Comparative outcomes of self-directed learning and student-centred learning on hand hygiene and biomedical waste management among medical students: a quasi-experimental study

Abstract

Hand hygiene (HH) and Biomedical waste management (BMWM) are fundamental elements of infection prevention and control. Published comparisons of these active learning methods among medical students are limited and conflicting. The objectives of this study were to compare the outcomes of two active training methods on HH and BMWM among medical students enrolled in the Faculty of Medicine of Monastir (Tunisia), as well as to assess student satisfaction with each training method. We conducted a quasi-experimental study to compare the outcomes of student-centred learning (SCL) and self-directed learning (SDL) from September 2024 to May 2025 among all fifth-year medical students. We used the World Health Organization HH Knowledge Questionnaire and the “BMWM audit” validated by the Nosocomial Infection Control Committee in France before and after each training method. Since randomisation was not feasible, an alternating weekly allocation assigned each pre-established group to either the SDL or SCL method. A total of 285 students participated (143 in the SDL and 142 in the SCL). HH and BMWM scores increased significantly from pre-test to post-test in both training groups. Pre-test scores were comparable between groups for both HH and BMWM. Between-group analysis of post-test scores showed significantly higher HH scores in the SDL group than in the SCL group ( p = 0.02). In contrast, no significant between-group difference was observed for BMWM post-test scores. Overall satisfaction ( p = 0.04), perceived facilitator expertise ( p < 0.001), and the quality of interactions during the session ( p = 0.001) were significantly higher in the SCL group. Both methods significantly improved HH and BMWM scores, with SDL showing higher post-test HH scores and SCL showing higher satisfaction. Active learning should be strategically integrated into medical curricula with technology-enhanced tools, learner-centred environments, and alignment among outcomes, teaching strategies, and assessment.