Comparative analysis of university lectures, textbooks, and online video lectures: preferences, engagement, and impact on academic performance among medical students of Nowshera Medical College.

backgroundMedical students today rely on a combination of traditional and digital learning modalities, such as university lectures (UL), textbooks (TB), and online video lectures (OVL). While the use of OVL is growing worldwide and in Pakistan, little is known about medical students' preferences, engagement, and perceptions across these modalities. This study aimed to explore learning behaviours, preferred modalities, and their association with academic performance.

methodsA cross-sectional survey was carried out at Nowshera Medical College, Pakistan, with the overall study period spanning from July 2024 to August 2025. We surveyed 355 undergraduate students from all academic years through stratified random sampling. The questionnaire asked about students' demographics, preferred learning modality, frequency of use, and perceived effectiveness. It also assessed student perceptions regarding UL and mandatory attendance policies. Data were analysed using descriptive statistics, chi-square tests, ANOVA, correlation, and regression analyses.

resultsOVL were the most preferred learning modality (71.7%), followed by TB (26.9%) and UL (1.4%). The majority of students used YouTube (84.5%) but shifted towards specialized platforms as they entered clinical years. OVL were perceived as the most engaging and effective modality, TB as most helpful for exam confidence and long-term recall, while UL were consistently ranked lowest. Frequency of usage mirrored these views: 92.1% reported often or always using OVL, 88.8% for TB, and just 37.5% for UL. Preferred modality was not significantly linked to exam scores, but students who combined different modalities showed slightly better outcomes. Perceptions of UL and mandatory attendance were generally negative, declining across academic years, though female students rated UL more positively than males.

conclusionsOVL have become the main source of learning, while TB continue to provide structured guidance. UL, however, received the lowest ratings. Students who used a combination of different learning resources tended to have slightly higher exam scores compared with those who relied on only one. These findings highlight a clear need to integrate digital resources with textbooks, and for UL to be redesigned so that learning is both engaging and effective. Finally, teaching methods should be aligned with students' actual learning habits in order to optimize outcomes.