Active Learning outscored Passive and Gamified methods in a Medical Microbiology and Immunology Course: A Repeated-Measures Analysis

Introduction Medical education has historically relied on lecture-centric, traditional models despite evidence that learner-centered approaches better support durable learning, an issue that often affects dense, foundational courses like medical microbiology and immunology. To address limited evidence in podiatric curricula, we compared Passive, Active, and Gamified instructional methods in a first-year podiatric course. Methods A total of 54 first-year podiatric medical students participated in a within-subjects repeated-measures study with a complete-case design, comparing Passive, Active, and Gamified instructional methods within a balanced instructional framework. Learning gains were assessed using pre- and post-quizzes across six unique content sessions, with data analyzed using repeated-measures ANOVA to determine which method most effectively improved knowledge performance. Results From the complete-case analysis (N = 43), Active learning produced the highest mean improvement in quiz scores (delta change = 1.64), followed by Passive (delta change = 0.98) and Gamified instruction (delta change = 0.65). A one-way repeated-measures ANOVA showed a significant effect of teaching method, F(2,84) = 10.16, p < 0.001, partial eta squared = 0.20. Pairwise comparisons revealed Active learning significantly outperformed both Gamified (p < 0.001) and Passive (p = 0.012), with no difference observed between the latter instructional methods (p = 0.447). Conclusion Despite growing interest in gamified and competitive formats, learning performance in preclinical podiatric education was strongest under active, collaborative, and engagement-focused instruction.