Association between Student Participation in PBL Sessions and Performance in Integrated Modular Examinations

Abstract

Background: Problem-based learning (PBL) is widely used in integrated medical curricula to promote active learning, collaborative problem-solving, communication, and application of knowledge to clinical scenarios. There are, however, considerable variations between students in their active involvement in PBL sessions and it is important to further study the correlation between student involvement during PBL sessions and examination scores.

Objective: To determine the association between student participation in PBL sessions and performance in integrated modular examinations among undergraduate medical students.

Methods: This analytical cross sectional study was carried out in Rawal Institute of Health Sciences between March 2025 and September 2025. 85 undergraduate medical students were involved. The extent of participation in PBL was evaluated by attendance data and tutor assessment of knowledge gained through preparation, knowledge shared during group discussion, problem solving, collaborative efforts, and overall involvement. The students were divided into three groups – low, moderate and high participation groups. Academic achievement was measured by the scores earned in the integrated modular examination for the same academic standards. Descriptive statistics, one-way analysis of variance, Chi-square test, correlation analysis and multiple linear regression were used to analyze data. The significance of p value was <0.05.

Results: The mean PBL attendance was 82.6 ± 11.7%, while the mean overall active participation score was 73.9 ± 12.8%. Of the 85 students, 21 (24.7%) had low participation, 34 (40.0%) had moderate participation, and 30 (35.3%) had high participation. Mean integrated modular examination scores increased significantly across participation groups, from 63.2 ± 8.1% in the low-participation group to 72.2 ± 7.4% in the moderate group and 79.1 ± 7.0% in the high-participation group (p < 0.001). Examination pass rates were 61.9%, 82.4%, and 93.3%, respectively (p = 0.018). Overall active participation showed a strong positive correlation with examination score (r = 0.62, p < 0.001), while attendance demonstrated a moderate positive correlation (r = 0.48, p < 0.001). In multivariable analysis, active PBL participation and attendance remained significant independent predictors of examination performance.

Conclusion: Higher participation in PBL sessions was significantly associated with better performance in integrated modular examinations. Active engagement demonstrated a stronger relationship with academic achievement than attendance alone. These findings support the use of structured PBL activities that encourage meaningful student participation, discussion, preparation, and problem-solving within integrated medical curricula.