Abstract
This study explores the impact of learner autonomy on academic performance in a free, non-mandatory online heart sound auscultation course, emphasizing the enhancement of online learning outcomes through learner autonomy. Medical students and doctors were recruited via WeChat groups and participated in four 2-hour live sessions over four weeks, delivered through Plaso teaching software. Participants engaged with real heart sounds using in-ear headphones and were evaluated through random questions during lectures and a comparison of scores on ten heart sound auscultation questions before and after training. Results from 122 doctors and 77 medical students showed that 146 (73%) attended and 46 (23%) completed all sessions, with heart auscultation scores improving significantly from 40 to 70 (p = 0.000). Full participation and active engagement were key predictors of successful exam performance, while intrinsic motivation correlated with complete course attendance (P = 0.045). Moreover, ROC curve analysis revealed that outstanding learners spent more time reviewing post-class materials. The study concludes that while learner autonomy is crucial for success in voluntary online courses, sole reliance on autonomy may not suffice. Effective learning requires identifying intrinsic needs, full participation, active interaction, and additional review. Course designers are advised to recruit learners precisely, incorporate interactive elements, and promote post-class review to enhance learner autonomy.