A comparative study of the implementation of the doughnut round teaching and the lecture method on self-regulation and motivation of medical students' academic progress: A semi-experimental study

Copy igh © 2025 Zanjan Uni e si y o Medical Sciences. Published by Zanjan Uni e si y o Medical Sciences. This wo k is licensed unde a C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional license (h ps://c ea i ecommons.o g/licenses/by- nc/4.0/). Noncomme cial uses o he wo k a e pe mi ed, p o ided he o iginal wo k is p ope ly ci ed. A compa a i e s udy o he implemen a ion o he doughnu ound eaching and he lec u e me hod on sel - egula ion and mo i a ion o medical s uden s' academic p og ess: A semi- expe imen al s udy Elmi a Khodabakhsh 1 , Ali Ke ama i 2, Azizeh Ba y3 , Ras ega Rahmani Tanha4, Ma yam Babazadeh5, Ghadi Pou bai amian6, Ghobad Ramezani7* 1Assis an P o esso o Gene al Su ge y, Mazanda an Uni e si y o Medical Sciences, Sa i, I an 2Depa men o Pedia ics, Medical School, Ke manshah Uni e si y o Medical Sciences, Ke manshah, I an 3Ph.D. S uden o Medical Educa ion, Cen e o Educa ional Resea ch in Medical Sciences (CERMS), Depa men o Medical Educa ion, School o Medicine, I an Uni e si y o Medical Sciences, Teh an, I an 4Depa men o Neu osu ge y, School o Medicine, Ke manshah Uni e si y o Medical Sciences, Ke manshah, I an 5pecialis in Social Medicine and P e en i e Medicine, Albo z Uni e si y o Medical Sciences, Facul y o Medicine, Depa men o Social Medicine 6Assis an P o esso o Medical Educa ion, Educa ion De elopmen Cen e , A dabil Uni e si y o Medical Sciences, A dabil, I an 7Educa ion De elopmen Cen e , Ke manshah Uni e si y o Medical Sciences, Ke manshah, I an A icle in o Abs ac In oduc ion S uden s om a ious clinical disciplines in each hospi al wa d a e conside ed pa o he ea men s a and ca e eam. Clinical educa ion is a c ucial phase o medical aining ha signi ican ly in luences s uden s' p o essional de elopmen and allows hem o apply hei heo e ical knowledge p ac ically. One o he mos isible o ms o clinical aining is he clinical ound, which occu s alongside diagnos ic, ea men , and pa ien ca e ac i i ies in eaching hospi al wa ds [1, 2]. One o he key objec i es o e e y medical school is o p epa e A icle his o y: Recei ed 31 Aug. 2024 Accep ed 5 Feb. 2025 Published 14 Ap . 2025 Khodabakhsh e al. J Med Edu De . 2025; 18(1): 42-53 Jou nal o Medical Educa ion De elopmen Backg ound & Objec i e: In medical educa ion, e ec i e eaching/lea ning s a egies a e c ucial, especially hose ha imp o e academic mo i a ion and sel -con ol. The aim o his s udy was o e alua e how he doughnu ound eaching me hod e sus he adi ional lec u e app oach a ec ed medical s uden s’ mo i a ion and sel - egula ion. Ma e ials & Me hods: Fo y medical s uden s pa icipa ed in his semi-expe imen al s udy. The pa icipan s we e di ided in o wo g oups using he andom alloca ion me hod h ough Excel so wa e: The A g oup was doughnu (20 s uden s), while he B g oup ollowed lec u e me hods (20 s uden s). Bo h be o e and a e he in e en ion, assessmen s we e conduc ed using Ha e 's academic mo i a ion scale and Bou a d's sel - egula ion scale. ANCOVA, he independen - es , he pai ed - es , and he Kolmogo o -Smi no es we e among he s a is ics we employed o da a analysis. So wa e called SPSS e sion 16 was used o all o ou analyses. Resul s: The ea men g oup demons a ed signi ican imp o emen s in academic mo i a ion (p < 0.001) and sel - egula ion (p < 0.001) in he pos - es , while he con ol g oup showed no signi ican changes. The expe imen al g oup's p e- es and pos - es sco es signi ican ly di e ed, indica ing he e ec i eness o he doughnu ound eaching me hod in enhancing sel - con ol and mo i a ion. Conclusion: The ound doughnu ound eaching echnique signi ican ly ou pe o med he s anda d lec u e s yle in e ms o s uden s' academic mo i a ion and sel - egula ion. This app oach p omo es independen s udy and ac i e pa icipa ion, which may imp o e academic pe o mance in medical school. Keywo ds: sel - egula ion, mo i a ion, medical educa ion, eaching me hods, ac i e lea ning, educa ional ounds, andomized con olled ial *Co esponding au ho : Ghobad Ramezani, Educa ion De elopmen Cen e , Ke manshah Uni e si y o Medical Sciences, Ke manshah, I an Email: [email protected] O iginal A icle How o ci e his a icle: Khodabakhsh E, Ke ama i A, Ba y A, Rahmani Tanha R, Babazadeh M, Pou bai amian Gh, Ramezani Gh. A compa a i e s udy o he implemen a ion o he doughnu ound eaching and he lec u e me hod on sel - egula ion and mo i a ion o medical s uden s' academic p og ess: A semi-expe imen al s udy. J Med Edu De . 2025; 18(1): 42-53. [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 1 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1¦ 2025 43 s uden s o become e ec i e membe s o he medical s a and o de elop skilled heal hca e p o essionals o socie y. In his con ex , he ole and signi icance o clinical educa ion become e en mo e signi ican . P ope clinical aining allows s uden s o gain aluable expe iences essen ial o hei u u e ca ee s in medicine [3-5].One o m o conduc ing ounds is he con e ence- based ound, also known as an educa ional ound. In his ype o ound, he p o esso and s uden s engage in discussions and exchange opinions abou he disease o speci ic condi ions o a pa ien , culmina ing in a con e ence p esen a ion on he opic. This o m o aining, along wi h clinical ounds, con ibu es o he p o essional de elopmen o s uden s du ing hei s udy and in e nship pe iods [6]. Howe e , i has been no ed ha non-clinical ounds o en do no ollow a p ope implemen a ion amewo k, leading o a ious obs acles and challenges. Key issues include a lack o alignmen be ween heo e ical and p ac ical componen s, o e c owding o s uden s, and he s ess ul clinical en i onmen s in which hese aining ounds occu , such as c owded co ido s and busy ope a ing ooms [7- 9].These de iciencies highligh he need o a e ision o he cu en app oach. The e o e, he e is a g owing in e es in adop ing new, ac i e, and sel -di ec ed educa ional me hods o non-clinical ounds. One such app oach is he doughnu ound eaching. The way his educa ional ound is held is ha s a ing one week be o e he ound, he p o esso de e mines he sou ces o s udy wi h he s uden s' consen , and hen each s uden is asked o w i e he speci ied con en . S udy he week and design 10 ques ions wi h di e en axonomies (easy, medium and di icul ) and in di e en o ma s (sho answe , mul iple choices) and p epa e hei answe s. Be o e holding he ound, he ele an p o esso mus ha e all he ques ions designed by Con i m he s uden s wi h he co ec answe . In he ollowing, acco ding o he schedule se in ad ance by he p o esso , which is usually one session, one hou pe week, and he s uden s appea in small g oups and only he basic in o ma ion o he ele an case is p o ided by he p o esso a he beginning o he session, hen andomly one o he s uden s asks ano he s uden his ques ion and gi es a sco e om 1 o 3 acco ding o his sa is ac ion wi h his answe and hen gi es he co ec answe as well. I a s uden answe s co ec ly, hey will choose he nex pa icipan . I he answe is inco ec , he i s s uden will selec he nex pe son. This p ocess will con inue un il he champion s uden , de e mined by he poin s ea ned, is es ablished. The en i e opic ela ed o he case will be co e ed, and pa icipan s will lea n abou he subjec h ough hese ques ions, answe s, and hei in e ac ions wi h each o he [10].This aining ound, cha ac e ized by i s s uc u ed o ma , se es as a sel - di ec ed lea ning app oach. I o e s nume ous ad an ages, including he oppo uni y o s uc u ed discussions wi h mul iple pa icipan s wi hin a sho ime ame, enhancing he sel -con idence o lea ne s, imp o ing communica ion skills, and boos ing mo i a ion o acqui e knowledge. Addi ionally, his eaching me hod encou ages ac i e pa icipa ion in he lea ning p ocess and is ecognized as an app oach oo ed in games and en e ainmen [11-13].On he o he hand, he discussion o sel - egula ion and he mo i a ion o p og ess in s uden s is one o he mos impo an ecen opics in he ield o medical educa ion. Resea che s do no conside sel - egula ion lea ning s a egies as a ixed and unchanging ai , bu conside i a skill ha esul s in i s de elopmen in he indi idual h ough pe sonal expe iences and he use o hese s a egies in p ac ice [14]. Lea ne s who use sel - egula ed lea ning s a egies while achie ing highe le els o sel -e icacy and co ec unde s anding o lea ning as a ask alue, will be able o imp o e hei academic pe o mance le els [15].Sel - egula ion can be conside ed a beha io ha e e s o he op imal use o a ious esou ces and inc eases lea ning. Mo i a ional sel - egula ion e e s o he ac i e use o mo i a ional s a egies o inc ease lea ning. Lea ne s wi h mo i a ional sel - egula ion in all s ages o lea ning conside hemsel es o be sel -e icacious and independen . Cogni i ely and me cogni i ely, sel - egula ing people a e people who use planning, o ganizing, sel -lea ning, sel -con ol, and sel - e alua ion in he lea ning p ocess. Lea ning sel - egula ion du ing he acquisi ion o skills may jus i y he indi idual di e ences o people [16, 17]. Mo i a ion is one o he common concep s in educa ional issues, and i s ole in academic p og ess has long been he ocus o psychologis s. Nowadays, c ea ing mo i a ion as a mo i a ing ac o in lea ne s and di ec ing hei ac i i ies is mo e and mo e he a en ion o educa ional au ho i ies. In educa ional heo ies, mo i a ion is conside ed a basic concep . Psychologis s and eache s conside mo i a ion as one o he key concep s used o explain di e en le els o p og ess. This concep ells he di e ence in he amoun o e o o do he homewo k [18]. Acco ding o he abo e documen s and he new indings o psychology and educa ion, he necessi y o he p esen s udy is o use new and ac i e me hods and me hods o eaching and aining, especially in he ield o clinical educa ion. To [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 2 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion 44 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025 educa e medical s uden s du ing he non-clinical ounds, he esea che s plan o u ilize a eaching me hod known as he doughnu ound. They will hen e alua e and compa e he e ec i eness o his me hod wi h adi ional lec u es in enhancing academic sel - egula ion and mo i a ing s uden p og ess. The esea ch hypo heses included he ollowing: 1. The a e age academic sel - egula ion sco e o medical s uden s be o e he in e en ion is di e en in he expe imen al and con ol g oups. 2. The e is a di e ence in he a e age academic sel - egula ion sco e o medical s uden s a e he in e en ion in he expe imen al and con ol g oups. 3. The e is a di e ence be ween he mean sco e o medical s uden s' academic achie emen mo i a ion be o e and a e he in e en ion in he con ol g oup. 4. The e is a di e ence be ween he mean sco es o medical s uden s' academic achie emen mo i a ion be o e and a e he in e en ion in he expe imen al g oup. 5. The a e age sco e o sel - egula ion and academic achie emen mo i a ion o medical s uden s in he expe imen al and a con ol g oup is di e en based on demog aphic cha ac e is ics. Ma e ials & Me hods Design and se ing(s) This semi-expe imen al s udy was conduc ed on 40 medical s uden s (20 people in each g oup) a Ke manshah Uni e si y o Medical Sciences. The cu en s udy is a semi-expe imen al s udy o p e- es and pos - es ypes wi h andom assignmen o wo con ol and expe imen al g oups, in which he e ec o he doughnu ound eaching and lec u e me hod was s udied. Be o e he in e en ion, bo h g oups esponded o Bou a d's sel - egula ion scale and Ha e 's mo i a ion o academic p og ess. A he end o he in e en ion, bo h g oups esponded o he ool again. Pa icipan s and sampling The esea ch popula ion consis ed o medical s uden s en olled a Ke manshah Uni e si y o Medical Sciences o he 2023-24 academic yea . The sample size o his s udy was de e mined using Cohen's able o speci y sample sizes o expe imen al s udies. Conside ing an e ec size o 1, a es powe o 0.80, and a signi icance le el o 0.05, he minimum sample size equi ed o each g oup was es ablished as 17 indi iduals. In addi ion o Cohen's o mula, acco ding o Gall e al., ansla ed by Nas , he c i e ion o selec ing 15 people o each g oup is also based on p e ious s udies and expe s' opinions, so a 15-pe son sample size is conside ed su icien in semi-expe imen al s udies. (Gall M, Bo g W, Gall J. Nas AR, ansla o [19].Conside ing an an icipa ed d opou a e o app oxima ely 15%, a sample size o 20 s uden s pe g oup was deemed app op ia e. Figu e 1. CONSORT low diag am o he s udy [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 3 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1¦ 2025 45 Figu e 1 p esen s a CONSORT low diag am showing he s udy p ocess. The pa icipan s we e di ided in o wo g oups using he andom alloca ion me hod h ough Excel so wa e: The A g oup consis ed o doughnu s (20 s uden s). In con as , he B g oup ollowed lec u e me hods (20 s uden s). The eligibili y c i e ia equi ed s uden s o p o ide in o med consen and o ha e passed he p e equisi e c edi s (including basic science cou ses and clinical p epa a ion). The exclusion c i e ia included lack o consen , ailu e o pass p e equisi e c edi s, and missing mo e han wo sessions. Tools/Ins umen s Bou a d's sel - egula ion scale is a 14-ques ion ques ionnai e designed o measu e sel - egula ion based on Bandu a's social-cogni i e heo y. The ques ions o his ques ionnai e a e on a 5-poin Like scale (comple ely ag ee 5, ag ee 4, ha e no opinion 3, disag ee 2, and comple ely disag ee 1) and measu e wo ac o s o cogni i e s a egies and me acogni i e s a egies o sel - egula ion. Ques ions 5, 13, and 14 a e sco ed in a e e se way; he o al sco es o each pe son can be 14-60. A highe sco e in each componen shows a pe son's endency o use ha componen . The o e all eliabili y coe icien o Bou a d's sel - egula ion scale was ob ained based on C onbach's alpha o 0.71. The eliabili y o he cogni i e s a egies subscale is 0.70, and he me acogni i e subscale is 0.68. The eliabili y o he abo e es was epo ed as 0.63 in esea ch conduc ed by En eza i e al. [20]. In addi ion, he eliabili y o he abo e es was epo ed as 0.67 and 0.69, espec i ely, in he s udy conduc ed by Zamani e al. [21] and Baghe i Ke achi and Razmjoo [22]. In addi ion, he eliabili y o Bou a d's sel - egula ion scale in esea ch conduc ed by Ghaz ineh e al. [23] has been ob ained. The ac o analysis esul s showed ha he co ela ion coe icien be ween he ques ions is app op ia e, he alue load ela ed o he ac o s is accep able, and i s alidi y is also a he desi ed le el. baghe i mousa i and Kadi a [4] also s udied he alidi y and eliabili y o Bou a d's sel - egula ion scale. The cons uc alidi y o his ques ionnai e has been epo ed o be op imal by using co ela ion coe icien s and ac o analysis o disc imina ing co ela ion coe icien s be ween ques ionnai e ques ions. C onbach's alpha coe icien o measu e in e nal consis ency was 0.08. Based on his, his ques ionnai e can p edic he sco es and ac ual sco es o he subjec s. In his s udy, i e medical educa ion specialis s con i med he ace alidi y o he ques ionnai e, and C onbach's alpha was calcula ed a 0.82. Ano he ques ionnai e was he Ha e academic mo i a ion scale. This scale measu es people's academic mo i a ion le el in he wo componen s: In insic and ex e nal mo i a ion. This ques ionnai e has 33 ques ions; he answe o each ques ion is on a i e-poin Like scale om ne e o always. Also, Ha e 's academic mo i a ion ques ionnai e has alidi y, eliabili y, and sco ing. The alpha eliabili y coe icien was 0.83 in he s udy o Za e e al. [25] and 0.86 in he s udy o Fallahi e al. [26] The alidi y o his ool has been p o en in he abo e esea ch. In his s udy, i e medical educa ion specialis s con i med he ace alidi y o he ques ionnai e, and C onbach's alpha was calcula ed as 0.79. Da a collec ion me hods Be o e implemen ing he in e en ion, a p e- es was conduc ed o assess he s uden s' knowledge le els on speci ied opics. This p e- es was adminis e ed o all ou g oups one day be o e he i s in e en ion. The p e- es ool consis ed o a 20-i em mul iple-choice ques ionnai e de eloped speci ically o his s udy. The ques ions we e designed based on a s uc u ed bluep in de i ed om co e educa ional opics, including e e wi hou a sou ce, poisoning wi h chemicals, gas oen e i is, and neona al jaundice. Each ques ion ollowed he s anda ds o he Millman checklis o ensu e ele ance and ho ough con en co e age. The ques ions we e ini ially d a ed based on key opics wi hin he clinical cu iculum and e ined wi h inpu om i e clinical educa ion specialis s. This panel o expe s e iewed each ques ion o cla i y, ele ance, and alignmen wi h he educa ional objec i es o es ablish ace and con en alidi y. To assess he eliabili y o he es , C onbach's alpha was calcula ed and yielded a coe icien o 0.78, indica ing accep able in e nal consis ency. This sugges s ha he es p o ides a eliable measu e o s uden s' baseline knowledge in he speci ied opics. Each co ec answe was assigned one poin , wi h 20 poin s possible. This sco e p o ided a baseline index o each s uden 's knowledge o he selec ed clinical opics. In he in e en ion implemen a ion s age, he aining o he in e en ion g oup began one day a e he p e- es . O e he i s wo days o each week, a one-hou session was held o g oup A and a sepa a e one-hou session o g oup B. Be o e implemen ing he in e en ion, a p e- es was conduc ed o assess he s uden s' knowledge [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 4 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion 46 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025 le els on speci ied opics. This p e- es was adminis e ed o all ou g oups one day be o e he i s in e en ion. A schedule was de eloped o p esen specialized opics, wi h s udy esou ces de e mined by he p o esso in ag eemen wi h he s uden s. Each s uden was equi ed o s udy he assigned con en and p epa e en ques ions wi h a ying di icul y le els (easy, medium, and ha d) and in di e en o ma s (e.g., sho answe , mul iple choice), along wi h hei co ec answe s. The p o esso e iewed and app o ed hese ques ions be o e he ound commenced. Based on he p e-de e mined schedule, he p o esso p esen ed he ele an case in o ma ion o he g oup du ing he sessions. S uden s ook u ns answe ing ques ions, ecei ing sco es be ween 1 and 3 based on hei esponses, wi h he co ec answe s p o ided by he p o esso . I a s uden answe ed co ec ly, hey chose he nex s uden o espond; i no , he i s s uden selec ed he nex pa icipan . This p ocess con inued un il a "champion" s uden was iden i ied based on accumula ed poin s. Th oughou he session, he p o esso ac ed as an ac i e lis ene , closely moni o ing he s uden s' esponses o ensu e all aspec s o he case we e add essed. Fo he con ol g oups (C and D), he same ins ances augh o he in e en ion g oups using he "doughnu ound" me hod we e p esen ed by he p o esso h ough lec u es wi hou equi ing he s uden s o s udy he ma e ial be o ehand. These lec u es we e deli e ed wo days weekly in a i ual o ma , accompanied by ques ions and answe s. The in e en ion las ed o h ee mon hs, o aling 12 weeks, du ing which 48 sessions we e conduc ed—24 sessions o he in e en ion g oup and 24 sessions o he con ol g oup. Two weeks a e he las pos - es session, in e en ion and con ol we e aken om all ou g oups wi h he same w i en es used in he p e- es . Da a analysis Da a analysis used desc ip i e and in e en ial s a is ics o es he esea ch hypo heses. Desc ip i e s a is ical indices, such as he mean and s anda d de ia ion, we e used o desc ibe he collec ed da a. The Kolmogo o - Smi no es (KS es ) was conduc ed i s o check he dis ibu ion o he da a. Since he da a we e ound o be no mally dis ibu ed, independen , and pai ed - es s, Analysis o Co a iance (ANCOVA) was used o emo e he e ec o in e ening a iables using s a is ical me hods o ob ain he esul s mo e accu a ely. All s a is ical p ocedu es we e conduc ed using he SPSS-16 so wa e. Random numbe s be ween 0 and 40 we e gene a ed o de e mine g oups, and pa icipan s we e assigned o g oups based on whe he each numbe was odd o e en. Odd numbe s esul ed in assignmen o g oup A (con ol g oup), while e en numbe s assigned pa icipan s o g oup B (in e en ion g oup). This p ocess con inued un il wo g oups o 20 pa icipan s we e o med. To enhance he igo o andomiza ion, we used he Excel andom alloca ion unc ion o assign pa icipan s, ensu ing an equal dis ibu ion in bo h he "doughnu ound eaching" g oup (n = 20) and he "con en ional lec u e aining" g oup (n = 20). Blinding was ca e ully main ained h oughou he s udy o educe bias. The pa icipan s and he indi iduals esponsible o da a collec ion and analysis needed o be made awa e o g oup assignmen s. Gi en he na u e o he in e en ion, only he alloca ion codes (A o he in e en ion g oup and B o he con ol g oup) we e eco ded, and da a collec ion o ms did no e eal which in e en ion was associa ed wi h each code. To u he ensu e unbiased alloca ion, an independen hi d pa y, who had no ole in he s udy's execu ion o da a analysis, pe o med he andomiza ion. This indi idual's sole ole was o handle he andomiza ion p ocess and assign codes based on he andom numbe sequence. This p e en ed any di ec in luence om he esea ch eam on g oup assignmen s, ensu ing he in eg i y o he blinding and andomiza ion p ocess. Resul s The da a in Table 1 illus a es he age dis ibu ion o he esea ch sample ac oss he wo g oups, in e en ion and con ol. I indica es ha mos pa icipan s all wi hin he age ange o 23 yea s. Fu he mo e, he independen - es esul s e eal no s a is ically signi ican di e ence in he a e age age be ween he wo g oups, wi h alues epo ed as = 1.912 and p = 0.058. This sugges s ha age may no be a di e en ia ing ac o be ween his s udy's in e en ion and con ol g oups. The da a p esen ed in Table 1 ou lines he gende dis ibu ion o he esea ch sample wi hin he wo g oups. In he in e en ion g oup, 53% o pa icipan s we e emale and 47% we e male. In con as , 54% we e emale in he con ol g oup and 46% we e male. The Chi-squa e es esul s indica e no s a is ically signi ican di e ence in gende composi ion be ween he wo g oups (χ² = 0.426, p = 0.692). [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 5 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1¦ 2025 47 Table1. Dis ibu ion o he s a is ical sample acco ding o age, gende , esidence s a us in wo g oups Va iables G oup Independen es - 𝝌𝟐 Sig. Expe imen al g oup (doughnu ) M+SD Con ol g oup M+SD Age 23.11 ±3.74 23.86 ±3.29 =1.912 d =55 p = 0.58 Gende Male F 16 (0.47) F 15 (0.46) 𝜒2=0.426 d =1 p = 0.692 Female F 18 (0.53) F 17 (0.54) Residence Do mi o y F 13 (0.38) F 15 (0.46) 𝜒2=0.0364 d =1 p = 0.587 P i a e F 9 (0.27) F 7 (0.23) Ren al F 12 (0.35) F 10 (0.31) Abb e ia ions: M, Mean; SD, s anda d de ia ion; F, F equency; X2, Chi-squa e es ; Sig, s a is ical signi icance. Addi ionally, he able p o ides in o ma ion on he esidence s a us o he pa icipan s. I shows ha 38% o s uden s in he in e en ion g oup li e in a do mi o y, compa ed o 46% in he con ol g oup. Fu he mo e, 27% o s uden s in he in e en ion g oup eside in a p i a e house. In compa ison, 23% o hose in he con ol g oup do he same. This da a con ibu es o unde s anding he demog aphic cha ac e is ics o he sample. In addi ion, 35% o hem in he in e en ion g oup and 31% in he con ol g oup li e in en ed houses. The Chi-squa e es esul s indica ed no s a is ically signi ican di e ence be ween he wo g oups ega ding hei s a e o esidence, wi h a p- alue o 0.587. Assessing he da a o no mal dis ibu ion is essen ial be o e conduc ing a ious s a is ical es s on he collec ed da a. To accomplish his, he Kolmogo o -Smi no es was pe o med on he main a iables o he s udy o e alua e hei dis ibu ion cha ac e is ics. This p elimina y s ep is c ucial o ensu ing ha he assump ions o subsequen s a is ical analyses a e me . The esul s o his s udy a e p esen ed in Table 2. Based on he da a p esen ed in Table 2, he signi icance le els ob ained o he esea ch a iables a e mo e signi ican han 0.05. I shows ha he da a has a no mal dis ibu ion, and pa ame ic s a is ical es s can be used o check hese da a. Table 2. Kolmogo o -Smi no es S a is ical index Mo i a ion o p og ess Academic sel - egula ion Z 0.83 0.96 p- alue 0.177 0.150 Sig. 0.412 0.368 Abb e ia ions: p- alue, p obabili y alue indica ing he signi icance le el o he co ela ion coe icien ; Z, es s a is ic alue; P, p obabili y- alue; Sig, s a is ical signi icance. Table 3 demons a es a signi ican di e ence be ween he a e age sco es o bo h a iables when compa ing p e- es and pos - es esul s among s uden s in he wo g oups, wi h his di e ence being s a is ically signi ican (p < 0.0001). Howe e , he wo g oups had no signi ican s a is ical di e ence in he p e- es sco es, indica ing ha he mean sco es we e nea ly iden ical be o e he in e en ion (p = 0.316 o he i s a iable and p = 0.602 o he second a iable). This sugges s ha while he in e en ion had a no able impac on pos - es sco es, he g oups s a ed wi h simila baseline pe o mances. Based on he esul s ob ained om Le ine's es , he ob ained signi icance le el (0.425) is g ea e han he c i ical alue a he 0.95 le el (0.05), so he p edic ion o he assump ion o homogenei y o a iance is con i med. The esul s o co a iance analysis show ha he e is a signi ican di e ence be ween he academic sel - egula ion o he in e en ion and con ol g oups (p < 0.01) and F = 20.83. I s squa e equals 0.62; 62% o he educa ional sel - egula ion is ela ed o implemen ing educa ion h ough doughnu ounds. In o he wo ds, he educa ion by doughnu ound eaching me hod signi ican ly a ec s medical s uden s' academic sel - egula ion (Table 4). In addi ion, he esul s o co a iance analysis in Table 5 show ha he e is a signi ican di e ence be ween he p og ess mo i a ion o he in e en ion and con ol g oups (p < 0.01) and F = 31.06. I s squa e equals 0.66; 66% o he p og ess mo i a ion is ela ed o implemen ing aining h ough he doughnu ound. In o he wo ds, eaching using he doughnu ound me hod signi ican ly a ec s he mo i a ion le el o medical s uden s. [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 6 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion 48 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025 Table 3. Pai ed - es o check he di e ence be ween he a e age sco es in he p e- and pos - es o s uden s in wo g oup Time Va iable S ep/ g oup Mean SD T p- alue Be o e Academic sel - egula ion Expe imen al 24.09 6.236 19.061 0.316 Con ol 26.71 5.912 A e Academic sel - egula ion Be o e 47.13 7.210 15.803 0.001 A e 27.01 4.328 Be o e Mo i a ion o p og ess Expe imen al 57.16 6.850 18.976 0.602 Con ol 58.71 7.489 A e Mo i a ion o p og ess Expe imen al 128.36 8.366 19.414 0.001 Con ol 60.42 8.514 No e: Pai ed - es was used o compa e he mean sco es o s uden s be o e and a e he in e en ion in bo h expe imen al and con ol g oups. Abb e ia ions: M, mean; SD, s anda d de ia ion; p- alue, p obabili y alue indica ing he signi icance le el o he co ela ion coe icien ; T, -s a is ic alue. Table 4. The esul s o co a iance analysis o wo expe imen al and con ol g oups in he le el o academic sel - egula ion Academic sel - egula ion Sum o squa es d Mean squa e F Sig. amoun o e ec S a is ical powe Pos - es (in e en ion g oup) 24.90 1 48.53 20.83 0.001 0.62 0.05 Pos - es (Con ol) 24.68 179 42.37 8.66 0.1 0.11 - g oup 6.204 1 9.480 34.24 0.000 -- 0.01 E o 19.10 4 68.39 - - - - To al 116.51 185 - - - - - No e: Analysis o co a iance (ANCOVA) was used o examine he di e ence in academic sel - egula ion be ween he expe imen al and con ol g oups, adjus ing o p e- es sco es. Abb e ia ions: F, analysis o a iance es ; Sig, s a is ical signi icance; p, p obabili y- alue; d , deg ees o eedom. Table 5. The esul s o co a iance analysis o wo expe imen al and con ol g oups in he le el o p og ess mo i a ion Academic sel - egula ion Sum o squa es d Mean squa e F Sig. Amoun o e ec S a is ical powe Pos - es (in e en ion g oup) 73.15 1 96.23 31.06 0.001 0.66 0.05 Pos - es (con ol) 36.19 66 46.70 4.34 0.1 0.07 - G oup 9.382 1 11.581 42.05 0.000 - 0.01 E o 15.36 4 52.21 - - - - To al 123.79 37 - - - - - No e: Analysis o co a iance (ANCOVA) was used o examine he di e ence in p og ess mo i a ion be ween he expe imen al and con ol g oups, adjus ing o p e- es sco es. Abb e ia ions: F, analysis o a iance es ; Sig, s a is ical signi icance; p, p obabili y- alue; d , deg ees o eedom. [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 7 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1¦ 2025 49 Discussion This s udy compa ed he e ec s o he adi ional lec u e and doughnu ound eaching me hods on medical s uden 's academic mo i a ion and sel - egula ion. Compa ed o he con ol g oup, he esul s showed a signi ican imp o emen in academic mo i a ion and sel - egula ion in he doughnu ound in e en ion g oup. The e we e s a is ically signi ican di e ences be ween he p e- es and pos - es sco es (p < 0.01), indica ing ha s uden s in he doughnu ound eaching g oup demons a ed highe engagemen and imp o ed lea ning ou comes. The con ol g oup was gi en lec u e-based ins uc ion and did no see hese gains. This indica es how well he doughnu ound eaching me hod p omo es sel -di ec ed skills and ac i e lea ning. Doughnu ound eaching is an inc easingly popula sel - di ec ed lea ning echnique ha is being p og essi ely added o medical cu icula. Sel -di ec ed lea ne s use a ious esou ces o lea n independen ly o wi h li le help om o he s. As his skill becomes mo e widely acknowledged as a equi ed compe ency in hei educa ion, all s uden s pu suing clinical ields should acqui e i [10]. E idence has shown ha he sel -di ec ed lea ning app oach has many ad an ages o e di ec aining, such as lec u es [11]. S udies [10-12] show ha , in addi ion o being used in medicine, doughnu ounds ha e also been used as in o mal discussion sessions o cu iculum de elopmen in o he disciplines, such as nu sing, and ha e ecen ly become popula a Ox o d Uni e si y. I has achie ed a lo , and so a , i has been used o each unde g adua e s uden s a ious subjec s such as su ge y, ana omy, pedia ics, eme gency, and medicine. P o esso s can implemen i in a ious o he subjec s. The sel - egula ion s a egy is one o he mos impo an in e nal ac o s con ibu ing o academic p og ess. I acili a es lea ning and helps s uden s manage hei beha io by enabling hem o espond o he s imuli hey c ea e hemsel es. Fo his eason, i has always been he ocus o educa ion specialis s and he main subjec o a signi ican pa o he esea ch conduc ed in he coun y. An in es iga ion by Zhang and colleagues was named " Suppo ed Sel -Di ec ed Lea ning o Clinical Ana omy: A Pilo S udy o Doughnu Rounds." In his s udy, 17 i s -yea medical s uden s used he doughnu ound me hod o lea n he clinical ana omy o he lowe limb in small g oups o e six weeks (one-hou sessions). Las ly, he e was a 77% inc ease in he s uden s' sel -con idence and an 87% inc ease in hei lowe ana omy lea ning a e. Acco ding o his s udy, using he doughnu ound has enhanced s uden s' unde s anding o he lowe ana omy opic. I can be applied o any numbe o s uden s. A opic should be applied in di e en ields o medicine [10]. Buls ode e al. [13] conduc ed a andomized con olled ial compa ing adi ional lec u es and he doughnu ound me hod o eaching medical s uden s abou auma and o hopedics. Thei s udy aimed o assess which eaching me hods be e acili a ed knowledge ans e among medical s uden s. One hund ed six s uden s om Ox o d uni e si y pa icipa ed in he ial, and hey we e andomly di ided in o wo g oups: one ecei ing adi ional lec u es and he o he unde going he doughnu ound me hod. The esea che s adminis e ed a p e- es , ollowed by h ee pos - es s conduc ed a di e en in e als: one a he end o he 4 h week, ano he a he end o he 10 h week, and he las a he end o he 17 h week. The a e age sco es om bo h eaching me hods we e compa ed ac oss hese h ee- ime poin s. The esul s indica ed ha he doughnu ound me hod yielded a e age sco es o 41.0 in he 4 h week, 36.3 in he 10 h week, and 38.7 in he 17 h week. In compa ison, he lec u e me hod achie ed a e ages o 40.1 in he 4 h week, 37.3 in he 10 h week, and 38.1 in he 17 h week. No signi ican di e ences be ween he wo me hods we e obse ed a hese h ee s ages. This s udy concluded ha he doughnu ound me hod was less e ec i e han he lec u e me hod o eaching auma concep s, con as ing ou indings. The key indings o ou s udy, which indica e signi ican imp o emen s in sel - egula ion and academic mo i a ion using he doughnu ound me hod, a e di ec ly compa ed o simila esul s om he s udies conduc ed by Zhang e al. [10]. Fu he mo e, he dis inc ions ound in he s udy by Buls ode e al., [13] ha con as ed he lec u e and doughnu ound app oaches o eaching auma concep s ha e been ho oughly examined. The ype o ins uc ion, indica ing ha he doughnu ound eaching app oach wo ks bes in subjec s ha call o g ea e sel -con ol and ac i e engagemen , explains hese a ia ions. Ano he esea ch p ojec used he doughnu ounds me hod a a uni e si y o p omo e ac i e lea ning in a la ge class se ing. I p o ed ha his in e ac i e app oach aised s uden s' con idence in hei subjec ma e and enhanced engagemen . Acco ding o eedback, s uden s enjoyed he o ma mo e han adi ional lec u es, which suppo he idea ha g oup lea ning can g ea ly impac knowledge e en ion and academic achie emen [27]. The esul s o hese s udies [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 8 / 12 Khodabakhsh e al . : Doughnu ound eaching and lec u e me hods on mo i a ion and sel - egula ion 50 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025 a e consis en wi h he p esen s udy's indings and show he posi i e e ec o implemen ing he doughnu ound eaching. The ac i e engagemen o s uden s in he doughnu ound eaching me hod has led o imp o ed lea ning o he cou se ma e ial. As a esul , hey ha e ob ained mo e academic sel - egula ion sco es in he knowledge assessmen es . A he same ime, he lea ne s who pa icipa e in he lec u e me hod some imes o ge he ma e ial due o elying on hei memo y. Hence, he p obabili y o emembe ing ha ma e ial du ing he es is low. This esul con i ms ha implemen ing he doughnu ound me hod compa ed o he lec u e me hod has a emendous e ec on inc easing he mo i a ion and unde s anding o lea ne s. In o he wo ds, he doughnu ound eaching me hod encou ages mo e se ious pa icipa ion and highe le els o engagemen om lea ne s. This c ea es a mo e conduci e en i onmen o unde s anding ela ionships, ul ima ely leading o mo e s able lea ning ou comes o hem [19-20]. The e o e, hey can ha e a deepe unde s anding o educa ional ma e ials by be e using hei powe o easoning and judgmen in he con ex o he opics aised in he class. Acco ding o Soh abi e al., eaching ope a ing oom nu sing s uden s—especially hose in hei senio yea — h ough he i ual doughnu ound me hod is mo e e ec i e han adi ional lec u es [28]. In a s udy Ra elle JT e al concluded ha doughnu ounds ha e been used success ully in ma ine science classes o encou age s uden pa icipa ion. Compa ed o adi ional eaching me hods, he esul s show ha s uden s el mo e engaged and could be e connec heo e ical concep s wi h eal-wo ld applica ions [29]. In a s udy, Buls ode e al. [30] hin ed a how doughnu ounds a ec medical s uden s' clinical easoning abili ies and hei sel - assu ance when using hese abili ies in p ac ical si ua ions. The au ho s disco e ed ha s uden s' con idence and eamwo k had conside ably inc eased. In a s udy, Elbasa eeny e al. [31] ound ha a ious c ea i e eaching echniques, such as doughnu ounds, imp o e medical ainees' eamwo k and communica ion. Acco ding o he esul s, hese ounds p omo e a mo e coope a i e lea ning a mosphe e. Ou indings align wi h ea lie esea ch, showing ha he doughnu ound eaching app oach signi ican ly imp o es s uden mo i a ion, sel -con ol, and engagemen . Ra elle JT e al [29], o example, showed how he doughnu ound me hod enhances s uden engagemen and connec ion o he subjec ma e by encou aging ac i e lea ning in ma ine science educa ion. Simila ly, Buls ode e al. [30] disco e ed ha medical s uden s exp essed g ea e con idence and enhanced clinical easoning abili ies a e in oducing doughnu ounds. Elbasa eeny e al. [31-32] also emphasized how his c ea i e s a egy encou ages ainee coope a ion and communica ion, which suppo s he doughnu ound me hod's e icacy in educa ional se ings. Toge he , hese s udies suppo he doughnu ound eaching me hod's bene icial e ec s on s uden lea ning ou comes, consis en wi h he no able gains we ound in ou esea ch. The doughnu ound-based eaching app oach acili a es lea ning, os e s deep lea ning, and boos s s uden pa icipa ion and sel - egula ion abili ies. This me hod should be used mo e in he educa ion o lea ne s in a ious ields o medical sciences. One o he main limi a ions o his s udy was he ela i ely small sample size, which may es ic he gene alizabili y o he esul s o la ge popula ions. Also, mo e han h ee mon hs o in e en ion implemen a ion ( h ee mon hs) may be equi ed o ully e alua e he long- e m e ec s o he doughnu ound me hod on sel - egula ion and achie emen mo i a ion. O he limi a ions include using sel - epo ques ionnai es o assess mo i a ional and sel - egula o y a iables, which may ha e been a ec ed by subjec i e ac o s o esponse bias. Also, his s udy was conduc ed in a speci ic educa ional en i onmen , and i s esul s may need o be mo e gene alizable o o he uni e si ies o academic ields. Se e al in eg a ed s eps a e ecommended o implemen he doughnu ound eaching me hod e ec i ely in medical educa ion. T aining wo kshops can be conduc ed o amilia ize acul y membe s wi h key ac ics, like ime managemen du ing ounds and os e ing an in e ac i e en i onmen , so hey can success ully inco po a e his me hod in o hei ins uc ion. Designa ing pa icula in e ac i e lea ning spaces in educa ional ins i u ions can also enhance he collabo a i e na u e o his app oach by mo i a ing s uden s o engage wi h he ma e ial and ac i ely pa icipa e. Examining a hyb id eaching model ha inco po a es aspec s o doughnu ounds wi h adi ional lec u es could imp o e s uden engagemen and accommoda e a a ie y o lea ning s yles, especially conside ing he bene i s o combining adi ional and in e ac i e echniques. Las ly, longi udinal s udies ha moni o s uden s' sel - egula ion, academic mo i a ion, and clinical compe encies o e ime o e essen ial insigh s [ DOI: 10.61186/edcj.18.1.42 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 9 / 12