Implementing Bilingual Education in Gastrointestinal Surgery: Theory, Practice, and Insights from China

Implementing Bilingual Education in Gastrointestinal Surgery: Theory, Practice, and Insights from China | 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 Implementing Bilingual Education in Gastrointestinal Surgery: Theory, Practice, and Insights from China Chengxing Wang, Chaorong Zhou, Yongfeng Ma, Canxiu He, Jinglin Zhao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7727572/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Objective This study aims to evaluate the effectiveness of a structured Chinese–English bilingual teaching model in the context of gastrointestinal surgery education, focusing on both theoretical learning and clinical practice in Chinese setting. Methods A total of 100 medical students undergoing training in gastrointestinal surgery at Jiangmen Central Hospital were randomly assigned to a bilingual group (n = 50) or a control group (n = 50). The bilingual group received integrated instruction combining Chinese and English materials, including bilingual explanations of terminology, interactive case discussions, and clinically applied language practice. The control group received traditional monolingual (Chinese) teaching. Outcomes were assessed through clinical competency examinations-evaluating theoretical knowledge, literature analysis, and practical skills-and a teaching quality questionnaire. Results The bilingual group scored significantly higher in overall clinical competency (81.10 ± 7.19 vs. 73.50 ± 8.01, P < 0.001), with notable improvements in frontier literature analysis (25.24 ± 2.40 vs. 21.36 ± 3.26, P < 0.001) and clinical practice skills (24.18 ± 2.49 vs. 21.18 ± 3.10, P < 0.001). Theoretical knowledge scores were comparable between groups ( P = 0.458). Questionnaire results indicated significantly greater satisfaction in the bilingual group across all domains, including professional English mastery (p < 0.001), with 76% overall satisfaction versus 32% in the control group ( P < 0.001). Conclusion The integrated bilingual education model significantly enhances competencies in literature interpretation, clinical reasoning, and student engagement without compromising acquisition of core knowledge. These findings support the adoption of bilingual strategies in medical education systems where English is a foreign language, highlighting its potential to cultivate globally competent surgical professionals. Bilingual Education Gastrointestinal Surgery Teaching Reform Figures Figure 1 1. Introduction The rapid globalization of medicine necessitates that surgical education evolve to cultivate graduates capable of critically engaging with international literature, clinical guidelines, and collaborative academic discussions [ 1 – 3 ]. This is particularly relevant in gastrointestinal surgery, a field characterized by constant innovations predominantly published in English [ 3 – 4 ]. Traditional monolingual educational models-exclusively relying on Chinese-often fail to bridge the gap between students and cutting-edge knowledge, thereby limiting their ability to integrate the latest global evidence into clinical practice [ 5 – 7 ]. In China, despite the gradual adoption of bilingual medical education, significant gaps remain in its implementation, particularly within specialized surgical disciplines. Current approaches often prioritize vocabulary translation over the cultivation of comprehensive dual-language cognitive skills, thus falling short of fostering genuine bilingual academic and clinical proficiency [ 7 – 9 ]. Medical students in China increasingly recognize the necessity of mastering professional English to access frontier research, pursue international exchanges, and enhance their competitiveness in global academic and clinical settings. However, existing curricula rarely provide systematic support for these needs, leaving students underprepared for the demands of modern medical practice [ 10 ]. The theoretical learning phase, which underpins clinical reasoning and practice, offers a critical yet underexplored opportunity for the effective integration of bilingual education [ 11 ]. This study moves beyond general advocacy for bilingual instruction by presenting a structured application within the theoretical and clinical framework of gastrointestinal surgery. Through a detailed examination of an integrated bilingual intervention in both theoretical and clinical training, this article evaluates how such a model influences students’ mastery of core concepts, analytical capabilities, and overall educational experience. The findings aim to establish a replicable model for advancing surgical education in China and other countries / regions where English is not the first language, directly addressing the evolving needs of those medical students. 2. Materials and Methods 2.1. Study Design and Participants The detailed research workflow is shown in Fig. 1 .This study selected a total of 100 medical students who undertook theoretical learning and clinical internships in the Department of Gastrointestinal Surgery at Jiangmen Central Hospital from January 2024 to January 2025. All participants volunteered to join the study and provided informed consent. Every subject completed the entire teaching and evaluation process. The participants were randomly assigned to either a Bilingual Group (n = 50) or a Control Group (n = 50). The Bilingual Group received Chinese–English bilingual teaching, with a male-to-female ratio of 26:24, aged 22–24 years (mean age 22.86 ± 0.61). The Control Group received instruction in Chinese only, with a male-to-female ratio of 25:25, aged 22–24 years (mean age 23.06 ± 0.79). The ratio of students with a College English Test GPA ≥ 3.5 to those with 0.05)(Table 1 ). This study was approved as exempt by the Medical Ethics Committee of Jiangmen Central Hospital (No. JXY [2024]218A). Table 1. Comparison of Baseline Characteristics between Groups 2.2. Teaching Intervention The theory learning and clinical internship course in gastrointestinal surgery for both groups of medical students were taught and supervised by senior attending physicians and above, all specialists in gastrointestinal surgery. The teaching process included clinical theory related to gastrointestinal surgery related diseases, case discussions, clinical patient interviewing, and literature sharing. The clinical competency assessment consisted of a theoretical examination on gastrointestinal surgery, critical reading and analysis of frontier literature, and an evaluation of clinical practical skills. 2.2.1 Bilingual Group The gastrointestinal surgery department teaching reform team compiled English lesson plans for the theory learning and clinical internship course at Jiangmen Central Hospital. These were combined with traditional Chinese teaching materials (based on the 9th edition of Surgery published by People’s Medical Publishing House, China.) to implement an integrated teaching approach. During instruction, frontier theories and professional terminology were explained bilingually in both Chinese and English to ensure that students could comprehend specialized terms and concepts in both languages while learning about gastrointestinal surgery related diseases. Interactive methods such as group discussions and case analysis were employed to encourage students to express their opinions and understandings in English, thereby enhancing their language application skills Multimedia tools such as videos, PowerPoint presentations, and online resources were used to demonstrate international frontier research and treatment cases, helping students understand and apply bilingual knowledge in authentic contexts. Through clinical consultations, students practiced using bilingual communication with patients and in case discussions, improving both their clinical skills and language proficiency. Upon completion of the course, clinical competency assessments and classroom evaluations were conducted. 2.2.2 Control Group During the internship teaching process, this group of students received exactly the same textbooks and teaching content as the Bilingual Group, except for the English lesson plans developed by the teaching team. By analyzing real cases, students gained an in-depth understanding of the etiology, diagnosis, and treatment strategies for gastrointestinal surgery related diseases, fostering clinical reasoning skills. Students were organized into groups to discuss specific cases or research literature, encouraging them to share perspectives and insights, thereby promoting collaborative learning and critical thinking. Students also participated in clinical interviews, personally experiencing the diagnosis and treatment process of patients with gastrointestinal surgery related diseases, which enhanced their practical skills and understanding of patient needs. After completing the course, clinical competency assessments and classroom evaluations were conducted. 2.3 Teaching Outcome Evaluation 2.3.1 Clinical Competency Assessment The assessment consisted of three components: theoretical knowledge of gastrointestinal surgery (40%), ability to read and analyze frontier literature (30%), and clinical practical skills (30%), totaling 100 points. The assessment covered theoretical knowledge of gastrointestinal surgery, reading and analysis of frontier literature, medical history taking, development of diagnostic and treatment plans, and prognostic judgment ability. A total score of < 60 was considered "Fail," 60–74 as "Pass," 75–84 as "Good," and ≥ 85 as "Excellent." 2.3.2 Teaching Quality Questionnaire Survey Upon completion of the teaching and assessment process, students from both groups filled out a teaching quality questionnaire (Supplementary file 1) . The questionnaire, designed by the gastrointestinal surgery clinical internship teaching reform team, included the following domains: teaching satisfaction (20%), mastery of theoretical knowledge (20%), classroom engagement (20%), acquisition of clinical skills (20%), and mastery of professional English terminology (20%), totaling 100 points. A total score of < 60 indicated "Dissatisfied," 60–79 as "Neutral," 80–89 as "Basically Satisfied," and ≥ 90 as "Satisfied." 2.4 Statistical Analysis Statistical analysis was performed using SPSS version 26.0. Categorical data were expressed as percentages (%) and compared using the χ 2 test. Continuous data were presented as mean ± standard deviation (m ± SD) and analyzed with independent samples t-test, provided that they followed a normal distribution. P<0.05 was considered statistically significant. 3. Results 3.1 Evaluation of Professional Competence in Both Groups The professional competence assessment scores were 81.10 ± 7.19 in the bilingual group and 73.50 ± 8.01 in the control group. Students in the bilingual group demonstrated significantly higher scores compared to those in the control group (P < 0.05). Specifically, the bilingual group showed significantly better performance in frontier literature reading and analytical ability, as well as clinical practical skills (P < 0.05)(Table 2 ). Table 2 Comparison of Clinical Competency Scores ( Score, Mean ± SD ) Group n Theoretical Knowledge Literature & Analysis Clinical Practice Total Score Bilingual 50 31.68 ± 4.42 25.24 ± 2.40 24.18 ± 2.49 81.10 ± 7.19 Control 50 31.00 ± 4.71 21.36 ± 3.26 21.18 ± 3.10 73.50 ± 8.01 t 0.745 6.787 5.335 4.993 P 0.458 <0.001 <0.001 <0.001 3.2 Analysis of Questionnaire Results from Both Groups Students in the observational group showed higher satisfaction scores than the control group across all five indicators: teaching satisfaction, mastery of theoretical knowledge, classroom engagement, acquisition of clinical skills, and mastery of professional English terminology (Table 3 ). The overall satisfaction rate (including “Basically Satisfied” and above) was 76% in the observational group and 32% in the control group, showing a statistically significant difference (P < 0.05) (Table 4 ). Table 3 Teaching Quality Questionnaire Survey ( Score, Mean ± SD ) Group n Teaching Satisfaction Theoretical Knowledge Classroom Engagement Clinical Skills Professional English Bilingual 50 15.12 ± 1.62 16.08 ± 1.81 15.80 ± 1.87 16.80 ± 1.50 17.80 ± 1.29 Control 50 13.48 ± 2.65 14.32 ± 2.50 14.08 ± 2.80 14.68 ± 3.10 14.68 ± 2.47 t 3.729 4.033 3.612 4.361 7.934 P <0.001 <0.001 0.001 <0.001 <0.001 Table 4 Overall Teaching satisfaction survey [ n, (%) ] Group n Satisfied Basically Satisfied Neutral Dissatisfied Total Satisfaction Bilingual 50 4(8) 34(68) 12(24) 0(0) 76 Control 50 0(0) 16(32) 30(60) 4(8) 32 χ 2 - - - - - 19.485 P - - - - - <0.001 4. Discussion The present study demonstrates that integrating a structured Chinese-English bilingual teaching model within gastrointestinal surgery education significantly enhances students’ comprehensive competencies, particularly in areas requiring critical engagement and application of knowledge. The bilingual group achieved notably higher scores in literature analysis and clinical practice, coupled with strongly positive subjective feedback, supporting the efficacy of bilingual pedagogy in aligning with both educational objectives and the evolving demands of medical practice in a globalized context. One of the most prominent advantages observed was the marked improvement in students’ ability to retrieve, interpret, and critically evaluate frontier medical literature. The significantly higher scores in literature analysis (25.24 ± 2.40 vs. 21.36 ± 3.26) underscore that bilingual training greatly facilitates access to and comprehension of international guidelines and research, a competence increasingly essential for evidence-based practice in specialties like gastrointestinal surgery where treatment paradigms evolve rapidly. Furthermore, the superior performance in clinical practice assessments (24.18 ± 2.49 vs. 21.18 ± 3.10) indicates that the use of bilingual case discussions, history-taking simulations, and structured feedback helps bridge theoretical knowledge and real-world clinical reasoning. This is especially relevant in cultivating a ability to articulate diagnoses and management strategies in both languages, strengthening readiness for participation in international collaborations and academic exchanges. Notably, the fact that theoretical knowledge scores between the two groups showed no significant difference (31.68 ± 4.42 vs. 31.00 ± 4.71) alleviates a common concern that bilingual instruction might compromise core content acquisition. On the contrary, it appears that learning key concepts in two languages reinforces understanding through comparative contextualization and semantic redundancy. Moreover, the high satisfaction rates and perceived gains in professional English mastery indicate that students recognize the practical value of bilingual training for their future careers—an important motivational factor in sustaining engagement in demanding surgical specialties. Nevertheless, these advantages must be considered alongside the challenges of implementing bilingual education effectively. Some students experienced initial difficulty with specialized terminology, highlighting the need for systematic lexical support such as pre-session glossaries and adaptive instruction that tolerates and even encourages code-switching [ 12 – 13 ]. Faculty readiness is another critical factor, as effective bilingual teaching requires instructors to be not only linguistically proficient but also skilled in designing and delivering integrated content [ 14 – 15 ]. Looking ahead, future efforts should emphasize scalable and sustainable models—such as sharing open-access bilingual teaching resources across institutions, offering faculty development programs focused on bilingual instructional methods, and incorporating digital tools like simulated patient encounters in English and AI-assisted terminology learning. Multi-center studies with longer follow-up will be essential to assess the long-term impact of bilingual medical education on research output, clinical performance, and professional development. Ultimately, a thoughtfully implemented bilingual approach can play a pivotal role in shaping a new generation of surgeons who are both locally grounded and globally connected. 5. Conclusion The application of a thoughtfully designed bilingual education model within the theoretical learning framework of gastrointestinal surgery proves highly effective. It successfully enhances students' capabilities in navigating international scientific literature, applying theoretical knowledge in practical clinical scenarios, and fosters a more engaging and satisfying learning experience. By implementing a tiered approach that integrates bilingual elements without compromising core knowledge acquisition, educators can empower the next generation of surgeons with the skills and mindset necessary for excellence in both local and global healthcare contexts. This practice serves as a replicable model for reform in surgical and medical education broadly. Declarations Abbreviations Not applicable. Ethics declarations This study was approved as exempt by the Medical Ethics Committee of Jiangmen Central Hospital (No. JXY [2024]218A). All methods of this study were carried out in accordance with relevant guidelines and regulations (declaration of Helsinki), and all participants volunteered to join the study and provided informed consent. Consent for publication Not applicable. Availability of data and materials The data used and/or analyzed during this study are available from the corresponding authors on reasonable request. Competing Interests Not applicable. Funding This study was funded by Guangdong Medical University Clinical Education Base Teaching Reform Research Grant (LCJX2024063), and Jiangmen Central Hospital Educational Reform Research Project (JG202404). Authors’ contributions CW, JZ and YH designed the study. CW and CZ wrote the manuscript. CW, CZ, YM and CH contributed to the collection of the data. JZ and YH contributed to the critical revision of the manuscript. All authors contributed to the article and approved the submitted version. Acknowledgments The authors would like to extend their sincere gratitude to Professor Jens Werner from the University Hospital of Ludwig Maximilian University of Munich, as well as Hong Liu, MD, Weixing Lin, PhD, and Qunying Tan, MD, from Jiangmen Central Hospital, for their valuable contributions and support in the development of the Chinese–English bilingual teaching materials. References Ammon,Ulrich.English Next. Why global English may mean the end of 'English as a Foreign Language.'[J].Language Problems & Language Planning, 2008, 32(2):203-207.DOI:10.1075/lplp.32.1.08amm. Natasa Milosavljević.Interrelationship between learning English language and students' medical education[J].Srpski Arhiv Za Celokupno Lekarstvo, 2008, 136(7-8):441. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clin. 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Supplementary Files QuestionnaireontheQualityofBilingualTeachinginGastrointestinalSurgery.pdf Cite Share Download PDF Status: Published Journal Publication published 27 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 31 Oct, 2025 Reviews received at journal 30 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers invited by journal 15 Oct, 2025 Editor assigned by journal 13 Oct, 2025 Editor invited by journal 13 Oct, 2025 Submission checks completed at journal 10 Oct, 2025 First submitted to journal 10 Oct, 2025 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. 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16:11:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":928895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7727572/v1/5f8258de-3d36-4ee6-bc03-173e6da1e1b1.pdf"},{"id":94640637,"identity":"2ffcc6ea-de04-4708-a828-0d2adc87db0d","added_by":"auto","created_at":"2025-10-29 07:49:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":39870,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireontheQualityofBilingualTeachinginGastrointestinalSurgery.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7727572/v1/2dcb0639155d293a5018f554.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementing Bilingual Education in Gastrointestinal Surgery: Theory, Practice, and Insights from China","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe rapid globalization of medicine necessitates that surgical education evolve to cultivate graduates capable of critically engaging with international literature, clinical guidelines, and collaborative academic discussions [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This is particularly relevant in gastrointestinal surgery, a field characterized by constant innovations predominantly published in English [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Traditional monolingual educational models-exclusively relying on Chinese-often fail to bridge the gap between students and cutting-edge knowledge, thereby limiting their ability to integrate the latest global evidence into clinical practice [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn China, despite the gradual adoption of bilingual medical education, significant gaps remain in its implementation, particularly within specialized surgical disciplines. Current approaches often prioritize vocabulary translation over the cultivation of comprehensive dual-language cognitive skills, thus falling short of fostering genuine bilingual academic and clinical proficiency [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Medical students in China increasingly recognize the necessity of mastering professional English to access frontier research, pursue international exchanges, and enhance their competitiveness in global academic and clinical settings. However, existing curricula rarely provide systematic support for these needs, leaving students underprepared for the demands of modern medical practice [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe theoretical learning phase, which underpins clinical reasoning and practice, offers a critical yet underexplored opportunity for the effective integration of bilingual education [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This study moves beyond general advocacy for bilingual instruction by presenting a structured application within the theoretical and clinical framework of gastrointestinal surgery. Through a detailed examination of an integrated bilingual intervention in both theoretical and clinical training, this article evaluates how such a model influences students\u0026rsquo; mastery of core concepts, analytical capabilities, and overall educational experience. The findings aim to establish a replicable model for advancing surgical education in China and other countries / regions where English is not the first language, directly addressing the evolving needs of those medical students.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study Design and Participants\u003c/h2\u003e\n \u003cp\u003eThe detailed research workflow is shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.This study selected a total of 100 medical students who undertook theoretical learning and clinical internships in the Department of Gastrointestinal Surgery at Jiangmen Central Hospital from January 2024 to January 2025. All participants volunteered to join the study and provided informed consent. Every subject completed the entire teaching and evaluation process. The participants were randomly assigned to either a Bilingual Group (n\u0026thinsp;=\u0026thinsp;50) or a Control Group (n\u0026thinsp;=\u0026thinsp;50). The Bilingual Group received Chinese\u0026ndash;English bilingual teaching, with a male-to-female ratio of 26:24, aged 22\u0026ndash;24 years (mean age 22.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61). The Control Group received instruction in Chinese only, with a male-to-female ratio of 25:25, aged 22\u0026ndash;24 years (mean age 23.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79). The ratio of students with a College English Test GPA\u0026thinsp;\u0026ge;\u0026thinsp;3.5 to those with \u0026lt;\u0026thinsp;3.5 was 26:24 in the Bilingual Group and 26:24 in the Control Group. The baseline characteristics between the two groups were comparable, with no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). This study was approved as exempt by the Medical Ethics Committee of Jiangmen Central Hospital (No. JXY [2024]218A).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Comparison of Baseline Characteristics between Groups\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Teaching Intervention\u003c/h2\u003e\n \u003cp\u003eThe theory learning and clinical internship course in gastrointestinal surgery for both groups of medical students were taught and supervised by senior attending physicians and above, all specialists in gastrointestinal surgery. The teaching process included clinical theory related to gastrointestinal surgery related diseases, case discussions, clinical patient interviewing, and literature sharing. The clinical competency assessment consisted of a theoretical examination on gastrointestinal surgery, critical reading and analysis of frontier literature, and an evaluation of clinical practical skills.\u003c/p\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1 Bilingual Group\u003c/h2\u003e\n \u003cp\u003eThe gastrointestinal surgery department teaching reform team compiled English lesson plans for the theory learning and clinical internship course at Jiangmen Central Hospital. These were combined with traditional Chinese teaching materials (based on the 9th edition of Surgery published by People\u0026rsquo;s Medical Publishing House, China.) to implement an integrated teaching approach. During instruction, frontier theories and professional terminology were explained bilingually in both Chinese and English to ensure that students could comprehend specialized terms and concepts in both languages while learning about gastrointestinal surgery related diseases. Interactive methods such as group discussions and case analysis were employed to encourage students to express their opinions and understandings in English, thereby enhancing their language application skills Multimedia tools such as videos, PowerPoint presentations, and online resources were used to demonstrate international frontier research and treatment cases, helping students understand and apply bilingual knowledge in authentic contexts. Through clinical consultations, students practiced using bilingual communication with patients and in case discussions, improving both their clinical skills and language proficiency. Upon completion of the course, clinical competency assessments and classroom evaluations were conducted.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2 Control Group\u003c/h2\u003e\n \u003cp\u003eDuring the internship teaching process, this group of students received exactly the same textbooks and teaching content as the Bilingual Group, except for the English lesson plans developed by the teaching team. By analyzing real cases, students gained an in-depth understanding of the etiology, diagnosis, and treatment strategies for gastrointestinal surgery related diseases, fostering clinical reasoning skills. Students were organized into groups to discuss specific cases or research literature, encouraging them to share perspectives and insights, thereby promoting collaborative learning and critical thinking. Students also participated in clinical interviews, personally experiencing the diagnosis and treatment process of patients with gastrointestinal surgery related diseases, which enhanced their practical skills and understanding of patient needs. After completing the course, clinical competency assessments and classroom evaluations were conducted.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Teaching Outcome Evaluation\u003c/h2\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.1 Clinical Competency Assessment\u003c/h2\u003e\n \u003cp\u003eThe assessment consisted of three components: theoretical knowledge of gastrointestinal surgery (40%), ability to read and analyze frontier literature (30%), and clinical practical skills (30%), totaling 100 points. The assessment covered theoretical knowledge of gastrointestinal surgery, reading and analysis of frontier literature, medical history taking, development of diagnostic and treatment plans, and prognostic judgment ability. A total score of \u0026lt;\u0026thinsp;60 was considered \u0026quot;Fail,\u0026quot; 60\u0026ndash;74 as \u0026quot;Pass,\u0026quot; 75\u0026ndash;84 as \u0026quot;Good,\u0026quot; and \u0026ge;\u0026thinsp;85 as \u0026quot;Excellent.\u0026quot;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.2 Teaching Quality Questionnaire Survey\u003c/h2\u003e\n \u003cp\u003eUpon completion of the teaching and assessment process, students from both groups filled out a teaching quality questionnaire\u003cstrong\u003e(Supplementary file 1)\u003c/strong\u003e. The questionnaire, designed by the gastrointestinal surgery clinical internship teaching reform team, included the following domains: teaching satisfaction (20%), mastery of theoretical knowledge (20%), classroom engagement (20%), acquisition of clinical skills (20%), and mastery of professional English terminology (20%), totaling 100 points. A total score of \u0026lt;\u0026thinsp;60 indicated \u0026quot;Dissatisfied,\u0026quot; 60\u0026ndash;79 as \u0026quot;Neutral,\u0026quot; 80\u0026ndash;89 as \u0026quot;Basically Satisfied,\u0026quot; and \u0026ge;\u0026thinsp;90 as \u0026quot;Satisfied.\u0026quot;\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e\n \u003cp\u003eStatistical analysis was performed using SPSS version 26.0. Categorical data were expressed as percentages (%) and compared using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e test. Continuous data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (m\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) and analyzed with independent samples t-test, provided that they followed a normal distribution. P\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Evaluation of Professional Competence in Both Groups\u003c/h2\u003e\u003cp\u003eThe professional competence assessment scores were 81.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19 in the bilingual group and 73.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01 in the control group. Students in the bilingual group demonstrated significantly higher scores compared to those in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Specifically, the bilingual group showed significantly better performance in frontier literature reading and analytical ability, as well as clinical practical skills (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eComparison of Clinical Competency Scores (\u003cem\u003eScore, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTheoretical Knowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLiterature \u0026amp; Analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eClinical Practice\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilingual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.993\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Analysis of Questionnaire Results from Both Groups\u003c/h2\u003e\u003cp\u003eStudents in the observational group showed higher satisfaction scores than the control group across all five indicators: teaching satisfaction, mastery of theoretical knowledge, classroom engagement, acquisition of clinical skills, and mastery of professional English terminology (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The overall satisfaction rate (including \u0026ldquo;Basically Satisfied\u0026rdquo; and above) was 76% in the observational group and 32% in the control group, showing a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\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\u003eTeaching Quality Questionnaire Survey (\u003cem\u003eScore, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTeaching Satisfaction\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTheoretical Knowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eClassroom Engagement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eClinical Skills\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eProfessional English\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilingual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.729\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.934\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\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\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOverall Teaching satisfaction survey [\u003cem\u003en, (%)\u003c/em\u003e]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBasically Satisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDissatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal Satisfaction\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilingual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12(24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19.485\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe present study demonstrates that integrating a structured Chinese-English bilingual teaching model within gastrointestinal surgery education significantly enhances students\u0026rsquo; comprehensive competencies, particularly in areas requiring critical engagement and application of knowledge. The bilingual group achieved notably higher scores in literature analysis and clinical practice, coupled with strongly positive subjective feedback, supporting the efficacy of bilingual pedagogy in aligning with both educational objectives and the evolving demands of medical practice in a globalized context.\u003c/p\u003e\u003cp\u003eOne of the most prominent advantages observed was the marked improvement in students\u0026rsquo; ability to retrieve, interpret, and critically evaluate frontier medical literature. The significantly higher scores in literature analysis (25.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 vs. 21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26) underscore that bilingual training greatly facilitates access to and comprehension of international guidelines and research, a competence increasingly essential for evidence-based practice in specialties like gastrointestinal surgery where treatment paradigms evolve rapidly. Furthermore, the superior performance in clinical practice assessments (24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 vs. 21.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10) indicates that the use of bilingual case discussions, history-taking simulations, and structured feedback helps bridge theoretical knowledge and real-world clinical reasoning. This is especially relevant in cultivating a ability to articulate diagnoses and management strategies in both languages, strengthening readiness for participation in international collaborations and academic exchanges.\u003c/p\u003e\u003cp\u003eNotably, the fact that theoretical knowledge scores between the two groups showed no significant difference (31.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42 vs. 31.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71) alleviates a common concern that bilingual instruction might compromise core content acquisition. On the contrary, it appears that learning key concepts in two languages reinforces understanding through comparative contextualization and semantic redundancy. Moreover, the high satisfaction rates and perceived gains in professional English mastery indicate that students recognize the practical value of bilingual training for their future careers\u0026mdash;an important motivational factor in sustaining engagement in demanding surgical specialties.\u003c/p\u003e\u003cp\u003eNevertheless, these advantages must be considered alongside the challenges of implementing bilingual education effectively. Some students experienced initial difficulty with specialized terminology, highlighting the need for systematic lexical support such as pre-session glossaries and adaptive instruction that tolerates and even encourages code-switching [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Faculty readiness is another critical factor, as effective bilingual teaching requires instructors to be not only linguistically proficient but also skilled in designing and delivering integrated content [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Looking ahead, future efforts should emphasize scalable and sustainable models\u0026mdash;such as sharing open-access bilingual teaching resources across institutions, offering faculty development programs focused on bilingual instructional methods, and incorporating digital tools like simulated patient encounters in English and AI-assisted terminology learning. Multi-center studies with longer follow-up will be essential to assess the long-term impact of bilingual medical education on research output, clinical performance, and professional development. Ultimately, a thoughtfully implemented bilingual approach can play a pivotal role in shaping a new generation of surgeons who are both locally grounded and globally connected.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe application of a thoughtfully designed bilingual education model within the theoretical learning framework of gastrointestinal surgery proves highly effective. It successfully enhances students' capabilities in navigating international scientific literature, applying theoretical knowledge in practical clinical scenarios, and fosters a more engaging and satisfying learning experience. By implementing a tiered approach that integrates bilingual elements without compromising core knowledge acquisition, educators can empower the next generation of surgeons with the skills and mindset necessary for excellence in both local and global healthcare contexts. This practice serves as a replicable model for reform in surgical and medical education broadly.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved as exempt by the Medical Ethics Committee of Jiangmen Central Hospital (No. JXY [2024]218A). All methods of this study were carried out in accordance with relevant guidelines and regulations (declaration of Helsinki), and all participants volunteered to join the study and provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed during this study are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Guangdong Medical University Clinical Education Base Teaching Reform Research Grant (LCJX2024063), and Jiangmen Central Hospital Educational Reform Research Project (JG202404).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCW, JZ and YH designed the study.\u0026nbsp;CW and CZ wrote the manuscript. CW, CZ, YM and CH contributed to the collection of the data. JZ and YH contributed to the critical revision of the manuscript. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to extend their sincere gratitude to Professor Jens Werner from the University Hospital of Ludwig Maximilian University of Munich, as well as Hong Liu, MD, Weixing Lin, PhD, and Qunying Tan, MD, from Jiangmen Central Hospital, for their valuable contributions and support in the development of the Chinese–English bilingual teaching materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmmon,Ulrich.English Next. Why global English may mean the end of \u0026apos;English as a Foreign Language.\u0026apos;[J].Language Problems \u0026amp; Language Planning, 2008, 32(2):203-207.DOI:10.1075/lplp.32.1.08amm. \u003c/li\u003e\n\u003cli\u003eNatasa Milosavljević.Interrelationship between learning English language and students\u0026apos; medical education[J].Srpski Arhiv Za Celokupno Lekarstvo, 2008, 136(7-8):441. \u003c/li\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clin. (2024) 74(3):229\u0026ndash;63. doi: 10.3322/caac.21834 \u003c/li\u003e\n\u003cli\u003eBaethge C .The Languages of Medicine[J].Deutsches \u0026quot;{A}rzteblatt international, 2008.DOI:10.3238/arztebl.2008.0037.\u003c/li\u003e\n\u003cli\u003eHe W , Xu Y , Zhu J .Bilingual teaching in nursing education in China: Evolution, status, and future directions[J].Nursing \u0026amp; Health Sciences, 2011, 13(3):371-377.DOI:10.1111/j.1442-2018.2011.00623.x.\u003c/li\u003e\n\u003cli\u003eTou-Jiao F , Ye W U , Ying T .Difficulties and Tentative Solutions of Bilingual Teaching Practice in Colleges and Universities[J].Journal of Educational Science of Hunan Normal University, 2009.\u003c/li\u003e\n\u003cli\u003eYi-Xi B , You-Hong X , Kun T .Exploration of Several Problems of Bilingual Teaching in Medical Education[J].Researches in Medical Education, 2008. \u003c/li\u003e\n\u003cli\u003eZhi-Dong W U , Zhan-Guo H , Zhi H E .Evaluation of pharmacology bilingual teaching among undergraduates majoring in clinical medicine[J].Journal of Shanxi Medical University, 2003.\u003c/li\u003e\n\u003cli\u003eChen C , Wang X , Zeng X ,et al.Bilingual Teaching in Medical Colleges and Universities in China: Problems and Suggestions[J]. 2018.DOI:10.2991/icsshe-18.2018.54. \u003c/li\u003e\n\u003cli\u003eHong-Yan C , Zhi-Ying Y U .Bottleneck problems in the development of higher medical bilingual teaching and countermeasures[J].Researches in Medical Education, 2010. \u003c/li\u003e\n\u003cli\u003eYan S J , Chen Y Q , Chen J ,et al.Evaluation of teaching-in-English reform in five-year clinical tropical medicine program\u0026ndash;Case analysis of curriculum reform of clinical medicine in Hainan Medical University[J].Asian Pacific Journal of Tropical Biomedicine, 2017(12):75-78.DOI:CNKI:SUN:APTB.0.2017-12-012. \u003c/li\u003e\n\u003cli\u003eXiao-Ming D E , Xiu-Fang L , Ling L I .Investigation and analysis of bilingual teaching in medical college[J].Journal of Shanxi Medical University(Preclinical Medical Education Edition), 2005. \u003c/li\u003e\n\u003cli\u003eJurinjak Z Z , Alexopoulos C G .The Efficiency of the Use of Medical Bilingual Dictionary in English Language Teaching in Vocational College[J].Proceedings of The 4th World Conference on Social Sciences Studies, 2022.DOI:10.33422/4th.3sconf.2022.11.102. \u003c/li\u003e\n\u003cli\u003eZuo-Jie L , Liang L , Ying C .Analysis of bilingual teaching in seven-year program medical students[J].Journal of Shanxi Medical University(Preclinical Medical Education Edition), 2009. \u003c/li\u003e\n\u003cli\u003eShi X Y , Zhang M Q .[Exploration of bilingual teaching models for Chinese medicine on Internet].[J].Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine, 2014, 34(9):1135. \u003c/li\u003e\n\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":"Bilingual Education, Gastrointestinal Surgery, Teaching Reform","lastPublishedDoi":"10.21203/rs.3.rs-7727572/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7727572/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aims to evaluate the effectiveness of a structured Chinese\u0026ndash;English bilingual teaching model in the context of gastrointestinal surgery education, focusing on both theoretical learning and clinical practice in Chinese setting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 100 medical students undergoing training in gastrointestinal surgery at Jiangmen Central Hospital were randomly assigned to a bilingual group (n\u0026thinsp;=\u0026thinsp;50) or a control group (n\u0026thinsp;=\u0026thinsp;50). The bilingual group received integrated instruction combining Chinese and English materials, including bilingual explanations of terminology, interactive case discussions, and clinically applied language practice. The control group received traditional monolingual (Chinese) teaching. Outcomes were assessed through clinical competency examinations-evaluating theoretical knowledge, literature analysis, and practical skills-and a teaching quality questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe bilingual group scored significantly higher in overall clinical competency (81.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19 vs. 73.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with notable improvements in frontier literature analysis (25.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 vs. 21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and clinical practice skills (24.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 vs. 21.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Theoretical knowledge scores were comparable between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.458). Questionnaire results indicated significantly greater satisfaction in the bilingual group across all domains, including professional English mastery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 76% overall satisfaction versus 32% in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe integrated bilingual education model significantly enhances competencies in literature interpretation, clinical reasoning, and student engagement without compromising acquisition of core knowledge. These findings support the adoption of bilingual strategies in medical education systems where English is a foreign language, highlighting its potential to cultivate globally competent surgical professionals.\u003c/p\u003e","manuscriptTitle":"Implementing Bilingual Education in Gastrointestinal Surgery: Theory, Practice, and Insights from China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 07:33:55","doi":"10.21203/rs.3.rs-7727572/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-31T08:23:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-30T18:21:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T08:47:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205440326016984049647380109351682803632","date":"2025-10-24T17:42:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334391454627979686147710414006604694512","date":"2025-10-24T02:00:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-15T14:11:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T15:47:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T10:34:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T12:11:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-10-10T12:08:11+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":"6f01557c-59b9-4236-8cbc-5ddfb4c24fa8","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:03:33+00:00","versionOfRecord":{"articleIdentity":"rs-7727572","link":"https://doi.org/10.1186/s12909-025-08322-0","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-11-27 15:56:54","publishedOnDateReadable":"November 27th, 2025"},"versionCreatedAt":"2025-10-29 07:33:55","video":"","vorDoi":"10.1186/s12909-025-08322-0","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08322-0","workflowStages":[]},"version":"v1","identity":"rs-7727572","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7727572","identity":"rs-7727572","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}