When to inquire and when to instruct: Prior knowledge and element interactivity in medical learning

Teaching in medical education often alternates between explicit instruction and inquiry-based learning, yet their optimal sequencing for high-element-interactivity content as a function of prior knowledge remains unclear. This study investigated whether sequencing explicit instruction before inquiry, or inquiry before explicit instruction, differentially affects learning of pharmacology concepts with high element interactivity. Participants were 211 undergraduate prehospital care students. In a randomised design, students were assigned to either explicit instruction before inquiry or inquiry before explicit instruction. Prior knowledge was measured via a pre-test and included as a continuous variable. Post-test performance was analysed using ANCOVA. All participants completed an identical clinical simulation. The main effect of prior knowledge was non-significant, whereas the main effect of instructional sequence was significant, indicating that students in the explicit instruction before inquiry condition outperformed those in the inquiry before explicit instruction condition on the post-test. A significant interaction between instructional sequence and prior knowledge was also found. For students with lower prior knowledge, explicit instruction before inquiry led to higher performance. For students with higher prior knowledge, the reverse sequence was more effective. Findings are consistent with cognitive load theory and the expertise reversal effect. Explicit instruction before inquiry benefited learners with lower prior knowledge, whereas the reverse sequence was more effective for those with higher prior knowledge. Aligning instructional sequence with prior knowledge may optimise conceptual learning in complex domains such as medical education. • Adaptive sequences integrate explicit instruction and inquiry-based activities. • Optimal order depends on element interactivity and prior knowledge. • Explicit-inquiry sequencing is more effective for low prior knowledge. • Inquiry-explicit sequencing is more effective for higher prior knowledge. • Cognitive load theory guides instruction in complex domains like medical education.