Effectiveness of practicing with an e-learning tool based on an error-driven learning algorithm in physiology education

Physiology is an essential component of clinical education. However, because physiology requires understanding of causal mechanisms and integrated physiological processes, many healthcare students experience difficulties during the early stages of learning, particularly when prior knowledge is insufficient. These difficulties may increase the risk of subsequent academic problems. Therefore, effective approaches are required to support introductory physiology education. In this study, we developed an e-learning tool conceptually based on error-driven learning theory and implemented it in a physiology course for first-year students at a health science university. Unlike conventional tools, this tool was designed to support correction of incorrect recall by linking feedback on errors with the selection of subsequent questions. We then evaluated the effectiveness of the tool using objective measures from students' activity logs and final examination performance. More repetitions were associated not only with higher accuracy on practice questions but also with higher final examination scores, even after adjusting for pre-admission academic aptitude test scores and initial accuracy. These results suggest that, in the early stages of the course, engagement with the e-learning tool was associated with improved examination performance, even after adjusting for baseline academic aptitude and prior knowledge, although causal inference is limited by the observational design. Therefore, e-learning tools designed to emphasize error-driven learning may provide an effective approach to support early-stage physiology education for healthcare students.