Project-Based Learning in Medical Physiology: Effects on Knowledge Gain and Student Perceptions

Background: Although project-based learning (PBL) is well-established in advanced medical curricula, evidence supporting its implementation in first-year undergraduate programs remains limited.Early research exposure may enhance student engagement.Objective: This study evaluated whether structured PBL in muscle physiology was associated with improvements in subject knowledge acquisition among first-year MBBS students.Methods: An observational study was conducted at a single medical institution in Tamil Nadu, India, from July to August 2023.Formal institutional ethics approval was obtained prior to participant recruitment.Of 250 eligible first-year MBBS students, 40 consented to participate; five subsequently withdrew citing curriculum workload concerns, yielding 35 participants (30 females, five males; mean age 18.35 years).Students underwent pre-assessment comprising 10 short-answer questions on muscle physiology (maximum score 20) and were randomized to 10 project groups via lottery.Students conducted investigations on exercise physiology over three to four hours weekly for one month.Post-assessment utilized identical questions.Thirty-two students completed a structured feedback questionnaire (six Likertscale items, 1-5 scale) and provided open-ended commentary.Assessment scores were compared via paired t-testing and Shapiro-Wilk testing.Pearson correlation assessed satisfaction-knowledge associations.Qualitative analysis employed thematic coding by two independent raters using predefined and emergent themes with inter-rater agreement assessment.Results: Post-assessment scores (12.588 ± 2.943) significantly exceeded pre-assessment scores (5.265 ± 2.89), yielding a mean improvement of 7.324 ± 2.446 points (t(34) = -17.952,p < 0.001, Cohen's d = -3.034;95% CI (-3.821, -2.239)).This large effect size must be interpreted cautiously given the observational design, self-selected sample, identical assessment questions, and potential testing-practice effects.Post-hoc power analysis confirmed an achieved power of 0.99.The mean satisfaction score was 22.563 ± 3.519 out of 30.No statistically significant association existed between satisfaction and knowledge improvement (r = 0.082, p = 0.657).Qualitative analysis demonstrated predominantly favorable responses, with 26 of 35 students (74.3%) expressing interest in future research participation.Conclusion: Structured PBL was associated with substantial knowledge improvement and positive student perception among participating students.However, the single-group observational design, self-selected sample, and identical assessments preclude causal inference regarding PBL's effectiveness.Larger comparative randomized trials are necessary to establish whether PBL produces educational benefits relative to standard instruction and whether effects persist over time.