• clinical reasoning;
  • computerised tutorial;
  • epilepsy;
  • medical student teaching;
  • randomised crossover trial

Aim:  Research has shown computerised tutorial to be as effective as face-to-face teaching in promoting knowledge acquisition. Subsequently, the clinician must synthesise and interpret data (clinical reasoning). This study extends previous research and compares the effectiveness of interactive lecture and computerised tutorial in promoting observational skills and clinical reasoning in the evaluation of paroxysmal events.

Methods:  The modalities were compared through a randomised crossover trial teaching epilepsy to third and fourth year medical students. The content matter (history and video clip) and format were identical for each topic (Topic 1: altered awareness, Topic 2: movement and posturing) in both modalities (interactive lecture and computerised tutorial). Structured worksheets promoted and evaluated skills of observation and clinical reasoning. Responses in both domains were compared with gold standard qualitative scores. Participants rated modality preference and perceptions of teaching.

Results:  One-hundred and fifty-seven medical students participated. Interactive lecture and computerised tutorial were both effective in promoting observational skills and clinical reasoning with no differences between modalities. Participants preferred the interactive lecture and rated it more enjoyable and effective. Twenty-five participants randomised to the computerised tutorial for Topic 1, elected to withdraw participation. Both modalities promoted interest and willingness to further learn.

Conclusion:  This is the first randomised crossover trial evaluating the teaching of clinical reasoning in comparative medical education research. Interactive lecturing and computerised tutorial were both effective in teaching observational skills and clinical reasoning. Interactive lecture is the preferred method, and may influence initial engagement in learning.