Evaluation of the Effectiveness of an Interactive Module in Enhancing Clinical Reasoning Skills in Second-Year Medical Students

Evaluation of the Effectiveness of an Interactive Module in Enhancing Clinical Reasoning Skills in Second-Year Medical Students | 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 Short Report Evaluation of the Effectiveness of an Interactive Module in Enhancing Clinical Reasoning Skills in Second-Year Medical Students Smriti Agnihotri, Namrata Chhabra This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8991422/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Effective clinical reasoning is essential in medical education, yet traditional didactic methods often promote passive learning and may not foster higher-order cognitive skills. Interactive e-learning modules offer an active, self-directed approach that can enhance experiential learning and clinical reasoning. Objective: To evaluate the effectiveness of an interactive module in enhancing clinical reasoning and explore its impact on student engagement among second-year medical students. Methods: A prospective, non-comparative interventional mixed-method study was conducted at the American University of Antigua College of Medicine. Two hundred third-semester students participated in an interactive, multimedia-based module on the clinical approach to arthritis, developed using iSpring Suite 11. Pre- and post-module quizzes assessed knowledge gains. Student perceptions were evaluated using a validated feedback questionnaire and focus group discussions. Quantitative data were analyzed using paired t-tests, and qualitative data were assessed using thematic analysis. Results: A total of 162 students out of 200 completed both quizzes. Post-module scores improved significantly (mean: 64.5 to 73.2; p < .001). Over 75% of students agreed that the module enhanced clinical reasoning, knowledge retention, and understanding of diagnostic gaps. Thematic analysis revealed appreciation for the active learning design, structured format, and self-paced delivery, which supported deeper reflection and clinical application. Conclusion: The interactive module significantly improved clinical reasoning and student engagement. Incorporating such tools in early medical education may bridge the gap between theoretical knowledge and clinical practice through active, learner-centered strategies. Clinical Trial Registration Not applicable. Clinical reasoning Interactive module Medical education Active learning iSpring Suite Figures Figure 1 Figure 2 INTRODUCTION Medical errors are a significant cause of morbidity and mortality worldwide, with a substantial proportion attributed to failures in clinical reasoning that result in diagnostic and management errors [1,2]. As such, a core objective of medical education is to develop competent physicians capable of sound clinical judgment and decision-making across a range of health conditions [3]. Clinical reasoning is a complex cognitive process involving the collection, analysis, and interpretation of patient data to arrive at accurate diagnoses and appropriate management plans. These skills should be introduced early in the medical curriculum—ideally during the basic sciences phase—to bridge the gap between foundational knowledge and its clinical application. However, the traditional structure of undergraduate medical education—comprising two years of lecture-based basic sciences followed by two years of clinical clerkship—is often criticized for being rigid, overly prolonged, and insufficiently learner-centered [4]. In today’s technology-driven learning environment, students have unprecedented access to digital resources. Yet, without proper guidance, this access can lead to fragmented learning and poor time management. There is thus a growing need for instructional strategies that foster deeper engagement and more effective development of clinical reasoning skills. Interactive educational modules, which utilize methods such as case-based learning, simulations, role plays, and virtual microscopy, have shown promise in enhancing knowledge retention, diagnostic accuracy, and critical thinking [5]. For instance, Ariana et al. [6] demonstrated the effectiveness of a self-directed, e-learning histopathology module for dental students, reporting significantly improved assessment scores in the intervention group compared to controls. While their focus was on pathology content delivery, their findings underscore the broader potential of interactive modules in fostering active learning and cognitive skill development. Several studies have echoed these findings, highlighting that interactive, student-centered learning approaches improve clinical reasoning, critical thinking, and application of knowledge more effectively than conventional didactic methods [7–10]. By promoting autonomy and flexibility—allowing learners to engage at their own time, place, and pace—such modules support self-directed learning and sustained engagement. This study aims to evaluate the effectiveness of an interactive module in enhancing clinical reasoning, decision-making skills, and active engagement among undergraduate medical students. Despite growing literature on digital tools in medical education, few studies have systematically assessed their impact on clinical reasoning during the early, pre-clinical phase—an area this study seeks to address. METHOLOLOGY This study was conducted using a noncomparative interventional mixed method approach, at the American University of Antigua, College of Medicine, Antigua. The Institute’s curriculum is an outcome-based curriculum following the AAMC guidelines and trains students for the USMLE Step 1 examinations. Two hundred third-semester medical students participated in the study as a part of purposive sampling. Before starting the module students were provided with an explanation of how the interactive modules could enhance their in-depth knowledge, higher-order thinking, and clinical reasoning skills. An interactive module was created on the topic of Arthritis using the e-learning tool iSpring Suite 11. This module was created to enhance diagnostic and clinical reasoning skills by incorporating the exercises, ranging from lower-order to higher-order applications in a stepwise manner (Fig. 1 ). The framework of the module included pre-module quiz of 10 multiple-choice questions. The questions were based on the guidelines provided by the National Board of Medical Examiners (NBME). The module consisted of exercises involving clinical history, physical examination, laboratory, and radiological findings to guide them a stepwise structured approach. The exercises were designed using principles of Bloom’s Taxonomy. Role-play scenarios were incorporated to apply the higher-order critical thinking and decision-making skills. At the end of the module, a post-module quiz (same as the one administered before the module) was reintroduced. At this point to assess improvements in clinical reasoning skills, students received scores and feedback for this post-module quiz. Implementation: An interactive module on “Arthritis” using the iSpring Suite11 digital tool was created after getting the project approval. The university had a subscription for this educational tool. Once the module was created, it underwent intra and interdepartmental (biochemistry and microbiology) validation processes by the certified members in medical education for content accuracy, validity and pedagogy. This module was implemented in the last week of September, after the didactic lectures on arthritis. Students were given clear instructions about the module and its utility. Prior to starting the module, students completed a pre-module quiz on the Learning Management System (Blackboard) to evaluate their baseline knowledge. The quiz was time-restricted, allowing 1 minute and 30 seconds per question. Grading and feedback were not revealed to the students. However, their scores were recorded through the Learning Management System (Blackboard). After the quiz, students took this module. The link to access this software was made available to students through the learning management system (Blackboard). Students took the same quiz after completion of the module. This time they received the feedback and grades. Students were given access to the module for a week. After that access was withdrawn. Data collection process: For evaluation of the effectiveness of the module, Kirkpatrick’s framework was used. A questionnaire was designed based on these guidelines. The model evaluated four levels of educational evidence: reaction, learning, behavior, and result. Accordingly, an anonymous, categorical questionnaire was developed. The questionnaire (annexure-1) consisted of 10 Likert scale-based questions. The questions were scaled from 1 to 4 depending on the level of agreement. (4 corresponding to strongly agree and 1 strongly disagree with the statement). Among the quantitative questions, those pertaining to reaction recorded students’ satisfaction, whereas those related to knowledge recorded the enhancement in their clinical reasoning skills. Qualitative assessment was done through focused group discussion using the interview guide (Annexure 2). The questionnaires were validated by both internal and external faculty members. A total of 56 students out of 162 students responded to the questionnaire. The students were notified about their voluntary participation and the anonymous nature of the responses collected through email. The validated Microsoft Forms survey link was distributed to students electronically to facilitate feedback collection. Students were asked to volunteer in the focus group discussion(FGD). An email was sent to give their consent in the form of a reply to agree to participate in a focused group discussion. 30 students replied to participate in the discussion. Three sessions, each comprising 10 students, were conducted by my co-investigator. The sessions were conducted in the home room and the responses were recorded on the smart phone audio recording, Later, discussions were transcribed using Google Transcription. Data analysis: Quantitative The quantitative data were analyzed using Wilcoxon signed-rank test of significance for ordinal data using the SPSS software package version. A paired t -test was applied to compare the scores on pre- and post-module quizzes. Cronbach’s alpha coefficient was used to assess the reliability of the construct. Cronbach’s revealed an acceptable internal consistency (0.99). Qualitative We used thematic analysis with an inductive coding approach, allowing themes to emerge naturally from the data. Coding was done manually, without the use of qualitative analysis software. Two researchers independently reviewed the transcripts and generated initial codes. These codes were then discussed and refined collaboratively to develop broader themes. To ensure validity, themes were reviewed iteratively, and consensus was reached through peer debriefing and regular discussions, with an audit trail maintained to enhance transparency and trustworthiness. Ethics: Ethical approval for the study was obtained from the Institutional Review Board of the American University of Antigua (IRB Approval Number: AUAIRBa24007). All participants were informed about the voluntary nature of participation and assured of the anonymity and confidentiality of their responses. Informed consent was obtained electronically prior to data collection. RESULTS Of the 200 students, 162 students completed the module. The students’ performance on pre- and post-module quizzes was compared using a paired sample test. Results obtained P<.001 were considered significant. (Fig. 2 ) Numbers and percentage responses for each of the categories of the questionnaire were calculated and have been shown in Table 1 . The interactive nature of the modules significantly enhanced participants’ ability to analyze and interpret clinical data in real-world scenarios. A substantial proportion of participants strongly agreed (35.7%) and agreed (39.3%) with this positive impact. Moreover, the modules effectively identified and addressed gaps in clinical reasoning abilities, emphasizing high satisfaction levels: strongly agree (39.3%) and agree (41.1%). Recommendations for continued use were robust, spanning both Pathology topics (strongly agree: 41.1%, agree: 37.5%) and other disciplines (strongly agree: 42.9%, agree: 33.9%). Importantly, participants foresee the acquired knowledge from these modules shaping them into better physicians in the future (strongly agree: 39.3%, agree: 39.3%). Overall, the intervention effectively met their learning needs, with a majority expressing satisfaction. Table 1 Student perceptions of the interactive module's effectiveness in enhancing clinical reasoning (Likert-scale responses, N = 56) 1 Strongly agree (4) Agree (3) Disagree (2) Strongly disagree (1) This module helped me to deeply understand the fundamental aspect of the topic 21 (37.5) 22 (39.3) 8 (14.3) 5 (8.9) 2 The module helped in better retention of the knowledge 19 (33.9) 24 (42.9) 9 (16.1) 4 (7.1) 3 This module helped me in solving clinical problems 20 (35.7) 25 (44.6) 7 (12.5) 4 (7.1) 4 The interactive modules effectively enhanced my understanding of clinical reasoning skills 21 (37.5) 21 (37.5) 10 (17.9) 4 (7.1) 5 The interactive modules improved my ability to analyze and interpret clinical data in real-world scenarios. 20 (35.7) 22 (39.3) 10 (17.9) 4 (7.1 ) 6 The interactive modules helped me identify and address gaps in my clinical reasoning abilities. 22 (39.3) 23 (41.1) 7 (12.5) 5 (8.9) 7 I recommend interactive modules for other topics in Pathology 23 (41.1) 21 (37.5) 7 (12.5) 5 (8.9) 8 I recommend this intervention for other disciplines 24 (42.9) 19 (33.9) 8 (14.3) 5 (8.9) 9 Knowledge gained through this module will help me to prepare myself as better physician in future 22 (39.3) 22 (39.3) 8 (14.3) 4 (7.1) 10 I am satisfied with this module as it addressed my learning needs 23 (41.1) 17 (30.4) 10 (17.9) 6 (10.7) Means and standard deviations for individual items on the questionnaire were calculated (Table 2 ). The responses indicate generally positive perceptions among students, with mean scores above 3 for most questions. Notably, students expressed higher satisfaction with the module's effectiveness in addressing their learning needs (Question 10) and in helping them identify and address gaps in clinical reasoning abilities (Question 6). The standard deviations suggest moderate agreement among participants. Table 2 Mean, median, and standard deviation of Likert scores. 1 Item Mean Median Std. Deviation This module helped me to deeply understand the fundamental aspect of the topic 3.05 3.00 .942 2 The module helped in better retention of the knowledge 3.04 3.00 .894 3 This module helped me in solving clinical problems 3.09 3.00 .880 4 The interactive modules effectively enhanced my understanding of clinical reasoning skills 3.05 3.00 .923 5 The interactive modules improved my ability to analyze and interpret clinical data in real-world scenarios. 3.04 3.00 .914 6 The interactive modules helped me identify and address gaps in my clinical reasoning abilities. 3.13 3.00 .896 7 I recommend interactive modules for other topics in Pathology 3.11 3.00 .947 8 I recommend this intervention for other disciplines 3.11 3.00 .966 9 Knowledge gained through this module will help me to prepare myself as better physician in future 3.11 3.00 .908 10 I am satisfied with this module as it addressed my learning needs 3.02 3.00 1.018 The Mean Satisfaction Index was calculated by adding the number of responses marked as "Strongly Agree" and "Agree," dividing this sum by the total number of responses, and then multiplying the result by 100. Using this method, the Mean Satisfaction Index was found to be 77%. FGDs were carried out to assess the effectiveness of this interactive module in improving clinical reasoning skills through students’ perceptions, opinions, and thoughts. The questions probed the students to evaluate their perception of their active learning, engagement, and improving clinical reasoning and diagnostic skills. The various themes that emerged through the focused group analysis were active learning, the structure of the module, and the delivery of the content fostering their learning process effectively (Table 3 ). The students liked the interactive nature, holistic approach, and diversity of assessment in the module. The structure of the module was conducive to students’ learning as being self-paced, fun-filled, and nongraded assignments. The students found this module an excellent source to enhance their active learning, concept-building, clinical reasoning, and diagnostic skills. Table 3 Themes derived from thematic analysis. Themes comments Active learning and Engagement I loved the module as it allowed us to drag and drop and could repeat if did not get correct answer I found it engaging and built my clinical reasoning skills by going in step wise manner. It was very helpful in enhancing my knowledge and my clinical reasoning skills Holistic structure I found it User-friendly. It was well organized module. Efficient delivery of the content I liked this as it included questions from lower order to higher order thinking in a step wise manner. I found it enjoyable as the content was delivered in engaging manner. I love the role-play as it looked as if talking to a doctor in the hospital. DISCUSSION Clinical reasoning is a core competency in medical education and essential for producing competent physicians capable of navigating complex diagnostic challenges. Despite its importance, teaching clinical reasoning remains difficult due to the inherent gap between theoretical instruction and real-world clinical application. Educational strategies that explicitly model and reinforce the reasoning process help students develop pattern recognition, data interpretation, and diagnostic synthesis skills [11–12]. Our study demonstrates that the integration of an interactive, self-paced e-learning module into the basic sciences curriculum can significantly improve students' clinical reasoning performance, as evidenced by the statistically significant improvement in post-module quiz scores. These findings align with prior research by Bigdeli et al. [13] and Wijaya [14]. who reported that interactive digital tools positively impact learners’ engagement and diagnostic reasoning. The effectiveness of our module may be attributed to its instructional design, which incorporated graduated clinical exercises based on Bloom’s taxonomy—progressing from foundational knowledge to higher-order analytical thinking [15]. By including clinical scenarios, histopathological and radiological images, and embedded feedback, the module created an authentic, case-oriented learning environment that mirrored real-world diagnostic tasks. Feedback from students further substantiated these results. Over 75% reported that the module enhanced their ability to analyze and interpret clinical data. Additionally, 71.5% expressed satisfaction with the module’s structure and found it aligned with their learning needs. This level of engagement underscores the value of integrating multimedia resources and learner-controlled pacing into clinical education. Blended learning strategies that combine traditional lectures with interactive, technology-enhanced modules have been shown to increase knowledge retention and promote critical thinking [16]. Our findings support this pedagogical approach and emphasize the role of active learning, self-assessment, and spaced repetition in reinforcing complex clinical reasoning skills. Ultimately, this study highlights the potential of interactive modules to bridge the gap between basic science education and clinical application. By fostering active, reflective, and visually enriched learning, these tools empower students to develop the diagnostic mindset of a physician, preparing them to navigate real-world clinical scenarios with greater confidence and competency. Limitation The lack of a control group limits causal inference and assessment of broader academic outcomes. Post-module-only surveys may introduce recall bias, and reasons behind some students’ negative perceptions were not explored. Conducted at a single institution with voluntary participation, the findings may be subject to selection bias and lack generalizability. Future studies with randomized designs, control groups, and long-term metrics are recommended to better evaluate the module’s impact. Directions for future research Future research should aim to evaluate the long-term impact of interactive modules on academic performance by incorporating a control group and comparing summative examination outcomes between students who use the module and those who do not. Specifically, studies could assess whether the integration of such modules into musculoskeletal system teaching leads to measurable improvements in diagnostic reasoning and exam performance. Additionally, multi-institutional studies with larger sample sizes and longitudinal follow-up would help validate the generalizability and sustainability of these findings. Declarations Acknowledgements Grateful to the CMCL-FAIMER team, faculty, and fellows for their valuable input and support. Special thanks to Dr. Deborah Dalmeida and Dr. Bharati Balachandran. Heartfelt appreciation to the Semester 3 students for enthusiastic participation. Clinical Trial Registration Not applicable. Ethics Approval and Consent to Participate Ethical approval for the study was obtained from the Institutional Review Board of the American University of Antigua (IRB Approval Number: AUAIRBa24007). All participants were informed about the voluntary nature of participation and assured of the anonymity and confidentiality of their responses. Informed consent was obtained electronically prior to data collection. All human-related procedures were performed in accordance with relevant guidelines and regulations of the American University of Antigua College of Medicine. Funding No funding was received for conducting this study. Data availability statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request . Author Contribution S.A. conceptualized and designed the study, developed the interactive e-learning module, coordinated implementation, collected and analyzed quantitative and qualitative data, and drafted the manuscript. N.C. contributed to study design, supervised methodology and educational framework alignment, supported data interpretation, and critically revised the manuscript for important intellectual content. All authors reviewed and approved the final manuscript. References Zhang GY, Gross CP. Protecting Patients by Reducing Diagnostic Error. JAMA Intern Med. 2024;184(Suppl 2):173. Mishra D, Gupta P, Singh T. Teaching for reducing diagnostic errors. Indian Pediatr. 2017;54:37-45. Verbree AR, Isik U, Janssen J, et al. Inclusion and diversity within medical education: a focus group study. BMC Med Educ. 2023;23:61. Irby DM, Cooke M, O’Brien BC. Calls for reform of medical education by the Carnegie Foundation. Acad Med. 2010;85:220-7. Bryner BS, Saddawi-Konefka D, Gest TR. Impact of interactive modules on preclinical medical education. Anat Sci Educ. 2008;1(6):247-51. Ariana A, Amin M, Pakneshan S, et al. E-learning methods in dental histopathology. J Dent Educ. 2016;80:1140-8. Zollner B, Sucha M, Berg C, et al. Pharmacases.de e-learning project. Med Teach. 2013;35(3):251-3. Abraham RR, Fisher M, Kamath A, et al. SDL readiness in physiology. Adv Physiol Educ. 2011;35(4):393-5. Longmuir KJ. Acid-base physiology CAI. Adv Physiol Educ. 2014;38(1):34-41. Karaksha A, Grant G, Nirthanan SN, et al. E-learning impact study. Educ Res Int. 2014;(10):1-11. Plackett R, Kassianos AP, Mylan S, et al. Virtual patient tools and clinical reasoning. BMC Med Educ. 2022;22:365. Hawks MK, Maciuba JM, Merkebu J, et al. Clinical reasoning curricula review. Acad Med. 2023;98(8):958-65. Bigdeli S, Hosseinzadeh Z, Dehnad A, et al. Medical educational games. Med J Islam Repub Iran. 2023;37. Wijaya JE, Vidianti A. E-modules and student outcomes. ICOPE Conf. 2020:86-9. Stringer JK, Santen SA, Lee E, et al. Bloom’s taxonomy in MCQs. Med Sci Educ. 2021;31(4):1311-7. Lewis-Pierre L, Aziza K. EOL education modules. Q Rev Distance Educ. 2017;18(1):9. Additional Declarations No competing interests reported. Supplementary Files ANNEXURE.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor invited by journal 09 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 04 Mar, 2026 First submitted to journal 04 Mar, 2026 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-8991422","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":616477433,"identity":"503f0a28-e89f-4a1b-94e1-389207a82139","order_by":0,"name":"Smriti Agnihotri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoElEQVRIiWNgGAWjYJCCAwwGNgxsIBYP0VoOGKSRqAVozWEIgygt8tPOPjz8oeB8Yh/7AcYHb9uI0GJwO90A6LDbiW08CcyGc4nSIp3GANEiwcAmzUuMFvnZYC3nQFrYfxOlheE2WMsBsC3MRGkxAGk5Y5Bs3MaT2Cw55xxxDmP+UPHHTnZ+++GDH96UEeMwBGBsIE39KBgFo2AUjALcAACM4TW0kQIMugAAAABJRU5ErkJggg==","orcid":"","institution":"University of Illinois College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Smriti","middleName":"","lastName":"Agnihotri","suffix":""},{"id":616477434,"identity":"2c260d48-518f-4f2a-a0dc-b307c51caec7","order_by":1,"name":"Namrata Chhabra","email":"","orcid":"","institution":"American University of Antigua","correspondingAuthor":false,"prefix":"","firstName":"Namrata","middleName":"","lastName":"Chhabra","suffix":""}],"badges":[],"createdAt":"2026-02-27 20:23:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8991422/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8991422/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106103433,"identity":"ba4d5f70-64ce-4fca-9a58-0bc8b02ac84c","added_by":"auto","created_at":"2026-04-03 13:13:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88959,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart for methodology\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8991422/v1/26a3dd6882edb13b3d5db2d4.jpg"},{"id":106103435,"identity":"5a2aa4e8-bbb1-47d1-a7b7-ebcb758326ef","added_by":"auto","created_at":"2026-04-03 13:13:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50896,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of pre- and post-module quiz scores (N = 162)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8991422/v1/f3f7452331033e77eda6b976.jpg"},{"id":106405568,"identity":"514effbb-559a-475f-a1cf-40e188516d78","added_by":"auto","created_at":"2026-04-08 09:27:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824206,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8991422/v1/35777795-ca76-44a8-b747-fe4a42655f1c.pdf"},{"id":106401833,"identity":"42aa62f7-5cf1-4447-b619-d3b63c0ef187","added_by":"auto","created_at":"2026-04-08 09:09:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19546,"visible":true,"origin":"","legend":"","description":"","filename":"ANNEXURE.docx","url":"https://assets-eu.researchsquare.com/files/rs-8991422/v1/50bd3e8e0a511ba7b22de13c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Effectiveness of an Interactive Module in Enhancing Clinical Reasoning Skills in Second-Year Medical Students","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMedical errors are a significant cause of morbidity and mortality worldwide, with a substantial proportion attributed to failures in clinical reasoning that result in diagnostic and management errors [1,2]. As such, a core objective of medical education is to develop competent physicians capable of sound clinical judgment and decision-making across a range of health conditions [3].\u003c/p\u003e \u003cp\u003eClinical reasoning is a complex cognitive process involving the collection, analysis, and interpretation of patient data to arrive at accurate diagnoses and appropriate management plans. These skills should be introduced early in the medical curriculum\u0026mdash;ideally during the basic sciences phase\u0026mdash;to bridge the gap between foundational knowledge and its clinical application.\u003c/p\u003e \u003cp\u003eHowever, the traditional structure of undergraduate medical education\u0026mdash;comprising two years of lecture-based basic sciences followed by two years of clinical clerkship\u0026mdash;is often criticized for being rigid, overly prolonged, and insufficiently learner-centered [4]. In today\u0026rsquo;s technology-driven learning environment, students have unprecedented access to digital resources. Yet, without proper guidance, this access can lead to fragmented learning and poor time management. There is thus a growing need for instructional strategies that foster deeper engagement and more effective development of clinical reasoning skills.\u003c/p\u003e \u003cp\u003eInteractive educational modules, which utilize methods such as case-based learning, simulations, role plays, and virtual microscopy, have shown promise in enhancing knowledge retention, diagnostic accuracy, and critical thinking [5]. For instance, Ariana et al. [6] demonstrated the effectiveness of a self-directed, e-learning histopathology module for dental students, reporting significantly improved assessment scores in the intervention group compared to controls. While their focus was on pathology content delivery, their findings underscore the broader potential of interactive modules in fostering active learning and cognitive skill development.\u003c/p\u003e \u003cp\u003eSeveral studies have echoed these findings, highlighting that interactive, student-centered learning approaches improve clinical reasoning, critical thinking, and application of knowledge more effectively than conventional didactic methods [7\u0026ndash;10]. By promoting autonomy and flexibility\u0026mdash;allowing learners to engage at their own time, place, and pace\u0026mdash;such modules support self-directed learning and sustained engagement.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the effectiveness of an interactive module in enhancing clinical reasoning, decision-making skills, and active engagement among undergraduate medical students. Despite growing literature on digital tools in medical education, few studies have systematically assessed their impact on clinical reasoning during the early, pre-clinical phase\u0026mdash;an area this study seeks to address.\u003c/p\u003e"},{"header":"METHOLOLOGY","content":"\u003cp\u003eThis study was conducted using a noncomparative interventional mixed method approach, at the American University of Antigua, College of Medicine, Antigua. The Institute\u0026rsquo;s curriculum is an outcome-based curriculum following the AAMC guidelines and trains students for the USMLE Step 1 examinations. Two hundred third-semester medical students participated in the study as a part of purposive sampling. Before starting the module students were provided with an explanation of how the interactive modules could enhance their in-depth knowledge, higher-order thinking, and clinical reasoning skills. An interactive module was created on the topic of Arthritis using the e-learning tool iSpring Suite 11. This module was created to enhance diagnostic and clinical reasoning skills by incorporating the exercises, ranging from lower-order to higher-order applications in a stepwise manner (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The framework of the module included pre-module quiz of 10 multiple-choice questions. The questions were based on the guidelines provided by the National Board of Medical Examiners (NBME). The module consisted of exercises involving clinical history, physical examination, laboratory, and radiological findings to guide them a stepwise structured approach. The exercises were designed using principles of Bloom\u0026rsquo;s Taxonomy. Role-play scenarios were incorporated to apply the higher-order critical thinking and decision-making skills. At the end of the module, a post-module quiz (same as the one administered before the module) was reintroduced. At this point to assess improvements in clinical reasoning skills, students received scores and feedback for this post-module quiz.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eImplementation:\u003c/h2\u003e \u003cp\u003eAn interactive module on \u0026ldquo;Arthritis\u0026rdquo; using the iSpring Suite11 digital tool was created after getting the project approval. The university had a subscription for this educational tool. Once the module was created, it underwent intra and interdepartmental (biochemistry and microbiology) validation processes by the certified members in medical education for content accuracy, validity and pedagogy. This module was implemented in the last week of September, after the didactic lectures on arthritis. Students were given clear instructions about the module and its utility. Prior to starting the module, students completed a pre-module quiz on the Learning Management System (Blackboard) to evaluate their baseline knowledge. The quiz was time-restricted, allowing 1 minute and 30 seconds per question.\u003c/p\u003e \u003cp\u003eGrading and feedback were not revealed to the students. However, their scores were recorded through the Learning Management System (Blackboard). After the quiz, students took this module. The link to access this software was made available to students through the learning management system (Blackboard). Students took the same quiz after completion of the module. This time they received the feedback and grades. Students were given access to the module for a week. After that access was withdrawn.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection process:\u003c/h3\u003e\n\u003cp\u003eFor evaluation of the effectiveness of the module, Kirkpatrick\u0026rsquo;s framework was used. A questionnaire was designed based on these guidelines. The model evaluated four levels of educational evidence: reaction, learning, behavior, and result. Accordingly, an anonymous, categorical questionnaire was developed. The questionnaire (annexure-1) consisted of 10 Likert scale-based questions. The questions were scaled from 1 to 4 depending on the level of agreement. (4 corresponding to strongly agree and 1 strongly disagree with the statement). Among the quantitative questions, those pertaining to reaction recorded students\u0026rsquo; satisfaction, whereas those related to knowledge recorded the enhancement in their clinical reasoning skills. Qualitative assessment was done through focused group discussion using the interview guide (Annexure 2). The questionnaires were validated by both internal and external faculty members. A total of 56 students out of 162 students responded to the questionnaire. The students were notified about their voluntary participation and the anonymous nature of the responses collected through email. The validated Microsoft Forms survey link was distributed to students electronically to facilitate feedback collection. Students were asked to volunteer in the focus group discussion(FGD). An email was sent to give their consent in the form of a reply to agree to participate in a focused group discussion. 30 students replied to participate in the discussion. Three sessions, each comprising 10 students, were conducted by my co-investigator. The sessions were conducted in the home room and the responses were recorded on the smart phone audio recording, Later, discussions were transcribed using Google Transcription.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eQuantitative\u003c/strong\u003e \u003cp\u003eThe quantitative data were analyzed using Wilcoxon signed-rank test of significance for ordinal data using the SPSS software package version. A paired \u003cem\u003et\u003c/em\u003e-test was applied to compare the scores on pre- and post-module quizzes. Cronbach\u0026rsquo;s alpha coefficient was used to assess the reliability of the construct. Cronbach\u0026rsquo;s revealed an acceptable internal consistency (0.99).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eQualitative\u003c/strong\u003e \u003cp\u003eWe used thematic analysis with an inductive coding approach, allowing themes to emerge naturally from the data. Coding was done manually, without the use of qualitative analysis software. Two researchers independently reviewed the transcripts and generated initial codes. These codes were then discussed and refined collaboratively to develop broader themes. To ensure validity, themes were reviewed iteratively, and consensus was reached through peer debriefing and regular discussions, with an audit trail maintained to enhance transparency and trustworthiness.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the study was obtained from the Institutional Review Board of the American University of Antigua (IRB Approval Number: AUAIRBa24007). All participants were informed about the voluntary nature of participation and assured of the anonymity and confidentiality of their responses. Informed consent was obtained electronically prior to data collection.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 200 students, 162 students completed the module. The students\u0026rsquo; performance on pre- and post-module quizzes was compared using a paired sample test. Results obtained P\u0026lt;.001 were considered significant. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNumbers and percentage responses for each of the categories of the questionnaire were calculated and have been shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The interactive nature of the modules significantly enhanced participants\u0026rsquo; ability to analyze and interpret clinical data in real-world scenarios. A substantial proportion of participants strongly agreed (35.7%) and agreed (39.3%) with this positive impact. Moreover, the modules effectively identified and addressed gaps in clinical reasoning abilities, emphasizing high satisfaction levels: strongly agree (39.3%) and agree (41.1%). Recommendations for continued use were robust, spanning both Pathology topics (strongly agree: 41.1%, agree: 37.5%) and other disciplines (strongly agree: 42.9%, agree: 33.9%). Importantly, participants foresee the acquired knowledge from these modules shaping them into better physicians in the future (strongly agree: 39.3%, agree: 39.3%). Overall, the intervention effectively met their learning needs, with a majority expressing satisfaction.\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\u003eStudent perceptions of the interactive module's effectiveness in enhancing clinical reasoning (Likert-scale responses, N\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrongly agree (4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgree (3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDisagree (2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStrongly disagree (1)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis module helped me to deeply understand the fundamental aspect of the topic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (37.5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe module helped in better retention of the knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis module helped me in solving clinical problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules effectively enhanced my understanding of clinical reasoning skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules improved my ability to analyze and interpret clinical data in real-world scenarios.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (7.1 )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules helped me identify and address gaps in my clinical reasoning abilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI recommend interactive modules for other topics in Pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI recommend this intervention for other disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge gained through this module will help me to prepare myself as better physician in future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am satisfied with this module as it addressed my learning needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMeans and standard deviations for individual items on the questionnaire were calculated (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The responses indicate generally positive perceptions among students, with mean scores above 3 for most questions. Notably, students expressed higher satisfaction with the module's effectiveness in addressing their learning needs (Question 10) and in helping them identify and address gaps in clinical reasoning abilities (Question 6). The standard deviations suggest moderate agreement among participants.\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\u003eMean, median, and standard deviation of Likert scores.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis module helped me to deeply understand the fundamental aspect of the topic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.942\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe module helped in better retention of the knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis module helped me in solving clinical problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.880\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules effectively enhanced my understanding of clinical reasoning skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules improved my ability to analyze and interpret clinical data in real-world scenarios.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe interactive modules helped me identify and address gaps in my clinical reasoning abilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.896\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI recommend interactive modules for other topics in Pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI recommend this intervention for other disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.966\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge gained through this module will help me to prepare myself as better physician in future\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI am satisfied with this module as it addressed my learning needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e The Mean Satisfaction Index was calculated by adding the number of responses marked as \"Strongly Agree\" and \"Agree,\" dividing this sum by the total number of responses, and then multiplying the result by 100. Using this method, the Mean Satisfaction Index was found to be 77%.\u003c/p\u003e \u003cp\u003eFGDs were carried out to assess the effectiveness of this interactive module in improving clinical reasoning skills through students\u0026rsquo; perceptions, opinions, and thoughts. The questions probed the students to evaluate their perception of their active learning, engagement, and improving clinical reasoning and diagnostic skills. The various themes that emerged through the focused group analysis were active learning, the structure of the module, and the delivery of the content fostering their learning process effectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The students liked the interactive nature, holistic approach, and diversity of assessment in the module. The structure of the module was conducive to students\u0026rsquo; learning as being self-paced, fun-filled, and nongraded assignments. The students found this module an excellent source to enhance their active learning, concept-building, clinical reasoning, and diagnostic skills.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes derived from thematic analysis.\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\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecomments\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive learning and Engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eI loved the module as it allowed us to drag and drop and could repeat if did not get correct answer\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eI found it engaging and built my clinical reasoning skills by going in step wise manner.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eIt was very helpful in enhancing my knowledge and my clinical reasoning skills\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHolistic structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eI found it User-friendly.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eIt was well organized module.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEfficient delivery of the content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eI liked this as it included questions from lower order to higher order thinking in a step wise manner.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eI found it enjoyable as the content was delivered in engaging manner.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eI love the role-play as it looked as if talking to a doctor in the hospital.\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\u003eClinical reasoning is a core competency in medical education and essential for producing competent physicians capable of navigating complex diagnostic challenges. Despite its importance, teaching clinical reasoning remains difficult due to the inherent gap between theoretical instruction and real-world clinical application. Educational strategies that explicitly model and reinforce the reasoning process help students develop pattern recognition, data interpretation, and diagnostic synthesis skills [11\u0026ndash;12].\u003c/p\u003e \u003cp\u003eOur study demonstrates that the integration of an interactive, self-paced e-learning module into the basic sciences curriculum can significantly improve students' clinical reasoning performance, as evidenced by the statistically significant improvement in post-module quiz scores. These findings align with prior research by Bigdeli et al. [13] and Wijaya [14]. who reported that interactive digital tools positively impact learners\u0026rsquo; engagement and diagnostic reasoning.\u003c/p\u003e \u003cp\u003eThe effectiveness of our module may be attributed to its instructional design, which incorporated graduated clinical exercises based on Bloom\u0026rsquo;s taxonomy\u0026mdash;progressing from foundational knowledge to higher-order analytical thinking [15]. By including clinical scenarios, histopathological and radiological images, and embedded feedback, the module created an authentic, case-oriented learning environment that mirrored real-world diagnostic tasks.\u003c/p\u003e \u003cp\u003eFeedback from students further substantiated these results. Over 75% reported that the module enhanced their ability to analyze and interpret clinical data. Additionally, 71.5% expressed satisfaction with the module\u0026rsquo;s structure and found it aligned with their learning needs. This level of engagement underscores the value of integrating multimedia resources and learner-controlled pacing into clinical education.\u003c/p\u003e \u003cp\u003eBlended learning strategies that combine traditional lectures with interactive, technology-enhanced modules have been shown to increase knowledge retention and promote critical thinking [16]. Our findings support this pedagogical approach and emphasize the role of active learning, self-assessment, and spaced repetition in reinforcing complex clinical reasoning skills.\u003c/p\u003e \u003cp\u003eUltimately, this study highlights the potential of interactive modules to bridge the gap between basic science education and clinical application. By fostering active, reflective, and visually enriched learning, these tools empower students to develop the diagnostic mindset of a physician, preparing them to navigate real-world clinical scenarios with greater confidence and competency.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitation\u003c/strong\u003e \u003cp\u003eThe lack of a control group limits causal inference and assessment of broader academic outcomes. Post-module-only surveys may introduce recall bias, and reasons behind some students\u0026rsquo; negative perceptions were not explored. Conducted at a single institution with voluntary participation, the findings may be subject to selection bias and lack generalizability. Future studies with randomized designs, control groups, and long-term metrics are recommended to better evaluate the module\u0026rsquo;s impact.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDirections for future research\u003c/strong\u003e \u003cp\u003eFuture research should aim to evaluate the long-term impact of interactive modules on academic performance by incorporating a control group and comparing summative examination outcomes between students who use the module and those who do not. Specifically, studies could assess whether the integration of such modules into musculoskeletal system teaching leads to measurable improvements in diagnostic reasoning and exam performance. Additionally, multi-institutional studies with larger sample sizes and longitudinal follow-up would help validate the generalizability and sustainability of these findings.\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e Grateful to the CMCL-FAIMER team, faculty, and fellows for their valuable input and support. Special thanks to Dr. Deborah Dalmeida and Dr. Bharati Balachandran. Heartfelt appreciation to the Semester 3 students for enthusiastic participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Institutional Review Board of the American University of Antigua (IRB Approval Number: AUAIRBa24007). All participants were informed about the voluntary nature of participation and assured of the anonymity and confidentiality of their responses. Informed consent was obtained electronically prior to data collection.\u0026nbsp;All human-related procedures were performed in accordance with relevant guidelines and regulations of the American University of Antigua College of Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.A. conceptualized and designed the study, developed the interactive e-learning module, coordinated implementation, collected and analyzed quantitative and qualitative data, and drafted the manuscript. N.C. contributed to study design, supervised methodology and educational framework alignment, supported data interpretation, and critically revised the manuscript for important intellectual content. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhang GY, Gross CP. Protecting Patients by Reducing Diagnostic Error. JAMA Intern Med. 2024;184(Suppl 2):173.\u003c/li\u003e\n \u003cli\u003eMishra D, Gupta P, Singh T. Teaching for reducing diagnostic errors. Indian Pediatr. 2017;54:37-45.\u003c/li\u003e\n \u003cli\u003eVerbree AR, Isik U, Janssen J, et al.\u0026nbsp;Inclusion and diversity within medical education: a focus group study. BMC Med Educ. 2023;23:61.\u003c/li\u003e\n \u003cli\u003eIrby DM, Cooke M, O’Brien BC. Calls for reform of medical education by the Carnegie Foundation. Acad Med. 2010;85:220-7.\u003c/li\u003e\n \u003cli\u003eBryner BS, Saddawi-Konefka D, Gest TR. Impact of interactive modules on preclinical medical education. Anat Sci Educ. 2008;1(6):247-51.\u003c/li\u003e\n \u003cli\u003eAriana A, Amin M, Pakneshan S, et al.\u0026nbsp;E-learning methods in dental histopathology. J Dent Educ. 2016;80:1140-8.\u003c/li\u003e\n \u003cli\u003eZollner B, Sucha M, Berg C, et al.\u0026nbsp;Pharmacases.de e-learning project. Med Teach. 2013;35(3):251-3.\u003c/li\u003e\n \u003cli\u003eAbraham RR, Fisher M, Kamath A, et al.\u0026nbsp;SDL readiness in physiology. Adv Physiol Educ. 2011;35(4):393-5.\u003c/li\u003e\n \u003cli\u003eLongmuir KJ. Acid-base physiology CAI. Adv Physiol Educ. 2014;38(1):34-41.\u003c/li\u003e\n \u003cli\u003eKaraksha A, Grant G, Nirthanan SN, et al.\u0026nbsp;E-learning impact study. Educ Res Int. 2014;(10):1-11.\u003c/li\u003e\n \u003cli\u003ePlackett R, Kassianos AP, Mylan S, et al.\u0026nbsp;Virtual patient tools and clinical reasoning. BMC Med Educ. 2022;22:365.\u003c/li\u003e\n \u003cli\u003eHawks MK, Maciuba JM, Merkebu J, et al.\u0026nbsp;Clinical reasoning curricula review. Acad Med. 2023;98(8):958-65.\u003c/li\u003e\n \u003cli\u003eBigdeli S, Hosseinzadeh Z, Dehnad A, et al.\u0026nbsp;Medical educational games. Med J Islam Repub Iran. 2023;37.\u003c/li\u003e\n \u003cli\u003eWijaya JE, Vidianti A. E-modules and student outcomes. ICOPE Conf. 2020:86-9.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp; Stringer JK, Santen SA, Lee E, et al. Bloom’s taxonomy in MCQs. Med Sci Educ. \u0026nbsp;2021;31(4):1311-7.\u003c/li\u003e\n \u003cli\u003eLewis-Pierre L, Aziza K. EOL education modules. Q Rev Distance Educ. 2017;18(1):9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical reasoning, Interactive module, Medical education, Active learning, iSpring Suite","lastPublishedDoi":"10.21203/rs.3.rs-8991422/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8991422/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eEffective clinical reasoning is essential in medical education, yet traditional didactic methods often promote passive learning and may not foster higher-order cognitive skills. Interactive e-learning modules offer an active, self-directed approach that can enhance experiential learning and clinical reasoning.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo evaluate the effectiveness of an interactive module in enhancing clinical reasoning and explore its impact on student engagement among second-year medical students.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA prospective, non-comparative interventional mixed-method study was conducted at the American University of Antigua College of Medicine. Two hundred third-semester students participated in an interactive, multimedia-based module on the clinical approach to arthritis, developed using iSpring Suite 11. Pre- and post-module quizzes assessed knowledge gains. Student perceptions were evaluated using a validated feedback questionnaire and focus group discussions. Quantitative data were analyzed using paired t-tests, and qualitative data were assessed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 162 students out of 200 completed both quizzes. Post-module scores improved significantly (mean: 64.5 to 73.2; p \u0026lt; .001). Over 75% of students agreed that the module enhanced clinical reasoning, knowledge retention, and understanding of diagnostic gaps. Thematic analysis revealed appreciation for the active learning design, structured format, and self-paced delivery, which supported deeper reflection and clinical application.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThe interactive module significantly improved clinical reasoning and student engagement. Incorporating such tools in early medical education may bridge the gap between theoretical knowledge and clinical practice through active, learner-centered strategies.\u003c/p\u003e\u003ch2\u003eClinical Trial Registration\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Effectiveness of an Interactive Module in Enhancing Clinical Reasoning Skills in Second-Year Medical Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-03 13:13:48","doi":"10.21203/rs.3.rs-8991422/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-09T20:47:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88549131583523225827948884446401257780","date":"2026-04-09T16:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T06:20:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T08:14:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T11:01:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-05T01:21:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Education","date":"2026-03-05T00:00:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32b60be0-084b-43b6-99c8-3ee6c42b31c5","owner":[],"postedDate":"April 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T13:13:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-03 13:13:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8991422","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8991422","identity":"rs-8991422","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}