From Passive Reception to Active Engagement: Transforming learning for first-year medical students under the Competency based medical curriculum

From Passive Reception to Active Engagement: Transforming learning for first-year medical students under the Competency based medical curriculum | 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 From Passive Reception to Active Engagement: Transforming learning for first-year medical students under the Competency based medical curriculum Hemal Panchal, Minal Patel, Sarmishtha Ghosh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6427549/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 Autonomic Nervous System (ANS) is a core topic in Physiology taught at the beginning of the MBBS course. This complex topic requires conceptualization as it is applicable to the regulation of body systems and later in Pharmacology and Medicine. With technology creating interactivity, educators need to improve their teaching-learning activities to ensure effective learning of ANS through student-centric strategies. The objective was to explore the effectiveness of an interactive "lecture-tutorial-classroom assessment-feedback" method to enhance the teaching of ANS and foster improved understanding to be able to apply concepts in real-world applications. First-year medical students under CBME were given an interactive lecture on ANS. One week later, this was followed by an interactive tutorial using cases and scenarios through multimedia, images, and critical thinking questions (CTQs). A test using CTQs, based on the presented visuals, was used. Performance scores with real-time feedback were provided. Finally, students were allowed to give feedback on a Google form. The entire process was evaluated regarding Kirkpatrick Level 1 (reaction) and Level 2 (learning). Students were very satisfied with the method but had concerns about the time available for the task and also the surprise tests. Formative assessment scores showed significant improvement, in testifying learning. Students demonstrated a more practical and relatable understanding of ANS, with improved comprehension and real-world application. The method ensured the identification of conceptual gaps, corrected through feedback. Interactive lectures are still recommended for uniform knowledge dissemination and assimilation among students. active learning case-based learning flipped classroom inquiry-based learning Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 BACKGROUND and AIMS The autonomic nervous system (ANS) which is responsible for responses due to sensations received through the central nervous system and is important for the survival of the organisms, occupies a pivotal position in medical physiology. ANS consisting of two main branches: sympathetic and parasympathetic, that work antagonistically to maintain homeostasis and play a crucial role in regulating vital bodily functions, including heart rate, digestion, and thermoregulation (Stanković et al., 2021). 1 The central autonomic network integrates emotional and cognitive functions with physiological responses, influencing various organ systems, including bladder control (9). Understanding ANS development is essential, as it impacts numerous bodily functions from fetal stages through adulthood (10).ANS dysfunction can lead to various diseases, such as hypertension, and researchers are exploring ways to manipulate the ANS to treat these conditions. Siegel & Watanabe (2021) have also indicated that assessing ANS activity through non-invasive methods, like heart rate variability analysis, offers potential for early detection and intervention in autonomic disorders (10). Additionally, an extensive knowledge of ANS serves as a foundational pillar for future applications in pharmacology and clinical medicine. Therefore teaching and learning of ANS in early days in the MBBS curriculum is necessary for students’ thorough understanding of the ANS in order to grasp the intricate control mechanisms governing all bodily systems.. Traditional teaching methods like large classroom didactic lectures, often fail to foster deep learning due to minimal student engagement. The American Physiological Society's learning module on the ANS emphasizes the need to address key facts and misconceptions surrounding the system to facilitate better comprehension (1). Serious concerns exist regarding the effectiveness of conventional teaching methods. A growing body of research suggests that traditional lectures and rote memorization are not suitable for deep learning and retention of concepts in medical students, Studies on teaching-learning activities have suggested that interactive learning methods are generally more effective than traditional lectures in health professions education. Studies on dental and nursing students have reported that engaging and interactive lectures led to found that engaging lectures led to significantly higher exam scores and improved long-term retention alongwith greater student satisfaction with compared to traditional lectures in dental students. (7). In the current century, both curriculum and characteristics of stakeholders have undergone a paradigm shift and hence a relook is necessary for the teaching learning activities. The year 2019 marked the implementation of Competency based Medical Education (CBME) by the National Medical Commission of India (NMC) which is the regulatory body controlling medical education in India. CBME is an outcome-based approach that focuses on the abilities that medical professionals should possess to provide medical care to the population. In view of tremendous explosion of content and advent of technology, multiple teaching learning methods need to be introduced judiciously to take care of students’ cognitive load and improve their conceptualization of important topics. Harris et al (2010) suggested that CBME follows a learner-centered model focused on competency attainment.(4). It aims to produce graduates capable of addressing complex healthcare challenges by emphasizing domain-specific knowledge, skills, and rapid knowledge acquisition (5). Virk et al, (2022) stated that competency-based medical education (CBME) aims to develop essential competencies in medical graduates, integrating knowledge with clinical and attitudinal skills to provide high-quality patient care (13). The pre-CBME days saw the teaching being undertaken as didactic lecture and tutorial, where there was significant launae in concetual understanding and application of knowlledge in later years. This paradigm shift necessitated shifting the teaching-learning activities from traditional to modern innovative approaches, which warranted active teaching-learning strategies, for example interactive lectures, scenario-based, or case-based learning sessions with use of technology to ensure interactivity and engagement in the learning process [5]. Realizing the importance of potential for deep learning and effective student engagement with the concepts of ANS, being taught in the first year, it was planned to retain large group lectures but make it interactive, by incorporating learning activities and follow it up with case based critical thinking group activities with immediate feedback session. The aim of the study was to implement and evaluate the effectiveness of an interactive learning activity that would enhance student engagement, comprehension, and learning outcomes related to the topic of ANS. Methodology Ethical Approval The study was approved by the Institutional Ethics Committee (IEC) at Pramukhswami Medical College . Subjects were provided with clear information about the importance and method of the study and were requested to provide informed consent. They were explicitly assured of the confidentiality of their information.All students were informed beforehand of the method and purpose of the study. This was a routine teaching-learning activity to satisfy student-centric learning as directed by NMC, and therefore received a waiver of written consent. Study Design The stud was conducted with 150 first-year undergraduate medical students in an NMC-recognized private medical college in Gujarat. Sine this study was conceived after observing poor performance in earlier batches, there were no control and experimental groups. All students, were made to undetake the sessions as a routine activity. Method The teaching event consisted of a two-part process delivered one week apart: Part 1: Interactive Lecture: An interactive lecture on ANS was delivered to the students. The lecture was constructed based on principles of Gagne's Instructional Design 10 , starting with a case to trigger thinking and attract the attention of the students. The lecture incorporated activities that fostered student engagement and participation, as opposed to a traditional passive lecture. The pictures show an actual session in progress. The lecture of 1 hour is divided into 3 sections of bite-sized information being delivered interactively, based on the pre-determined learning outcomes. Part 2: Interactive Tutorial: One week following the lecture, students participated in an interactive tutorial focused on applying their knowledge of the ANS. This tutorial utilized multimedia resources, images, and critical thinking questions (CTQs) to present real-world clinical cases and scenarios. Formative Assessment: To assess student learning outcomes (Level 2), a formative assessment test was administered after the interactive tutorial. This test specifically employed CTQs based on the visuals presented during the tutorial. The specific content of the CTQs or the format of the test (e.g., multiple choice, short answer) was not provided. However, it can be inferred that the questions required students to think critically and apply their understanding of the ANS concepts presented in the lecture and tutorial. Performance Scores and Feedback: Students received their performance scores on the formative assessment along with real-time feedback. The feedback consisted of a general address to the correct and incorrect answers with respective justifications. Students also received a view of their strengths and weaknesses of responses to the CTQs. The facilitator provided a near-ideal answer to each question and made the students aware of the expectations in the examination if such questions were asked. Student Feedback: At the end of the exercise, students were invited to provide feedback on their experience with this interactive learning approach. This feedback was called via a prevalidated Google form (G-form) likely which included 11 questions, on their overall impressions and level of satisfaction (Level 1 of Kirkpatrick evaluation scale) and any suggestions for improvement regarding the lecture and tutorial format, content, or assessment methods. The data collected from the formative assessment was used to evaluate student learning outcomes. The percentage of students who passed the assessment (defined as scoring above 50%) was calculated. Additionally, the distribution of scores within the passing group (e.g., percentage scoring above 80%) was reported. Student feedback was was taken on a google form which asked for satisfaction and open comments. Items were asked on a 5 point Likert scale (1= least agree to 5 (most agree), which were analysed as reported a Mean+/- SD. The open comments were analysed qualitatively to identify common themes and areas for improvement in the interactive learning approach. Result This study investigated the effectiveness of an interactive learning approach for teaching the Autonomic Nervous System (ANS) to first-year medical students enrolled in a Competency-Based Medical Education (CBME) program. The evaluation focused on student reactions (Kirkpatrick Level 1) and learning outcomes (Kirkpatrick Level 2). The immediate responses with respect to satisfaction of the teachning learning session are stated in Figure 1. Majority of students expressed overall satisfaction for the interactive learning approach. Only 4.3% expressed frank dissatisfaction regarding the process. (Figure 1) The students’ perception about the tutorial process through specific items being asked on the Google form showed that all items were scored at a mean of 3.4 to 3.65 out of 5, excepting “time given to think and discuss” which had a low score of 3.3 (Table 2) The analysis of the open comments yielded five common themes which were as follows : (Table 1) 1. Positive Teaching Methods: Many comments highlight the effectiveness of the teaching methods used, emphasizing clarity and understanding of concepts. 2. Need for Improved Preparation: Several suggestions focus on the necessity for increased preparation time and advance notice regarding topics and tests to enhance student readiness. 3. Desire for More Interactive Learning: There is a recurring request for more discussions on case scenarios and case-based questions to foster deeper understanding. 4. Overall Satisfaction: The feedback reflects a generally positive experience with the sessions, indicating that students find them beneficial for their studies. 5. Feedback and Follow-up: A theme of wanting appropriate answers and follow-up after sessions is noted, suggesting that it would enhance their learning. Table 1 shows the common themes that emerged through the open comments alongwith the representatve quotes. Themes Representative Quotes 1 Positive Teaching Methods 1. Good method to revise and clarify concepts. 2. This session is good and effective for my studies. 3. Your teaching method is very nice; it helps in understanding concepts better. 2 Need for Improved Preparation Please make time increase for things like the picture. There should be adequate preparation time of at least 15 minutes. Surprise tests are not beneficial; prior notice should be given. Students should be informed beforehand about the topics to prepare adequately. 3 Desire for More Interactive Learning More discussion about case scenarios is appreciated. More case-based questions should be discussed along with written tests. 4 Overall Satisfaction Good overall experience. Everything was perfectly fine. 5 Feedback and Follow-up Keep it up; it was good Provide appropriate answers after the session. It is important for all students to get proper knowledge about main exams. The formative assessment served as the primary measure of student learning outcomes related to the ANS. (Kirkpatrik Level 2). The results (Figure 3) indicated that among 142 students, 110 students (77.5%) passed the test, achieving a score greater than 50%. while 32 students (22.5%) failed the assessment, scoring below 50%.A further analysis of the passing scores revealed that 8 students (approximately 6%) scored exceptionally well, achieving marks above 80%. (Figure 3). This suggests that a significant portion of the class grasped the ANS concepts effectively through the interactive learning intervention. Discussion Case-based learning (CBL) has shown promising results in enhancing medical students' understanding and retention of physiological concepts. Multiple studies have demonstrated its effectiveness as an adjunct to traditional teaching methods. Bennal et al. (2016) found a significant improvement in students' knowledge after implementing CBL in physiology courses (2). Panja et al. (2013) observed that CBL not only improved students' performance on case-based questions but also enhanced their critical thinking skills for non-case-based items (8). Gade and Chari (2013) reported that CBL promoted self-directed learning, problem-solving abilities, and soft skills development among medical students (3). Additionally, Thistlethwaite et al. (2011) conducted a systematic review supporting the effectiveness of CBL in health professional education. These studies collectively suggest that CBL can be a valuable tool for enhancing conceptual learning in physiology, fostering analytical skills, and preparing students for clinical practice (12). Integration of CBL into traditional teaching methods may lead to improved learning outcomes in medical education. Our study proposes the implementation of interactive learning activities that utilize technology-based tools to enhance the understanding of the Autonomic Nervous System (ANS) among first-year medical students in a Competency-Based Medical Education (CBME) program. The interactive tools include case studies, gamification, and interactive animations. A realistic and engaging environment for exploring the functioning of the ANS in various physiological scenarios was provided, through interactive cases that presented real-world clinical situations involving ANS dysfunction, encouraging collaborative discussions and problem-solving activities for diagnosis and management. This also had some elements of educational games incorporating elements of the ANS to create a fun and stimulating learning environment, fostering active engagement and testing students' understanding. Additionally, interactive animations helped in visualizing effectively the anatomical pathways and neurotransmitter interactions within the ANS, aiding students to grasp the complex interplay between different components in ANS under a curriculum that teaches discipline-based preclinical subjects. These interactive learning activities addressed several key limitations of traditional teaching methods. They shifted the focus from passive learning to active engagement, thereby fostering a deeper understanding of the material. The engaging nature of these activities enhanced knowledge retention and recall while encouraging students to apply their knowledge to real-world clinical scenarios. Collaborative learning activities also promoted teamwork and communication skills, which are essential for success in the medical field. The findings of this study demonstrated that incorporating interactive learning activities that leverage technology can significantly improve student engagement and understanding of the ANS compared to traditional teaching methods. This approach has the potential to revolutionize the teaching of the ANS in medical education, fostering a generation of medical professionals with a deeper and more comprehensive understanding of this critical system. The study investigated the effectiveness of an interactive learning approach for teaching the ANS to first-year medical students enrolled in a CBME program. The intervention, which combined an interactive lecture with a case-based interactive tutorial using multimedia and critical thinking questions (CTQs), yielded positive results in terms of student learning outcomes and overall reception, indicating a good grasp of the presented concepts. This aligned with the goals of the CBME curriculum and emphasized the acquisition of core competencies. Furthermore, the performance of a subset of students (approximately 6%) who scored exceptionally well, suggested that the interactive approach has the potential to foster a deep understanding of the ANS in motivated learners. This is particularly encouraging, as a strong foundation in ANS physiology is essential for success in various medical specialties, later on in their course. Positive student feedback regarding the interactive approach further supported its effectiveness. Students found the intervention engaging and effective, indicating that it fostered active participation and deeper learning compared to traditional lecture formats. These corroborated previous studies that highlighted the limitations of passive learning methods and the benefits of interactive activities in promoting knowledge retention and critical thinking skills. Overall, the study underscored the significant potential of interactive learning activities in enhancing student learning for complex systems like the ANS. Limitations and Future Directions Even though the students and facilitators were satisfied, with the conduct of the study, we realized a few limitations which need to be addressed. One of them is the student feedback regarding time constraints associated with completing the tasks and the element of surprise related to the assessment. Time management is a crucial skill for medical professionals, and incorporating activities that encourage students to manage time effectively within the learning process would be beneficial. We shall provide clear time limits for tasks within the tutorial or allow students enough opportunities to practice. To avoid unnecessary anxiety, we would plan a pre-announced assessment schedule, or incorporate formative assessments throughout the learning process through AI tools that they can perform on their own time. Future research efforts should aim to replicate these findings in a broader student sample across different CBME programs. Additionally, a more detailed analysis of the formative assessment, including the specific content of the CTQs and the assessment format, would provide valuable insights into the learning outcomes. Knowing the specific areas where students excelled or struggled would allow for targeted improvements to the interactive learning approach. Finally, the student feedback will be planned employing a standardized method such as surveys or focus groups, which would yield more robust and comparable qualitative data. Declarations Disclosure Acknowledgements The authors would like to express their sincere gratitude to the first-year 2023-24 MBBS students for their invaluable contributions to this work. Clinical trial number Not applicable. Corresponding author Sarmishtha Ghosh, (SG) Authors’ contributions SG conceptualized and developed the research idea and outlined the research objectives. She also reviewed and finalized the manuscript. HP implemented the process and collected data, converted it to usable information. He also created the initial draft of the research paper. MP reviewed the manuscript and provided feedback for improvement. All the authors critically revised the article for important intellectual content and approved the final manuscript. Funding This research received no specific grant from any funding agency Data availability The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Consent for publication Yes. Informed consent was taken from all whose pictures have been posted in the result section. Competing interests The authors declare no competing interests. References Autonomic Nervous System Learning Module | American Physiological Society [Internet]. [cited 2024 Jul 5]. Available from: https://www.physiology.org/professional-development/career/cpe/teaching-integrative-physiology/ans-learning?SSO=Y Bennal A, Pattar M, Taklikar R. Effectiveness of “case-based learning” in physiology. Natl J Physiol Pharm Pharmacol [Internet]. 2016 [cited 2024 Jul 6];6(1):65. Available from: http://www.scopemed.org/fulltextpdf.php?mno=205361 Gade S, Chari S. Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students. Advances in Physiology Education [Internet]. 2013 Dec [cited 2024 Jul 6];37(4):356–60. Available from: https://www.physiology.org/doi/10.1152/advan.00076.2012 Harris P, Snell L, Talbot M, Harden RM, for the International CBME Collaborators. Competency-based medical education: implications for undergraduate programs. Medical Teacher [Internet]. 2010 Aug [cited 2024 Jul 5];32(8):646–50. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2010.500703 Kasarla RR, Kasarla RR, Thummala SR. Competency-Based Medical Curriculum: A Resurgent Paradigm for Medical and Dental Graduates. Med J Eastern Nep [Internet]. 2023 Dec 21 [cited 2024 Jul 5];2(02):26–31. Available from: https://www.nepjol.info/index.php/mjen/article/view/60786 Khadjooi K, Rostami K, Ishaq S. How to use Gagne's model of instructional design in teaching psychomotor skills. Gastroenterol Hepatol Bed Bench. 2011 Summer;4(3):116-9. PMID: 24834168; PMCID: PMC4017416. Miller CJ, McNear J, Metz MJ. A comparison of traditional and engaging lecture methods in a large, professional-level course. Advances in Physiology Education [Internet]. 2013 Dec [cited 2024 Jul 5];37(4):347–55. Available from: https://www.physiology.org/doi/10.1152/advan.00050.2013 Panja S, Bhowmick K, Sadhu M. Efficacy of case-based learning as an adjunct to traditional teaching learning methods in Physiology. SE Asian Jnl Med Educ [Internet]. 2013 Jun 30 [cited 2024 Jul 6];7(1):31. Available from: https://seajme.sljol.info/article/10.4038/seajme.v7i1.147/ Roy HA, Green AL. The Central Autonomic Network and Regulation of Bladder Function. Front Neurosci [Internet]. 2019 Jun 13 [cited 2024 Jul 5];13:535. Available from: https://www.frontiersin.org/article/10.3389/fnins.2019.00535/full Siegel RE, Watanabe M. Introduction to the special focus on the development of the autonomic nervous system. Birth Defects Research [Internet]. 2021 Jul [cited 2024 Jul 5];113(11):843–4. Available from: https://onlinelibrary.wiley.com/doi/10.1002/bdr2.1902 Stanković I, Adamec I, Kostić V, Habek M. Autonomic nervous system—Anatomy, physiology, biochemistry. In: International Review of Movement Disorders [Internet]. Elsevier; 2021 [cited 2024 Jul 5]. p. 1–17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666787821000065 Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Purkis J, Clay D. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34(6):e421-44. doi: 10.3109/0142159X.2012.680939. PMID: 22578051. Virk A, Mahajan R, Singh T. Conceptualizing problem-based learning: An overview. Int J App Basic Med Res [Internet]. 2022 [cited 2024 Jul 5];12(1):1. Available from: https://journals.lww.com/10.4103/ijabmr.ijabmr_827_21 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Jun, 2025 Reviewers agreed at journal 09 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 20 May, 2025 Editor invited by journal 02 May, 2025 Submission checks completed at journal 29 Apr, 2025 First submitted to journal 29 Apr, 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-6427549","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463287917,"identity":"b238d549-d472-48ff-a94e-b5b8e586918f","order_by":0,"name":"Hemal Panchal","email":"","orcid":"","institution":"Bhaikaka University","correspondingAuthor":false,"prefix":"","firstName":"Hemal","middleName":"","lastName":"Panchal","suffix":""},{"id":463287918,"identity":"f3ec83d5-6a2c-4ca2-ae4a-276353bcbde2","order_by":1,"name":"Minal Patel","email":"","orcid":"","institution":"Bhaikaka 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21:18:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2141829,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6427549/v1/9c2db6dc-c1e0-43e6-a1ce-dbcce5791386.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Passive Reception to Active Engagement: Transforming learning for first-year medical students under the Competency based medical curriculum","fulltext":[{"header":"BACKGROUND and AIMS","content":"\u003cp\u003eThe autonomic nervous system (ANS) which is responsible for responses due to sensations received through the central nervous system and is important for the survival of the organisms, occupies a pivotal position in medical physiology. ANS consisting of two main branches: sympathetic and parasympathetic, that work antagonistically to maintain homeostasis and play a crucial role in regulating vital bodily functions, including heart rate, digestion, and thermoregulation (Stanković et al., 2021).\u003csup\u003e1\u003c/sup\u003e\u0026nbsp; The central autonomic network integrates emotional and cognitive functions with physiological responses, influencing various organ systems, including bladder control (9). Understanding ANS development is essential, as it impacts numerous bodily functions from fetal stages through adulthood (10).ANS dysfunction can lead to various diseases, such as hypertension, and researchers are exploring ways to manipulate the ANS to treat these conditions. Siegel \u0026amp; Watanabe (2021) have also indicated that assessing ANS activity through non-invasive methods, like heart rate variability analysis, \u0026nbsp;offers potential for early detection and intervention in autonomic disorders (10). Additionally, an extensive knowledge of ANS serves as a foundational pillar for future applications in pharmacology and clinical medicine. Therefore teaching and learning of ANS in early days in the MBBS curriculum is necessary for students’ thorough understanding of the ANS in order to grasp the intricate control mechanisms governing all bodily systems..\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTraditional teaching methods like large classroom didactic lectures, often fail to foster deep learning due to minimal student engagement. The American Physiological Society's learning module on the ANS emphasizes the need to address key facts and misconceptions surrounding the system to facilitate better comprehension (1). Serious concerns exist regarding the effectiveness of conventional teaching methods. A growing body of research suggests that traditional lectures and rote memorization are not suitable for deep learning and retention of concepts in medical students, Studies on teaching-learning activities have suggested that interactive learning methods are generally more effective than traditional lectures in health professions education. Studies on dental and nursing students have reported that engaging and interactive lectures led to \u0026nbsp;found that engaging lectures led to significantly higher exam scores and improved long-term retention alongwith greater student satisfaction with compared to traditional lectures in dental students. (7). \u0026nbsp;In the current century, both curriculum and characteristics of stakeholders have undergone a paradigm shift and hence a relook is necessary for the teaching learning activities.\u003c/p\u003e\n\u003cp\u003eThe year 2019 marked the implementation of Competency based Medical Education (CBME) by the National Medical Commission of India (NMC) which is the regulatory body controlling medical education in India. CBME is an outcome-based approach that focuses on the abilities that medical professionals should possess to provide medical care to the population. In view of tremendous explosion of content and advent of technology, multiple teaching learning methods need to be introduced judiciously to take care of students’ cognitive load and improve their conceptualization of important topics. Harris et al (2010) suggested that CBME follows a learner-centered model focused on competency attainment.(4). It aims to produce graduates capable of addressing complex healthcare challenges by emphasizing domain-specific knowledge, skills, and rapid knowledge acquisition (5).\u0026nbsp;\u0026nbsp;Virk et al, (2022) stated that competency-based medical education (CBME) aims to develop essential competencies in medical graduates, integrating knowledge with clinical and attitudinal skills to provide high-quality patient care (13).\u003c/p\u003e\n\u003cp\u003eThe pre-CBME days saw the teaching being undertaken as didactic lecture and tutorial, where there was significant launae in concetual understanding and application of knowlledge in later years.\u003c/p\u003e\n\u003cp\u003eThis paradigm shift necessitated shifting the teaching-learning activities from traditional to modern innovative approaches, which warranted active teaching-learning strategies, for example interactive lectures, scenario-based, or case-based learning sessions with use of technology to ensure interactivity and engagement in the learning process [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRealizing the importance of potential for deep learning and effective student engagement with the concepts of ANS, being taught in the first year, it was planned to retain large group lectures but make it interactive, by incorporating learning activities and follow it up with case based critical thinking group activities with immediate feedback session.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe aim of the study was to implement and evaluate the effectiveness of an interactive learning activity that would enhance student engagement, comprehension, and learning outcomes related to the topic of ANS.\u0026nbsp;\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was \u0026nbsp;approved by the Institutional Ethics Committee (IEC) at Pramukhswami Medical College . Subjects were provided with clear information about the importance and method of the study and were requested to provide \u0026nbsp;informed consent. They were explicitly assured of the confidentiality of their information.All students were informed beforehand of the method and purpose of the study. This was a routine teaching-learning activity to satisfy student-centric learning as directed by NMC, and therefore received a waiver of written consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe stud was conducted with 150 first-year undergraduate medical students in an NMC-recognized private medical college in Gujarat. Sine this study was conceived after observing poor performance in \u0026nbsp; earlier batches, there were no control and experimental groups. All students, were made to undetake the sessions as a routine activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe teaching event consisted of a two-part process delivered one week apart:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003ePart 1: Interactive Lecture:\u003c/strong\u003e An interactive lecture on ANS was delivered to the students. The lecture was constructed based on principles of Gagne\u0026apos;s Instructional Design\u003csup\u003e10\u003c/sup\u003e, starting with a case to trigger thinking and attract the attention of the students. The lecture incorporated activities that fostered student engagement and participation, as opposed to a traditional passive lecture. The pictures show an actual session in progress. The lecture of 1 hour is divided into 3 sections of bite-sized information being delivered interactively, based on the pre-determined learning outcomes.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ePart 2: Interactive Tutorial:\u003c/strong\u003e One week following the lecture, students participated in an interactive tutorial focused on applying their knowledge of the ANS. This tutorial utilized multimedia resources, images, and critical thinking questions (CTQs) to present real-world clinical cases and scenarios.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eFormative Assessment:\u003c/strong\u003e To assess student learning outcomes (Level 2), a formative assessment test was administered after the interactive tutorial. This test specifically employed CTQs based on the visuals presented during the tutorial. The specific content of the CTQs or the format of the test (e.g., multiple choice, short answer) was not provided. However, it can be inferred that the questions required students to think critically and apply their understanding of the ANS concepts presented in the lecture and tutorial.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePerformance Scores and Feedback:\u003c/strong\u003e Students received their performance scores on the formative assessment along with real-time feedback. The feedback consisted of a general address to the correct and incorrect answers with respective justifications. Students also received a view of their strengths and weaknesses of responses to the CTQs. The facilitator provided a near-ideal answer to each question and made the students aware of the expectations in the examination if such questions were asked.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eStudent Feedback:\u003c/strong\u003e At the end of the exercise, students were invited to provide feedback on their experience with this interactive learning approach. This feedback was called via a prevalidated Google form (G-form) likely which included 11 questions, on their overall impressions and level of satisfaction (Level 1 of Kirkpatrick evaluation scale) and any suggestions for improvement regarding the lecture and tutorial format, content, or assessment methods.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe data collected from the formative assessment was used to evaluate student learning outcomes. The percentage of students who passed the assessment (defined as scoring above 50%) was calculated. Additionally, the distribution of scores within the passing group (e.g., percentage scoring above 80%) was reported.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudent feedback was was taken on a google form which asked for satisfaction and open comments. Items were asked on a 5 point Likert scale (1= least agree to 5 (most agree), which were analysed as reported a Mean+/- SD. The open comments were \u0026nbsp; analysed qualitatively to identify common themes and areas for improvement in the interactive learning approach.\u003c/p\u003e"},{"header":"Result ","content":"\u003cp\u003eThis study investigated the effectiveness of an interactive learning approach for teaching the Autonomic Nervous System (ANS) to first-year medical students enrolled in a Competency-Based Medical Education (CBME) program. The evaluation focused on student reactions (Kirkpatrick Level 1) and learning outcomes (Kirkpatrick Level 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe immediate responses with respect to satisfaction of the teachning learning session are stated in Figure 1. \u0026nbsp;Majority of students \u0026nbsp;expressed overall satisfaction for the interactive learning approach. Only 4.3% expressed frank dissatisfaction regarding the process. (Figure 1)\u003c/p\u003e\n\u003cp\u003eThe students\u0026rsquo; perception about the tutorial process through specific items being asked on the Google form showed that all items were scored at a mean of 3.4 to 3.65 out of 5, excepting \u0026nbsp;\u0026ldquo;time given to think and discuss\u0026rdquo; which had a low score of 3.3\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Table 2)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis of the open comments yielded five common themes which were as follows :\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Table 1)\u003cbr\u003e\u0026nbsp;1. Positive Teaching Methods: Many comments highlight the effectiveness of the teaching methods used, emphasizing clarity and understanding of concepts.\u003cbr\u003e\u0026nbsp;2. Need for Improved Preparation: Several suggestions focus on the necessity for increased preparation time and advance notice regarding topics and tests to enhance student readiness.\u003cbr\u003e\u0026nbsp;3. Desire for More Interactive Learning: There is a recurring request for more discussions on case scenarios and case-based questions to foster deeper understanding.\u003cbr\u003e\u0026nbsp;4. Overall Satisfaction: The feedback reflects a generally positive experience with the sessions, indicating that students find them beneficial for their studies.\u003cbr\u003e\u0026nbsp;5. Feedback and Follow-up: A theme of wanting appropriate answers and follow-up after sessions is noted, suggesting that it would enhance their learning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 shows the common themes that emerged through the open comments alongwith the representatve quotes.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eThemes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eRepresentative Quotes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePositive Teaching Methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003e1. Good method to revise and clarify concepts.\u003c/p\u003e\n \u003cp\u003e2. This session is good and effective for my studies.\u003c/p\u003e\n \u003cp\u003e3. Your teaching method is very nice; it helps in understanding concepts better.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eNeed for Improved Preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003col\u003e\n \u003cli\u003ePlease make time increase for things like the picture.\u003c/li\u003e\n \u003cli\u003eThere should be adequate preparation time of at least 15 minutes.\u003c/li\u003e\n \u003cli\u003eSurprise tests are not beneficial; prior notice should be given.\u003c/li\u003e\n \u003cli\u003eStudents should be informed beforehand about the topics to prepare adequately.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eDesire for More Interactive Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003col\u003e\n \u003cli\u003eMore discussion about case scenarios is appreciated.\u003c/li\u003e\n \u003cli\u003eMore case-based questions should be discussed along with written tests.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eOverall Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003col\u003e\n \u003cli\u003eGood overall experience.\u003c/li\u003e\n \u003cli\u003eEverything was perfectly fine.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eFeedback and Follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003col\u003e\n \u003cli\u003eKeep it up; it was good\u003c/li\u003e\n \u003cli\u003eProvide appropriate answers after the session.\u003c/li\u003e\n \u003cli\u003eIt is important for all students to get proper knowledge about main exams.\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe formative assessment served as the primary measure of student learning outcomes related to the ANS. (Kirkpatrik Level 2). \u0026nbsp;The results (Figure 3) indicated that among 142 students, 110 students (77.5%) passed the test, achieving a score greater than 50%. while 32 students (22.5%) failed the assessment, scoring below 50%.A further analysis of the passing scores revealed that 8 students (approximately 6%) scored exceptionally well, achieving marks above 80%. (Figure 3). This suggests that a significant portion of the class grasped the ANS concepts effectively through the interactive learning intervention.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCase-based learning (CBL) has shown promising results in enhancing medical students\u0026apos; understanding and retention of physiological concepts. Multiple studies have demonstrated its effectiveness as an adjunct to traditional teaching methods. Bennal et al. (2016)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e found a significant improvement in students\u0026apos; knowledge after implementing CBL in physiology courses (2). Panja et al. (2013)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e observed that CBL not only improved students\u0026apos; performance on case-based questions but also enhanced their critical thinking skills for non-case-based items (8). Gade and Chari (2013)\u003csup\u003e\u0026nbsp;\u003c/sup\u003ereported that CBL promoted self-directed learning, problem-solving abilities, and soft skills development among medical students (3). Additionally, Thistlethwaite et al. (2011) conducted a systematic review supporting the effectiveness of CBL in health professional education. These studies collectively suggest that CBL can be a valuable tool for enhancing conceptual learning in physiology, fostering analytical skills, and preparing students for clinical practice (12). Integration of CBL into traditional teaching methods may lead to improved learning outcomes in medical education.\u003c/p\u003e\n\u003cp\u003eOur study proposes the implementation of interactive learning activities that utilize technology-based tools to enhance the understanding of the Autonomic Nervous System (ANS) among first-year medical students in a Competency-Based Medical Education (CBME) program. The interactive tools include case studies, gamification, and interactive animations. A realistic and engaging environment for exploring the functioning of the ANS in various physiological scenarios was provided, through interactive cases that presented real-world clinical situations involving ANS dysfunction, encouraging collaborative discussions and problem-solving activities for diagnosis and management. This also had some elements of educational games incorporating elements of the ANS to create a fun and stimulating learning environment, fostering active engagement and testing students\u0026apos; understanding. Additionally, interactive animations helped in visualizing effectively the anatomical pathways and neurotransmitter interactions within the ANS, aiding students to grasp the complex interplay between different components in ANS under a curriculum that teaches discipline-based preclinical subjects.\u003c/p\u003e\n\u003cp\u003eThese interactive learning activities addressed several key limitations of traditional teaching methods. They shifted the focus from passive learning to active engagement, thereby fostering a deeper understanding of the material. The engaging nature of these activities enhanced knowledge retention and recall while encouraging students to apply their knowledge to real-world clinical scenarios. Collaborative learning activities also promoted teamwork and communication skills, which are essential for success in the medical field. The findings of this study demonstrated that incorporating interactive learning activities that leverage technology can significantly improve student engagement and understanding of the ANS compared to traditional teaching methods. This approach has the potential to revolutionize the teaching of the ANS in medical education, fostering a generation of medical professionals with a deeper and more comprehensive understanding of this critical system.\u003c/p\u003e\n\u003cp\u003eThe study investigated the effectiveness of an interactive learning approach for teaching the ANS to first-year medical students enrolled in a CBME program. The intervention, which combined an interactive lecture with a case-based interactive tutorial using multimedia and critical thinking questions (CTQs), yielded positive results in terms of student learning outcomes and overall reception, indicating a good grasp of the presented concepts. This aligned with the goals of the CBME curriculum and emphasized the acquisition of core competencies. Furthermore, the performance of a subset of students (approximately 6%) who scored exceptionally well, suggested that the interactive approach has the potential to foster a deep understanding of the ANS in motivated learners. This is particularly encouraging, as a strong foundation in ANS physiology is essential for success in various medical specialties, later on in their course.\u003c/p\u003e\n\u003cp\u003ePositive student feedback regarding the interactive approach further supported its effectiveness. Students found the intervention engaging and effective, indicating that it fostered active participation and deeper learning compared to traditional lecture formats. These corroborated previous studies that highlighted the limitations of passive learning methods and the benefits of interactive activities in promoting knowledge retention and critical thinking skills. Overall, the study underscored the significant potential of interactive learning activities in enhancing student learning for complex systems like the ANS.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Future Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEven though the students and facilitators were satisfied, with the conduct of the study, we realized a few limitations which need to be addressed. One of them is the student feedback regarding time constraints associated with completing the tasks and the element of surprise related to the assessment.\u003c/p\u003e\n\u003cp\u003eTime management is a crucial skill for medical professionals, and incorporating activities that encourage students to manage time effectively within the learning process would be beneficial. We shall provide clear time limits for tasks within the tutorial or allow students enough opportunities to practice. To avoid unnecessary anxiety, we would plan a pre-announced assessment schedule, or incorporate formative assessments throughout the learning process through AI tools that they can perform on their own time.\u003c/p\u003e\n\u003cp\u003eFuture research efforts should aim to replicate these findings in a broader student sample across different CBME programs. Additionally, a more detailed analysis of the formative assessment, including the specific content of the CTQs and the assessment format, would provide valuable insights into the learning outcomes. Knowing the specific areas where students excelled or struggled would allow for targeted improvements to the interactive learning approach. Finally, the student feedback will be planned employing a standardized method such as surveys or focus groups, which would yield more robust and comparable qualitative data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDisclosure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the first-year 2023-24 MBBS students for their invaluable contributions to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSarmishtha Ghosh, (SG)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSG conceptualized and developed the research idea and outlined the research objectives. She also reviewed and finalized the manuscript.\u003c/p\u003e\n\u003cp\u003eHP implemented the process and collected data, converted it to usable information. He also created the initial draft of the research paper.\u003c/p\u003e\n\u003cp\u003eMP reviewed the manuscript and provided feedback for improvement.\u003c/p\u003e\n\u003cp\u003eAll the authors critically revised the article for important intellectual content and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYes.\u003c/p\u003e\n\u003cp\u003eInformed consent was taken from all whose pictures have been posted in the result section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAutonomic Nervous System Learning Module | American Physiological Society [Internet]. [cited 2024 Jul 5]. Available from: https://www.physiology.org/professional-development/career/cpe/teaching-integrative-physiology/ans-learning?SSO=Y\u003c/li\u003e\n\u003cli\u003eBennal A, Pattar M, Taklikar R. Effectiveness of \u0026amp;#147;case-based learning\u0026amp;#148; in physiology. Natl J Physiol Pharm Pharmacol [Internet]. 2016 [cited 2024 Jul 6];6(1):65. Available from: http://www.scopemed.org/fulltextpdf.php?mno=205361\u003c/li\u003e\n\u003cli\u003eGade S, Chari S. Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students. Advances in Physiology Education [Internet]. 2013 Dec [cited 2024 Jul 6];37(4):356\u0026ndash;60. Available from: https://www.physiology.org/doi/10.1152/advan.00076.2012\u003c/li\u003e\n\u003cli\u003eHarris P, Snell L, Talbot M, Harden RM, for the International CBME Collaborators. Competency-based medical education: implications for undergraduate programs. Medical Teacher [Internet]. 2010 Aug [cited 2024 Jul 5];32(8):646\u0026ndash;50. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2010.500703\u003c/li\u003e\n\u003cli\u003eKasarla RR, Kasarla RR, Thummala SR. Competency-Based Medical Curriculum: A Resurgent Paradigm for Medical and Dental Graduates. Med J Eastern Nep [Internet]. 2023 Dec 21 [cited 2024 Jul 5];2(02):26\u0026ndash;31. Available from: https://www.nepjol.info/index.php/mjen/article/view/60786\u003c/li\u003e\n\u003cli\u003eKhadjooi K, Rostami K, Ishaq S. How to use Gagne\u0026apos;s model of instructional design in teaching psychomotor skills. Gastroenterol Hepatol Bed Bench. 2011 Summer;4(3):116-9. PMID: 24834168; PMCID: PMC4017416.\u003c/li\u003e\n\u003cli\u003eMiller CJ, McNear J, Metz MJ. A comparison of traditional and engaging lecture methods in a large, professional-level course. Advances in Physiology Education [Internet]. 2013 Dec [cited 2024 Jul 5];37(4):347\u0026ndash;55. Available from: https://www.physiology.org/doi/10.1152/advan.00050.2013\u003c/li\u003e\n\u003cli\u003ePanja S, Bhowmick K, Sadhu M. Efficacy of case-based learning as an adjunct to traditional teaching learning methods in Physiology. SE Asian Jnl Med Educ [Internet]. 2013 Jun 30 [cited 2024 Jul 6];7(1):31. Available from: https://seajme.sljol.info/article/10.4038/seajme.v7i1.147/\u003c/li\u003e\n\u003cli\u003eRoy HA, Green AL. The Central Autonomic Network and Regulation of Bladder Function. Front Neurosci [Internet]. 2019 Jun 13 [cited 2024 Jul 5];13:535. Available from: https://www.frontiersin.org/article/10.3389/fnins.2019.00535/full\u003c/li\u003e\n\u003cli\u003eSiegel RE, Watanabe M. Introduction to the special focus on the development of the autonomic nervous system. Birth Defects Research [Internet]. 2021 Jul [cited 2024 Jul 5];113(11):843\u0026ndash;4. Available from: https://onlinelibrary.wiley.com/doi/10.1002/bdr2.1902\u003c/li\u003e\n\u003cli\u003eStanković I, Adamec I, Kostić V, Habek M. Autonomic nervous system\u0026mdash;Anatomy, physiology, biochemistry. In: International Review of Movement Disorders [Internet]. Elsevier; 2021 [cited 2024 Jul 5]. p. 1\u0026ndash;17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666787821000065\u003c/li\u003e\n\u003cli\u003eThistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Purkis J, Clay D. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34(6):e421-44. doi: 10.3109/0142159X.2012.680939. PMID: 22578051.\u003c/li\u003e\n\u003cli\u003eVirk A, Mahajan R, Singh T. Conceptualizing problem-based learning: An overview. Int J App Basic Med Res [Internet]. 2022 [cited 2024 Jul 5];12(1):1. Available from: https://journals.lww.com/10.4103/ijabmr.ijabmr_827_21\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":"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":"active learning, case-based learning, flipped classroom, inquiry-based learning","lastPublishedDoi":"10.21203/rs.3.rs-6427549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6427549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAutonomic Nervous System (ANS) is a core topic in Physiology taught at the beginning of the MBBS course. This complex topic requires conceptualization as it is applicable to the regulation of body systems and later in Pharmacology and Medicine. With technology creating interactivity, educators need to improve their teaching-learning activities to ensure effective learning of ANS through student-centric strategies. The objective was to explore the effectiveness of an interactive \"lecture-tutorial-classroom assessment-feedback\" method to enhance the teaching of ANS and foster improved understanding to be able to apply concepts in real-world applications. First-year medical students under CBME were given an interactive lecture on ANS. One week later, this was followed by an interactive tutorial using cases and scenarios through multimedia, images, and critical thinking questions (CTQs). A test using CTQs, based on the presented visuals, was used. Performance scores with real-time feedback were provided. Finally, students were allowed to give feedback on a Google form. The entire process was evaluated regarding Kirkpatrick Level 1 (reaction) and Level 2 (learning). Students were very satisfied with the method but had concerns about the time available for the task and also the surprise tests. Formative assessment scores showed significant improvement, in testifying learning. Students demonstrated a more practical and relatable understanding of ANS, with improved comprehension and real-world application. The method ensured the identification of conceptual gaps, corrected through feedback. Interactive lectures are still recommended for uniform knowledge dissemination and assimilation among students.\u003c/p\u003e","manuscriptTitle":"From Passive Reception to Active Engagement: Transforming learning for first-year medical students under the Competency based medical curriculum","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 20:46:07","doi":"10.21203/rs.3.rs-6427549/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-20T03:12:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103827357328019616712690315092953513625","date":"2025-06-09T13:30:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T10:46:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T03:08:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-02T13:04:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-29T11:26:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-29T11:25:13+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":"c8eaf83c-48cb-4f9a-85fb-d6e27205c62d","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T20:46:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-02 20:46:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6427549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6427549","identity":"rs-6427549","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}