It was a cross-sectional study conducted at a medical college in Manipur over a three-month period from November 2023 to January 2024. The objective was to explore first-year MBBS students’ perceptions of Problem-Based Learning (PBL) and to compare its educational effectiveness with traditional lecture-based instruction. All 100 enrolled first-year MBBS students were invited to participate in the study. A total of 86 students (86%) provided written informed consent, and their responses were included in the final analysis. Ethical approval was obtained from the Institutional Ethics Committee. The remaining 14 students who did not respond were excluded from the study. To assess for potential selection bias, age and gender distributions were compared between responders and non-responders.

Before introducing the PBL module, students received four 60-minute didactic lectures on pulmonary function testing. These sessions were conducted by the Department of Physiology and covered essential theoretical content including physiological principles, interpretation of pulmonary function parameters, and their clinical applications. These lectures served as the baseline instructional modality and reflected the conventional pedagogy employed in undergraduate medical teaching.

Following the lectures, students participated in a four-week integrated PBL module focused on pulmonary function testing. The first week comprised orientation sessions delivered through four structured one-hour classes- two by Physiology faculties and two by Clinical Medicine faculties. These sessions introduced students to clinical trigger cases, provided background information, and outlined specific learning objectives. In the subsequent three weeks, students were randomly allocated to 12 small groups consisting of 6 students each. Group formation considered gender representation and prior academic performance to ensure balanced participation. Each group conducted two 60-minute PBL sessions weekly, during which they collaboratively analysed clinical cases, identified learning issues, and proposed relevant solutions through self-directed inquiry and discussion. Faculty members acted as facilitators to guide and stimulate critical thinking without providing direct answers. At the end of Week 4, each group presented a 10-minute summary of their case findings and reflective learning insights to their peers and faculty members.

A structured 14-item questionnaire was developed to evaluate students’ perceptions of PBL and to enable direct comparison with traditional lectures. Three items specifically compared PBL and lectures with respect to engagement, understanding, and effectiveness. The instrument used a five-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree). Face and content validity were established through expert review by five faculty members with training in medical education. Pilot testing was conducted among 20 second-year MBBS students to assess reliability and item performance. All items demonstrated item–total correlations greater than 0.30, and the overall instrument exhibited good internal consistency with a Cronbach’s alpha of 0.81.

At the conclusion of the PBL module in January 2024, the questionnaire was administered electronically using a secure and anonymised digital platform. Students’ demographic information, including age and gender, was collected alongside their Likert-scale responses. All data were de-identified prior to statistical analysis to maintain confidentiality and reduce bias.

Data were analysed using SPSS version 21 and Microsoft Excel. Descriptive statistics, including frequencies and percentages, were calculated for each survey item. Continuous variables such as age were summarised using means and standard deviations. Medians and interquartile ranges were reported for the three prespecified comparative items (PBL vs lecture). The Mann–Whitney U test was used to examine gender differences, with a Bonferroni-adjusted significance level set at α = 0.017 for the three comparisons. Due to the ordinal nature of the data and non-normal distributions, non-parametric statistical methods were applied. A p-value of less than 0.05 was considered statistically significant unless otherwise noted.

A total of 86 first-year MBBS students completed the study. Their mean age was 19 ± 2.5 years; 45 (52.3%) were male and 41 (47.7%) were female. No significant differences in age or gender distribution were observed between responders and non-responders.

Table 1

SL no	Question	Strongly Disagree	Disagree	Neutral	Agree	Strongly agree
1	PBL is interesting and interactive method of learning	14(16.2%)	8(9.3%)	4(4.6%)	16(18.6%)	44(51.1%)
2	PBL has helped in understanding the concept clearly	10(11.6)	5(5.8%)	9(10.4%)	32(37.2%)	30(34.8%)
3	proper orientation was given to students before starting PBL session	12(13.9%)	6(6.9%)	16(18.6%)	34(39.5%)	18(20.9%)
4	PBL helps in retention of the concept	15(17.4%)	12(13.9%)	15(17.4%)	19(22.0%)	25(29.1%)
5	PBL helps in identifying areas of weakness	16(18.6%)	11(12.7)	18(20.9%)	17(19.7%)	24(27.9%)
6	PBL takes more time than traditional Lectures	12(13.9%)	10(11.6%)	15(17.4%)	30(34.8%)	19(22.0%)
7	PBL promotes self-Learning	14(16.2%)	12(13.9%)	16(18.6%)	18(20.9%)	26(30.23%)
8	Should PBL be applied to all topics	25(29.1%)	21(24.4%)	14(16.2%)	10(11.6)	16(18.6%)
9	Will PBL help in preparing for Examinations	24(27.9%)	23(26.7)	16(18.6%)	11(12.7)	12(13.9%)
10	PBL Methods provides better linkage between Basic and Clinical sciences	17(19.7%)	13(15.1%)	7(8.1%)	20(23.2%)	29(33.7%)
11	PBL was conducted in a systematic manner	14(16.2%)	13(15.1%)	5(5.8%)	22(25.5%)	32(37.2%)
12	Role of the facilitator was helpful	12(13.9%)	14(16.2%)	6(6.9%)	25(29.1%)	29(33.7%)
13	Does PBL improve the problem-solving skills	10(11.6)	9(10.4%)	3(3.4%)	31(36.04%)	33(38.7%)
14	Is PBL better than traditional methods	16(18.6%)	15(17.4%)	4(4.6%)	20(23.2%)	32(37.2%)

Table 2

Theme	Perception Item	Agree + Strongly Agree (%)	Neutral/Disagree (%)
Engagement and Interactivity	PBL was engaging	69.7	30.3
	More time-consuming than lectures	56.8	43.2
Conceptual Understanding	Improved concept clarity	72.0	28.0
	Linked basic and clinical sciences	56.9	43.1
Instructional Design	Orientation was adequate	60.4	39.6
	Facilitators were helpful	62.8	37.2
	Sessions were well-structured	62.8	37.2
Self-Directed and Analytical Learning	Promoted self-directed learning	51.2	48.8
	Improved problem-solving	74.4	25.6
Utility and Application	Useful for exam preparation	26.6	73.4
	Should be used for all topics	30.2	69.8

Table 3

Item	Median (IQR)
1. PBL is more engaging than traditional lectures	5 (4–5)
2. PBL better prepares me for examinations than lectures	2 (2–3)
3. Overall, PBL is better than traditional teaching methods	4 (2–4)

Item-level responses (Table 1) indicate majority of students strongly agreed that PBL was engaging (51%) and improved problem-solving skills (39%), and a majority also considered its use for conceptual clarity (35%) and basic-clinical integration (34%). In contrast, fewer students strongly agreed that PBL helped exam preparation (14%), and substantial proportions strongly disagreed or were neutral on retention (17%/17%), self-directed learning (16%/19%), orientation adequacy (14%/19%), and universal application (29%/16%).

Responses are grouped by theme. Values indicate percentage of students who agreed or strongly agreed versus those neutral or disagreeing.

Students found PBL highly engaging and useful for understanding core concepts. Nearly 70% agreed it was engaging, and 72% said it improved concept clarity. More than half (57%) also felt it linked basic science with clinical practice, although 43% were neutral or disagreed (Table 2).

Views on delivery and broader benefits were more mixed. About 60% agreed the orientation, facilitators, and session structure were adequate. While 74% reported improved problem-solving skills, only 51% felt PBL promoted self-directed learning. Even fewer believed it would help with exam preparation (27%) or should be applied to every topic (30%), indicating reservations about its practicality and assessment alignment (Table 2).

Analysis of the three comparative items (Table 3) shows that students rated PBL’s engagement very highly, with a median score of 5 (IQR 4–5), indicating strong agreement that PBL is more engaging than lectures. In contrast, the exam‐preparation item had a median of 2 (IQR 2–3), reflecting general disagreement that PBL aids in preparing for examinations. Overall preference for PBL over traditional methods was moderate, with a median of 4 (IQR 2–4).

Mann–Whitney U test for Item 3 (“Overall, PBL is better than traditional methods”) showed no significant gender difference (U = 992.0; Z = 0.611; p = 0.541; r = 0.07).