# Impact of integrated clinical case exposure on phase I MBBS students in their learning process in biochemistry

## TL;DR

This study shows that using clinical cases in teaching biochemistry to medical students improves their learning and understanding compared to traditional lectures.

## Contribution

The study introduces Early Clinical Exposure (ECE) as a novel teaching method in Phase I MBBS biochemistry education.

## Key findings

- Students in the ECE group scored significantly higher on post-tests compared to traditional lecture-based students.
- Most students felt ECE improved their understanding of biochemistry's clinical relevance and retention.
- The study found statistically significant improvements in both knowledge retention and application with ECE.

## Abstract

The integrated clinical case approach connects foundational medical concepts to real-life clinical scenarios, encouraging active problem-solving and interdisciplinary thinking. In contrast, traditional lecture-based teaching often presents subjects in isolation, without emphasizing clinical relevance. This study explores the potential impact of Early Clinical Exposure (ECE) through integrated clinical cases on biochemistry learning among Phase I MBBS students.

The integrated clinical case approach connects foundational medical concepts to real-life clinical scenarios, encouraging active problem-solving and interdisciplinary thinking. In contrast, traditional: After obtaining informed consent, 100 Phase I MBBS students were randomly allocated into two groups: an ECE group and a non-ECE (traditional lecture-based) group, using a computer-generated random number table to minimize allocation bias. Both groups underwent pre-test and post-test assessments comprising multiple-choice questions (MCQs) (15 marks) and problem-based learning (PBL) questions (10 marks) designed to assess knowledge retention and application. A validated perception questionnaire was also administered post-intervention to gather students’ self-reported feedback on the learning experience.

Both groups demonstrated statistically significant improvement in post-test scores compared to pre-test scores (p < 0.001). The ECE group achieved higher mean post-test scores in MCQ (9.34 ± 1.45) and PBL (6.89 ± 0.99) compared to the non-ECE group (MCQ: 7.24 ± 1.29; PBL: 5.72 ± 0.73). An ANCOVA controlling for pre-test scores confirmed that these between-group differences in post-test scores were statistically significant for both MCQs (F(1,97) = 55.2, p < 0.001) and PBL scores (F(1,97) = 38.1, p < 0.001), indicating a significant effect of the intervention. Responses from the perception questionnaire indicated that most students felt ECE improved their understanding of biochemistry’s clinical relevance and enhanced motivation. Between 94% and 98% of students agreed that ECE helped them connect biochemistry concepts with clinical cases and aided content retention. However, these outcomes were subjective perceptions, not objectively measured indicators of engagement or motivation.

The findings indicate that ECE was associated with improved knowledge retention and application of biochemistry concepts in clinical contexts compared to traditional lecture-based learning. While students reported increased motivation and appreciation of clinical relevance, these perceptions were self-reported and should be interpreted cautiously. Objective, long-term measures of engagement, clinical reasoning, and performance are recommended in future studies to substantiate these observations.

The online version contains supplementary material available at 10.1186/s12909-025-08050-5.