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Background: Teaching surgery to students means covering two main learning fields: theoretical knowledge and practical skills. The objective of this study was to compare a multimedia-based surgical procedure manual to a text-based one in a student population. Methods: This randomized controlled trial in a pre-post-retention test design was conducted online with the participation of 101 medical students. Subjects studied the performance of a laparoscopic cholecystectomy either in a multimedia-based (MMG) or text-based (TG) presentation. The post-test surveyed the knowledge gain and 3 months later a retention test assessed the sustainability of that knowledge. Results: The study showed a significant knowledge gain in the intragroup comparison. Regarding the procedural knowledge, the MMG scored significantly higher in Δpost-test with 3.84 (MMG) vs 2.98 (TG) correct answers (p = 0.040). This finding was confirmed in the retention test. The MMG (7.17) scored overall significantly higher than the TG (6.41) with correct answers (p = 0.028). Conclusions: Multimedia-based learning can be regarded as an alternative to text-based learning. Students learn factual knowledge equally well with both devices but the MMG scored higher in procedural and more complex knowledge. [ABSTRACT FROM AUTHOR]