Application and Practice of a 3D Model–Driven Clinically Oriented, Three-Stage Progressive Teaching Program in Histology and Embryology

Application and Practice of a 3D Model–Driven Clinically Oriented, Three-Stage Progressive Teaching Program in Histology and Embryology | 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 and Practice of a 3D Model–Driven Clinically Oriented, Three-Stage Progressive Teaching Program in Histology and Embryology Na Liang, Xiang Lu, Jun Tan, Qiongyou Liu, Lian Liu, Renlian Cai, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8881845/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Objective To implement the educational philosophy of fostering virtue and talent, this study aimed to develop and evaluate a 3D model–driven, clinically oriented, three-stage progressive teaching program in Histology and Embryology, designed to cultivate application-oriented medical professionals with clinical reasoning and practical skills. Methods The proposed teaching program divided the learning process into three sequential phases: knowledge verification, preliminary exploration, and practical application. It integrated multiple instructional tools—including medical illustrations, clay models, 3D-printed models, AI-based animations, and online learning resources—to facilitate the combination of theoretical understanding, spatial visualization, and clinical application skills. The model was implemented in undergraduate medical courses, and student outcomes were evaluated through academic performance, spatial reasoning tests, clinical problem-solving exercises, and participation in research and science communication activities. Results Implementation of the program significantly improved students’ academic performance, spatial reasoning, and clinical problem-solving abilities. Students achieved excellent outcomes in drawing, model construction, photomicrography, and slide interpretation competitions. The number of student-led research projects and science communication activities also increased substantially, reflecting enhanced research awareness and innovation capability. Conclusion The 3D model–driven, clinically oriented, three-stage progressive teaching program provides an effective, scalable, and transferable framework for basic medical education reform. It promotes integration of theoretical knowledge, spatial understanding, and clinical application, offering valuable insights and practical experience for cultivating innovative and application-oriented medical professionals in the era of New Medical Sciences. Histology and Embryology three-stage progressive program 3D model clinical orientation teaching reform formative assessment 1 Introduction With the advancement of the New Medical Sciences initiative, medical education in universities is shifting from a traditional knowledge-transmission model to a student-centered, competency-oriented approach that emphasizes the cultivation of practice-oriented and clinically competent medical professionals. Histology and Embryology is the first core course in the basic medical curriculum, focusing on the microscopic structures of the human body and the principles of development. It lays an essential foundation for subsequent learning in anatomy, pathology, and clinical medicine [ 1 ] . To meet the ongoing trends in medical education reform, our teaching team systematically restructured the curriculum content, teaching methods, and evaluation system, and proposed a 3D model–driven, clinically oriented, three-stage progressive program. This approach aims to cultivate students’ knowledge integration ability, spatial reasoning, critical thinking, clinical reasoning skills, and scientific literacy [ 2 ] , facilitating their transformation from passive recipients of knowledge to active inquirers. 2 Material and methods 2.1 Analysis of Teaching Problems and Strategy Development To address key challenges in Histology and Embryology teaching, we conducted a systematic analysis of existing problems, their underlying causes, and corresponding innovative strategies. The findings are summarized below (Table 1 ). Table 1 Matrix of Instructional Problems and Innovative Strategies Teaching Problem Underlying Cause Innovative Strategy Fragmented knowledge and lack of systematic integration. Students possess strong memorization skills but have weak structural understanding and poor knowledge integration. The curriculum was reconstructed, and conceptual mind maps were designed to visualize relationships among topics. In the Knowledge Verification Stage, fragmented concepts were reorganized into a coherent, systematic framework. Weak spatial imagination, dominated by two-dimensional observation. Students demonstrate sound logical reasoning but lack training in spatial and dynamic visualization. In the Preliminary Exploration Stage, 3D models, clay modeling, and AI-based animations were employed to guide students toward spatial understanding of structures and their functional correlations. Insufficient clinical reasoning, reliance on memorization rather than analytical thinking. Students are cognitively adaptable but lack clinically oriented training. In the Practical Application Stage, clinical cases and abnormal anatomical models were introduced to develop clinical reasoning and integrated application skills, thereby bridging theory with practice. 2.2 Teaching Innovations and Instructional Design 2.2.1 Curriculum Reconstruction The original course consisted of 80 class hours (40 hours of theory and 36 hours of laboratory work), which was optimized to 76 hours. The curriculum content was transformed from a traditional tissue-type–based sequence to a function- and organ-oriented modular structure, emphasizing the integration of hollow and solid organs, layered tubular organs, and endocrine and exocrine glands. This restructuring achieved a deeper integration of the knowledge system and strengthened the linkage between structure and function. 2.2.2 Three-Stage Progressive Teaching Program From the Clinical Medicine cohorts of 2017–2023, a total of 6415 clinical medicine students were selected to participate in the three-stage progressive learning program. Knowledge Verification Stage: Guided by theoretical knowledge, this stage integrates microscopic slide observation with conceptual mind mapping to strengthen knowledge comprehension and integration. Preliminary Exploration Stage: Centered on normal structural 3D models, this phase encourages students to explore the relationship between structure and function, fostering spatial cognition and morphological understanding. Practical Application Stage: By incorporating clinical cases and abnormal anatomical models, students are guided to analyze clinical problems, thereby developing clinical reasoning and interdisciplinary integration abilities. 2.3 Optimization of the Teaching Evaluation System The course assessment consisted of formative assessment (25%), theoretical examination (55%), and practical (laboratory) examination (20%). The formative assessment included chapter quizzes (8%), laboratory assignments (8%), model presentations (5%), drawing assignments (2%), and attendance and learning attitude (2%). This component primarily evaluated students’ class participation, laboratory performance, and model-making skills. The theoretical examination focused on the mastery of fundamental knowledge and case analysis ability, while the practical examination emphasized hands-on competence and spatial reasoning skills. This comprehensive evaluation system integrated knowledge-based, process-oriented, and competency-based assessments, thereby enhancing students’ self-directed learning and awareness of continuous improvement. 2.4 Results 2.4.1 Academic Performance and Learning Behavior From the 2017 to 2023 cohorts of Clinical Medicine students, the overall trend in academic performance showed a steady upward trajectory. The average score of the 2023 cohort was 75.53, which was notably higher than that of 2022 (72.66) and 2021 (71.72). Compared with earlier cohorts, such as 2018 (66.59) and 2017 (65.54), the improvement was particularly significant. In terms of grade distribution, the proportion of high-achieving students (≥ 80 points) continued to rise. In the 2023 cohort, 37.61% of students scored 80 points or above, a clear increase compared with 21.66% in 2022 and 22.79% in 2021. Conversely, the proportion of students scoring below 60 dropped to 6.42%, the lowest level in the past six years. Meanwhile, approximately 35% of students consistently fell within the 70–79 range, indicating a stable and balanced academic performance across the cohort. It is noteworthy that the 2020 cohort experienced relatively lower average scores (67.84), largely due to the initial phase of teaching reform and external factors such as the shift to online learning during the COVID-19 pandemic. However, following the continued implementation of reforms, student performance recovered rapidly and showed substantial improvement. The 2019 cohort, while achieving the highest average score (83.17), was assessed under exceptional conditions involving online examinations and modified instructional arrangements, which may limit direct comparability. Overall, after the implementation of the 3D model–driven, clinically oriented, three-stage progressive teaching program, students’ grade distribution became more balanced, with a marked increase in the proportion of high achievers and a notable decline in failing rates. These results indicate that the model effectively enhanced students’ learning outcomes and the overall quality of teaching. In addition, continuous improvement in formative assessment scores suggests that students became more proactive in pre-class preparation, classroom engagement, and post-class assignments. The improvement in practical examination performance further confirms the positive role of 3D and 3D-printed models in fostering spatial reasoning and hands-on skills. The completion rate of pre-class tasks exceeded 90%, and both class participation and teamwork capabilities showed significant enhancement. 2.4.2 Development of Higher-Order Competencies and Practical Skills Through model-making, drawing, and experimental training, students developed strong spatial structural cognition and hands-on skills. The use of 3D models and AI animations effectively facilitated the transition from two-dimensional knowledge to three-dimensional understanding, fostering self-directed exploration and innovative thinking. 2.4.3 Enhancement of Research Literacy and Interdisciplinary Competence Driven by the teaching reform, students applied for national and provincial undergraduate innovation and entrepreneurship projects, published research papers, and participated in science popularization works that received awards. These outcomes demonstrate that the course reform significantly promoted students’ research awareness and interdisciplinary capabilities. 3 Discussion 3.1 Pedagogical Basis of the Three-Stage Progressive Program and Promotion of Higher-Order Cognition This teaching program embodies the core principles of constructivism and Bloom’s taxonomy of cognitive objectives. Through a progressive “knowledge verification–preliminary exploration–practical application” approach, students’ learning processes transition from memorization and understanding to analysis, evaluation, and innovation. In the knowledge verification stage, mind maps and histological slide observations are used to facilitate knowledge integration; during the preliminary exploration stage, 3D models, clay models, and 3D printing technology promote the development of spatial thinking [ 3 ] ; in the practical application stage, clinical cases are incorporated to strengthen problem-solving and clinical reasoning abilities [ 4 ] , thus establishing a complete pathway for higher-order cognitive development [ 5 ] . Furthermore, the three-stage progressive program not only aligns with Bloom’s cognitive levels in terms of objectives, but also embodies the constructivist principles of situated learning and learner-driven knowledge construction [ 6 ] . In the knowledge verification stage, organized presentation of knowledge combined with guided exercises helps students establish an initial cognitive framework. During the preliminary exploration stage, hands-on operations and model reconstruction serve as a medium to restructure concepts and develop stable spatial representations through iterative practice and feedback [ 7 ] . The practical application stage situates learning within complex and highly authentic clinical scenarios, promoting knowledge transfer and contextual application [ 8 ] . This pathway, through repeated cognitive processing (understanding → application → analysis → evaluation → creation), reduces cognitive load while enhancing metacognitive skills, enabling students to apply constructed representations for reasoning and decision-making when facing novel problems. Therefore, this teaching system not only supports long-term retention of knowledge [ 9 ] ,but also effectively fosters the synergistic development of clinical reasoning, problem-identification, and innovation abilities [ 10 ] , laying a solid cognitive and skill foundation for subsequent clinical learning and research practice. 3.2 Integration of Models and Multimedia Technologies The application of three-dimensional models and AI animations overcomes the limitations of traditional two-dimensional teaching [ 11 ] . 3D models and AI animations dynamically visualize microscopic structures and developmental processes [ 12 ] , significantly enhancing students’ learning immersion and depth of understanding. Through multimodal information presentation, students can develop more intuitive cognitive representations across visual, tactile, and spatial modalities, facilitating a deeper comprehension of complex structure-function relationships. The model-making process itself represents a reconstruction of knowledge, allowing students to “learn by doing” and “discover through creation”, continuously verifying forms and adjusting understanding, thus transforming knowledge from superficial memorization into conceptual internalization and effectively promoting the development of innovative thinking [ 13 ] . Moreover, the integration of models and multimedia technologies transforms the traditional “teacher-centered lecturing–student-centered receiving” model, making the learning process more interactive and exploratory. Students can actively explore the spatial logic and functional connections of tissue structures by manipulating virtual 3D models—zooming, rotating, and observing in layers [ 14 – 15 ] . The dynamic demonstrations of AI animations further help learners understand the continuity of embryonic development and tissue formation across the temporal dimension [ 16 ] . This dual spatial–temporal visualization approach aligns with the multichannel processing theory in cognitive psychology and effectively reduces the cognitive load associated with learning abstract structures. At the same time, 3D printing and modeling technologies not only demonstrate significant value in foundational teaching but have also been widely applied in clinical education and physician training, including orthopedics [ 17 ] , urology [ 18 ] , cardiology [ 19 ] , dentistry [ 20 ] , ultrasonography [ 21 ] , gynecology [ 22 ] , ophthalmology [ 23 ] , and emergency medicine [ 24 ] . Educational practice indicates that model-assisted teaching enhances learners’ intuitive understanding of complex structures, shortens the learning curve, and facilitates the transfer of theoretical knowledge into clinical skills. Therefore, the deep integration of models and multimedia technologies not only broadens the scope of teaching resources but also provides students with a multidimensional learning environment that is hands-on, interactive, and clinically oriented, serving as a key driver for the reform of basic medical courses and transformation of learning approaches. 3.3 Enhancement of Clinical-Oriented Task-Driven Learning and Problem-Solving Abilities In the practical application stage, authentic clinical cases and abnormal structure models are introduced to encourage students to integrate their acquired knowledge within open and realistic scenarios [ 25 ] . This design reflects the principles of case-based learning (CBL) and situated cognition [ 26 ] , including online CBL instruction [ 27 – 28 ] . Through a task-driven approach, students are required to synthesize foundational knowledge, structural understanding, and functional reasoning when facing real or simulated clinical problems, completing the full process of problem identification, information analysis, hypothesis formulation, and outcome verification [ 29 ] . This process not only enhances logical thinking and systematic analysis skills but also fosters a problem-centered, inquiry-based learning mindset in medical contexts [ 30 ] . The model emphasizes that students actively construct cognitive frameworks within complex knowledge networks, achieving knowledge transfer and application through collaborative discussion, role assignment, and project design. The contextualized case settings embed learning activities within authentic clinical scenarios, allowing students to experience the clinical significance of histology and embryology knowledge during problem-solving, thereby enhancing the purposefulness and practice-orientation of learning. Research indicates that teaching strategies combining task-driven learning and CBL effectively promote students’ active learning and teamwork skills, improve the development pathway of clinical reasoning [ 31 ] , and facilitate vertical knowledge integration and interdisciplinary application. Moreover, during the course implementation, instructors shift from being “knowledge transmitters” to “learning facilitators” and “thinking promoters”, gradually setting progressive problem difficulty levels to guide students in forming higher-order thinking through reflection, discussion, and verification. Throughout the continuous problem-solving process, students learn to apply evidence-based reasoning, critical analysis, and reflective learning, transitioning from single-knowledge application to integrated decision-making. Practice demonstrates that this stage of learning not only effectively enhances students’ ability to solve complex problems, but also implicitly cultivates clinical reasoning awareness [ 32 ] , scientific inquiry spirit, and lifelong learning competence [ 33 ] . 3.4 Educational Effectiveness of a Diversified Assessment System The course adopts a diversified assessment system that combines formative and summative evaluations, focusing not only on the learning process but also on students’ comprehensive abilities. Formative assessment provides dynamic feedback and continuous motivation [ 34 ] , while summative exams test higher-order cognition through case-based questions. This system achieves “assessment for learning and teaching”, aligning with the principles of authenticity and developmental orientation in educational evaluation. During course implementation, formative assessment runs through all stages of teaching [ 35 ] , continuously tracking students’ learning engagement and skill development through chapter quizzes, class performance, model production, drawing assignments, and group presentations. Such process-oriented evaluation not only identifies students’ weak points in understanding and application in a timely manner but also enables instructors to adjust teaching strategies based on feedback, providing personalized guidance and differentiated support [ 36 ] . Compared with traditional summative exams, formative assessment emphasizes learning behaviors and cognitive development trajectories, shifting evaluation from a single score to a multidimensional measure of overall competence and learning quality [ 37 ] . Summative assessment focuses on evaluating students’ knowledge integration and higher-order cognitive abilities [ 38 ] . Through case-based questions and practical experiments, it assesses students’ clinical reasoning, spatial visualization, and knowledge transfer, thereby reinforcing the connection between theory and practice. A diversified assessment system encourages students to maintain goal-oriented and self-regulated learning behaviors, facilitating the transition from “passive test-takers” to “active learners” [ 39 ] . Moreover, the system ensures both fairness and developmental orientation in evaluation. By introducing multidimensional assessment criteria, feedback involves instructors, peers, and self-assessment, forming a more open and interactive evaluation ecosystem. Students continuously reflect and adjust their learning strategies, enhancing autonomy and responsibility. Practical results indicate that the implementation of this diversified assessment system significantly improves students’ engagement, classroom participation, and overall competence, demonstrating the positive impact of assessment on learning behaviors and skill development [ 40 ] . 3.5 Educational Value and Pedagogical Significance of Teaching Innovation This educational program achieves a three-dimensional integration of “knowledge–skills–competence”, reflecting systematic innovation in teaching philosophy, content structure, and learning methods. Its pedagogical significance is manifested as follows: Shift from content-oriented to competency-oriented teaching [ 41 ] . The focus of instruction moves from knowledge transmission to skill and competence development, emphasizing the learner’s central role and the cultivation of critical thinking. By integrating three-dimensional models with clinical cases, students develop active inquiry and innovative thinking through continuous problem-solving [ 42 ] , thus achieving the transition from “acquiring knowledge” to “thinking critically” and “applying knowledge”. This competency-oriented reform aligns with the international trend of Outcome-Based Education (OBE) in medical education. Transition from static knowledge to dynamic understanding. This model transforms abstract histology knowledge into dynamic and interactive learning objects through the use of AI animations, three-dimensional models, and practical tasks, allowing students to comprehend the relationships between structure and function while perceiving the process of knowledge generation and evolution. This is consistent with previous reports, where scholars employed Virtual Reality (VR) and Augmented Reality (AR) in teaching; dynamic instruction facilitates holistic understanding of complex systems, promotes deep learning and knowledge transfer, and helps cultivate integrated analytical and structural reasoning skills [ 43 – 45 ] . A new humanized digital active learning model—Virtual Case-Based Learning (VCBL)—has been shown to improve the teaching process and enhance students’ knowledge acquisition and satisfaction [ 46 ] . Transition from single-discipline to interdisciplinary integration. This model integrates foundational medical sciences [ 47 ] , and organically combines them with clinical medicine, art and design, and information technology, forming a multidimensional learning platform [ 48 – 49 ] . Through interdisciplinary project design and model creation, students experience the unity of scientific thinking and artistic expression during knowledge construction, enhancing their comprehensive innovation ability and team collaboration awareness. This cross-boundary teaching approach not only expands the horizons of medical education but also reflects the integrated and multidisciplinary characteristics of modern medical talent cultivation [ 50 ] . Moreover, the promotional value of this model lies in its replicability and scalability. In the era of digitalization, the modular design of teaching concepts and resource systems [ 51 ] , and allows for localized adaptation and reconstruction according to the characteristics of different courses, showing potential for application in foundational courses such as anatomy, physiology, and pathology [ 52 ] . This teaching model breaks down barriers between disciplines, providing a feasible pathway for the integrated and innovative development of medical education. Particularly in the context of the new medical curriculum reform, it helps promote the coordinated transformation of teaching methods, evaluation systems, and talent cultivation objectives, offering a new paradigm for training high-quality medical professionals with clinical thinking, innovative awareness, and social responsibility. 3.6 Continuous Improvement and Future Prospects In the future, the digital teaching system will be further enhanced through the integration of three-dimensional models and AI resource libraries, establishing a sustainably updatable platform that allows teaching content and resources to dynamically adapt to advances in medical knowledge and technology. By incorporating artificial intelligence–based learning analytics and personalized feedback mechanisms [ 53 ] , AI-driven medical education enables real-time monitoring and precise assessment of learning behaviors. Teachers can optimize instructional design based on data feedback [ 54 ] , while students can receive tailored guidance according to individual learning paths, thereby enhancing personalized learning and educational efficiency [ 55 ] . At the same time, future teaching reforms will increasingly rely on the development of immersive technologies. The exploration of virtual reality (VR) and augmented reality (AR) in histology teaching can not only enhance clinical realism and interactive experiences, but also provide students with multi-angle and multi-level perspectives, allowing them to simulate slide observation, organ construction, and developmental processes in virtual scenarios, addressing the limitations of visualization in traditional teaching. The introduction of these technologies supports the improvement of spatial imagination and clinical reasoning skills, and promotes the intelligent, visualized, and experiential development of basic medical education [ 56 ] . Furthermore, the appropriate use of social networking platforms and new media tools, such as TikTok Live streaming [ 57 ] , and Youku videos [ 58 ] , offers new possibilities for teaching dissemination and interactive learning. Formats like short videos and live interactions can effectively facilitate teacher-student communication and learning resource sharing, extending learning beyond the classroom and creating a blended online-offline learning ecosystem. The combination of online lectures and hybrid teaching further expands the boundaries of teaching space and time, enabling learners to continuously deepen their understanding in a flexible and continuous learning environment [ 59 ] . In the future, emphasis should also be placed on international exchange and research on bilingual education [ 60 ] . By collaborating with international medical education institutions and sharing experiences, the internationalization and standardization of teaching models can be promoted. On this basis, further improvement of the teaching quality assurance system will facilitate the continuous optimization of teaching concepts, content, and methods, ensuring the sustainable development and high-quality advancement of medical education [ 61 ] . 4 Conclusion The practice of has demonstrated significant effectivenessthe “Three-Stage Progressive Teaching Program Driven by Stereoscopic Models for Clinical Orientation” in histology and embryology courses. This model significantly enhances students’ knowledge integration, spatial thinking, clinical reasoning, and research literacy, achieving an organic unity of knowledge mastery, skill development, and competency cultivation. By integrating stereoscopic models, AI animations, 3D printing technology, and clinical cases, the model breaks through the limitations of traditional teacher-centered and two-dimensional observation-based teaching, strengthening students’ active exploration and problem-solving abilities. Moreover, the model possesses strong scalability and reproducibility, making it applicable to basic medical courses such as anatomy, physiology, and pathology, and extendable to clinically-oriented courses. It provides a practical paradigm and exemplary experience for cultivating innovative and application-oriented medical talents under the new medical education framework. Overall, this teaching model not only optimizes course design and learning experiences, but also offers a sustainable pathway for systematically developing higher-order cognitive abilities and innovation skills, holding significant value for advancing medical education reform and improving the quality of talent cultivation. Declarations Acknowledgements The authors would like to thank all the students and faculty members who participated in this study. Their engagement and feedback were invaluable for the design, implementation, and evaluation of the 3D model–driven, clinically oriented, three-stage progressive teaching program. The authors also acknowledge the support of the Department of Histology and Embryology, School of Preclinical Medicine, Zunyi Medical University. Authors’ contributions Na Liang, Xiang Lu and Jun Tan contributed to the conception and design of the study. Qiongyou Liu, Lian Liu and Renlian Cai were involved in data collection and analysis. Xiaodong Yi and Ying Wu assisted with the preparation of teaching materials and implementation of the teaching model. Yanping Ren supervised the project and critically revised the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate This study analyzed students’ academic performance and participation in routine teaching activities within the Histology and Embryology course. It did not involve human tissue, patient data, or any clinical interventions. According to educational research management guidelines, this type of study does not require formal ethics approval or informed consent. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Funding This work was supported by the Teaching Content and Curriculum System Reform Project of Higher Education Institutions in Guizhou (grants SJJG-2023183). This study was supported by the Zunyi Medical University Graduate Education Teaching Reform Project (Grant No. YJSJG2025005). The authors also acknowledge the support of the Department of Histology and Embryology, School of Basic Medical Sciences, Zunyi Medical University. And the Project Funded under the Undergraduate Education and Teaching Reform Program of Zunyi Medical University (XJJG2025-02 and XJJG2023-34). Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Carneiro BD, Pozza DH, Tavares I. Perceptions of medical students towards the role of histology and embryology during curricular review[J]. BMC Med Educ. 2023;30;23(1):74-84. Ahmed Y, Taha MH, Khayal S. Integrating Research and Teaching in Medical Education: Challenges, Strategies, and Implications for Healthcare[J]. J Adv Med Educ Prof. 2024;1;12(1):1-7. van Velzen M, Boru A, Sarton E, et al. Design thinking in medical education to tackle real world healthcare problems: The MasterMinds Challenge[J]. Med Teach. 2024;46(5):611-613. 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Reviewing the current state of virtual reality integration in medical education - a scoping review[J]. BMC Med Educ. 2024;23;24(1):788-812. Canesin MF, Furtado FN, Gonçalves RM, et al. Learning: New Strategy for Humanized Digital Medical Education and Training in Cardiology[J]. Arq Bras Cardiol. 2022;119(5 suppl 1):35-42. Dennis JF, Creamer BA. Destination integration: linking physiology, histology, and embryology content in foundational sciences[J]. Front Physiol. 2023;14;14:1236562-1236566. Taş F, Bolatlı G. A new model in medicine education: smart model education set[J]. Surg Radiol Anat. 2022 Aug;44(8):1201-1209. Fink K, Forster M, Oettle M, et al. Tumor board simulation improves interdisciplinary decision-making in medical students[J]. J Cancer Res Clin Oncol. 2024;30;150(8):407-420. Rohr JM, Mukherjee M, Donnelly A, et al. Successful integration of thyroid cytopathology and surgical pathology education in an E-module format[J]. J Pathol Inform. 2022;5;13:100124-100128. Bani D, Guelfi MR, Shtylla J, et al. Retrospective analysis of the educational efficacy of digital resources in blended learning for teaching Human Histology & Embryology to medical students[J]. Morphologie. 2025;109(365):100963-100969. Amalinei C, Timofte AD, Căruntu ID, et al. Digital morphology network for effective teaching of cytology, histology and histopathology for medical and biology curriculum[J]. VM3.0 Erasmus+ project. Folia Histochem Cytobiol. 2024;62(2):61-75. Divito CB, Katchikian BM, Gruenwald JE, et al. The tools of the future are the challenges of today: The use of ChatGPT in problem-based learning medical education[J]. Med Teach. 2024;46(3):320-322. Knopp MI, Warm EJ, Weber D, et al. AI-Enabled Medical Education: Threads of Change, Promising Futures, and Risky Realities Across Four Potential Future Worlds[J]. JMIR Med Educ. 2023;25;9:e50373-50392. Ahsan Z. Integrating artificial intelligence into medical education: a narrative systematic review of current applications, challenges, and future directions[J]. BMC Med Educ. 2025;23;25(1):1187-1205. Mistry D, Brock CA, Lindsey T. The Present and Future of Virtual Reality in Medical Education: A Narrative Review[J]. Cureus. 2023;26;15(12):e51124-51129. Zapata-Martínez I, Rius-Diaz F, Lorenzo-Álvarez R, et al. Radiation Oncology Active Learning in Undergraduate Medical Education: The Usefulness of Kahoot and TikTok[J]. J Cancer Educ. 2025;40(6):847-853. Cetinavci D, Yasar V, Yucel A, et al. Evaluation of the usage of YouTube videos about Histology and Embryology as an educational material[J]. Anat Histol Embryol. 2022;51(6):810-817. Dara P, Mopuri R, A S. Evaluation of online active learning strategies in first year medical students[J]. Natl Med J India. 2024;37(5):267-269. Zou L, Su J, Li J, et al. Application of bilingual simulated patients in the medical history collection for international medical students in China[J]. BMC Med Educ. 2023;22;23(1):525-531. Wang C, Zhou C, Ma Y, et al. Implementing bilingual education in gastrointestinal surgery: theory, practice, and insights from China[J]. BMC Med Educ. 2025;27;26(1):8-14. Additional Declarations No competing interests reported. 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It lays an essential foundation for subsequent learning in anatomy, pathology, and clinical medicine\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTo meet the ongoing trends in medical education reform, our teaching team systematically restructured the curriculum content, teaching methods, and evaluation system, and proposed a 3D model\u0026ndash;driven, clinically oriented, three-stage progressive program. This approach aims to cultivate students\u0026rsquo; knowledge integration ability, spatial reasoning, critical thinking, clinical reasoning skills, and scientific literacy\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, facilitating their transformation from passive recipients of knowledge to active inquirers.\u003c/p\u003e"},{"header":"2 Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Analysis of Teaching Problems and Strategy Development\u003c/h2\u003e \u003cp\u003eTo address key challenges in Histology and Embryology teaching, we conducted a systematic analysis of existing problems, their underlying causes, and corresponding innovative strategies. The findings are summarized below (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eMatrix of Instructional Problems and Innovative Strategies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching Problem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderlying Cause\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInnovative Strategy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFragmented knowledge and lack of systematic integration.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents possess strong memorization skills but have weak structural understanding and poor knowledge integration.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe curriculum was reconstructed, and conceptual mind maps were designed to visualize relationships among topics. In the Knowledge Verification Stage, fragmented concepts were reorganized into a coherent, systematic framework.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeak spatial imagination, dominated by two-dimensional observation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents demonstrate sound logical reasoning but lack training in spatial and dynamic visualization.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the Preliminary Exploration Stage, 3D models, clay modeling, and AI-based animations were employed to guide students toward spatial understanding of structures and their functional correlations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient clinical reasoning, reliance on memorization rather than analytical thinking.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents are cognitively adaptable but lack clinically oriented training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the Practical Application Stage, clinical cases and abnormal anatomical models were introduced to develop clinical reasoning and integrated application skills, thereby bridging theory with practice.\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=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Teaching Innovations and Instructional Design\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Curriculum Reconstruction\u003c/h2\u003e \u003cp\u003eThe original course consisted of 80 class hours (40 hours of theory and 36 hours of laboratory work), which was optimized to 76 hours. The curriculum content was transformed from a traditional tissue-type\u0026ndash;based sequence to a function- and organ-oriented modular structure, emphasizing the integration of hollow and solid organs, layered tubular organs, and endocrine and exocrine glands. This restructuring achieved a deeper integration of the knowledge system and strengthened the linkage between structure and function.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Three-Stage Progressive Teaching Program\u003c/h2\u003e \u003cp\u003eFrom the Clinical Medicine cohorts of 2017\u0026ndash;2023, a total of 6415 clinical medicine students were selected to participate in the three-stage progressive learning program.\u003c/p\u003e \u003cp\u003eKnowledge Verification Stage: Guided by theoretical knowledge, this stage integrates microscopic slide observation with conceptual mind mapping to strengthen knowledge comprehension and integration.\u003c/p\u003e \u003cp\u003ePreliminary Exploration Stage: Centered on normal structural 3D models, this phase encourages students to explore the relationship between structure and function, fostering spatial cognition and morphological understanding.\u003c/p\u003e \u003cp\u003ePractical Application Stage: By incorporating clinical cases and abnormal anatomical models, students are guided to analyze clinical problems, thereby developing clinical reasoning and interdisciplinary integration abilities.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Optimization of the Teaching Evaluation System\u003c/h2\u003e \u003cp\u003eThe course assessment consisted of formative assessment (25%), theoretical examination (55%), and practical (laboratory) examination (20%). The formative assessment included chapter quizzes (8%), laboratory assignments (8%), model presentations (5%), drawing assignments (2%), and attendance and learning attitude (2%). This component primarily evaluated students\u0026rsquo; class participation, laboratory performance, and model-making skills.\u003c/p\u003e \u003cp\u003eThe theoretical examination focused on the mastery of fundamental knowledge and case analysis ability, while the practical examination emphasized hands-on competence and spatial reasoning skills. This comprehensive evaluation system integrated knowledge-based, process-oriented, and competency-based assessments, thereby enhancing students\u0026rsquo; self-directed learning and awareness of continuous improvement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Results\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Academic Performance and Learning Behavior\u003c/h2\u003e \u003cp\u003eFrom the 2017 to 2023 cohorts of Clinical Medicine students, the overall trend in academic performance showed a steady upward trajectory. The average score of the 2023 cohort was 75.53, which was notably higher than that of 2022 (72.66) and 2021 (71.72). Compared with earlier cohorts, such as 2018 (66.59) and 2017 (65.54), the improvement was particularly significant.\u003c/p\u003e \u003cp\u003eIn terms of grade distribution, the proportion of high-achieving students (\u0026ge;\u0026thinsp;80 points) continued to rise. In the 2023 cohort, 37.61% of students scored 80 points or above, a clear increase compared with 21.66% in 2022 and 22.79% in 2021. Conversely, the proportion of students scoring below 60 dropped to 6.42%, the lowest level in the past six years. Meanwhile, approximately 35% of students consistently fell within the 70\u0026ndash;79 range, indicating a stable and balanced academic performance across the cohort.\u003c/p\u003e \u003cp\u003eIt is noteworthy that the 2020 cohort experienced relatively lower average scores (67.84), largely due to the initial phase of teaching reform and external factors such as the shift to online learning during the COVID-19 pandemic. However, following the continued implementation of reforms, student performance recovered rapidly and showed substantial improvement. The 2019 cohort, while achieving the highest average score (83.17), was assessed under exceptional conditions involving online examinations and modified instructional arrangements, which may limit direct comparability.\u003c/p\u003e \u003cp\u003eOverall, after the implementation of the 3D model\u0026ndash;driven, clinically oriented, three-stage progressive teaching program, students\u0026rsquo; grade distribution became more balanced, with a marked increase in the proportion of high achievers and a notable decline in failing rates. These results indicate that the model effectively enhanced students\u0026rsquo; learning outcomes and the overall quality of teaching.\u003c/p\u003e \u003cp\u003eIn addition, continuous improvement in formative assessment scores suggests that students became more proactive in pre-class preparation, classroom engagement, and post-class assignments. The improvement in practical examination performance further confirms the positive role of 3D and 3D-printed models in fostering spatial reasoning and hands-on skills. The completion rate of pre-class tasks exceeded 90%, and both class participation and teamwork capabilities showed significant enhancement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Development of Higher-Order Competencies and Practical Skills\u003c/h2\u003e \u003cp\u003eThrough model-making, drawing, and experimental training, students developed strong spatial structural cognition and hands-on skills. The use of 3D models and AI animations effectively facilitated the transition from two-dimensional knowledge to three-dimensional understanding, fostering self-directed exploration and innovative thinking.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Enhancement of Research Literacy and Interdisciplinary Competence\u003c/h2\u003e \u003cp\u003eDriven by the teaching reform, students applied for national and provincial undergraduate innovation and entrepreneurship projects, published research papers, and participated in science popularization works that received awards. These outcomes demonstrate that the course reform significantly promoted students\u0026rsquo; research awareness and interdisciplinary capabilities.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3 Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Pedagogical Basis of the Three-Stage Progressive Program and Promotion of Higher-Order Cognition\u003c/h2\u003e \u003cp\u003eThis teaching program embodies the core principles of constructivism and Bloom\u0026rsquo;s taxonomy of cognitive objectives. Through a progressive \u0026ldquo;knowledge verification\u0026ndash;preliminary exploration\u0026ndash;practical application\u0026rdquo; approach, students\u0026rsquo; learning processes transition from memorization and understanding to analysis, evaluation, and innovation. In the knowledge verification stage, mind maps and histological slide observations are used to facilitate knowledge integration; during the preliminary exploration stage, 3D models, clay models, and 3D printing technology promote the development of spatial thinking\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e; in the practical application stage, clinical cases are incorporated to strengthen problem-solving and clinical reasoning abilities\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, thus establishing a complete pathway for higher-order cognitive development\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, the three-stage progressive program not only aligns with Bloom\u0026rsquo;s cognitive levels in terms of objectives, but also embodies the constructivist principles of situated learning and learner-driven knowledge construction\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In the knowledge verification stage, organized presentation of knowledge combined with guided exercises helps students establish an initial cognitive framework. During the preliminary exploration stage, hands-on operations and model reconstruction serve as a medium to restructure concepts and develop stable spatial representations through iterative practice and feedback\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The practical application stage situates learning within complex and highly authentic clinical scenarios, promoting knowledge transfer and contextual application\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. This pathway, through repeated cognitive processing (understanding \u0026rarr; application \u0026rarr; analysis \u0026rarr; evaluation \u0026rarr; creation), reduces cognitive load while enhancing metacognitive skills, enabling students to apply constructed representations for reasoning and decision-making when facing novel problems. Therefore, this teaching system not only supports long-term retention of knowledge\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e,but also effectively fosters the synergistic development of clinical reasoning, problem-identification, and innovation abilities\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, laying a solid cognitive and skill foundation for subsequent clinical learning and research practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Integration of Models and Multimedia Technologies\u003c/h2\u003e \u003cp\u003eThe application of three-dimensional models and AI animations overcomes the limitations of traditional two-dimensional teaching\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. 3D models and AI animations dynamically visualize microscopic structures and developmental processes\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, significantly enhancing students\u0026rsquo; learning immersion and depth of understanding. Through multimodal information presentation, students can develop more intuitive cognitive representations across visual, tactile, and spatial modalities, facilitating a deeper comprehension of complex structure-function relationships. The model-making process itself represents a reconstruction of knowledge, allowing students to \u0026ldquo;learn by doing\u0026rdquo; and \u0026ldquo;discover through creation\u0026rdquo;, continuously verifying forms and adjusting understanding, thus transforming knowledge from superficial memorization into conceptual internalization and effectively promoting the development of innovative thinking\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, the integration of models and multimedia technologies transforms the traditional \u0026ldquo;teacher-centered lecturing\u0026ndash;student-centered receiving\u0026rdquo; model, making the learning process more interactive and exploratory. Students can actively explore the spatial logic and functional connections of tissue structures by manipulating virtual 3D models\u0026mdash;zooming, rotating, and observing in layers\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The dynamic demonstrations of AI animations further help learners understand the continuity of embryonic development and tissue formation across the temporal dimension\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This dual spatial\u0026ndash;temporal visualization approach aligns with the multichannel processing theory in cognitive psychology and effectively reduces the cognitive load associated with learning abstract structures.\u003c/p\u003e \u003cp\u003eAt the same time, 3D printing and modeling technologies not only demonstrate significant value in foundational teaching but have also been widely applied in clinical education and physician training, including orthopedics\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, urology\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, cardiology\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, dentistry\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, ultrasonography\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, gynecology\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, ophthalmology\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, and emergency medicine\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Educational practice indicates that model-assisted teaching enhances learners\u0026rsquo; intuitive understanding of complex structures, shortens the learning curve, and facilitates the transfer of theoretical knowledge into clinical skills. Therefore, the deep integration of models and multimedia technologies not only broadens the scope of teaching resources but also provides students with a multidimensional learning environment that is hands-on, interactive, and clinically oriented, serving as a key driver for the reform of basic medical courses and transformation of learning approaches.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Enhancement of Clinical-Oriented Task-Driven Learning and Problem-Solving Abilities\u003c/h2\u003e \u003cp\u003eIn the practical application stage, authentic clinical cases and abnormal structure models are introduced to encourage students to integrate their acquired knowledge within open and realistic scenarios\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. This design reflects the principles of case-based learning (CBL) and situated cognition\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, including online CBL instruction\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Through a task-driven approach, students are required to synthesize foundational knowledge, structural understanding, and functional reasoning when facing real or simulated clinical problems, completing the full process of problem identification, information analysis, hypothesis formulation, and outcome verification\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. This process not only enhances logical thinking and systematic analysis skills but also fosters a problem-centered, inquiry-based learning mindset in medical contexts\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe model emphasizes that students actively construct cognitive frameworks within complex knowledge networks, achieving knowledge transfer and application through collaborative discussion, role assignment, and project design. The contextualized case settings embed learning activities within authentic clinical scenarios, allowing students to experience the clinical significance of histology and embryology knowledge during problem-solving, thereby enhancing the purposefulness and practice-orientation of learning. Research indicates that teaching strategies combining task-driven learning and CBL effectively promote students\u0026rsquo; active learning and teamwork skills, improve the development pathway of clinical reasoning\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, and facilitate vertical knowledge integration and interdisciplinary application.\u003c/p\u003e \u003cp\u003eMoreover, during the course implementation, instructors shift from being \u0026ldquo;knowledge transmitters\u0026rdquo; to \u0026ldquo;learning facilitators\u0026rdquo; and \u0026ldquo;thinking promoters\u0026rdquo;, gradually setting progressive problem difficulty levels to guide students in forming higher-order thinking through reflection, discussion, and verification. Throughout the continuous problem-solving process, students learn to apply evidence-based reasoning, critical analysis, and reflective learning, transitioning from single-knowledge application to integrated decision-making. Practice demonstrates that this stage of learning not only effectively enhances students\u0026rsquo; ability to solve complex problems, but also implicitly cultivates clinical reasoning awareness\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, scientific inquiry spirit, and lifelong learning competence\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Educational Effectiveness of a Diversified Assessment System\u003c/h2\u003e \u003cp\u003eThe course adopts a diversified assessment system that combines formative and summative evaluations, focusing not only on the learning process but also on students\u0026rsquo; comprehensive abilities. Formative assessment provides dynamic feedback and continuous motivation\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, while summative exams test higher-order cognition through case-based questions. This system achieves \u0026ldquo;assessment for learning and teaching\u0026rdquo;, aligning with the principles of authenticity and developmental orientation in educational evaluation.\u003c/p\u003e \u003cp\u003eDuring course implementation, formative assessment runs through all stages of teaching\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, continuously tracking students\u0026rsquo; learning engagement and skill development through chapter quizzes, class performance, model production, drawing assignments, and group presentations. Such process-oriented evaluation not only identifies students\u0026rsquo; weak points in understanding and application in a timely manner but also enables instructors to adjust teaching strategies based on feedback, providing personalized guidance and differentiated support\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Compared with traditional summative exams, formative assessment emphasizes learning behaviors and cognitive development trajectories, shifting evaluation from a single score to a multidimensional measure of overall competence and learning quality\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSummative assessment focuses on evaluating students\u0026rsquo; knowledge integration and higher-order cognitive abilities\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Through case-based questions and practical experiments, it assesses students\u0026rsquo; clinical reasoning, spatial visualization, and knowledge transfer, thereby reinforcing the connection between theory and practice. A diversified assessment system encourages students to maintain goal-oriented and self-regulated learning behaviors, facilitating the transition from \u0026ldquo;passive test-takers\u0026rdquo; to \u0026ldquo;active learners\u0026rdquo;\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, the system ensures both fairness and developmental orientation in evaluation. By introducing multidimensional assessment criteria, feedback involves instructors, peers, and self-assessment, forming a more open and interactive evaluation ecosystem. Students continuously reflect and adjust their learning strategies, enhancing autonomy and responsibility. Practical results indicate that the implementation of this diversified assessment system significantly improves students\u0026rsquo; engagement, classroom participation, and overall competence, demonstrating the positive impact of assessment on learning behaviors and skill development\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Educational Value and Pedagogical Significance of Teaching Innovation\u003c/h2\u003e \u003cp\u003eThis educational program achieves a three-dimensional integration of \u0026ldquo;knowledge\u0026ndash;skills\u0026ndash;competence\u0026rdquo;, reflecting systematic innovation in teaching philosophy, content structure, and learning methods. Its pedagogical significance is manifested as follows: Shift from content-oriented to competency-oriented teaching\u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. The focus of instruction moves from knowledge transmission to skill and competence development, emphasizing the learner\u0026rsquo;s central role and the cultivation of critical thinking. By integrating three-dimensional models with clinical cases, students develop active inquiry and innovative thinking through continuous problem-solving\u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e, thus achieving the transition from \u0026ldquo;acquiring knowledge\u0026rdquo; to \u0026ldquo;thinking critically\u0026rdquo; and \u0026ldquo;applying knowledge\u0026rdquo;. This competency-oriented reform aligns with the international trend of Outcome-Based Education (OBE) in medical education.\u003c/p\u003e \u003cp\u003eTransition from static knowledge to dynamic understanding. This model transforms abstract histology knowledge into dynamic and interactive learning objects through the use of AI animations, three-dimensional models, and practical tasks, allowing students to comprehend the relationships between structure and function while perceiving the process of knowledge generation and evolution. This is consistent with previous reports, where scholars employed Virtual Reality (VR) and Augmented Reality (AR) in teaching; dynamic instruction facilitates holistic understanding of complex systems, promotes deep learning and knowledge transfer, and helps cultivate integrated analytical and structural reasoning skills\u003csup\u003e[\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. A new humanized digital active learning model\u0026mdash;Virtual Case-Based Learning (VCBL)\u0026mdash;has been shown to improve the teaching process and enhance students\u0026rsquo; knowledge acquisition and satisfaction\u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTransition from single-discipline to interdisciplinary integration. This model integrates foundational medical sciences\u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e, and organically combines them with clinical medicine, art and design, and information technology, forming a multidimensional learning platform\u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e. Through interdisciplinary project design and model creation, students experience the unity of scientific thinking and artistic expression during knowledge construction, enhancing their comprehensive innovation ability and team collaboration awareness. This cross-boundary teaching approach not only expands the horizons of medical education but also reflects the integrated and multidisciplinary characteristics of modern medical talent cultivation\u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, the promotional value of this model lies in its replicability and scalability. In the era of digitalization, the modular design of teaching concepts and resource systems\u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e, and allows for localized adaptation and reconstruction according to the characteristics of different courses, showing potential for application in foundational courses such as anatomy, physiology, and pathology\u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. This teaching model breaks down barriers between disciplines, providing a feasible pathway for the integrated and innovative development of medical education. Particularly in the context of the new medical curriculum reform, it helps promote the coordinated transformation of teaching methods, evaluation systems, and talent cultivation objectives, offering a new paradigm for training high-quality medical professionals with clinical thinking, innovative awareness, and social responsibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Continuous Improvement and Future Prospects\u003c/h2\u003e \u003cp\u003eIn the future, the digital teaching system will be further enhanced through the integration of three-dimensional models and AI resource libraries, establishing a sustainably updatable platform that allows teaching content and resources to dynamically adapt to advances in medical knowledge and technology. By incorporating artificial intelligence\u0026ndash;based learning analytics and personalized feedback mechanisms\u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e, AI-driven medical education enables real-time monitoring and precise assessment of learning behaviors. Teachers can optimize instructional design based on data feedback\u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e, while students can receive tailored guidance according to individual learning paths, thereby enhancing personalized learning and educational efficiency\u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAt the same time, future teaching reforms will increasingly rely on the development of immersive technologies. The exploration of virtual reality (VR) and augmented reality (AR) in histology teaching can not only enhance clinical realism and interactive experiences, but also provide students with multi-angle and multi-level perspectives, allowing them to simulate slide observation, organ construction, and developmental processes in virtual scenarios, addressing the limitations of visualization in traditional teaching. The introduction of these technologies supports the improvement of spatial imagination and clinical reasoning skills, and promotes the intelligent, visualized, and experiential development of basic medical education\u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, the appropriate use of social networking platforms and new media tools, such as TikTok Live streaming\u003csup\u003e[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e, and Youku videos\u003csup\u003e[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/sup\u003e, offers new possibilities for teaching dissemination and interactive learning. Formats like short videos and live interactions can effectively facilitate teacher-student communication and learning resource sharing, extending learning beyond the classroom and creating a blended online-offline learning ecosystem. The combination of online lectures and hybrid teaching further expands the boundaries of teaching space and time, enabling learners to continuously deepen their understanding in a flexible and continuous learning environment\u003csup\u003e[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the future, emphasis should also be placed on international exchange and research on bilingual education\u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. By collaborating with international medical education institutions and sharing experiences, the internationalization and standardization of teaching models can be promoted. On this basis, further improvement of the teaching quality assurance system will facilitate the continuous optimization of teaching concepts, content, and methods, ensuring the sustainable development and high-quality advancement of medical education\u003csup\u003e[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eThe practice of has demonstrated significant effectivenessthe \u0026ldquo;Three-Stage Progressive Teaching Program Driven by Stereoscopic Models for Clinical Orientation\u0026rdquo; in histology and embryology courses. This model significantly enhances students\u0026rsquo; knowledge integration, spatial thinking, clinical reasoning, and research literacy, achieving an organic unity of knowledge mastery, skill development, and competency cultivation. By integrating stereoscopic models, AI animations, 3D printing technology, and clinical cases, the model breaks through the limitations of traditional teacher-centered and two-dimensional observation-based teaching, strengthening students\u0026rsquo; active exploration and problem-solving abilities.\u003c/p\u003e \u003cp\u003eMoreover, the model possesses strong scalability and reproducibility, making it applicable to basic medical courses such as anatomy, physiology, and pathology, and extendable to clinically-oriented courses. It provides a practical paradigm and exemplary experience for cultivating innovative and application-oriented medical talents under the new medical education framework. Overall, this teaching model not only optimizes course design and learning experiences, but also offers a sustainable pathway for systematically developing higher-order cognitive abilities and innovation skills, holding significant value for advancing medical education reform and improving the quality of talent cultivation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the students and faculty members who participated in this study. Their engagement and feedback were invaluable for the design, implementation, and evaluation of the 3D model–driven, clinically oriented, three-stage progressive teaching program. The authors also acknowledge the support of the Department of Histology and Embryology, School of Preclinical Medicine, Zunyi Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNa Liang, Xiang Lu and Jun Tan contributed to the conception and design of the study. Qiongyou Liu, Lian Liu and Renlian Cai were involved in data collection and analysis. Xiaodong Yi and Ying Wu assisted with the preparation of teaching materials and implementation of the teaching model. Yanping Ren supervised the project and critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study analyzed students’ academic performance and participation in routine teaching activities within the Histology and Embryology course. It did not involve human tissue, patient data, or any clinical interventions. According to educational research management guidelines, this type of study does not require formal ethics approval or informed consent. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Teaching Content and Curriculum System Reform Project of Higher Education Institutions in Guizhou (grants SJJG-2023183). This study was supported by the Zunyi Medical University Graduate Education Teaching Reform Project (Grant No. YJSJG2025005). The authors also acknowledge the support of the Department of Histology and Embryology, School of Basic Medical Sciences, Zunyi Medical University. And the Project Funded under the Undergraduate Education and Teaching Reform Program of Zunyi Medical University (XJJG2025-02 and XJJG2023-34).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCarneiro BD, Pozza DH, Tavares I. Perceptions of medical students towards the role of histology and embryology during curricular review[J]. 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BMC Med Educ. 2025;27;26(1):8-14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"Histology and Embryology, three-stage progressive program, 3D model, clinical orientation, teaching reform, formative assessment","lastPublishedDoi":"10.21203/rs.3.rs-8881845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8881845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo implement the educational philosophy of fostering virtue and talent, this study aimed to develop and evaluate a 3D model\u0026ndash;driven, clinically oriented, three-stage progressive teaching program in Histology and Embryology, designed to cultivate application-oriented medical professionals with clinical reasoning and practical skills.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe proposed teaching program divided the learning process into three sequential phases: knowledge verification, preliminary exploration, and practical application. It integrated multiple instructional tools\u0026mdash;including medical illustrations, clay models, 3D-printed models, AI-based animations, and online learning resources\u0026mdash;to facilitate the combination of theoretical understanding, spatial visualization, and clinical application skills. The model was implemented in undergraduate medical courses, and student outcomes were evaluated through academic performance, spatial reasoning tests, clinical problem-solving exercises, and participation in research and science communication activities.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eImplementation of the program significantly improved students\u0026rsquo; academic performance, spatial reasoning, and clinical problem-solving abilities. Students achieved excellent outcomes in drawing, model construction, photomicrography, and slide interpretation competitions. The number of student-led research projects and science communication activities also increased substantially, reflecting enhanced research awareness and innovation capability.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 3D model\u0026ndash;driven, clinically oriented, three-stage progressive teaching program provides an effective, scalable, and transferable framework for basic medical education reform. It promotes integration of theoretical knowledge, spatial understanding, and clinical application, offering valuable insights and practical experience for cultivating innovative and application-oriented medical professionals in the era of New Medical Sciences.\u003c/p\u003e","manuscriptTitle":"Application and Practice of a 3D Model–Driven Clinically Oriented, Three-Stage Progressive Teaching Program in Histology and Embryology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-09 08:17:00","doi":"10.21203/rs.3.rs-8881845/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T08:16:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T18:58:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T03:28:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51332405233517389216970084298122585367","date":"2026-03-08T02:41:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T10:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94976063110227630372125184977932763262","date":"2026-03-04T17:39:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T10:36:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33689877584738366624579665645899161095","date":"2026-03-04T10:11:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189307550052083488100237397501040585136","date":"2026-03-04T09:53:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-04T06:51:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T06:43:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-03T04:42:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-02T17:18:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-02T10:23:29+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":"96a00bc8-ffea-4b32-9f95-ab1d8b96f52a","owner":[],"postedDate":"March 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T01:38:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-09 08:17:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8881845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8881845","identity":"rs-8881845","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}