Low-Cost, High-Impact Teaching in Pharmacology: A Mixed-Methods Study Assessing the Effectiveness of a Ball-and-Balloon Activity on Student Engagement and Learning Outcomes

Background Pharmacology education often relies on didactic lectures, leading to challenges in maintaining student engagement and translating abstract drug mechanisms into a concrete understanding. This is particularly challenging in resource-constrained settings where access to high-fidelity simulations is limited. In alignment with competency-based medical education (CBME) principles, there is a pressing need for affordable, innovative, and highly impactful teaching-learning (T-L) methods that foster deep conceptual understanding and positive professional attitudes. Methods A pre- and post-intervention, mixed-methods study was conducted among second-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students (n=50) in Puducherry, India. The topic of instruction was 'Drugs acting on the uterus.' The intervention involved a 60-minute didactic lecture followed immediately by a 15-minute hands-on Ball-and-Balloon activity, where students used a small plastic ball (representing the fetus) inside an inflated, inverted balloon (representing the uterus) to visualize the actions of uterotonic and tocolytic drugs. Knowledge was assessed using a validated 10-point questionnaire (pre- and post-test). Student feedback on engagement and attitude was collected via Likert scales and open-ended questions. Quantitative data were analysed using a paired t-test, and qualitative feedback underwent thematic analysis. Results The mean post-test score (<i>x</i>=9.2±0.8) was significantly higher than the mean pre-test score (<i>x</i>=7.0±1.5), demonstrating a substantial knowledge gain (<i>p</i><0.001). Qualitative analysis identified seven major themes: Creative do-it-yourself learning, learning through positive psychology, reinforcing knowledge, concept-based learning, metacognition experience, positive inclination towards the subject, and multisensory learning experience. Students emphasized the activity's effectiveness in converting abstract concepts into a tangible, memorable experience. Conclusion The Ball-and-Balloon activity is a highly effective, low-cost T-L strategy that significantly improves student knowledge and fosters a positive attitude and deeper engagement with pharmacology. This model serves as a practical, replicable template for resource-limited institutions seeking to integrate active learning and visual teaching tools to meet contemporary CBME and professional development competencies.