JMIR Publications

ABSTRACT

Background:

Providing lecture handouts before face-to-face teaching may support preparation for synchronous teaching and reduce cognitive load. However, the isolated effect of early handout availability is unclear, particularly in pathology courses.

Objective:

This study evaluated whether making lecture handouts available before face-to-face lectures was associated with improved learning compared with making the same materials available after the lectures.

Methods:

A quasi-experimental pre-post study was conducted in an undergraduate pathology course. Eleven topics included 6 intervention topics with handouts available through the learning management system before class and 5 control topics with handouts available after class. The course also included formative audience response system (ARS) questions. The primary endpoint was T1 topic-specific posttest performance data from all students (n=227). Exploratory analyses included T0-pretest survey data from 72 students, T1-posttest survey data from 23 students, ARS data, attendance data, and handout download data. Nonparametric tests were used due to small samples, ordinal variables, and topic-level clustering.

Results:

In the primary paired T1 comparison (n=227), there was no significant difference in median performance for intervention-topic items (64.3%) and control-topic items (62.5%; Wilcoxon signed-rank test, P=.87; rank-biserial r=-.013). In the matched T0-T1 sample (n=13), median performance increased from 33% at T0 to 63% at T1, corresponding to a median knowledge gain of 29 percentage points (Wilcoxon signed-rank test, P<.001; rank-biserial r=1.00). Within the same matched sample, T1 performance on intervention-topic items did not differ significantly from control-topic items (median 71% vs. 63%; P=.64). The median T0-T1 gain was 29% for intervention topics and 37% for control topics (P=.37). In the larger T1 posttest dataset (n=227), correct answers were similar: intervention topics revealed 2003 out of 3220 responses (62%) versus 1140 out of 1840 responses for control topics (62%; P=.95; Cliff’s Δ=.03). In the T1 survey dataset (n=23), complete-case correlations showed no significant associations between T1 performance and self-reported attendance (P=.73), handout use before class (P=.15), or perceived usefulness of handouts (P=.18). Attendance was overall below 20%. Handout downloads were not significantly associated with T1 performance(P=.93).

Conclusions:

Students showed substantial learning gains, but early handout availability was not associated with a statistically robust performance advantage. Because all handouts were available before the final assessment, the intervention-control contrast was reduced. Passive handout availability alone may be insufficient to produce measurable learning benefits; future studies should combine pre-lecture materials with guided preparation tasks and individual-level learning analytics.