Comparative evaluation of case studies and role-playing techniques in enhancing problem-based learning outcomes in Medical Biochemistry education- An educational randomized controlled trial.

Background and objective: Problem-based learning (PBL) strategies such as case studies and role-playing are increasingly adopted in medical education to promote critical thinking, communication, and teamwork. However, comparative evidence regarding their effectiveness in medical biochemistry remains limited. This study aims to evaluate and compare the impact of case studies and role-playing on learning outcomes, engagement and skill development among first year MBBS students. Material and methods: An educational randomized controlled trial (RCT) with a within-subjects crossover design was conducted in the Department of Biochemistry involving forty-five first-year MBBS students. Participants were randomly assigned to receive case studies and role-playing in a counterbalanced sequence. Learning outcomes were assessed using pre- and post- tests, a structured feedback questionnaire and qualitative reflections. Data were analysed using appropriate parametric and non-parametric tests, along with adjusted analysis using ANCOVA to account for baseline performance. Results: All participants completed both methods, with no significant difference in baseline knowledge between arms (P=0.12). Both case studies and role-playing produced significant pre- to post- test improvements (P<0.001). Unadjusted analyses showed higher learning gains with role-playing, but pre-crossover ANCOVA demonstrated comparable effectiveness after baseline adjustment. Exploratory pooled analysis suggested a moderate cumulative advantage for role-playing. Student feedback indicated higher engagement and perceived skill development with role-playing, while both methods were viewed as relevant and educationally valuable. Conclusion: Both case studies and role-playing were effective PBL strategies for improving understanding and application of medical biochemistry concepts. Although student feedback and unadjusted analyses indicated higher engagement with role-playing, adjusted analysis at initial exposure showed comparable effectiveness between the two methods. Role-playing supported interactive learning and AETCOM -related skills, while case studies strengthened structured analytical reasoning. A combined approach may therefore offer a balanced and comprehensive PBL framework in medical education.