E-Learning Modules Based on Bloom Taxonomy and the Miller Pyramid for First-Year Indian Medical Students: Randomized Controlled Study in Medical Education

Background: Competency-based medical education (CBME) in India emphasizes early competency formation, higher-order cognitive processing, and self-directed learning. Although e-learning is widely adopted, there is limited evidence on structured e-modules explicitly designed using Bloom taxonomy and the Miller pyramid for Indian MBBS students. Objective: This study aims to design, validate, implement, and evaluate CBME-aligned e-modules for first-year MBBS foundational subjects (anatomy, physiology, and biochemistry) and to compare their effectiveness with traditional teaching on cognitive, psychomotor, and affective learning outcomes using Kirkpatrick levels 1 and 2. Methods: A randomized controlled study was conducted among 690 first-year medical undergraduates (control: n=370; intervention: n=320). The intervention group received Sharable Content Object Reference Model-based interactive e-modules through Moodle (Modular Object-Oriented Dynamic Learning Environment) in addition to standard lectures, while the control group received lectures only. e-Modules were designed using Bloom taxonomy and the Miller pyramid, validated by internal and external experts, and implemented following Kern 6-step approach. Learning outcomes were assessed using structured feedback (Kirkpatrick level 1) and end-of-block internal assessments comprising multiple choice questions, short notes, and objective structured clinical examinations (Kirkpatrick level 2). Results: Students in the intervention group performed significantly better across all cognitive levels compared with the control group: remember (mean 6.52, SD 2.24 vs mean 5.26, SD 2.89; P<.001), understand (mean 2.92, SD 1.45 vs mean 2.55, SD 1.13; P<.001), apply (mean 3.43, SD 1.06 vs mean 2.56, SD 1.08; P<.001), and analyze (mean 3.01, SD 0.83 vs mean 2.53, SD 1.11; P<.001). Psychomotor scores (objective structured clinical examination manipulation: mean 4.55, SD 1.12 vs mean 4.10, SD 1.42; P<.001) and affective domain scores (mean 3.02, SD 0.81 vs mean 2.03, SD 0.81; P<.001) were also significantly higher in the intervention group. Subgroup analysis showed the largest gains among medium achievers across domains. Conclusions: CBME-aligned e-modules significantly enhanced student performance in cognitive, psychomotor, and affective domains compared with traditional teaching alone, with particularly pronounced benefits for medium achievers. Well-designed e-modules represent a scalable, adaptable strategy to support CBME implementation across diverse medical education settings in India.