The ‘Spoil Syndrome’: From Textbooks to Tabs – Exploring the Paradigm Shift from Textbook Learning to Internet Dependence among MBBS Undergraduates.

Abstract

Objective: To evaluate the patterns and extent of internet and artificial intelligence (AI) use among MBBS students in private medical colleges of Punjab, Pakistan, with attention to gender-based differences, and to compare their perceived outcomes of textbook-based learning versus digital/AI-assisted learning. The study will reference the phenomenon of “spoil syndrome,” defined as superficial, exam-oriented learning that arises from over-dependence on internet and AI resources.
Methodology: This cross-sectional, questionnaire-based study was conducted from September 2024 to February 2026 in three private medical colleges of Punjab, Pakistan, among students from first to final year. A pre-tested, semi-structured questionnaire assessed demographics, devices and access, preferred sources, learning activities, and per-ceived outcomes. Of 1615 students approached, 1336 met the inclusion criteria and responded. Gender differences were tested using chi-square (α=0.05).
Results: AI awareness was high among both female and male students (83.0% vs. 87.5%; p=0.082). However, males reported significantly greater daily use of AI tools (88.3% vs. 71.1%; p<0.001) and a stronger preference for AI over con-ventional internet resources (80.2% vs. 69.5%; p<0.001). The primary applications of AI included concept clarification (65%), quick revision summaries (60%), and MCQ/quiz generation (59.5%) (all p<0.001), whereas its use for research and methodology support remained low (11.5%). Learning preferences indicated a clear inclination toward blended ap-proaches, with 38.5% favoring books plus internet/AI and 29.5% preferring slides plus internet/AI. Only 4.5% of students relied exclusively on internet/AI resources. Among AI platforms, ChatGPT emerged as the most frequently used tool (44.2%). Students perceived that internet/AI use enhanced their digital skills, motivation, and receptiveness to learning.
Conclusion: Students mainly use AI alongside conventional resources, but its concentration in exam-oriented tasks indicates a risk of superficial learning. The findings are self-reported, cross-sectional, and limited to private colleges, and are therefore exploratory. Curricular policies, faculty training, and assessment reform are needed to promote ethical, critical use of AI alongside textbooks and to prevent “spoil syndrome.”
Keywords: Spoil syndrome; artificial intelligence; internet-based learning; medical education; MBBS students; Pakistan.