Is It Time to Turn the Screens Off? A Randomised Pilot Study Comparing Digital Slideshow-Based and Tech-Free Teaching Among UK Foundation Doctors

Introduction/Background Digital slideshow-based teaching has become the dominant instructional format in postgraduate medical education, often adopted by institutional default rather than deliberate pedagogical choice. Existing research frequently conflates pedagogical design with presentation medium, making it difficult to isolate the specific effect of teaching format on learner engagement. This study examines whether the teaching medium itself influences learner engagement and knowledge acquisition when pedagogical design and instructional quality are held constant. Methods A randomised comparative pilot study was conducted within a single UK National Health Service (NHS) trust between October and December 2025. Foundation Year 1 doctors attended scheduled postgraduate teaching sessions delivered in either a digital slideshow-based or tech-free format across five clinical topics. Content, facilitator, cases, and session duration were identical across formats. The primary outcome was self-reported learner engagement (10-point Likert scale); secondary outcomes were immediate knowledge acquisition (multiple-choice question (MCQ)) and additional engagement measures. Qualitative free-text responses were analysed using thematic content analysis. Evaluation/Results 61 session attendances were recorded (slideshow n = 34; tech-free n = 27) with 100% questionnaire completion. Tech-free teaching was associated with a statistically significantly higher engagement score (adjusted mean difference 0.73 points; 95% CI 0.06–1.40; p = 0.034). No statistically significant difference in knowledge acquisition was observed (adjusted mean difference 3.6 percentage points; 95% CI –3.6 to 10.9; p = 0.326). Three qualitative themes were identified: interactivity and active participation; shared educational strengths across formats; and learner-related factors influencing attention. Discussion/Implications When pedagogical design was held constant, teaching medium appeared to influence learner engagement — consistent with cognitive load theory. These findings do not advocate abandoning technology but support more deliberate format selection in postgraduate medical education. Conclusion Teaching medium may independently influence learner engagement in postgraduate medical education without compromising short-term knowledge acquisition. Further multi-centre research is needed to confirm these findings.