A Crossover Study Comparing Small-group Discussion and Self-directed Learning in Teaching Clinicopathological Concepts to Undergraduate Medical Students

Background: The Competency-based Medical Education (CBME) curriculum allocates instructional time for both Small Group Discussion (SGD) and Self-directed Learning (SDL). However, the comparative effectiveness of these approaches in routine undergraduate teaching remains unclear. This study compared SGD and SDL in teaching clinicopathological concepts with respect to academic performance, baseline academic motivation, and learner perceptions. Methods: This longitudinal crossover study was conducted among second-year MBBS students ( n = 83) from May to December 2022. Students participated in three sessions each of SGD and SDL on comparable topics. Academic motivation was assessed at baseline using the Self-Determination Index. The learning outcomes were measured through weekly and final assessments and student involvement and perceptions were collected using a structured questionnaire. Results: Baseline academic motivation was generally positive across all the participants. There was no statistically significant difference in final assessment scores between SGD and SDL (mean final score 4.02 vs. 4.00; P = 0.81). Self-reported involvement and recommendation scores were comparable between the two methods ( P > 0.05). SDL was associated with higher self-reported self-confidence and holistic understanding ( P < 0.001), whereas SGD was associated with higher perceived correctness of learning ( P < 0.001). Conclusion: SGD and SDL resulted in comparable learning outcomes for clinicopathological concepts among Phase II MBBS students. Structured SDL does not compromise academic performance and may complement faculty-led instructional methods within CBME curricula.