Effectiveness of Different Educational Approaches in Improving Comprehensive Clinical Competence Among Medical Students: A Systematic Review and Meta-Analysis

Abstract

Active, student-centred teaching strategies are increasingly being adopted to bridge the gap between biomedical knowledge and clinical performance in health-profession education. This systematic review and meta-analysis aims to evaluate the comparative effectiveness of five student-centred educational approaches in medical students’ knowledge acquisition and clinical skills performance. We conducted a systematic review with random-effects meta-analysis of 21 controlled trials enrolling 1,028 intervention and 961 control participants. Outcomes were classified as knowledge based (MCQ or written exams; n = 11) or skills based (Objective Structured Clinical Examination, Objective Structured Assessment of Technical Skills, Script Concordance Test; n = 10). Interventions were grouped into five categories: case-based methods, conventional simulation, virtual reality (VR)/video simulation, artificial intelligence-guided tutoring and flipped/outcome-based formats. Heterogeneity was assessed using I² and τ², with leave-one-out and trim-and-fill sensitivity analyses, and subgroup differences were tested by χ². Knowledge-based outcomes showed a pooled Hedges’ g of 1.40 (95% confidence interval [CI] 0.78–2.01; I² = 95.0%), whereas skills-based outcomes yielded 3.11 (95% CI 1.83–4.39; I² = 97.7%), with a significant domain difference (χ² = 5.60, p = 0.018). Subgroup analysis by pedagogical mechanism demonstrated significant effect variation (χ² = 15.03, df = 4, p = 0.018), with conventional simulation and VR/video simulation producing the largest gains. It should be noted that some categories, such as AI-guided tutoring, were represented by only a single study. Despite extreme heterogeneity, sensitivity analyses confirmed robustness, and publication bias minimally attenuated skills-based estimates. Student-centred approaches markedly outperform lectures for both knowledge acquisition and clinical skills, notably with simulation-based methods. Educators should integrate these strategies according to learning objectives and context. This study provides novel comparative evidence that the magnitude of benefit varies substantially across pedagogical approaches, with conventional simulation showing the greatest impact on skill acquisition, a distinction crucial for strategic curriculum design. Future research should explore long-term outcomes, cost-effectiveness and patient-care impact.