning method. However, those who began by creating MCQs showed a higher preference for this method and for many this was the first time they had ever created MCQs. Indeed, the “exposure effect” demonstrates that people tend to develop a preference for things merely because they are familiar with them [ 18 ]. Therefore, we assume that those who started with creating MCQs might have developed a slightly greater preference for this method due to their greater initial familiarity with it. The literature also suggests that students' attitudes towards composing MCQs as a learning task are mixed. Our research is one more in which students, despite creating valid questions, underestimated their educational value [ 19 ]. Students often express a dislike for composing MCQs as a learning task. This can be attributed to several factors. Firstly, creating MCQs requires a higher cognitive load than simply answering them. Students must not only understand the material but also apply it in a way that creates a valid question and plausible distractors [ 20 ]. This can be challenging and time-consuming, leading to frustration. Students may feel that the task does not contribute to their learning. Further, they may perceive the creation of MCQs as a teacher's responsibility, not a learning activity [ 21 ]. Therefore education of the benefits of MCQ creation must be explained to the students before integrating this method into curricula. On the other hand, research suggests that students have positive attitudes towards composing MCQs, which they see as an effective learning strategy that promotes higher-order thinking and deep learning. It encourages students to think critically about the material, understand it deeply, and apply it in a new context [ 22 ]. Furthermore, students appreciate the opportunity to actively engage with the material and take ownership of their learning. However, it is important to note that the effectiveness and enjoyment of this method can vary depending on the individual student's learning style, the subject matter, and the way the task is implemented [ 3 ]. It seems that, in the case of our study, the obligatory nature of the task and the specificity of the subject could have resulted in a reluctant attitude of students towards composing MCQs. Perhaps giving individuals the possibility to choose their preferred method of learning in the future could potentially improve exam performance and this personalised preference approach should be considered in future studies. A notable strength of our study is that it fills a knowledge gap concerning learning support methods amongst the Polish physiotherapy student. However, it is important to note that our study design allows for a comparison between NT and MCQ creation but does not directly evaluate the independent effectiveness of each method on examination results. While numerous studies have emphasised the efficacy of both tools in aiding learning [6; 23–24] our research design does not provide a direct demonstration of this efficacy in this narrow head-to-head setting. The results seen in this study here may be related to the subject matter of the seminars (non-clinical content). The seminar topics included complex content related to understanding the patient-medical practitioner relationship, which can be quite challenging for first-year students. Conclusion Educators should consider offering both NT and MCQ creation to students, thereby catering to diverse learning preferences and enhancing the overall educational experience. Allowing students to choose their preferred learning method may positively influence their engagement and subsequent examination performance and this approach should be examined in future studies. In addition, the implementation of a student-centred teaching model could be effective in learning and retaining knowledge and developing competencies as health professionals [ 25 – 26 ]. Abbreviations DGs Dean Groups MCQs Multiple-Choice Questions NT Note-Taking T1 Test 1 T2 Test 2 Declarations Ethics approval and consent to participate: The research was conducted in accordance with the ethical principles set out in the Helsinki Declaration. The local Institutional Review Board (the Bioethical Committee of the Medical University of Lodz) gave an opinion that consent was not needed, in line with national regulations (RNN/218/22/KE). Consent for publication - Not Applicable Data Availability (Kindly provide this statement on system as well) The anonymized dataset generated and analysed during the current study is available in the Zenodo repository, DOI: 10.5281/zenodo.15861339. Competing Interests : No competing interest Funding: No funds were used for this research Authors' contributions: MW: Methodology, Investigation, Writing – Original Draft JR: Conceptualization, Methodology, Formal analysis, Investigation, Writing – Original Draft KWBO: Methodology, Investigation, Writing – Original Draft MK: Methodology, Investigation, Writing – Original Draft VA: Writing – Original Draft SRLH: Methodology JLW: Writing – Original Draft AH: Writing – Original Draft BHLH: Conceptualization, Methodology, Formal analysis, Writing – Original Draft All authors reviewed the manuscript Acknowledgements: Not Applicable References Sandoval-Hernández I, Molina-Torres G, León-Morillas F. et al. Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study. BMC Med Educ. 2023; 23:675. https://doi.org/10.1186/s12909-023-04576-8 Stacy E, Cain J. Note-taking and Handouts in The Digital Age. Am J Pharm Educ. 2015; 79: 107. doi: 10.5688/ajpe797107. McLeod PJ, Snell L. Student-generated MCQs. Med Teach. 1996; 18(1):23-25. Palmer E, Devitt P. Constructing multiple choice questions as a method for learning. Ann Acad Med Singap. 2006; 35(9):604-608. Harris BHL, Walsh JL, Tayyaba S, Harris DA, Wilson DJ, Smith PE. A novel student-led approach to multiple-choice question generation and online database creation with targeted clinician input. Teach Learn Med. 2025; 27(2):182-188. doi: 10.1080/10401334.2015.1011651. Touissi Y, Hjiej G, Hajjioui A, Ibrahimi A, Fourtassi M. Does developing multiple-choice questions improve medical students' learning? A systematic review. Med Educ Online. 2022; 27(1):2005505. doi: 10.1080/10872981.2021.2005505. Piolat A, Olive T, Kellogg RT. Cognitive effort during note-taking. Appl Cogn Psychol. 2005; 19(3):291–312. doi: 10.1002/acp.1086. Manzi A, Martinez SA, Durmysheva Y. Cognitive correlates of lecture note taking: Handwriting speed and attention. North Am J Psychol. 2027; 19(1):195–217. Liu M, Uesaka Y. Identification of cognitive activities that underlie variations in lecture note-taking: An exploration of Japanese and Chinese high school students’ strategies in mathematics class. Front Educ. 2022; 7:893237. doi: 10.3389/feduc.2022.893237. McDermott KB, Agarwal PK, D'Antonio L, Roediger HL, McDaniel MA. Both multiple-choice and short-answer quizzes enhance later exam performance in middle and high school classes. J Exp Psychol Appl. 2014; 20(1):3–21. doi: 10.1037/xap0000004. Fiorella L, Mayer RE. Learning as a Generative Activity: Eight Learning Strategies That Promote Understanding. Cambridge: Cambridge University Press; 2015. Smoter K. Strategie indywidualnego uczenia się i inne charakterystyki studiowania w pierwszej fazie zdalnego nauczania podczas pandemii COVID-19. E-mentor. 2022; 3(95):4–12. doi: 10.15219/em95.1568. Dymek J, Kowalski T, Golda A, Polak W, Skowron A. The First Objective Structured Practical Examination (OSPE) in Pharmacy Teaching in Poland: Designing, Implementing and Assessing the Results. Indian J Pharm Educ Res. 2020; 54(3):574-578. Janczukowicz J. Medical education in Poland. Med Teach. 2013; 35(7):537-543. doi: 10.3109/0142159X.2013.789133. Walankar PP, Panhale VP, Situt SA. Evaluation of learning approaches in physiotherapy students: A valuable insight. J Educ Health Promot. 2019; 8:25. doi: 10.4103/jehp.jehp_254_18. Stander J, Grimmer K, Brink Y. Learning styles of physiotherapists: a systematic scoping review. BMC Med Educ. 2019; 19(1):2. doi: 10.1186/s12909-018-1434-5. Scardamalia M, Bereiter C. Knowledge telling and knowledge transforming in written composition. Adv Appl Psycholinguist. 1987; 2:142-175. Zajonc RB. Attitudinal effects of mere exposure. J Pers Soc Psychol. 1968 ; (2, Pt. 2:1-27. doi: 10.1037/h0025848. Grainger R, Dai W, Osborne E. Medical students create multiple-choice questions for learning in pathology education: a pilot study. BMC Med Educ. 2018; 18:201. doi: 10.1186/s12909-018-1312-1. Gierl MJ, Zhou J, Alves C. Developing a taxonomy of item model types to promote assessment engineering. J Technol Learn Assess. 2008; 7(2). https://ejournals.bc.edu/index.php/jtla/article/view/1629. Birenbaum M, Tatsuoka KK. Effects of "on-line" test feedback on the seriousness of subsequent errors. J Educ Meas. 1987; 24(2):145-155. Yu FY. Scaffolding student-generated questions: Design and development of a customizable online learning system. Comput Hum Behav. 2015; 48:301-314. doi: 10.1016/j.chb.2015.01.056. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychol Sci Public Interest. 2013;14(1):4-58. Titsworth BS, Kiewra KA. Spoken organizational lecture cues and student notetaking as facilitators of student learning. Contemp Educ Psychol. 2004; 29(4):447-461. Molina-Torres G, Sandoval-Hernández I, Ropero-Padilla C, Rodriguez-Arrastia M, Martínez-Cal J, Gonzalez-Sanchez M. Escape Room vs. Traditional Assessment in Physiotherapy Students’ anxiety, stress and gaming experience: a comparative study. Int J Environ Res Public Health. 2021;18:12778. Pooja, Gakhar M, Verma B, Jagga V. Evaluation of Learning Approaches Among Physiotherapy Students in Haryana: A Cross-Sectional Study. J Eval Clin Pract. 2025; 31(1):e14253. doi: 10.1111/jep.14253. PMID: 39644511. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 16 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviews received at journal 02 Sep, 2025 Reviews received at journal 01 Sep, 2025 Reviewers agreed at journal 22 Aug, 2025 Reviewers agreed at journal 21 Aug, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviewers invited by journal 28 Jul, 2025 Editor assigned by journal 22 Jul, 2025 Submission checks completed at journal 18 Jul, 2025 First submitted to journal 18 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6964393","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494792172,"identity":"83a6af04-c40a-4131-b377-e0afec394da3","order_by":0,"name":"Magdalena Wrzesińska","email":"data:image/png;base64,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","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":true,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Wrzesińska","suffix":""},{"id":494792173,"identity":"3bab64ec-8d55-4b1b-bb87-3620e1720053","order_by":1,"name":"Jarosław Rakoczy","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Jarosław","middleName":"","lastName":"Rakoczy","suffix":""},{"id":494792174,"identity":"d9eeaf7f-ab1e-4cb2-8994-7480ec3a56e3","order_by":2,"name":"Katarzyna Weronika Binder-Olibrowska","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"Weronika","lastName":"Binder-Olibrowska","suffix":""},{"id":494792176,"identity":"bbc21a52-d607-459a-b2b8-5baea14ad7e5","order_by":3,"name":"Magdalena Kostyła","email":"","orcid":"","institution":"Medical University of Lodz","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Kostyła","suffix":""},{"id":494792178,"identity":"77ce6401-4fdb-4210-8de9-77bf80e706d6","order_by":4,"name":"Vincent Allott","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Vincent","middleName":"","lastName":"Allott","suffix":""},{"id":494792179,"identity":"ba520fab-43f8-44d1-afba-22638742b378","order_by":5,"name":"Samuel Rhys Lole Harris","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Rhys Lole","lastName":"Harris","suffix":""},{"id":494792180,"identity":"69d72bc0-8946-4403-8270-32c62bd10d1d","order_by":6,"name":"Jason Leo Walsh","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Jason","middleName":"Leo","lastName":"Walsh","suffix":""},{"id":494792182,"identity":"28a0b71d-f150-4345-95aa-c9b9f3c65d11","order_by":7,"name":"Ashok Handa","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Ashok","middleName":"","lastName":"Handa","suffix":""},{"id":494792184,"identity":"5ef5f7bf-94ec-4566-af2f-f4a9a8856c12","order_by":8,"name":"Benjamin Harris","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Harris","suffix":""}],"badges":[],"createdAt":"2025-06-24 09:53:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6964393/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6964393/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08272-7","type":"published","date":"2025-12-01T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88228071,"identity":"4f200e02-a5ab-4d8c-91f5-9bf0bbcf514d","added_by":"auto","created_at":"2025-08-04 09:02:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24402,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic illustration of the cluster-randomised controlled crossover study of NT vs MCQ creation in physiotherapy students.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6964393/v1/b47eb0d40d2cb1c73d485670.png"},{"id":97723736,"identity":"4b4b6343-5e0a-433f-b673-7f582086921d","added_by":"auto","created_at":"2025-12-08 15:59:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":600654,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6964393/v1/29b7a5a6-b164-45f5-8205-25e02e608a7f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating active learning strategies among physiotherapy students: a comparison of note- taking and multiple-choice question writing on summative examination performance","fulltext":[{"header":"Background","content":"\u003cp\u003eThe education and training of health professionals is important in developing the competence-based learning necessary for their future professional practice. It has been shown that additional student engagement and participation can lead to better achievement of academic goals compared to their passive role in the integration of knowledge during lectures or tutorials [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNote-taking (NT) and multiple-choice questions (MCQs) are used in health educational settings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although the effectiveness of both learning strategies can vary depending on the individual and the context, some research suggests that both NT and composing MCQs can be effective in different ways [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNT can help students remember information, especially when they are encouraged to review and revise their notes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Taking notes during and after class is a complex cognitive task that involves interrelated cognitive processes: attention, encoding, selection, organisation, elaboration (adding additional information to the note in order to fully understand the material) and reviewing. By developing these skills, students can improve their ability to learn and retain information from their classes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eComposing MCQs can also enhance learning by encouraging students to think more deeply about the material and to anticipate potential exam questions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, Fiorella and Mayer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] found that students who generated questions during learning performed better on subsequent tests than those who simply took notes. This suggests that the active process of generating questions may lead to deeper processing and better understanding of the material. Moreover, creating MCQs also involves complex cognitive skills such as analysis, synthesis, and evaluation. It requires students to collect and synthesise information about the topic from multiple sources before generating each MCQ [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this way, students can identify gaps in their knowledge and improve their higher-order thinking skills. While students might readily recognise the immediate advantages of answering MCQs, they may overlook the enduring cognitive benefits of formulating them. Hence, incorporating MCQ composition as a post-class activity can foster enhanced cognitive engagement and ultimately bolster their educational outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe scientific literature on learning strategies used by Polish students of medical school mainly refers to students of medicine. Some studies have shown that taking their own notes, highlighting key information, annotating in the text were the most common learning methods used during the remote learning period of pandemic [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally the potential of MCQs as a learning technique has been evaluated among Polish students of medical faculties over the past decade [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the evaluation of using different educational methods among students of physiotherapy is not commonly described in the studies. This is perhaps odd as physiotherapists are integral members of the interdisciplinary health‑care team and their education involves acquisition and development of a large amount of knowledge, skill, and competences by fostering critical thinking process, synthesis, and making inferences [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To maintain high academic standards and quality of learning among different groups of students, it is necessary to offer a variety of teaching materials and resources adjusted to the preferences of students to facilitate them to achieve their educational goals [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In order to provide evidence on the effectiveness of using different study methods in a group of physiotherapy students, research was undertaken to compare the effects of using NT and MCQs as homework assignments on the final exam performance of physiotherapy students in a psychology course, and to present and discuss students' opinions on both methods. The main research questions are:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIs there a significant difference in first-year Polish physiotherapy students' summative examination performance who use NT vs MCQ creation in their homework assignments?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhich of the two methods is preferred by these students?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFirst-year students of physiotherapy from the Medical University of Lodz in Poland who took part in the psychology course were enrolled. The study group consisted of 173 participants (116 women and 57 men). Participants' ages ranged from 18 to 23 years (mean: 19.1 years; standard deviation: 0.69 years). Students were divided into 14 dean groups (DGs). Each DGs consisted of 8 to 15 students. The study was conducted from October 2022 to February 2023. The research was conducted in accordance with the ethical principles set out in the Helsinki Declaration. The local Institutional Review Board gave an opinion that informed consent was not needed, in line with national regulations. Ethical opinion for the study was gained from the Bioethical Committee of the Medical University of Lodz (RNN/218/22/KE).\u003c/p\u003e\u003cp\u003eDuring the first lecture, the objectives of the project were explained, and all students were briefly informed of procedures. Each person could ask questions to the instructors and had the opportunity to withdraw from the study at any time. Informed consent to participate in the study was obtained from all participants.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSetting and study design\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo assess the impact of preparing online notes and MCQs as post-seminar assignments on students' final test exam performance, a cluster-randomised controlled crossover study was conducted. All respondents participated in the psychology course taught by three academic teachers. The course consisted of 12 online lectures and six in person seminars. Data was only analysed from seminar material because this part of the course was obligatory. At the first lecture, students were instructed on how to prepare homework to pass each of the six seminars. Post-seminar home assignments consisted of creating one MCQ or writing a 100–300 word note on the course content. The aim of the tasks was to evaluate the knowledge provided during classes as a way of preparation for the exam planned after completing the psychology course. Both tasks were to be completed and evaluated by teachers.\u003c/p\u003e\u003cp\u003eEach of the 14 DGs were randomly assigned to one of the two arms of the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In Arm A, students created an MCQ after the first class and a note after the second seminar with each teacher. In Arm B, the assignments were reversed. In DGs assigned to Arm A there were 91 participants, whereas in DGs assigned to Arm B there were 82.\u003c/p\u003e\u003cp\u003eFor the exam, the teachers created nine questions (six MCQs and three short answer questions) for each of the topics taught. In total, 27 questions were created for the topics from seminar 1 of each teacher, which constituted one part of the exam - Test 1 (T1). Similarly, Test 2 (T2), which tested knowledge of the topics discussed in seminar 2 of each teacher, consisted of 27 questions. The exam comprised 69 questions in total : 27 questions each for T1 and T2 split between each of the three teachers, and 15 questions relating to lecture topics (T3). To assess the impact of NT and MCQ tasks on students' exam performance, T1 (N = 87) and T2 (N = 81) were included in the analysis.\u003c/p\u003e\u003cp\u003eStudents attitudes towards learning methods were collecting by using an on-line survey after the final exam, and 134 (77.5%) students completed it. Students had the possibility to answer to the following question: “Being able to choose only one of these two methods to support learning, which of the methods would you choose: NT or MCQs?” and students were then asked to justify their choice. All given answers were independently read by two independent judges (KBO and JR) who manually identified themes and categories independently. A uniform coding frame was developed after common discussions and second independence category assignment was done by the same person. Finally, any discrepancies in the assignment of individual survey participant responses to the pre-agreed categories were identified and reconciled through common discussion.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe statistical analyses were performed using Statistica v. 13 (TIBCO Software Inc.). To determine the required sample size for this cluster-randomised controlled trial, an initial power analysis was executed via G*Power. Assuming an effect size d = 0.3, the software’s estimation yielded a sample size of 90 under the premise of individual randomisation, set at α = 0.05 and β = 0.8. Acknowledging the clustered structure of our research design, adjustments were necessary to accommodate for intra-cluster correlation. As such, the final adjusted sample size deemed necessary for the study was established.\u003c/p\u003e\u003cp\u003eTo compare student performance, the significance of T1 and T2 scores between the study arms was determined using the Mann-Whitney U test. To ensure a consistent and comparative evaluation of the examination data, results from the two sections of the examination test (T1 and T2) were standardized using Z-scores. Comparisons of standardized T1 and T2 scores within the same study arm were assessed using the Wilcoxon signed-rank test.\u003c/p\u003e\u003cp\u003eAdditionally, to compare the frequency of the revision method preferences in the post-survey, the chi-square test was employed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eThe effect of NT and MCQ creation on student exam performance\u003c/em\u003e\u003c/p\u003e\u003cp\u003e168 students took the final exam (116 women). In the intra-group analysis for Arm A, contrasting T1 with T2 revealed no statistically significant differences (p\u0026thinsp;=\u0026thinsp;0.142). Similarly, for Arm B's intra-group evaluation, the differences between the tests were not statistically significant (p\u0026thinsp;=\u0026thinsp;0.111). In the inter-group assessment of T1, distinguishing between Arm A and Arm B, there were no significant differences detected (p\u0026thinsp;=\u0026thinsp;0.161). Likewise, the inter-group analysis for T2 also demonstrated no significant variance between the two arms (p\u0026thinsp;=\u0026thinsp;0.296) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStandardised scores of both parts of the exam test (T1 and T2) in both arms of the study (N\u0026thinsp;=\u0026thinsp;168). Inter-group comparisons: Mann-Whitney U; intra-group comparisons: Wilcoxon T.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp; Arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 254px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 269px;\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eA (N=87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.07\u003csup\u003e1A\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-0.11\u003csup\u003e2A\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eB (N=81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.31\u003csup\u003e1B\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-0.11\u003csup\u003e2B\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e-2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e1A/2A \u0026nbsp;\u0026nbsp;\u003c/sup\u003eT=1567.00; p=0.142\u0026nbsp;\u003csup\u003e1B/2B\u003c/sup\u003e T=1322.00; p=0.111\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003csup\u003e1A/1B\u003c/sup\u003e U=3081.50; p=0.161\u0026nbsp;\u003cbr\u003e\u003csup\u003e2A/2B\u003c/sup\u003e U=3193.50; p=0.296\u003c/p\u003e\u003cp\u003e\u003cem\u003eStudent perceptions of NT vs MCQ creation\u003c/em\u003e\u003c/p\u003e\u003cp\u003e134 (77.5%) students completed the post-course survey. Significantly more students would prefer notes when being able to choose only one between NT or MCQ to support learning (N\u0026thinsp;=\u0026thinsp;116, 86.6% vs. N\u0026thinsp;=\u0026thinsp;18, 13.4%; z\u0026thinsp;=\u0026thinsp;8.379; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, those who prepared MCQ as their first post-classes task (Arm A) were more likely to appreciate this method than students from Arm B (19% vs. 7%; χ\u0026sup2; = 4.28; p\u0026thinsp;=\u0026thinsp;0.039; phi\u0026thinsp;=\u0026thinsp;0.19).\u003c/p\u003e\u003cp\u003eThe predominant rationale for selecting NT was the students' belief that this is a more effective form of learning that covers a broader range of knowledge and allows for better assimilation, comprehension and repetition of information in less time than MCQ preparation. Another argument in favour of NT was its evaluation as a student-friendly method; students admitted that they prefer notes because it is a known method, easier to do and implement in learning, and less tiring than creating an MCQ.\u003c/p\u003e\u003cp\u003eIn contrast, those who chose MCQs as their preferred method of learning argued that it was more interesting, less monotonous, and more creativity-inducing than the NT. Students pointed out other advantages of the MCQs - that they are more effective than notes in terms of exam preparation. Participants highlighted the efficiency of repetitive memory stimulation that reinforces knowledge on a specific topic, noting its advantage in time-saving when compared to the traditional process of NT (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes for choosing NT vs MCQ creation with number of exemplar quotes.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe reason for preference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents\u0026rsquo; quotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eOpinions on MCQ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInteresting \u0026amp; creative form of learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Composing questions was more enjoyable for me because I could be creative and get into the role of a therapist\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Is more interesting and less monotonous than taking classic class notes\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffectiveness of the method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;This is an innovative and, in my opinion, more effective method of learning [than NT], because it stimulates our creativity, we can imagine life situations that fit the issue, and based on this we can make conclusions and remember the issue in the long run.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Creating questions was a better way for me to repeat the material after class\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;They make me think typically in terms of the exam\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;A question is created shorter (than NT) and contains condensed knowledge on a given topic\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpinions on NT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffectiveness of the method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The notes force us to create such a \u0026ldquo;mental shortcut\u0026rdquo; on the issues, which not only can be used for learning, but the very reading of such content makes us often able to add the rest on our own, which we associate from the class or from another source.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;For me, creating notes is a longer [than MCQ], but consequently a more effective way of learning.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;More knowledge in less effort.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[notes] seem to me to activate the student's attention and memory more.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;By NTs, I remember more and repeat the material more. NT is useful for further study for an exam.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent-friendly method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have been choosing this form for many years and perhaps it is a matter of habit and convenience.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I learn more easily when I can use my own form of language and not come up with false answers (distractions) that I could accidentally remember.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Can be easily shared with others\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTransitioning into the nuanced cognitive strategies in writing, it becomes clear that NT predominantly aligns as a \"knowledge telling\" strategy. In contrast, composing MCQs, especially those accompanied by clinical vignettes or real-life scenarios, tends to activate the more intricate \"knowledge transforming\" strategy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study found no significant difference in students\u0026rsquo; of physiotherapy exam performance whether notes or MCQ creation was used as a summarising of knowledge obtained during seminars. Students generally preferred NT over question creation as a learning method. However, those who began by creating MCQs showed a higher preference for this method and for many this was the first time they had ever created MCQs. Indeed, the \u0026ldquo;exposure effect\u0026rdquo; demonstrates that people tend to develop a preference for things merely because they are familiar with them [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, we assume that those who started with creating MCQs might have developed a slightly greater preference for this method due to their greater initial familiarity with it.\u003c/p\u003e\u003cp\u003eThe literature also suggests that students' attitudes towards composing MCQs as a learning task are mixed. Our research is one more in which students, despite creating valid questions, underestimated their educational value [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Students often express a dislike for composing MCQs as a learning task. This can be attributed to several factors. Firstly, creating MCQs requires a higher cognitive load than simply answering them. Students must not only understand the material but also apply it in a way that creates a valid question and plausible distractors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This can be challenging and time-consuming, leading to frustration. Students may feel that the task does not contribute to their learning. Further, they may perceive the creation of MCQs as a teacher's responsibility, not a learning activity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore education of the benefits of MCQ creation must be explained to the students before integrating this method into curricula.\u003c/p\u003e\u003cp\u003eOn the other hand, research suggests that students have positive attitudes towards composing MCQs, which they see as an effective learning strategy that promotes higher-order thinking and deep learning. It encourages students to think critically about the material, understand it deeply, and apply it in a new context [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, students appreciate the opportunity to actively engage with the material and take ownership of their learning. However, it is important to note that the effectiveness and enjoyment of this method can vary depending on the individual student's learning style, the subject matter, and the way the task is implemented [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It seems that, in the case of our study, the obligatory nature of the task and the specificity of the subject could have resulted in a reluctant attitude of students towards composing MCQs. Perhaps giving individuals the possibility to choose their preferred method of learning in the future could potentially improve exam performance and this personalised preference approach should be considered in future studies.\u003c/p\u003e\u003cp\u003eA notable strength of our study is that it fills a knowledge gap concerning learning support methods amongst the Polish physiotherapy student. However, it is important to note that our study design allows for a comparison between NT and MCQ creation but does not directly evaluate the independent effectiveness of each method on examination results. While numerous studies have emphasised the efficacy of both tools in aiding learning [6; 23\u0026ndash;24] our research design does not provide a direct demonstration of this efficacy in this narrow head-to-head setting. The results seen in this study here may be related to the subject matter of the seminars (non-clinical content). The seminar topics included complex content related to understanding the patient-medical practitioner relationship, which can be quite challenging for first-year students.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEducators should consider offering both NT and MCQ creation to students, thereby catering to diverse learning preferences and enhancing the overall educational experience. Allowing students to choose their preferred learning method may positively influence their engagement and subsequent examination performance and this approach should be examined in future studies. In addition, the implementation of a student-centred teaching model could be effective in learning and retaining knowledge and developing competencies as health professionals [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDGs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDean Groups\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCQs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultiple-Choice Questions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNote-Taking\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eT1\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTest 1\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eT2\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTest 2\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the ethical principles set out in the Helsinki Declaration. The local Institutional Review Board (the Bioethical Committee of the Medical University of Lodz) gave an opinion that consent was not needed, in line with national regulations (RNN/218/22/KE).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e- Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability (Kindly provide this statement on system as well)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymized dataset generated and analysed during the current study is available in the Zenodo repository, DOI: 10.5281/zenodo.15861339.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e: No competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funds were used for this research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMW: Methodology, Investigation, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eJR: Conceptualization, Methodology, Formal analysis, Investigation, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eKWBO: Methodology, Investigation, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eMK: Methodology, Investigation, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eVA: Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eSRLH: Methodology\u003c/p\u003e\n\u003cp\u003eJLW: Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eAH: Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eBHLH: Conceptualization, Methodology, Formal analysis, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSandoval-Hern\u0026aacute;ndez I, Molina-Torres G, Le\u0026oacute;n-Morillas F. et al. Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study. BMC Med Educ. 2023; 23:675. https://doi.org/10.1186/s12909-023-04576-8\u003c/li\u003e\n\u003cli\u003eStacy E, Cain J. Note-taking and Handouts in The Digital Age. Am J Pharm Educ. 2015; 79: 107. doi: 10.5688/ajpe797107.\u003c/li\u003e\n\u003cli\u003eMcLeod PJ, Snell L. Student-generated MCQs. Med Teach. 1996; 18(1):23-25.\u003c/li\u003e\n\u003cli\u003ePalmer E, Devitt P. Constructing multiple choice questions as a method for learning. Ann Acad Med Singap. 2006; 35(9):604-608.\u003c/li\u003e\n\u003cli\u003eHarris BHL, Walsh JL, Tayyaba S, Harris DA, Wilson DJ, Smith PE. A novel student-led approach to multiple-choice question generation and online database creation with targeted clinician input. Teach Learn Med. 2025; 27(2):182-188. doi: 10.1080/10401334.2015.1011651.\u003c/li\u003e\n\u003cli\u003eTouissi Y, Hjiej G, Hajjioui A, Ibrahimi A, Fourtassi M. Does developing multiple-choice questions improve medical students\u0026apos; learning? A systematic review. Med Educ Online. 2022; 27(1):2005505. doi: 10.1080/10872981.2021.2005505.\u003c/li\u003e\n\u003cli\u003ePiolat A, Olive T, Kellogg RT. Cognitive effort during note-taking. Appl Cogn Psychol. 2005; 19(3):291\u0026ndash;312. doi: 10.1002/acp.1086.\u003c/li\u003e\n\u003cli\u003eManzi A, Martinez SA, Durmysheva Y. Cognitive correlates of lecture note taking: Handwriting speed and attention. North Am J Psychol. 2027; 19(1):195\u0026ndash;217.\u003c/li\u003e\n\u003cli\u003eLiu M, Uesaka Y. Identification of cognitive activities that underlie variations in lecture note-taking: An exploration of Japanese and Chinese high school students\u0026rsquo; strategies in mathematics class. Front Educ. 2022; 7:893237. doi: 10.3389/feduc.2022.893237.\u003c/li\u003e\n\u003cli\u003eMcDermott KB, Agarwal PK, D\u0026apos;Antonio L, Roediger HL, McDaniel MA. Both multiple-choice and short-answer quizzes enhance later exam performance in middle and high school classes. J Exp Psychol Appl. 2014; 20(1):3\u0026ndash;21. doi: 10.1037/xap0000004.\u003c/li\u003e\n\u003cli\u003eFiorella L, Mayer RE. Learning as a Generative Activity: Eight Learning Strategies That Promote Understanding. Cambridge: Cambridge University Press; 2015.\u003c/li\u003e\n\u003cli\u003eSmoter K. Strategie indywidualnego uczenia się i inne charakterystyki studiowania w pierwszej fazie zdalnego nauczania podczas pandemii COVID-19. E-mentor. 2022; 3(95):4\u0026ndash;12. doi: 10.15219/em95.1568.\u003c/li\u003e\n\u003cli\u003eDymek J, Kowalski T, Golda A, Polak W, Skowron A. The First Objective Structured Practical Examination (OSPE) in Pharmacy Teaching in Poland: Designing, Implementing and Assessing the Results. Indian J Pharm Educ Res. 2020; 54(3):574-578.\u003c/li\u003e\n\u003cli\u003eJanczukowicz J. Medical education in Poland. Med Teach. 2013; 35(7):537-543. doi: 10.3109/0142159X.2013.789133.\u003c/li\u003e\n\u003cli\u003eWalankar PP, Panhale VP, Situt SA. Evaluation of learning approaches in physiotherapy students: A valuable insight. J Educ Health Promot. 2019; 8:25. doi: 10.4103/jehp.jehp_254_18.\u003c/li\u003e\n\u003cli\u003eStander J, Grimmer K, Brink Y. Learning styles of physiotherapists: a systematic scoping review. BMC Med Educ. 2019; 19(1):2. doi: 10.1186/s12909-018-1434-5.\u003c/li\u003e\n\u003cli\u003eScardamalia M, Bereiter C. Knowledge telling and knowledge transforming in written composition. Adv Appl Psycholinguist. 1987; 2:142-175.\u003c/li\u003e\n\u003cli\u003eZajonc RB. Attitudinal effects of mere exposure. J Pers Soc Psychol. 1968 ; (2, Pt. 2:1-27. doi: 10.1037/h0025848.\u003c/li\u003e\n\u003cli\u003eGrainger R, Dai W, Osborne E. Medical students create multiple-choice questions for learning in pathology education: a pilot study. BMC Med Educ. 2018; 18:201. doi: 10.1186/s12909-018-1312-1.\u003c/li\u003e\n\u003cli\u003eGierl MJ, Zhou J, Alves C. Developing a taxonomy of item model types to promote assessment engineering. J Technol Learn Assess. 2008; 7(2). https://ejournals.bc.edu/index.php/jtla/article/view/1629.\u003c/li\u003e\n\u003cli\u003eBirenbaum M, Tatsuoka KK. Effects of \u0026quot;on-line\u0026quot; test feedback on the seriousness of subsequent errors. J Educ Meas. 1987; 24(2):145-155.\u003c/li\u003e\n\u003cli\u003eYu FY. Scaffolding student-generated questions: Design and development of a customizable online learning system. Comput Hum Behav. 2015; 48:301-314. doi: 10.1016/j.chb.2015.01.056.\u003c/li\u003e\n\u003cli\u003eDunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students\u0026rsquo; learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychol Sci Public Interest. 2013;14(1):4-58.\u003c/li\u003e\n\u003cli\u003eTitsworth BS, Kiewra KA. Spoken organizational lecture cues and student notetaking as facilitators of student learning. Contemp Educ Psychol. 2004; 29(4):447-461.\u003c/li\u003e\n\u003cli\u003eMolina-Torres G, Sandoval-Hern\u0026aacute;ndez I, Ropero-Padilla C, Rodriguez-Arrastia M, Mart\u0026iacute;nez-Cal J, Gonzalez-Sanchez M. Escape Room vs. Traditional Assessment in Physiotherapy Students\u0026rsquo; anxiety, stress and gaming experience: a comparative study. Int J Environ Res Public Health. 2021;18:12778.\u003c/li\u003e\n\u003cli\u003ePooja, Gakhar M, Verma B, Jagga V. Evaluation of Learning Approaches Among Physiotherapy Students in Haryana: A Cross-Sectional Study. J Eval Clin Pract. 2025; 31(1):e14253. doi: 10.1111/jep.14253. PMID: 39644511.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Note-taking, Multiple-Choice Question, MCQ, Physiotherapy, Academic Performance","lastPublishedDoi":"10.21203/rs.3.rs-6964393/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6964393/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe education of health professionals plays a crucial role in developing the competence-based learning that is essential for their future practice. Increased student engagement and participation has been shown to significantly enhance academic achievement compared to passive knowledge integration during lectures or tutorials. However, the effectiveness of different learning strategies can vary depending on the individual and the context. This study investigated the impact of note-taking and generating multiple-choice questions (MCQs) on physiotherapy students' performance in summative examinations, as well as their preferences for using these methods.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cluster-randomised controlled crossover study was conducted among first-year undergraduate physiotherapy students enrolled in a psychology course at a Polish medical university. The study included 173 students (116 females, 57 males), aged 18\u0026ndash;23 years. Following the psychology module, students completed a homework assignment, either a written note or an MCQ, which was subsequently reviewed by instructors. These materials were intended to support students\u0026rsquo; preparation for the final psychology examination. The effectiveness of each method as a tool for knowledge consolidation was evaluated using summative exam scores. Additionally, students provided qualitative feedback on their preferred learning method via an open-ended question.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThere was no statistically significant difference at the 5% level in students\u0026rsquo; summative exam performance between the two learning methods. Overall, students expressed a preference for note-taking over the MCQ format, citing greater familiarity due to its use during their secondary education. However, students who began the learning process with the MCQ method demonstrated a slightly higher preference for that approach.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eGiven the diversity of student preferences, the integration of note-taking and MCQ learning methods may optimise the educational experience in psychology training in the psychotherapy course. Further research should investigate their equivalence, taking into account students' choice of learning method.\u003c/p\u003e","manuscriptTitle":"Evaluating active learning strategies among physiotherapy students: a comparison of note- taking and multiple-choice question writing on summative examination performance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 09:02:30","doi":"10.21203/rs.3.rs-6964393/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-16T06:34:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T10:17:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-02T16:50:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-02T02:43:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68179142397887592153535717921627737834","date":"2025-08-22T20:34:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256473087016396854723250440997062954852","date":"2025-08-21T16:17:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300501765097010637369393181473273175798","date":"2025-08-12T23:05:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-28T21:20:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T14:19:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-18T12:22:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-07-18T12:12:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4416d556-28e7-49c0-91da-e49f7cfa62c6","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:58:39+00:00","versionOfRecord":{"articleIdentity":"rs-6964393","link":"https://doi.org/10.1186/s12909-025-08272-7","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-01 15:56:50","publishedOnDateReadable":"December 1st, 2025"},"versionCreatedAt":"2025-08-04 09:02:30","video":"","vorDoi":"10.1186/s12909-025-08272-7","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08272-7","workflowStages":[]},"version":"v1","identity":"rs-6964393","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6964393","identity":"rs-6964393","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}