Active Versus Passive Learning in Large-Group Sessions in Medical School: A Randomized Cross-Over Trial Investigating Effects on Learning and the Feeling of Learning

Purpose: The evidence base for active learning in medical education is based largely on trials with suspect internal validity. We empirically compared the learning and feeling of learning of participants when in large-group interactive sessions and passive lectures using a rigorous trial capable of providing an unambiguous assessment of effect. Further, we evaluated if there was a differential effect based on prior achievement. Materials and Method: We conducted a two-day randomized cross-over trial with 146 s-year medical students. Passive learning involved lecture-based case presentation with minimal interaction; in the large-group interactive session, students worked in teams on the same cases. Participants completed a test of learning and a feeling of learning survey. Effects were estimated using linear mixed-effects models. Results: Participants in the large-group interactive session scored 0.27 standard deviations higher on the test of learning (p = 0.010) than when in the passive lecture. Learners in the lower 50% of prior achievement benefited most from active learning. The feeling of learning was 0.56 standard deviations higher in the large-group interactive session (p < 0.001). Conclusions: Transformation of passive lectures to interactive learning sessions is feasible, has the potential to close achievement gaps by benefiting the lowest achieving learners the most, and provides students a greater sense of learning than passive lectures.