Effectiveness of real case-based learning versus traditional lecture-based teaching on knowledge acquisition and satisfaction in benign breast diseases among undergraduate midwifery students: a quasi-experimental study

Traditional lecture-based teaching is still the predominant education method in midwifery despite evidence supporting better knowledge retention and clinical reasoning in case-based learning (CBL) approaches. This study compared the effectiveness of CBL with conventional lectures on knowledge acquisition in benign breast diseases and student satisfaction among undergraduate midwifery students. This quasi-experimental study was conducted on 54 fifth-semester midwifery students during a single semester at the Islamic Azad University, Mashhad, Iran. Participants were divided into two groups (27 each) receiving either traditional lectures (LBL) or anonymized real case reports in a facilitated discussion format (CBL). Knowledge was assessed using an identical pre- and post-intervention 20-item multiple-choice examination stratified by difficulty level (easy, medium, and hard questions). Satisfaction was measured with a 7-item Likert-scale questionnaire. Data were analyzed using analysis of covariance (ANCOVA) with bootstrapping (5000 resamples) to adjust for baseline scores, and chi-square tests, in SPSS version 24. After adjusting for baseline scores, the CBL had significantly higher total scores ( p = 0.001, 95% CI for intervention effect: 1.38–5.81), medium ( p = 0.003, 95% CI: 0.42–2.04), and hard ( p = 0.026, 95% CI: 0.12–2.36) scores compared with the LBL group. Both groups reported high levels of satisfaction with no significant difference ( p > 0.05). CBL was more effective than LBL particularly in higher-order cognitive domains, among undergraduate midwifery students studying benign breast diseases. Integration of CBL into midwifery curricula is recommended. Larger multicenter studies with long-term follow-up are needed to confirm these findings.