Background The ICAP framework based on Cognitive Science posits four modes of cognitive engagement: Interactive, Constructive, Active, and Passive. Focusing on the wider applicability of discussion as interactive engagement in medical education, we investigated the effect of discussion when self-study preceded it and further investigated the effect of generating questions before discussions. Methods This study was conducted in the second semester of 2018, and 129 students majoring in health professions, including medicine, dentistry, veterinary medicine, and nursing, participated. The students were assigned into four different trial groups, who were asked to fill out a Subjective Mental Effort Questionnaire after completing each session. Their performance in post-test scores and their mental efforts were analyzed. Results A Bonferroni test for group comparison indicated that the self-study and question-generated group had the highest performance and that the lecture and question-received group had the lowest performance when comparing the total score. By using a mediation model, it was confirmed that the participants who showed a higher level of testing mental effort also showed higher levels of studying and discussion mental effort. Conclusions Our findings support the ICAP framework and provide practical implications for medical education, representing the fact that students learn more when they are involved in active learning activities, such as self-study and question generation, prior to discussions.

BackgroundThe ICAP framework based on cognitive science posits four modes of cognitive engagement: Interactive, Constructive, Active, and Passive. Focusing on the wide applicability of discussion as interactive engagement in medical education, we investigated the effect of discussion when it was preceded by self-study and further investigated the effect of generating questions before discussions.MethodsThis study was conducted in the second semester of 2018 and was participated in by 129 students majoring in health professions, including medicine, dentistry, veterinary medicine, and nursing. The students were assigned to four different trial groups and were asked to fill out a Subjective Mental Effort Questionnaire after completing each session. Their performance in posttest scores was analyzed using Bonferroni test, and mental effort was analyzed using mediation analysis.ResultsThese results indicated that the self-study and question group had the highest performance and that the lecture and summary group had the lowest performance when comparing the total score. Using the analysis of mental effort, it was confirmed that the relationship between different study conditions and post-test performance was mediated by mental effort during test.ConclusionsOur findings support the ICAP framework and provide practical implications for medical education, representing the fact that students learn more when they are involved in active learning activities, such as self-study and question generation, prior to discussions.