Application of problem based learning (PBL) and case based learning (CBL) in the teaching of ectopic pregnancy

Application of problem based learning (PBL) and case based learning (CBL) in the teaching of ectopic pregnancy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of problem based learning (PBL) and case based learning (CBL) in the teaching of ectopic pregnancy Weimin Xie, Ya Li, Xiaohang Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5031510/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Objective: The aim of this study is to explore the effectiveness of combining problem-based learning (PBL) and case-based learning (CBL) in clinical teaching of ectopic pregnanancy. Methods: Fifth-year students majoring in clinical medicine were recruited in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from September 2023 to June 2024. The students were randomly assigned into either the combined PBL-CBL group or the traditional group. Students in the experimental group were trained using the combined PBL-CBL teaching method, while those in the traditional group were trained using a lecture based learning (LBL) teaching method. After the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire. Results: The basic knowledge score in the combined PBL-CBL group was significantly higher than in the traditional group (42.6 ± 3.6 vs 35.0 ± 2.3, p = 0.000).Similarly, the case analysis score was higher in the combined PBL-CBL group than in the traditional group (37.1 ± 6.2 versus 33.8 ± 5.7, P = 0.013). The scores for learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than that in the traditional group ( P <0.05 for all). However, the score for how much free time the course consumed in the combined PBL-CBL group was significantly higher than that in the traditional group ( P <0.05). Conclusion: The combined PBL-CBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the combined PBL-CBL teaching method might be a promising new mode for gynecologic education. Ectopic pregnancy problem-based learning case-based learning Introduction According to the Centers for Disease Control and Prevention, ectopic pregnancy accounts for approximately 2% of all reported pregnancies [ 1 ]. Despite improvements in diagnosis and management, ruptured ectopic pregnancy continues to be a significant cause of pregnancy-related mortality and morbidity [ 2 ]. Ectopic pregnancy is a complex and acute condition. Therefore, reforming the teaching method of ectopic pregnancy, cultivating students' logical thinking, and leading students to obtain better learning results in a limited time has become an urgent problem to be solved. Traditional teaching methods do not allow medical students to combine theoretical and practical knowledge. As a traditional teaching method, lecture-based learning (LBL) adopts an “indoctrination” teaching method, taking teachers as the teaching centre, students passively accepting knowledge, which medical students and teachers widely accept, and evidence suggests that LBL is easy to implement, but insufficient for the acquisition of knowledge and can lead to the students’ negligence [ 3 , 4 ]. Problem-based learning (PBL) is a student-centred pedagogy in which participants are allocated to groups of up to eight persons under non-directive tutors and given tasks or challenges that reflect situations relevant to the working environments they are anticipated to experience [ 5 ]. Case-based learning (CBL) is a case-based education method grounded in the analysis of medical records to restore the real clinical scene and prompt students to identify and develop new areas of learning [ 6 ]. However, when used alone, both PBL and CBL present some limitations [7.8]. CBL requires teachers to dedicate much time to preparing sufficient cases to support clinical teaching. At the same time, CBL also requires that teachers create a set of questions for students to discuss, leading to a lack of initiative and general enthusiasm for the learning experience. In contrast, PBL places the student at the centre, leading role during the classroom process. Given their heavy curriculum tasks and commitments, this function requires them to spend much time preparing questions and materials before class, which is extremely difficult for medical students. In addition, PBL emphasizes students' subjective initiative; however, the lack of guidance from teachers could lead to students missing the program focus, which could affect the course's overall quality. PBL is primarily student-driven, whereas CBL is collaborative [ 9 ]; we hypothesize that PBL and CBL are mutually complementary and that a combined PBL-CBL teaching method can better promote effective, high-quality student learning. In this study, we combined PBL with the CBL teaching method for clinical teaching of ectopic pregnancy. We assessed whether the combined PBL-CBL teaching method could compensate for the inadequacy of traditional teaching by improving learning interest and enhancing understanding of ectopic pregnancy. Materials and Methods This was a prospective, randomized, controlled study. We recruited fifth-year students majoring in clinical medicine in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from September 2023 to June 2024. The students were randomly assigned into either the combined PBL-CBL group, featuring a combined PBL-CBL teaching method, or the traditional group, featuring an LBL teaching method. An independent statistician prepared a randomization table using SAS (SAS Institute, Cary, NC, USA) software, and study participants were assigned using the simple randomization method. Neither the students nor the teachers knew the group information before the class started (double blind). The study was conducted with the approval of the hospital's institutional ethics committee. Written informed consent was obtained from each participant. The schedule for the combined PBL-CBL group was as follows. Before each class, the teacher prepared lecture videos and Supplemental materials, providing students with relevant information on typical clinical cases and five reference papers related to the course topic. The students were required to review these materials in their spare time outside of class. Before beginning the course, the teacher briefly introduced the topic and the class agenda. Next, a patient case with slides was presented as the first step in the classroom activities. Then, under the instructor's guidance, the students carried on small-group discussions. During these discussions, the students were encouraged to raise relevant questions and seek answers on the Internet and library databases. In the third step, a student representative from each group made a presentation reviewing the main points from the lesson, shared their group’s responses to the questions posed, and asked about any unsolved questions. Finally, the teacher summarized the course content and reviewed the challenging issues raised during the discussion. The schedule for the traditional group was as follows. Before the lecture, the students were instructed to only preview the course instead of watching videos or reading materials. These students learned the equivalent content via the traditional teaching method. The teacher thoroughly explained the theoretical knowledge within the official framework instead of discussing the cases in a group. In other words, teacher-centred instruction was the predominant method. After the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire. The quizzes comprised basic theoretical questions (worth 50 points) and clinical case analyses (worth 50 points). The anonymous questionnaire comprised nine questions about learning motivation, understanding, student-teacher interaction, how much free time the course consumed, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction[ 10 ]. The evaluation criteria were based on a previous study. The scores were divided into five grades based on the improvement, from 1 (poor) to 5 (excellent). In contrast to the other scored areas, 1 represents the lowest time consumption for free time consumed, while 5 indicates the highest. The reliability of the questionnaire was evaluated. The Cronbach's alpha coefficient was 0.872. Statistical analysis was performed using SPSS version 18 (IBM, Armonk, NY, USA). Continuous data are reported as mean and SD when normally distributed and median and interquartile range (IQR) when not normally distributed. Normally distributed continuous data were analyzed using the Student t-test. The Mann-Whitney U tests analyzed continuous data that was not normally distributed. The categorical data are reported as counts and percentages and were analyzed with χ2 and Fisher exact tests. All tests were two-sided, and p < 0.05 was considered significant. Results From September 2023 to June 2024, 80 students were enrolled and randomly assigned to the combined PBL-CBL group (n = 40) and the traditional group (n = 40). The basic student characteristics are shown in Table 1 . The average age of students was 22.8 ± 0.7 years old in the combined PBL-CBL group and 22.9 ± 0.7 years old in the traditional group; the difference between the two groups was not statistically significant ( P = 0.765). nineteen(47.5%)females were in the combined PBL-CBL group, and twenty-one(52.5%) females were in the traditional group; there was no significant difference between the two groups in gender. The average time spent on pre-class preparation was significantly longer in the combined PBL-CBL group than in the traditional group (9 ± 2.4 vs. 15 ± 3 min, p = 0.0001). Table 1 Comparison of general data between the combined PBL–CBL group and the traditional group. Item PBL–CBL group (N = 40) Traditional group (N = 40) P value Age 22.8 ± 0.7 22.9 ± 0.7 0.765 Gender Male 21(52.5%) 19(47.5%) Female 19(47.5%) 21(52.5%) 0.655 The quiz scores are shown in Table 2 . The basic knowledge score in the combined PBL-CBL group was significantly higher than in the traditional group (42.6 ± 3.6 vs 35.0 ± 2.3, p = 0.000). Similarly, the case analysis score was higher in the combined PBL-CBL group than in the traditional group (37.1 ± 6.2 versus 33.8 ± 5.7, P = 0.013). Accordingly, the total quiz score in the combined PBL-CBL group was higher than that in the traditional group (79.6 ± 6.9 versus 68.7 ± 5.7, P = 0.000). Table 2 The comparison of the post-class test scores of the combined PBL–CBL group vs. the traditional group (for all participants) Items PBL–CBL group (N = 40) Traditional group (N = 40) P value Total post-class score 79.6 ± 6.9 68.7 ± 5.7 0.000 Post-class basic knowledge score 42.6 ± 3.6 35.0 ± 2.3 0.000 Post-class case analysis score 37.1 ± 6.2 33.8 ± 5.7 0.013 The results of the anonymous questionnaire are shown in Table 3 . The scores for learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than in the traditional group ( P < 0.05 for all). However, the score for how much free time the course consumed in the combined PBL-CBL group was significantly higher than in the traditional group ( P < 0.05). Table 3 Comparison of questionnaire survey results between the combined PBL–CBL group and the traditional group. Items PBL–CBL group (N = 40) Traditional group (N = 40) P value Learning motivation 3.7 ± 0.8 3.2 ± 0.6 0.002 Understanding 3.7 ± 0.7 2.8 ± 0.6 0.000 Student-teacher interaction 3.6 ± 0.5 3.3 ± 0.6 0.013 Free time consumed 3.7 ± 0.7 2.5 ± 0.5 0.000 Communication skills 3.9 ± 0.6 2.6 ± 0.7 0.000 Clinical thinking skills 3.6 ± 0.7 2.8 ± 0.7 0.000 Self-learning skills 3.8 ± 0.7 2.5 ± 0.5 0.000 Knowledge absorption 3.8 ± 0.7 2.9 ± 0.8 0.000 Satisfaction with the course 4.2 ± 0.6 3.0 ± 0.6 0.000 Discussion Ectopic pregnancy is a potentially life-threatening condition and the leading cause of maternal mortality within the first trimester of pregnancy, with a rate of 9–14% and an incidence of 5–10% of all pregnancy-related deaths [ 11 ]. Women with nonspecific symptoms such as lower abdominal pain and vaginal bleeding in the first trimester have an ectopic pregnancy prevalence in emergency departments as high as 18%, which can be easily misdiagnosed as the previously described clinical mimics [ 12 ]. Therefore, prompt and accurate diagnosis is paramount, as early detection and treatment can decrease morbidity and mortality. Medical students have a short clinical learning cycle, a long interval between theoretical classes, and limited clinical reasoning ability. Simultaneously, traditional teaching methods focus on teachers while students passively receive theoretical knowledge. The limitation of this model is that teachers only focus on their understanding of the subject matter, failing to fulfil their role of guiding students to cultivate clinical thinking. Furthermore, many medical students lack initiative and creativity, ultimately making it difficult to apply the acquired knowledge to clinical practice [ 13 , 14 ]. Different from traditional teaching methods, PBL and CBL aim to establish real medical scenes and encourage students to adopt an active learning attitude, shifting from a “what I learn” paradigm to “what I want to learn” [ 15 ]. Compared with traditional lecture teaching methods, some studies have demonstrated that either PBL or CBL alone have some advantages and has been described as a promising tool for medical education [ 16 – 18 ]. Considering their respective advantages, our study applied a teaching method integrating PBL and CBL in teaching ectopic pregnancy, allowing them to complement and reinforce each other. To investigate the effectiveness and acceptability of the combined PBL-CBL teaching method in teaching ectopic pregnancy, we compared it with the traditional teaching method. Our study showed no significant difference in basic characteristics between the two groups. However, after the end of learning, the combined PBL-CBL group scored higher than the traditional group in the total quiz, the basic knowledge and the case analysis, demonstrating the effectiveness of the combined PBL-CBL teaching method. The results also indicated that students in the combined PBL-CBL group had formed a comprehensive and organized understanding of ectopic pregnancy, further enhancing their clinical thinking skills. Additionally, we assessed the subjective perceptions and experiences of the students. The results showed that students rated the combined PBL-CBL teaching method highly in learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course. These results also indicated that students in the combined PBL-CBL group tended to adopt a more balanced approach to learning and practice and obtain a higher satisfaction rate with the course, thereby becoming more proactive learners. This agrees with the findings of previous studies [ 10 , 19 – 20 ]. Zhao et al.[ 10 ] the combined PBL-CBL teaching method may improve medical students’ and residents’ performance and enhance their clinical skills and capabilities when learning about thyroid nodules in the Department of Thyroid Surgery. Liu et al. [ 20 ] showed that the PBL-CBL method resulted in better academic knowledge acquisition, case analysis ability and student satisfaction compared with the teacher-centred method in teaching maxillary sinus floor augmentation in implant dentistry. This study had some limitations. First, We assumed that PBL and CBL were mutually complementary and could achieve the best effect when combined. However, no control groups were using PBL or CBL alone in this study, and we could not determine whether the combined method was superior to PBL or CBL alone. Second, some analysis biases were unavoidable due to the lack of blinding in our study. Third, our results were based on one ectopic pregnancy course with a small sample size. Long-term follow-up data were not available to produce more grounded assessments. Therefore, more well-designed, randomized controlled trials with large samples are needed to confirm the effect of the combined PBL-CBL teaching method. In conclusion, our study showed that the students learning ectopic pregnancy with the combined PBL-CBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis than those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the combined PBL-CBL teaching method might be a promising new mode for gynecologic education. Declarations This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Heng Yang Central Hospital. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution YL conceived the idea and reviewed and edited the manuscript. WMX wrote the manuscript. YL and XHL conducted research, selection, data extraction, and statistical analysis. All authors reviewed the manuscript. Acknowledgements Not applicable. Data Availability The datasets obtained and/or analyzed during the current study are available from the corresponding author on reasonable request. References Ectopic pregnancy–United, States. 1990–1992. Centers for Disease Control and Prevention (CDC).MMWR Morb Mortal Wkly Rep. 1995;44:46–8. (Level II-2). Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin 191: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(2):e65–77. Zhang FY, Zhao L, Zeng YL, Xu K, Wen X. A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education. Nurse Educ Today. 2019;79:86–91. Yang WJ, Li H, Su A, Ding LP. Application of problem based learning (PBL) and case based learning (CBL) in the teaching of international classification of diseases encoding. Sci Rep. 2023;13(1):15220. Smits PB, de Buisonjé CD, Verbeek JH, van Dijk FJ, Metz JC, ten Cate OJ. Problem-based learning versus lecture-based learning in postgraduate medical education. Scand J Work Environ Health. 2003;29(4):280–7. Jamkar AV, Burdick W, Morahan P, Yemul VY, Sarmukadum, Singh G. PRoposed model of case based learning for training undergraduate medical student in surgery. Indian J Surg. 2007;69(5):176–83. Nair SP, Shah T, Seth S, Pandit N, Shah GV. Case based learning: a method for better understanding of biochemistry in medical students. J Clin Diagn Res Jcdr. 2013;7(8):1576–8. Sangam MR, Praveen K, Vinay G, Bokan RR, Deka R, Kaur A. Efficacy of case-based learning in anatomy. Cureus. 2021;13(12):e20472. Williams B. Case-based learning: a review of the literature—is there scope for this educational paradigm in prehospital education? Emerg Med J. 2005;22(8):577–81. Zhao WJ, He LY, Deng WY, Zhu JQ, Su AP, Zhang Y. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease. BMC Med Educ. 2020;20(1):381. Houser M, Kandalaft N, Khati NJ. Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls. Emerg Radiol. 2022;29(1):161–72. Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, et al. Guideline 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. J Obstet Gynaecol Can. 2021;43(5):614–e6301. Oderinu OH, Adegbulugbe IC, Orenuga OO, Butali A. Comparison of students’perception of problem-based learning and traditional teaching method in a Nigerian dental school. Eur J Dent Educ. 2020;24(2):207–12. Cantillon P. Teaching large groups. Br Med J. 2003;326(7386):437. Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418–27. Schwartz LR, Fernandez R, Kouyoumjian SR, Jones KA, Compton S. A randomized comparison trial of case-based learning versus human patient simulation in medical student education. Acad Emerg Med. 2007;14(2):130–7. Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide 23. Med Teach. 2012;34(6):e421–44. Kim YJ. The PBL teaching method in neurology education in the traditional Chinese medicine undergraduate students: An observational study.Medicine (Baltimore). 2023;102(39):e35143. Shen J, Yuan LL, Ge RX, Shao XF, Jiang XC. Improving medical student recruitment into neurosurgery through teaching reform. BMC Med Educ. 2022;22(1):656. Liu YF, Xu YM, Li YH, Wu QQ. Application of problem-based learning and case-based learning integrated method in the teaching of maxillary sinus floor augmentation in implant dentistry. PeerJ. 2020;16:8e8353. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 16 Sep, 2024 Editor assigned by journal 13 Sep, 2024 Submission checks completed at journal 13 Sep, 2024 First submitted to journal 04 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5031510","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":354444372,"identity":"cadb8d24-4bb1-4e27-b7b0-c11a442487ad","order_by":0,"name":"Weimin Xie","email":"","orcid":"","institution":"Affiliated Hengyang Hospital of Hunan Normal University \u0026 Hengyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weimin","middleName":"","lastName":"Xie","suffix":""},{"id":354444373,"identity":"38f0a9ba-aa14-499c-bcbc-ea766b171ae5","order_by":1,"name":"Ya Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACPmYg8cHAhoeNvSHxQUJFDWEtbEAtjDMq0uT4eA48Nnhw5hgRWoCYmefMYWM5icRnkg9bmInQws5j+IG3jTmxjSE5rSKxgY2Bv707gYDDeIwlJNvYgFqOpd1I3CHDIHHm7AZCWgwkDNt4EtsYe4BazrAxGEjkEtRi/COxTSKxjZn/WwGQJEqLmcSBMwbGbGwMaQxEamErs2yoSJBj42FIlkg4c4yHoF/4+Q9vvv3H4D+P/PwHiR9/VNTI8bf34tfCwMBhgMLlIaAcBNgfEKFoFIyCUTAKRjQAAOZvQ3xaN2ZxAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hengyang Hospital of Hunan Normal University \u0026 Hengyang Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ya","middleName":"","lastName":"Li","suffix":""},{"id":354444374,"identity":"ad70a4a5-56f7-44e3-bd0e-bfe510ffdf4d","order_by":2,"name":"Xiaohang Liu","email":"","orcid":"","institution":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaohang","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-09-04 12:10:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5031510/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5031510/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06327-9","type":"published","date":"2024-11-22T15:57:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69835147,"identity":"c0cca816-e658-470c-8674-24f511e4f057","added_by":"auto","created_at":"2024-11-25 16:12:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":349712,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5031510/v1/f473543a-870c-4898-8bb6-1a4721d84089.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of problem based learning (PBL) and case based learning (CBL) in the teaching of ectopic pregnancy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the Centers for Disease Control and Prevention, ectopic pregnancy accounts for approximately 2% of all reported pregnancies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite improvements in diagnosis and management, ruptured ectopic pregnancy continues to be a significant cause of pregnancy-related mortality and morbidity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Ectopic pregnancy is a complex and acute condition. Therefore, reforming the teaching method of ectopic pregnancy, cultivating students' logical thinking, and leading students to obtain better learning results in a limited time has become an urgent problem to be solved.\u003c/p\u003e \u003cp\u003eTraditional teaching methods do not allow medical students to combine theoretical and practical knowledge. As a traditional teaching method, lecture-based learning (LBL) adopts an \u0026ldquo;indoctrination\u0026rdquo; teaching method, taking teachers as the teaching centre, students passively accepting knowledge, which medical students and teachers widely accept, and evidence suggests that LBL is easy to implement, but insufficient for the acquisition of knowledge and can lead to the students\u0026rsquo; negligence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProblem-based learning (PBL) is a student-centred pedagogy in which participants are allocated to groups of up to eight persons under non-directive tutors and given tasks or challenges that reflect situations relevant to the working environments they are anticipated to experience [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Case-based learning (CBL) is a case-based education method grounded in the analysis of medical records to restore the real clinical scene and prompt students to identify and develop new areas of learning [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, when used alone, both PBL and CBL present some limitations [7.8]. CBL requires teachers to dedicate much time to preparing sufficient cases to support clinical teaching. At the same time, CBL also requires that teachers create a set of questions for students to discuss, leading to a lack of initiative and general enthusiasm for the learning experience.\u003c/p\u003e \u003cp\u003eIn contrast, PBL places the student at the centre, leading role during the classroom process. Given their heavy curriculum tasks and commitments, this function requires them to spend much time preparing questions and materials before class, which is extremely difficult for medical students. In addition, PBL emphasizes students' subjective initiative; however, the lack of guidance from teachers could lead to students missing the program focus, which could affect the course's overall quality. PBL is primarily student-driven, whereas CBL is collaborative [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; we hypothesize that PBL and CBL are mutually complementary and that a combined PBL-CBL teaching method can better promote effective, high-quality student learning.\u003c/p\u003e \u003cp\u003eIn this study, we combined PBL with the CBL teaching method for clinical teaching of ectopic pregnancy. We assessed whether the combined PBL-CBL teaching method could compensate for the inadequacy of traditional teaching by improving learning interest and enhancing understanding of ectopic pregnancy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a prospective, randomized, controlled study. We recruited fifth-year students majoring in clinical medicine in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from September 2023 to June 2024. The students were randomly assigned into either the combined PBL-CBL group, featuring a combined PBL-CBL teaching method, or the traditional group, featuring an LBL teaching method. An independent statistician prepared a randomization table using SAS (SAS Institute, Cary, NC, USA) software, and study participants were assigned using the simple randomization method. Neither the students nor the teachers knew the group information before the class started (double blind). The study was conducted with the approval of the hospital's institutional ethics committee. Written informed consent was obtained from each participant.\u003c/p\u003e \u003cp\u003eThe schedule for the combined PBL-CBL group was as follows. Before each class, the teacher prepared lecture videos and Supplemental materials, providing students with relevant information on typical clinical cases and five reference papers related to the course topic. The students were required to review these materials in their spare time outside of class. Before beginning the course, the teacher briefly introduced the topic and the class agenda. Next, a patient case with slides was presented as the first step in the classroom activities. Then, under the instructor's guidance, the students carried on small-group discussions. During these discussions, the students were encouraged to raise relevant questions and seek answers on the Internet and library databases. In the third step, a student representative from each group made a presentation reviewing the main points from the lesson, shared their group\u0026rsquo;s responses to the questions posed, and asked about any unsolved questions. Finally, the teacher summarized the course content and reviewed the challenging issues raised during the discussion.\u003c/p\u003e \u003cp\u003eThe schedule for the traditional group was as follows. Before the lecture, the students were instructed to only preview the course instead of watching videos or reading materials. These students learned the equivalent content via the traditional teaching method. The teacher thoroughly explained the theoretical knowledge within the official framework instead of discussing the cases in a group. In other words, teacher-centred instruction was the predominant method.\u003c/p\u003e \u003cp\u003eAfter the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire. The quizzes comprised basic theoretical questions (worth 50 points) and clinical case analyses (worth 50 points). The anonymous questionnaire comprised nine questions about learning motivation, understanding, student-teacher interaction, how much free time the course consumed, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The evaluation criteria were based on a previous study. The scores were divided into five grades based on the improvement, from 1 (poor) to 5 (excellent). In contrast to the other scored areas, 1 represents the lowest time consumption for free time consumed, while 5 indicates the highest. The reliability of the questionnaire was evaluated. The Cronbach's alpha coefficient was 0.872.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SPSS version 18 (IBM, Armonk, NY, USA). Continuous data are reported as mean and SD when normally distributed and median and interquartile range (IQR) when not normally distributed. Normally distributed continuous data were analyzed using the Student t-test. The Mann-Whitney U tests analyzed continuous data that was not normally distributed. The categorical data are reported as counts and percentages and were analyzed with χ2 and Fisher exact tests. All tests were two-sided, and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom September 2023 to June 2024, 80 students were enrolled and randomly assigned to the combined PBL-CBL group (n\u0026thinsp;=\u0026thinsp;40) and the traditional group (n\u0026thinsp;=\u0026thinsp;40). The basic student characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of students was 22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years old in the combined PBL-CBL group and 22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years old in the traditional group; the difference between the two groups was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.765). nineteen(47.5%)females were in the combined PBL-CBL group, and twenty-one(52.5%) females were in the traditional group; there was no significant difference between the two groups in gender. The average time spent on pre-class preparation was significantly longer in the combined PBL-CBL group than in the traditional group (9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 vs. 15\u0026thinsp;\u0026plusmn;\u0026thinsp;3 min, p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general data between the combined PBL\u0026ndash;CBL group and the traditional group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL\u0026ndash;CBL group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe quiz scores are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The basic knowledge score in the combined PBL-CBL group was significantly higher than in the traditional group (42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 vs 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3, p\u0026thinsp;=\u0026thinsp;0.000). Similarly, the case analysis score was higher in the combined PBL-CBL group than in the traditional group (37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 versus 33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7, P\u0026thinsp;=\u0026thinsp;0.013). Accordingly, the total quiz score in the combined PBL-CBL group was higher than that in the traditional group (79.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 versus 68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7, P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparison of the post-class test scores of the combined PBL\u0026ndash;CBL group vs. the traditional group (for all participants)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL\u0026ndash;CBL group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal post-class score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e79.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-class basic knowledge score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost-class case analysis score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the anonymous questionnaire are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The scores for learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than in the traditional group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all). However, the score for how much free time the course consumed in the combined PBL-CBL group was significantly higher than in the traditional group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of questionnaire survey results between the combined PBL\u0026ndash;CBL group and the traditional group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL\u0026ndash;CBL group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-teacher interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFree time consumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical thinking skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-learning skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge absorption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction with the course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEctopic pregnancy is a potentially life-threatening condition and the leading cause of maternal mortality within the first trimester of pregnancy, with a rate of 9\u0026ndash;14% and an incidence of 5\u0026ndash;10% of all pregnancy-related deaths [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Women with nonspecific symptoms such as lower abdominal pain and vaginal bleeding in the first trimester have an ectopic pregnancy prevalence in emergency departments as high as 18%, which can be easily misdiagnosed as the previously described clinical mimics [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, prompt and accurate diagnosis is paramount, as early detection and treatment can decrease morbidity and mortality. Medical students have a short clinical learning cycle, a long interval between theoretical classes, and limited clinical reasoning ability. Simultaneously, traditional teaching methods focus on teachers while students passively receive theoretical knowledge. The limitation of this model is that teachers only focus on their understanding of the subject matter, failing to fulfil their role of guiding students to cultivate clinical thinking. Furthermore, many medical students lack initiative and creativity, ultimately making it difficult to apply the acquired knowledge to clinical practice [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDifferent from traditional teaching methods, PBL and CBL aim to establish real medical scenes and encourage students to adopt an active learning attitude, shifting from a \u0026ldquo;what I learn\u0026rdquo; paradigm to \u0026ldquo;what I want to learn\u0026rdquo; [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Compared with traditional lecture teaching methods, some studies have demonstrated that either PBL or CBL alone have some advantages and has been described as a promising tool for medical education [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Considering their respective advantages, our study applied a teaching method integrating PBL and CBL in teaching ectopic pregnancy, allowing them to complement and reinforce each other.\u003c/p\u003e \u003cp\u003eTo investigate the effectiveness and acceptability of the combined PBL-CBL teaching method in teaching ectopic pregnancy, we compared it with the traditional teaching method. Our study showed no significant difference in basic characteristics between the two groups. However, after the end of learning, the combined PBL-CBL group scored higher than the traditional group in the total quiz, the basic knowledge and the case analysis, demonstrating the effectiveness of the combined PBL-CBL teaching method. The results also indicated that students in the combined PBL-CBL group had formed a comprehensive and organized understanding of ectopic pregnancy, further enhancing their clinical thinking skills. Additionally, we assessed the subjective perceptions and experiences of the students. The results showed that students rated the combined PBL-CBL teaching method highly in learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course. These results also indicated that students in the combined PBL-CBL group tended to adopt a more balanced approach to learning and practice and obtain a higher satisfaction rate with the course, thereby becoming more proactive learners. This agrees with the findings of previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Zhao et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] the combined PBL-CBL teaching method may improve medical students\u0026rsquo; and residents\u0026rsquo; performance and enhance their clinical skills and capabilities when learning about thyroid nodules in the Department of Thyroid Surgery. Liu et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] showed that the PBL-CBL method resulted in better academic knowledge acquisition, case analysis ability and student satisfaction compared with the teacher-centred method in teaching maxillary sinus floor augmentation in implant dentistry.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, We assumed that PBL and CBL were mutually complementary and could achieve the best effect when combined. However, no control groups were using PBL or CBL alone in this study, and we could not determine whether the combined method was superior to PBL or CBL alone. Second, some analysis biases were unavoidable due to the lack of blinding in our study. Third, our results were based on one ectopic pregnancy course with a small sample size. Long-term follow-up data were not available to produce more grounded assessments. Therefore, more well-designed, randomized controlled trials with large samples are needed to confirm the effect of the combined PBL-CBL teaching method.\u003c/p\u003e \u003cp\u003eIn conclusion, our study showed that the students learning ectopic pregnancy with the combined PBL-CBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis than those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the combined PBL-CBL teaching method might be a promising new mode for gynecologic education.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Heng Yang Central Hospital.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYL conceived the idea and reviewed and edited the manuscript. WMX wrote the manuscript. YL and XHL conducted research, selection, data extraction, and statistical analysis. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets obtained and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEctopic pregnancy\u0026ndash;United, States. 1990\u0026ndash;1992. Centers for Disease Control and Prevention (CDC).MMWR Morb Mortal Wkly Rep. 1995;44:46\u0026ndash;8. (Level II-2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCommittee on Practice Bulletins\u0026mdash;Gynecology. ACOG Practice Bulletin 191: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(2):e65\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang FY, Zhao L, Zeng YL, Xu K, Wen X. A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education. Nurse Educ Today. 2019;79:86\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang WJ, Li H, Su A, Ding LP. Application of problem based learning (PBL) and case based learning (CBL) in the teaching of international classification of diseases encoding. Sci Rep. 2023;13(1):15220.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmits PB, de Buisonj\u0026eacute; CD, Verbeek JH, van Dijk FJ, Metz JC, ten Cate OJ. Problem-based learning versus lecture-based learning in postgraduate medical education. Scand J Work Environ Health. 2003;29(4):280\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJamkar AV, Burdick W, Morahan P, Yemul VY, Sarmukadum, Singh G. PRoposed model of case based learning for training undergraduate medical student in surgery. Indian J Surg. 2007;69(5):176\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNair SP, Shah T, Seth S, Pandit N, Shah GV. Case based learning: a method for better understanding of biochemistry in medical students. J Clin Diagn Res Jcdr. 2013;7(8):1576\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSangam MR, Praveen K, Vinay G, Bokan RR, Deka R, Kaur A. Efficacy of case-based learning in anatomy. Cureus. 2021;13(12):e20472.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams B. Case-based learning: a review of the literature\u0026mdash;is there scope for this educational paradigm in prehospital education? Emerg Med J. 2005;22(8):577\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao WJ, He LY, Deng WY, Zhu JQ, Su AP, Zhang Y. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease. BMC Med Educ. 2020;20(1):381.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHouser M, Kandalaft N, Khati NJ. Ectopic pregnancy: a resident\u0026rsquo;s guide to imaging findings and diagnostic pitfalls. Emerg Radiol. 2022;29(1):161\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePo L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, et al. Guideline 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. J Obstet Gynaecol Can. 2021;43(5):614\u0026ndash;e6301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOderinu OH, Adegbulugbe IC, Orenuga OO, Butali A. Comparison of students\u0026rsquo;perception of problem-based learning and traditional teaching method in a Nigerian dental school. Eur J Dent Educ. 2020;24(2):207\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCantillon P. Teaching large groups. Br Med J. 2003;326(7386):437.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwartz LR, Fernandez R, Kouyoumjian SR, Jones KA, Compton S. A randomized comparison trial of case-based learning versus human patient simulation in medical student education. Acad Emerg Med. 2007;14(2):130\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide 23. Med Teach. 2012;34(6):e421\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim YJ. The PBL teaching method in neurology education in the traditional Chinese medicine undergraduate students: An observational study.Medicine (Baltimore). 2023;102(39):e35143.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen J, Yuan LL, Ge RX, Shao XF, Jiang XC. Improving medical student recruitment into neurosurgery through teaching reform. BMC Med Educ. 2022;22(1):656.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu YF, Xu YM, Li YH, Wu QQ. Application of problem-based learning and case-based learning integrated method in the teaching of maxillary sinus floor augmentation in implant dentistry. PeerJ. 2020;16:8e8353.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ectopic pregnancy, problem-based learning, case-based learning","lastPublishedDoi":"10.21203/rs.3.rs-5031510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5031510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aim of this study is to explore the effectiveness of combining problem-based learning (PBL) and case-based learning (CBL) in clinical teaching of ectopic pregnanancy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eFifth-year students majoring in clinical medicine were recruited in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from September 2023 to June 2024. The students were randomly assigned into either the combined PBL-CBL group or the traditional group. Students in the experimental group were trained using the combined PBL-CBL teaching method, while those in the traditional group were trained using a lecture based learning (LBL) teaching method. After the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The basic knowledge score in the combined PBL-CBL group was significantly higher than in the traditional group (42.6 ± 3.6 vs 35.0 ± 2.3, p = 0.000).Similarly, the case analysis score was higher in the combined PBL-CBL group than in the traditional group (37.1 ± 6.2 versus 33.8 ± 5.7, P = 0.013). The scores for learning motivation, understanding, student-teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than that in the traditional group (\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05 for all). However, the score for how much free time the course consumed in the combined PBL-CBL group was significantly higher than that in the traditional group (\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The combined PBL-CBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the combined PBL-CBL teaching method might be a promising new mode for gynecologic education.\u003c/p\u003e","manuscriptTitle":"Application of problem based learning (PBL) and case based learning (CBL) in the teaching of ectopic pregnancy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-07 03:56:59","doi":"10.21203/rs.3.rs-5031510/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-16T05:16:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-13T13:52:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-13T13:51:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-09-04T12:09:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5081d1ab-44ce-4ad2-927b-ea3105434350","owner":[],"postedDate":"November 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T16:05:59+00:00","versionOfRecord":{"articleIdentity":"rs-5031510","link":"https://doi.org/10.1186/s12909-024-06327-9","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-11-22 15:57:21","publishedOnDateReadable":"November 22nd, 2024"},"versionCreatedAt":"2024-11-07 03:56:59","video":"","vorDoi":"10.1186/s12909-024-06327-9","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06327-9","workflowStages":[]},"version":"v1","identity":"rs-5031510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5031510","identity":"rs-5031510","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}