Perceived Effectiveness of Paper and Electronic Logbooks Among Clinical-Year Medical Students in the Kurdistan Region of Iraq: A Multi-University Cross-sectional Mixed-Methods Study

Abstract

Background: Logbooks are widely used in medical education to bridge theoretical and clinical learning. Although their effectiveness is well documented internationally, evidence from the Kurdistan Region of Iraq remains limited. Objectives: This study evaluated the effectiveness of paper and electronic logbooks among medical students enrolled at universities in the Kurdistan Region of Iraq and identified factors influencing their satisfaction with and acceptance of logbooks. Methods: A cross-sectional mixed-methods study was conducted among 210 medical students from seven universities in the Kurdistan Region during the 2024 - 2025 academic year. Data were collected using a structured questionnaire assessing demographic characteristics, logbook characteristics, perceived benefits, challenges, and satisfaction. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression, whereas qualitative responses were analyzed using descriptive thematic analysis to identify recurring themes related to perceived benefits, challenges, and suggested improvements. Results: Most participants (63.8%) reported maintaining their logbooks regularly, and nearly half (47.1%) found the templates clear. Logbooks were perceived by 63.8% of students to support learning, particularly for monitoring clinical skills (73.3%) and improving patient interaction (58.6%). Ordinal logistic regression showed that regular logbook use (β = 0.98, P = 0.002) and template clarity (β = 1.04, P < 0.001) were strong positive predictors of satisfaction, whereas unclear guidelines (β = -0.66, P = 0.025) and difficulty recalling details (β = -0.68, P = 0.026) were associated with lower satisfaction. Binary logistic regression indicated institutional differences, with students from Hawler Medical University being significantly less likely to recommend logbooks (OR = 0.15, P = 0.013). Qualitative findings identified themes of improved clinical confidence, enhanced communication skills, and reflective learning, whereas negative perceptions focused on bureaucratic burden and unclear expectations. Conclusions: Logbooks enhance clinical learning, confidence, and reflective practice; however, their effectiveness is limited by time constraints and unclear guidelines. Standardization, faculty engagement, and transitioning to electronic formats are recommended to maximize their educational value in medical training across the Kurdistan Region.