Digital versus print reading modalities and their association with academic performance and motivation among medical students: a cross-sectional study from Syria

The shift from print to digital reading in medical education raises questions about its impact on learning outcomes. Existing evidence remains inconclusive, particularly in resource-constrained settings where digital infrastructure and reading practices differ from Western contexts. To examine the association between digital versus print reading modalities and academic performance, and to explore the relationship between digital reading behaviors and strength of motivation among medical students in Syria. A cross-sectional survey of 550 medical students (years 2–6) assessed study modality habits, academic performance (GPA, course failures), Strength of Motivation for Medical School-Revised (SMMS-R), and digital reading behavior constructs. Stratified consecutive sampling with proportional allocation across academic years was employed to ensure balanced year-level representation. Statistical analyses included t-tests, ANOVA, chi-square, Pearson correlations, and multiple linear regression. Reading modality showed no significant association with GPA ( p =.327). However, students with 76–100% screen-based study engagement had the highest proportion of single-subject failures (42.8%). Mean SMMS-R score was 52.77 ± 7.79/75; motivation scores were significantly lower in more advanced academic years ( p =.003). Device access and geographic location were consistently associated with differences in digital reading behaviors. Regression analysis revealed willingness to use (β = 0.151, p =.022) and performance expectations (β = 0.133, p =.022) as positive predictors of motivation, while social environment impact was a negative predictor (β=-0.124, p =.015; R²=0.044, p =.003). No significant association was detected between reading modality and GPA in this sample, though higher screen-based study engagement correlated with a greater proportion of course failures. Motivation scores were lower among more advanced academic-year groups in cross-sectional comparison. Willingness to use digital resources and performance expectations were positively associated with motivation scores, whereas social environment impact was negatively associated; these associations should be interpreted in light of the limited explained variance and the inability of the cross-sectional design to establish the direction of effects. These findings inform evidence-based integration of digital resources in medical curricula.