Six semi-structured focused group interviews were conducted ( n = 36). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). The qualitative data were analyzed using the qualitative content analysis method. the F2F lecture-based teaching of fundus examination. Next, we conducted student focus groups to explore the students’ thinking processes in the flexible e-learning video approach vs. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach’s effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. There is growing evidence suggesting a flexible e-learning video approach’s value in teaching physical examination procedures. Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians’ confidence in performing the funduscopic examination.