E-Learning Modules Based on Bloom Taxonomy and the Miller Pyramid for First-Year Indian Medical Students: Randomized...

Competency-based medical education (CBME) in India emphasizes early competency formation, higher-order cognitive processing, and self-directed learning. Although e-learning is widely adopted, there is limited evidence on structured e-modules explicitly designed using Bloom taxonomy and the Miller pyramid for Indian MBBS students.

This study aims to design, validate, implement, and evaluate CBME-aligned e-modules for first-year MBBS foundational subjects (anatomy, physiology, and biochemistry) and to compare their effectiveness with traditional teaching on cognitive, psychomotor, and affective learning outcomes using Kirkpatrick levels 1 and 2.

A randomized controlled study was conducted among 690 first-year medical undergraduates (control: n=370; intervention: n=320). The intervention group received Sharable Content Object Reference Model-based interactive e-modules through Moodle (Modular Object-Oriented Dynamic Learning Environment) in addition to standard lectures, while the control group received lectures only. e-Modules were designed using Bloom taxonomy and the Miller pyramid, validated by internal and external experts, and implemented following Kern 6-step approach. Learning outcomes were assessed using structured feedback (Kirkpatrick level 1) and end-of-block internal assessments comprising multiple choice questions, short notes, and objective structured clinical examinations (Kirkpatrick level 2).

Students in the intervention group performed significantly better across all cognitive levels compared with the control group: remember (mean 6.52, SD 2.24 vs mean 5.26, SD 2.89; P<.001), understand (mean 2.92, SD 1.45 vs mean 2.55, SD 1.13; P<.001), apply (mean 3.43, SD 1.06 vs mean 2.56, SD 1.08; P<.001), and analyze (mean 3.01, SD 0.83 vs mean 2.53, SD 1.11; P<.001). Psychomotor scores (objective structured clinical examination manipulation: mean 4.55, SD 1.12 vs mean 4.10, SD 1.42; P<.001) and affective domain scores (mean 3.02, SD 0.81 vs mean 2.03, SD 0.81; P<.001) were also significantly higher in the intervention group. Subgroup analysis showed the largest gains among medium achievers across domains.

CBME-aligned e-modules significantly enhanced student performance in cognitive, psychomotor, and affective domains compared with traditional teaching alone, with particularly pronounced benefits for medium achievers. Well-designed e-modules represent a scalable, adaptable strategy to support CBME implementation across diverse medical education settings in India.