title: Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum - results of a mixed methods trial.
abstract: BACKGROUND
  Modernised medical curricula in Germany (so called "reformed study programs") rely increasingly on alternative self-instructed learning forms such as e-learning and curriculum-guided self-study. However, there is a lack of evidence that these methods can outperform conventional teaching methods such as lectures and seminars. This study was conducted in order to compare extant traditional teaching methods with new instruction forms in terms of learning effect and student satisfaction.
  
  
  METHODS
  In a randomised trial, 244 students of medicine in their third academic year were assigned to one of four study branches representing self-instructed learning forms (e-learning and curriculum-based self-study) and instructed learning forms (lectures and seminars). All groups participated in their respective learning module with standardised materials and instructions. Learning effect was measured with pre-test and post-test multiple-choice questionnaires. Student satisfaction and learning style were examined via self-assessment.
  
  
  RESULTS
  Of 244 initial participants, 223 completed the respective module and were included in the study. In the pre-test, the groups showed relatively homogenous scores. All students showed notable improvements compared with the pre-test results. Participants in the non-self-instructed learning groups reached scores of 14.71 (seminar) and 14.37 (lecture), while the groups of self-instructed learners reached higher scores with 17.23 (e-learning) and 15.81 (self-study). All groups improved significantly (p < .001) in the post-test regarding their self-assessment, led by the e-learning group, whose self-assessment improved by 2.36.
  
  
  CONCLUSIONS
  The study shows that students in modern study curricula learn better through modern self-instructed methods than through conventional methods. These methods should be used more, as they also show good levels of student acceptance and higher scores in personal self-assessment of knowledge.
authors.affiliation: Department of Medical Informatics, RWTH Aachen University, Faculty of Medicine, Pauwelsstr. 30, 52074, Aachen, Germany. apeine@ukaachen.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Peine
authors.affiliation: Department of Medical Informatics, RWTH Aachen University, Faculty of Medicine, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kabino
authors.affiliation: Department of Medical Informatics, RWTH Aachen University, Faculty of Medicine, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Cord
authors.initials: C
authors.lastname: Spreckelsen
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003194:Computer-Assisted Instruction / Q000379:methods; D003479:Curriculum / Q000639:trends; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D018794:Problem-Based Learning / Q000639:trends*; D015397:Program Evaluation; D011897:Random Allocation; D012153:Retention, Psychology; D012647:Self-Assessment; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013664:Teaching Materials
keywords: Curriculum development; E-Learning; Germany; Learning style; Medical school; Medical student; Self-instructed learning