Application of Bedside Small-group Problem-based Learning in Clinical Practice Teaching of Dermatology

Application of Bedside Small-group Problem-based Learning in Clinical Practice Teaching of Dermatology | 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 Article Application of Bedside Small-group Problem-based Learning in Clinical Practice Teaching of Dermatology Xianfa Tang, Wenjun Wang, Songke Shen, Huayang Tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4432615/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and aims The problem-based learning (PBL) teaching model has significant advantages in inspiring and improving clinical thinking among medical students. Bedside teaching has always been regarded as one of the ideal clinical teaching modes. The aim of this study is to investigate the effects of bedside small-group PBL on dermatologic teaching in medical students. Methods Fifty interns (undergraduates) were randomly divided into the study and control groups. The study group received bedside PBL teaching while the control group received traditional bedside teaching. The teaching effectiveness of the two groups was evaluated by the computer-based case simulations (CCS), the mini clinical evaluation exercise (mini-CEX) and students’ satisfaction surveys. Results The average CCS score of the study group was significantly higher than that of the control group ( P < 0.05). For the mini-CEX, the medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence in study group significantly higher than those of the control group ( P < 0.05). The overall satisfaction, stimulation of active learning, improvement of clinical skills, facilitation of counseling skills and enhancement of teamwork were higher than those of the control group ( P < 0.05). Conclusion The bedside small-group PBL teaching model can not only stimulate the actively learning for undergraduates, but also improve their clinical reasoning, counseling skills and overall clinical competence, which can be served as a training system of dermatological clinical practice for medical undergraduates. Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research Dermatology Teaching model Problem-based learning Bedside teaching Figures Figure 1 Figure 2 Introduction Dermatology and venereology is a clinical discipline that focuses on morphological teaching. Its professional and practical characteristics require medical students to master solid theoretical knowledge and proficient clinical operational skills. Therefore, effective bedside teaching is particularly important to accelerate medical students' comprehensive understanding of clinical disciplines. The problem-based learning (PBL) teaching model has significant advantages in inspiring and improving clinical thinking among medical students 1–3 . Bedside teaching has been regarded as one of the clinical teaching modes, which can provide comprehensive clinical ability improvement for medical students by combining medical history and physical examination skills 4 , but the role of bedside teaching in the undergraduate' s learning experience has seen a witnessed decline and it has been estimated to represent just 8% of the formal clinical teaching delivered by medical schools 5 . The limitation of traditional bedside teaching is a teacher/patient-centered instruction model that fails to solve students' actual learning difficulties and prevents them from obtaining personalized teaching, so it is necessary to explore new practical bedside teaching methods because of the lack of learning motivation and problem-solving ability among students for traditional bedside teaching 6 . Based on the above situation, the student-centered for bedside PBL teaching might be a desirable and feasible model, and which can provide opportunities for students to actively participate in bedside practical teaching and experiential learning. This study conducted the feasibility and effectiveness of bedside small-group PBL in dermatology clinical teaching for undergraduates. Methods Subjects Fifty interns (undergraduates) were in the Department of Dermatology and Venereology at the First Affiliated Hospital of Anhui Medical University from January 2022 to September 2023, and these who were randomly divided into two groups (25 in the study group and 25 in the control group), Fig. 1 showed the flow chart for the two groups in bedside teaching. The general information of all participants was shown in Table 1 . There were no statistically significant differences in age, gender, and theoretical exam scores between the study group and the control group ( P > 0.05), which indicated comparability. Based on the Declaration of Helsinki principles, the study was approved by the Institutional Ethical Committee the First Affiliated Hospital of Anhui Medical University (PJ2023-13-41). The study group received bedside small-group PBL teaching while the control group received traditional bedside teaching. During the internship, interns encountered skin diseases (including pustular psoriasis, acute urticaria, drug eruption, allergic purpura, cutaneous vasculitis, pemphigus, lupus erythematosus, dermatomyositis, etc). Obtain informed consent from the patient or their family before each teaching activity. Two dermatology teachers with senior professional titles (who have received standardized training in PBL and bedside teaching) participated in the teaching for two groups. Teaching arrangement for the two groups The 25 interns in the study group were randomly assigned to 5 subgroups (each with 5 students), all these who received the bedside small-group PBL teaching. The cases with severe drug-induced dermatitis were selected for teaching. The study group consisted of three scenarios, which included clinical case preparation (the first scenario in multimedia classroom), discussion/preparation condition (the second scenario in multimedia classroom) and bedside PBL teaching (the third scenario in ward). The first scenario was conducted on one day, whereas the second and third scenarios were conducted on same day after 3 days. 1) Clinical case preparation by the first scenario: Teachers determined learning objectives and scope based on clinical case. Teachers showed relevant case basic information and theoretical knowledge to students by PowerPoint in multimedia classroom. Students found the key points and proposed the questions about relating to learning objectives, and achieved the goals of consensus. These were beneficial for students to collect information and familiarize relevant knowledge. Adequate pre-teaching preparation will ensure the good progress of PBL teaching; 2) Discussion of objectives problem and preparation condition by the second scenario: All Students shared learning content, discussed and solved the consensus problems each other by PowerPoint in multimedia classroom. Each student undergone an individual readiness assessment test before teaching (a sheet including 10 multiple-choice questions, to evaluate their preparation condition for PBL and ensure subsequent teaching implementation). After completing the test, the instructor provided the correct answers, and discussed the answers and proposes their own arguments in group. The current stage is an important component of PBL teaching, which can stimulate students' full preparation before teaching; 3) Bedside PBL teaching by the third scenario in ward: Students 1 and 2 completed medical history collection and physical examination, students 3–5 completed clinical reasoning, effective diagnosis and treatment strategies and doctor-patient communication. After completing each step, student raised their own questions and suggestions based on the pathogenesis, diagnosis/treatment of disease and doctor-patient communication. After all steps were completed, the instructor will provide appropriate supplements and guidance. After the bedside teaching activity, all students and instructors communicated and discussed with each other, which included the summarization, feedback and comments about instructors on students' performance in multimedia classroom. The 25 interns in the control group were randomly assigned to 5 subgroups (each with 5 students), all these who received traditional bedside teaching and the cases with severe drug-induced dermatitis were selected for teaching. The interns were informed to preview the related information about the case before the teaching. In teaching, students presented case reports and physical examinations, while teachers presented standardized physical examinations, history summary, condition analysis, proposed diagnosis and treatment strategies, and communicated with patients or family members about their condition. The teacher continuously interacted with the students in entire process, confirmed or corrected the case analysis and results reported by the students. Evaluation of teaching effectiveness Cognitive knowledge assessment Cognitive knowledge relating to medical history collection, physical examination, clinical reasoning and decision making were evaluated by the computer-based case simulations (CCS) 7 . Each intern collected patient history, conducted virtual physical examinations, and ordered investigations and tests. The interns narrowed their clinical reasoning hypotheses into a final diagnosis. Based on their diagnosis, they developed the patient management plan. Clinical reasoning scores were calculated based on the interns’ ability to list the diagnostic hypotheses related to the case. Management was scored based on the four subcategories of Required, Recommended, Related History and Physical Examination, and Related Lab, where each subcategory is assigned a numerical value based on the relative importance of each category. The scoring system in the CCS exam software tracked the interns’ interactions and provided a score for six categories of intern performance, namely professional attitude, clinical practice skills, learning ability, counseling skills, clinical reasoning and time management. Through the interaction between intern and computer, interns simulated doctors diagnosing and treating patients in a virtual medical context. The CCS exam lasts for 60 minutes, with a maximum score of 100 points. After submission, the computer will provide a unified rating. Interns received performance feedback immediately on completing the exam. Clinical skills assessment This assessment is based on the mini clinical evaluation exercise (mini-CEX, Fig. 2 ) in the form of bedside clinical cases 8 . The concept of miniCEX was explained to the faculty members and the systematic ways and methods of giving feedback were conveyed to students. All interns who consented were sensitized toward miniCEX. Preparation of a feedback questionnaire for interns and faculty was done and the questionnaire was validated by the peer group. All sessions of miniCEX were conducted for each intern inpatient department. Immediate feedback was provided to the students by the faculty. The scoring of the mini CEX tool included 7 items (medical interviewing skills, physical examination skills, humanistic qualities, clinical judgment, counseling skills, organizational efficiency and overall clinical competence, with each item scoring 9 points, a score of 1–3 was considered unsatisfactory, a score of 4–6 was considered satisfactory, and a score of 7–9 was considered superior). The actual mini CEX evaluation was conducted by teachers who have not participated in bedside teaching (who have received mini CEX training) and was unaware of the specific-assigned group. Students’ satisfaction survey A questionnaire will be distributed to the interns for an anonymous survey to investigate their satisfaction and teaching effectiveness in participating in current teaching activities. The questionnaire for students’ satisfaction survey mainly covered 6 items (Q1: Have you generally satisfied with this teaching? Q2: Can it stimulate you to active learning by this teaching? Q3: Can it motivate you to mastering theoretical knowledge? Q4: Can it improve your clinical skills by this teaching? Q5: Can it facilitate your counseling skills by this teaching? Q6: Can it enhance your teamwork power by this teaching?). Each item was evaluated on five levels, with a score of 1–5, namely 1 (strongly disagree), 2 (disagree), 3 (neutral), 4 (agree), and 5 (strongly agree). The responses all of interns were captured immediately and anonymously in site questionnaire survey after completing the teaching activities, and the data obtained from the questionnaires was analyzed by Cronbach' s alpha test to determine the internal consistency of responses. Data analysis All data were analyzed using the SPSS (Version 18.0). Data were expressed as mean ± standard deviation. t test or chi-square test between two groups was adopted, and P less than 0.05 was considered as statistically significant. Results Comparison of CCS and mini‑CEX results in two groups The CCS and mini CEX evaluation were estimated the students' dermatological clinical skills (Table 2 ). The average CCS score of the study group was significantly higher than that of the control group, and there was a statistical difference ( t = 3.43, P = 0.001). The medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence in study group significantly higher than those of the control group, and there were statistical differences ( t = 2.42, P = 0.02; t = 2.92, P = 0.005; t = 3.09, P = 0.003; t = 2.77, P = 0.008; t = 2.79, P = 0.008). However, there were no significant differences for the physical examination skills, and humanistic qualities between the two groups ( t = 0.68, P = 0.50; t = 1.12, P = 0.27). Comparison of teaching satisfaction in two groups Fifty questionnaires were received. Students' satisfaction in the study group was significantly higher than that of the control group: overall satisfaction ( t = 3.11, P = 0.003), stimulation of active learning ( t = 3.21, P = 0.002), improvement of clinical skills ( t = 2.56, P = 0.01), facilitation of counseling skills ( t = 2.77, P = 0.008) and enhancement of teamwork ( t = 3.20, P = 0.002) were higher than those of the control group. There was no significant difference between the two groups in mastering theoretical knowledge ( t = 1.24, P = 0.22) (Table 3 ). Discussion The rapid development of the educational environment has greatly affected medical education and traditional teaching models can no longer fully meet the medical students' learning needs 9 . PBL is a new trend in medical education in recent years, but there many obstacles and challenges that face the implementation of problem-based learning in many medical schools 10 . Practice is an effective learning pathway for improving clinical skills of medical students 11 . Essentially, the student-centered of problem-based and ability-based teaching can cultivate and improve the knowledge, skills and attitudes of students. The teacher-centered of traditional bedside teaching models emphasizes the knowledge and skills of teachers; it makes students lacking initiative and results in little benefit for students. Based on traditional teaching activities, it has been found that students still face various difficulties and challenges in clinical practice learning (such as, poor communication between students and patients, lack of ability to recognize disease signs and make diagnoses of diseases). These indicated that traditional bedside teaching has not effectively improved students' clinical abilities. Therefore, there is an urgent need to explore a new bedside teaching method to promote students' proactive learning. In clinical practice, active learning methods can effectively cultivate the critical thinking and problem-solving abilities of medical students for bedside PBL teaching 12 . Several previous PBL medical education studies showed some effectiveness as an instructional technique, such as, increasing students' understanding and learning interest, helping student to develop clinical problem-solving skills, improving students' satisfaction, test scores, self-learning ability and collaboration skills 13–15 . PBL teaching might focus more on cultivating students' problem-solving and clinical reasoning abilities, rather than simply memorizing the knowledge itself, thereby which can promote the application of clinical knowledge and improve the level of clinical learning 16 . A study also showed that students' expression and communication skills were effectively improved by medical history collection, joint discussion and summarization 17 . Dermatology is a subject with an inherited visual nature, and the recognition of rashes is often gleaned by the senses. This is somewhat 'seeing is believing'. This prominent feature of dermatology makes it perfectly suited to incorporate real patient and PBL teaching. In this study, both real patients and bedside small-group PBL teaching were considered to be more relevant to real-world clinical situations than paper cases. The current findings demonstrated that the average CCS score of students in the study group was significantly higher than that of the control group; the mini CEX performances (medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence) of students in the study group were superior to those of the control group. The questionnaire surveys also showed that PBL teaching helped to improve students' satisfaction, active learning, clinical skills, consulting skills and teamwork abilities. These indicated that PBL teaching not only can improve students' clinical ability, counseling skills, enhancement teamwork and satisfaction, but also stimulate students' interest in learning and encourage them to develop the habit of active learning. These findings were consistent with previous reported studies 13–16 . In addition, PBL teaching can help to increase teacher-student interaction, improve students' learning efficiency and fully emphasize students' subjective initiative. Unlike traditional teaching, the role of teacher has shifted from being a lecturer to a facilitator, while the students played a leading role in bedside PBL teaching activities. Although this study illustrated that bedside small-group PBL teaching improved active learning, clinical reasoning, counseling skills and overall clinical competence in medical undergraduates in dermatology, we also noted some problems in bedside teaching activities with PBL. Firstly, the sample size was limited, which might impact on the power of these results. Secondly, it only performed evaluation immediately after the teaching intervention, but delayed testing of students for learning retentions was needed in evaluating a novel teaching methodology. The lastly, although the sessions require less faculty time, the process of designing the modules requires time and dedication. Teachers should continuously improve the design of PBL teaching modules and content by considering systematic knowledge of case selection 18 . In addition, the students in study group fully can guarantee the enough duration of self-learning and their learning effectiveness was been tested before teaching activities, but the students in control group did not do them. These might resulted in differences in extracurricular time for self-learning between the students of two groups. To reduce possible confounding factors, subsequent study should consider to controlling the total spent time for students in the aspect of task arrangement and warrant further investigation with larger samples. Notably, bedside PBL teaching poses new challenges to teaching skills and forms for the perspective of teachers, which requires them to improve the teaching design and optimize the teaching resources. Teachers need to make sufficient preparations (including the training sessions, accurate instructional objectives and strategies, providing learning resources and selecting appropriate cases) before teaching activities, which ensures the smooth implementation of bedside PBL teaching. More research is recommended with medical undergraduates of other disciplines to confirm findings of current study and to evaluate the potential positive effects of small-group PBL teaching model. Conclusion The bedside small-group PBL teaching model can not only stimulate medical undergraduates' active learning, but also improve their clinical reasoning, counseling skills and overall clinical competence in dermatology. It can also enable them to master and understand the whole processes of diagnosis and treatment of diseases by using CCS and mini CEX to test students' clinical performance. Reasonable application of bedside small-group PBL teaching model can be served as a training system of dermatological clinical practice for medical undergraduates. Declarations Conflicts of Interest and Source of Funding All authors have no conflicts of interest to declare. This current study was funded by the National First Class Undergraduate Major Construction Project (Clinical Medicine Sub project) of Anhui Medical University. Acknowledgements Thanks all individuals in this research. Xianfa Tang designed the study, managed the data, performed the statistical analysis and wrote the manuscript; Wenjun Wang, Songke Shen and Huayang Tang conducted the teaching implementation. Author Contribution XF T designed the study, managed the data, performed the statistical analysis and wrote the manuscript; WJ W, SK Sh and HY T conducted the teaching implementation. Data Availability The raw data were obtained from in a supplementary information file. References Mumtaz S, Latif R. Learning through debate during problem-based learning: an active learning strategy. Advances in physiology education. 2017;41(3):390-394. Distler JW. Critical thinking and clinical competence: results of the implementation of student-centered teaching strategies in an advanced practice nurse curriculum. Nurse education in practice. 2007;7(1):53-59. Kaliyadan F, Amri M, Dhufiri M, et al. Effectiveness of a modified tutorless problem-based learning method in dermatology - a pilot study. 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Identification of Health Systems Science in a Problem-Based Learning Clinical Reasoning Exercise. Medical science educator. 2022;32(1):51-55. Zhang F, Wang H, Bai Y, et al. A Bibliometric Analysis of the Landscape of Problem-Based Learning Research (1981-2021). Frontiers in psychology. 2022;13:828390. Offiah G, Ekpotu LP, Murphy S, et al. Evaluation of medical student retention of clinical skills following simulation training. 2019;19(1):263. Schaller MD, Gencheva M, Gunther MR, et al. Training doctoral students in critical thinking and experimental design using problem-based learning. BMC medical education. 2023;23(1):579. Iwatsuki J, Kondo T. Problem-Based Learning in Child and Adolescent Psychiatry: A Perspective from Japan. Advances in medical education and practice. 2021;12:1329-1335. Ko CH. Studying on Learning Satisfaction in Teaching Keyboard Courses With Problem-Based Learning Teaching Mode. Frontiers in psychology. 2022;13:884311. Yu X, Qin L, Huang G, et al. 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Tables Table 1 Demographic characteristics of students in two groups Group Age Gender Theoretical Examination Scores Study group (n = 25) 22.68 ± 0.56 Male (n = 15)/Female (n = 10) 86.16 ± 4.52 Control group (n = 25) 22.44 ± 0.51 Male (n = 16)/Female (n = 9) 84.64 ± 5.77 t = 1.60 χ2 = 0.09 t = 1.04 P 0.12 0.77 0.31 Table 2 Comparison of CCS and mini-CEX results in two groups (Mean ± SD) Group CCS Scores mini-CEX Medical interviewing skills Physical examination skills Humanistic qualities Clinical judgment Counseling skills Organizational efficiency Overall clinical competence Study group (n = 25) 86.24 ± 4.03 7.08 ± 0.91 6.20 ± 0.82 6.08 ± 0.95 6.88 ± 1.05 6.64 ± 0.81 5.80 ± 0.76 6.16 ± 0.90 Control group (n = 25) 81.92 ± 4.83 6.44 ± 0.96 6.04 ± 0.84 5.80 ± 0.82 6.08 ± 0.98 5.88 ± 0.93 5.24 ± 0.66 5.52 ± 0.71 t 3.43 2.42 0.68 1.12 2.92 3.09 2.77 2.79 P 0.001 0.02 0.50 0.27 0.005 0.003 0.008 0.008 Table 3 Comparison of teaching satisfaction between two groups (Mean ± SD) Items surveyed Study group (n = 25) Control group (n = 25) t P Overall satisfaction 4.68 ± 0.56 4.16 ± 0.62 3.11 0.003 Stimulate active learning 4.68 ± 0.48 4.20 ± 0.58 3.21 0.002 Master theoretical knowledge 4.52 ± 0.51 4.32 ± 0.63 1.24 0.22 Improve clinical skills 4.64 ± 0.57 4.16 ± 0.75 2.56 0.01 Facilitate counseling skills 4.48 ± 0.65 3.96 ± 0.68 2.77 0.008 Emphasize more on teamwork 4.60 ± 0.50 4.08 ± 0.64 3.20 0.002 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4432615","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":309629100,"identity":"27318c5e-cdbd-4f32-b3a9-41cc0efd5a02","order_by":0,"name":"Xianfa Tang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBADHgYGxgcMHwxs7IhQzAzTwmzAOKMgLZloLSCGATPPh0OMDYQ08M/IP/i54NdhGf7ZzYyfbQwOMDOwHz66AZ8WiRvJzNIz+9J4JO4cZpbOMbjDx8CTlnYDrzU3khmkeXtseBhu5B8AannGzCDBY4ZXizzQlt+8PRI8YIaFwWHGBkJaDG4ks0nz/LDhATMYiNFieOaxmTVvQxqPIVCLZY9BWjIbIb/IHU98fJvnz2F7OaDDbvz4Y2PHz374GH7vCyQA470NSYANr3IQ4D8AJP4QVDYKRsEoGAUjGQAAjcBHVTYV9fYAAAAASUVORK5CYII=","orcid":"","institution":"Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xianfa","middleName":"","lastName":"Tang","suffix":""},{"id":309629101,"identity":"88bfdeee-fb1f-449f-9ad8-ec0ab639df37","order_by":1,"name":"Wenjun Wang","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjun","middleName":"","lastName":"Wang","suffix":""},{"id":309629102,"identity":"c4822f96-dd14-43d7-8bf3-60d23d22e08d","order_by":2,"name":"Songke Shen","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Songke","middleName":"","lastName":"Shen","suffix":""},{"id":309629103,"identity":"d92faf5d-b995-44f4-90ae-ce949db2af4a","order_by":3,"name":"Huayang Tang","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huayang","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2024-05-16 17:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4432615/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4432615/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57873484,"identity":"415a368b-b199-4ab5-a510-b30162549022","added_by":"auto","created_at":"2024-06-06 18:40:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":215832,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart of bedside teaching with problem-based learning and traditional teaching rounds\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4432615/v1/89b29558083b69d4211d2c13.png"},{"id":57873485,"identity":"9f424ab5-d2f7-4f48-9e26-65d116b3632b","added_by":"auto","created_at":"2024-06-06 18:40:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":202137,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMini‑CEX proforma\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4432615/v1/4c0628a9d50d53d6455aa9d5.png"},{"id":63468472,"identity":"b507d059-7ff1-4565-a28c-c38c2eaa3393","added_by":"auto","created_at":"2024-08-28 12:47:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":887526,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4432615/v1/df6b8de8-c900-483b-b696-2464177bad3d.pdf"},{"id":57873483,"identity":"b8917a1f-8279-44af-9088-727196bee55e","added_by":"auto","created_at":"2024-06-06 18:40:22","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13626,"visible":true,"origin":"","legend":"","description":"","filename":"rawdata.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4432615/v1/3250441aed0b7677d92a276b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of Bedside Small-group Problem-based Learning in Clinical Practice Teaching of Dermatology","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDermatology and venereology is a clinical discipline that focuses on morphological teaching. Its professional and practical characteristics require medical students to master solid theoretical knowledge and proficient clinical operational skills. Therefore, effective bedside teaching is particularly important to accelerate medical students' comprehensive understanding of clinical disciplines. The problem-based learning (PBL) teaching model has significant advantages in inspiring and improving clinical thinking among medical students\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e. Bedside teaching has been regarded as one of the clinical teaching modes, which can provide comprehensive clinical ability improvement for medical students by combining medical history and physical examination skills\u003csup\u003e4\u003c/sup\u003e, but the role of bedside teaching in the undergraduate' s learning experience has seen a witnessed decline and it has been estimated to represent just 8% of the formal clinical teaching delivered by medical schools\u003csup\u003e5\u003c/sup\u003e. The limitation of traditional bedside teaching is a teacher/patient-centered instruction model that fails to solve students' actual learning difficulties and prevents them from obtaining personalized teaching, so it is necessary to explore new practical bedside teaching methods because of the lack of learning motivation and problem-solving ability among students for traditional bedside teaching\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBased on the above situation, the student-centered for bedside PBL teaching might be a desirable and feasible model, and which can provide opportunities for students to actively participate in bedside practical teaching and experiential learning. This study conducted the feasibility and effectiveness of bedside small-group PBL in dermatology clinical teaching for undergraduates.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eFifty interns (undergraduates) were in the Department of Dermatology and Venereology at the First Affiliated Hospital of Anhui Medical University from January 2022 to September 2023, and these who were randomly divided into two groups (25 in the study group and 25 in the control group), Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed the flow chart for the two groups in bedside teaching. The general information of all participants was shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no statistically significant differences in age, gender, and theoretical exam scores between the study group and the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which indicated comparability. Based on the Declaration of Helsinki principles, the study was approved by the Institutional Ethical Committee the First Affiliated Hospital of Anhui Medical University (PJ2023-13-41).\u003c/p\u003e \u003cp\u003eThe study group received bedside small-group PBL teaching while the control group received traditional bedside teaching. During the internship, interns encountered skin diseases (including pustular psoriasis, acute urticaria, drug eruption, allergic purpura, cutaneous vasculitis, pemphigus, lupus erythematosus, dermatomyositis, etc). Obtain informed consent from the patient or their family before each teaching activity. Two dermatology teachers with senior professional titles (who have received standardized training in PBL and bedside teaching) participated in the teaching for two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eTeaching arrangement for the two groups\u003c/h2\u003e \u003cp\u003eThe 25 interns in the study group were randomly assigned to 5 subgroups (each with 5 students), all these who received the bedside small-group PBL teaching. The cases with severe drug-induced dermatitis were selected for teaching. The study group consisted of three scenarios, which included clinical case preparation (the first scenario in multimedia classroom), discussion/preparation condition (the second scenario in multimedia classroom) and bedside PBL teaching (the third scenario in ward). The first scenario was conducted on one day, whereas the second and third scenarios were conducted on same day after 3 days. 1) Clinical case preparation by the first scenario: Teachers determined learning objectives and scope based on clinical case. Teachers showed relevant case basic information and theoretical knowledge to students by PowerPoint in multimedia classroom. Students found the key points and proposed the questions about relating to learning objectives, and achieved the goals of consensus. These were beneficial for students to collect information and familiarize relevant knowledge. Adequate pre-teaching preparation will ensure the good progress of PBL teaching; 2) Discussion of objectives problem and preparation condition by the second scenario: All Students shared learning content, discussed and solved the consensus problems each other by PowerPoint in multimedia classroom. Each student undergone an individual readiness assessment test before teaching (a sheet including 10 multiple-choice questions, to evaluate their preparation condition for PBL and ensure subsequent teaching implementation). After completing the test, the instructor provided the correct answers, and discussed the answers and proposes their own arguments in group. The current stage is an important component of PBL teaching, which can stimulate students' full preparation before teaching; 3) Bedside PBL teaching by the third scenario in ward: Students 1 and 2 completed medical history collection and physical examination, students 3\u0026ndash;5 completed clinical reasoning, effective diagnosis and treatment strategies and doctor-patient communication. After completing each step, student raised their own questions and suggestions based on the pathogenesis, diagnosis/treatment of disease and doctor-patient communication. After all steps were completed, the instructor will provide appropriate supplements and guidance. After the bedside teaching activity, all students and instructors communicated and discussed with each other, which included the summarization, feedback and comments about instructors on students' performance in multimedia classroom.\u003c/p\u003e \u003cp\u003eThe 25 interns in the control group were randomly assigned to 5 subgroups (each with 5 students), all these who received traditional bedside teaching and the cases with severe drug-induced dermatitis were selected for teaching. The interns were informed to preview the related information about the case before the teaching. In teaching, students presented case reports and physical examinations, while teachers presented standardized physical examinations, history summary, condition analysis, proposed diagnosis and treatment strategies, and communicated with patients or family members about their condition. The teacher continuously interacted with the students in entire process, confirmed or corrected the case analysis and results reported by the students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of teaching effectiveness\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eCognitive knowledge assessment\u003c/h2\u003e \u003cp\u003eCognitive knowledge relating to medical history collection, physical examination, clinical reasoning and decision making were evaluated by the computer-based case simulations (CCS)\u003csup\u003e7\u003c/sup\u003e. Each intern collected patient history, conducted virtual physical examinations, and ordered investigations and tests. The interns narrowed their clinical reasoning hypotheses into a final diagnosis. Based on their diagnosis, they developed the patient management plan.\u003c/p\u003e \u003cp\u003eClinical reasoning scores were calculated based on the interns\u0026rsquo; ability to list the diagnostic hypotheses related to the case. Management was scored based on the four subcategories of Required, Recommended, Related History and Physical Examination, and Related Lab, where each subcategory is assigned a numerical value based on the relative importance of each category. The scoring system in the CCS exam software tracked the interns\u0026rsquo; interactions and provided a score for six categories of intern performance, namely professional attitude, clinical practice skills, learning ability, counseling skills, clinical reasoning and time management. Through the interaction between intern and computer, interns simulated doctors diagnosing and treating patients in a virtual medical context. The CCS exam lasts for 60 minutes, with a maximum score of 100 points. After submission, the computer will provide a unified rating. Interns received performance feedback immediately on completing the exam.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eClinical skills assessment\u003c/h2\u003e \u003cp\u003eThis assessment is based on the mini clinical evaluation exercise (mini-CEX, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) in the form of bedside clinical cases\u003csup\u003e8\u003c/sup\u003e. The concept of miniCEX was explained to the faculty members and the systematic ways and methods of giving feedback were conveyed to students. All interns who consented were sensitized toward miniCEX. Preparation of a feedback questionnaire for interns and faculty was done and the questionnaire was validated by the peer group. All sessions of miniCEX were conducted for each intern inpatient department. Immediate feedback was provided to the students by the faculty. The scoring of the mini CEX tool included 7 items (medical interviewing skills, physical examination skills, humanistic qualities, clinical judgment, counseling skills, organizational efficiency and overall clinical competence, with each item scoring 9 points, a score of 1\u0026ndash;3 was considered unsatisfactory, a score of 4\u0026ndash;6 was considered satisfactory, and a score of 7\u0026ndash;9 was considered superior). The actual mini CEX evaluation was conducted by teachers who have not participated in bedside teaching (who have received mini CEX training) and was unaware of the specific-assigned group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudents\u0026rsquo; satisfaction survey\u003c/h2\u003e \u003cp\u003eA questionnaire will be distributed to the interns for an anonymous survey to investigate their satisfaction and teaching effectiveness in participating in current teaching activities. The questionnaire for students\u0026rsquo; satisfaction survey mainly covered 6 items (Q1: Have you generally satisfied with this teaching? Q2: Can it stimulate you to active learning by this teaching? Q3: Can it motivate you to mastering theoretical knowledge? Q4: Can it improve your clinical skills by this teaching? Q5: Can it facilitate your counseling skills by this teaching? Q6: Can it enhance your teamwork power by this teaching?). Each item was evaluated on five levels, with a score of 1\u0026ndash;5, namely 1 (strongly disagree), 2 (disagree), 3 (neutral), 4 (agree), and 5 (strongly agree). The responses all of interns were captured immediately and anonymously in site questionnaire survey after completing the teaching activities, and the data obtained from the questionnaires was analyzed by Cronbach' s alpha test to determine the internal consistency of responses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAll data were analyzed using the SPSS (Version 18.0). Data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. \u003cem\u003et\u003c/em\u003e test or chi-square test between two groups was adopted, and \u003cem\u003eP\u003c/em\u003e less than 0.05 was considered as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of CCS and mini‑CEX results in two groups\u003c/h2\u003e \u003cp\u003eThe CCS and mini CEX evaluation were estimated the students' dermatological clinical skills (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The average CCS score of the study group was significantly higher than that of the control group, and there was a statistical difference (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.43, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). The medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence in study group significantly higher than those of the control group, and there were statistical differences (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.42, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.92, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.09, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.77, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.79, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). However, there were no significant differences for the physical examination skills, and humanistic qualities between the two groups (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.50; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.12, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComparison of teaching satisfaction in two groups\u003c/h2\u003e \u003cp\u003eFifty questionnaires were received. Students' satisfaction in the study group was significantly higher than that of the control group: overall satisfaction (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.11, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), stimulation of active learning (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), improvement of clinical skills (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.56, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), facilitation of counseling skills (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.77, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) and enhancement of teamwork (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.20, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) were higher than those of the control group. There was no significant difference between the two groups in mastering theoretical knowledge (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.24, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe rapid development of the educational environment has greatly affected medical education and traditional teaching models can no longer fully meet the medical students' learning needs\u003csup\u003e9\u003c/sup\u003e. PBL is a new trend in medical education in recent years, but there many obstacles and challenges that face the implementation of problem-based learning in many medical schools\u003csup\u003e10\u003c/sup\u003e. Practice is an effective learning pathway for improving clinical skills of medical students\u003csup\u003e11\u003c/sup\u003e. Essentially, the student-centered of problem-based and ability-based teaching can cultivate and improve the knowledge, skills and attitudes of students. The teacher-centered of traditional bedside teaching models emphasizes the knowledge and skills of teachers; it makes students lacking initiative and results in little benefit for students. Based on traditional teaching activities, it has been found that students still face various difficulties and challenges in clinical practice learning (such as, poor communication between students and patients, lack of ability to recognize disease signs and make diagnoses of diseases). These indicated that traditional bedside teaching has not effectively improved students' clinical abilities. Therefore, there is an urgent need to explore a new bedside teaching method to promote students' proactive learning. In clinical practice, active learning methods can effectively cultivate the critical thinking and problem-solving abilities of medical students for bedside PBL teaching\u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral previous PBL medical education studies showed some effectiveness as an instructional technique, such as, increasing students' understanding and learning interest, helping student to develop clinical problem-solving skills, improving students' satisfaction, test scores, self-learning ability and collaboration skills\u003csup\u003e13\u0026ndash;15\u003c/sup\u003e. PBL teaching might focus more on cultivating students' problem-solving and clinical reasoning abilities, rather than simply memorizing the knowledge itself, thereby which can promote the application of clinical knowledge and improve the level of clinical learning\u003csup\u003e16\u003c/sup\u003e. A study also showed that students' expression and communication skills were effectively improved by medical history collection, joint discussion and summarization\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDermatology is a subject with an inherited visual nature, and the recognition of rashes is often gleaned by the senses. This is somewhat 'seeing is believing'. This prominent feature of dermatology makes it perfectly suited to incorporate real patient and PBL teaching. In this study, both real patients and bedside small-group PBL teaching were considered to be more relevant to real-world clinical situations than paper cases. The current findings demonstrated that the average CCS score of students in the study group was significantly higher than that of the control group; the mini CEX performances (medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence) of students in the study group were superior to those of the control group. The questionnaire surveys also showed that PBL teaching helped to improve students' satisfaction, active learning, clinical skills, consulting skills and teamwork abilities. These indicated that PBL teaching not only can improve students' clinical ability, counseling skills, enhancement teamwork and satisfaction, but also stimulate students' interest in learning and encourage them to develop the habit of active learning. These findings were consistent with previous reported studies\u003csup\u003e13\u0026ndash;16\u003c/sup\u003e. In addition, PBL teaching can help to increase teacher-student interaction, improve students' learning efficiency and fully emphasize students' subjective initiative. Unlike traditional teaching, the role of teacher has shifted from being a lecturer to a facilitator, while the students played a leading role in bedside PBL teaching activities.\u003c/p\u003e \u003cp\u003eAlthough this study illustrated that bedside small-group PBL teaching improved active learning, clinical reasoning, counseling skills and overall clinical competence in medical undergraduates in dermatology, we also noted some problems in bedside teaching activities with PBL. Firstly, the sample size was limited, which might impact on the power of these results. Secondly, it only performed evaluation immediately after the teaching intervention, but delayed testing of students for learning retentions was needed in evaluating a novel teaching methodology. The lastly, although the sessions require less faculty time, the process of designing the modules requires time and dedication. Teachers should continuously improve the design of PBL teaching modules and content by considering systematic knowledge of case selection\u003csup\u003e18\u003c/sup\u003e. In addition, the students in study group fully can guarantee the enough duration of self-learning and their learning effectiveness was been tested before teaching activities, but the students in control group did not do them. These might resulted in differences in extracurricular time for self-learning between the students of two groups. To reduce possible confounding factors, subsequent study should consider to controlling the total spent time for students in the aspect of task arrangement and warrant further investigation with larger samples. Notably, bedside PBL teaching poses new challenges to teaching skills and forms for the perspective of teachers, which requires them to improve the teaching design and optimize the teaching resources. Teachers need to make sufficient preparations (including the training sessions, accurate instructional objectives and strategies, providing learning resources and selecting appropriate cases) before teaching activities, which ensures the smooth implementation of bedside PBL teaching. More research is recommended with medical undergraduates of other disciplines to confirm findings of current study and to evaluate the potential positive effects of small-group PBL teaching model.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe bedside small-group PBL teaching model can not only stimulate medical undergraduates' active learning, but also improve their clinical reasoning, counseling skills and overall clinical competence in dermatology. It can also enable them to master and understand the whole processes of diagnosis and treatment of diseases by using CCS and mini CEX to test students' clinical performance. Reasonable application of bedside small-group PBL teaching model can be served as a training system of dermatological clinical practice for medical undergraduates.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interest and Source of Funding\u003c/h2\u003e\n\u003cp\u003eAll authors have no conflicts of interest to declare. This current study was funded by the\u0026nbsp;National First Class Undergraduate Major Construction Project (Clinical Medicine Sub project) of Anhui Medical University.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAcknowledgements \u003c/h2\u003e\n\u003cp\u003eThanks all individuals in this research. Xianfa Tang designed the study, managed the data, performed the statistical analysis and wrote the manuscript; Wenjun Wang, Songke Shen and Huayang Tang conducted the teaching implementation.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXF T designed the study, managed the data, performed the statistical analysis and wrote the manuscript; WJ W, SK Sh and HY T conducted the teaching implementation.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw data were obtained from in a supplementary information file.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMumtaz S, Latif R. Learning through debate during problem-based learning: an active learning strategy. Advances in physiology education. 2017;41(3):390-394.\u003c/li\u003e\n\u003cli\u003eDistler JW. 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Medical education. 2011;45(8):792-806.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\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\u003eDemographic characteristics of students in two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\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\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTheoretical\u003c/p\u003e \u003cp\u003eExamination\u003c/p\u003e \u003cp\u003eScores\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;15)/Female (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;16)/Female (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u0026thinsp;=\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u0026thinsp;=\u0026thinsp;1.04\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\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\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=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of CCS and mini-CEX results in two groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCCS Scores\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003emini-CEX\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMedical interviewing skills\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePhysical examination skills\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eHumanistic qualities\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eClinical judgment\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eCounseling skills\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eOrganizational efficiency\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eOverall clinical competence\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003et\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.79\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\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.008\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=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of teaching satisfaction between two groups (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems surveyed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulate active learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster theoretical knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprove clinical skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacilitate counseling skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmphasize more on teamwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dermatology, Teaching model, Problem-based learning, Bedside teaching","lastPublishedDoi":"10.21203/rs.3.rs-4432615/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4432615/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and aims\u003c/h2\u003e \u003cp\u003eThe problem-based learning (PBL) teaching model has significant advantages in inspiring and improving clinical thinking among medical students. Bedside teaching has always been regarded as one of the ideal clinical teaching modes. The aim of this study is to investigate the effects of bedside small-group PBL on dermatologic teaching in medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFifty interns (undergraduates) were randomly divided into the study and control groups. The study group received bedside PBL teaching while the control group received traditional bedside teaching. The teaching effectiveness of the two groups was evaluated by the computer-based case simulations (CCS), the mini clinical evaluation exercise (mini-CEX) and students\u0026rsquo; satisfaction surveys.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe average CCS score of the study group was significantly higher than that of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For the mini-CEX, the medical interviewing skills, clinical judgment, counseling skills, organizational efficiency and overall clinical competence in study group significantly higher than those of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The overall satisfaction, stimulation of active learning, improvement of clinical skills, facilitation of counseling skills and enhancement of teamwork were higher than those of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe bedside small-group PBL teaching model can not only stimulate the actively learning for undergraduates, but also improve their clinical reasoning, counseling skills and overall clinical competence, which can be served as a training system of dermatological clinical practice for medical undergraduates.\u003c/p\u003e","manuscriptTitle":"Application of Bedside Small-group Problem-based Learning in Clinical Practice Teaching of Dermatology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-06 18:40:17","doi":"10.21203/rs.3.rs-4432615/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9532eea3-1d43-4de1-a890-c6bc53969cb3","owner":[],"postedDate":"June 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":32714150,"name":"Health sciences/Health care"},{"id":32714151,"name":"Health sciences/Health occupations"},{"id":32714152,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-08-28T12:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-06 18:40:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4432615","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4432615","identity":"rs-4432615","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}