Improving medical student recruitment into neurosurgery through teaching reform

Improving medical student recruitment into neurosurgery through teaching reform | 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 Improving medical student recruitment into neurosurgery through teaching reform Jun Shen, Lili Yuan, Ruixiang Ge, Xuefei Shao, Xiaochun Jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1621655/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective: This study aimed to determine whether a combination of case-based learning (CBL) and problem-based learning (PBL) methods in teaching can improve the academic performance and recruitment of medical students for neurosurgery. Methods: Four classes of fourth-year medical students were randomly divided into two groups. The traditional model group received the traditional teaching method, and the CBL-PBL group received the combined teaching methods of CBL and PBL. After the courses, the differences between the two groups in self-perceived competence, satisfaction with the course, postclass test scores, and clinical practice abilities were compared, and the proportions of neurosurgery major selection in pre- and postcurriculum between the two groups were also analyzed. Results: Self-perceived competence, postclass test scores, and clinical practice abilities in the CBL-PBL group were significantly better than those in the traditional model group. The students in the CBL-PBL group showed a higher degree of satisfaction with the course than those in the traditional model group. At the end of the semester, the proportion of students who chose neurosurgery majors in the CBL-PBL group increased significantly. Conclusion: Compared with the traditional teaching method, the CBL and PBL integrated method is more effective for improving the performance of medical students and enhancing their clinical capabilities in neurosurgery teaching. The CBL-PBL method effectively improved students’ interests in neurosurgery, potentially contributing to increasing medical student recruitment into neurosurgery. Case-based learning Neurosurgery Problem-based learning Traditional teaching method Figures Figure 1 1. Background Neurosurgery must continue to attract the best and brightest talent to promote the continuous development and survivability of our profession [ 1 ]. However, few medical students choose neurosurgery as a career in China. In postgraduate exams, in particular, neurosurgery is not usually the first choice of specialty, and some students were transferred to neurosurgery only when they were not accepted by other majors. There are several reasons for this phenomenon. First, neurosurgery requires comprehensive knowledge in the fields of neurology, anatomy, trauma care, critical care, and radiology [ 2 ], which is more difficult than other majors. Moreover, only eight class hours are scheduled in neurosurgery teaching, and it is impossible for students to master the complicated knowledge of neurosurgery in such a short time. Second, the income of neurosurgeons is lower than that of other majors in China. The imbalance between income and risk hardly arouses students’ interests in the profession. Last, neurosurgery started late in China. Many county-level hospitals do not have neurosurgery departments, which makes it difficult for neurosurgery students to find jobs after graduation. The traditional teaching method is regarded as a teacher-centered educational approach, emphasizing the delivery of the syllabus and knowledge points. The teacher explains the theoretical knowledge while the students receive the knowledge passively. This method has been widely used in medical and clinical teaching in the past few decades [ 3 , 4 ]. However, the knowledge system of medical courses is complex, multifaceted and boring, which leads to students losing the motivation and the ability to self-learn. The combination of curriculum and clinical work is insufficient to develop students’ clinical cognition. Therefore, traditional teaching methods have become increasingly unsuitable for modern medical education and have been gradually replaced by other teaching methods [ 3 , 5 ]. Case-based learning (CBL) is a patient-oriented and student-centered group discussion-style teaching approach, and problem-based learning (PBL) is an approach focused on the patients’ problem, engaging students in learning problem-solving skills. Both CBL and PBL approaches integrate theory into practice, cultivate students in self-guided learning, collaborate with fellows and scientific inquiry, and develop critical thinking, decision-making and clinical problem-solving abilities [ 6 – 11 ]. The CBL and PBL integrated method is more effective than traditional teaching methods in the teaching of various clinical specialties [ 12 – 14 ]. However, CBL and PBL integrated methods are rarely applied in neurosurgery teaching. In this study, we use the CBL and PBL integrated method in neurosurgery teaching to investigate whether students can benefit from teaching reforms that would change their perception of neurosurgery and increase their interest in neurosurgery. 2. Students And Methods 2.1 Students This was a prospectively randomized controlled study. We enrolled four classes of fourth-year medical students at the Wannan Medical College (30 students per class). The four classes were randomly divided into two groups. The traditional model group received the traditional teaching method, and the CBL-PBL group received the combined teaching method of CBL-and PBL. All students were anonymous and blinded to this study, which was represented by numbers. 2.2 Study design The experimental flow of this study is shown in Table 1 . Before fourth-year students started the curriculum (internal medicine, surgery, obstetrics and gynecology, pediatrics, etc., were completed in the fourth year), we distributed a questionnaire of specialty selection to all students to understand the students' interest in neurosurgery and arranged a basic knowledge test for them before the neurosurgery class. Table 1 The experimental flow of this study 1 A questionnaire of specialty selection when all courses have not yet started 2 A basic knowledge test before the neurosurgery class 3 Theory teaching: CB-PBL method vs Traditional teaching method 4 A suvey of tudents' self-evaluation after the course 5 A suvey of students’ satisfaction with teaching methods at the end of the course 6 A theory test to students after the course 7 A test of clinical practice ability 8 A questionnaire of specialty selection when all courses were completed The CBL-PBL teaching plan was implemented as follows. Before class, the teacher prepared a typical case and compiled the knowledge points into questions and then distributed the case and questions to the WeChat group class. The students were divided into 5 groups, and every group independently consulted textbooks, literature, and websites to determine the answers to the questions. In class, students formed a group discussion and reported the answers under the guidance of the teacher. After the student presentation, the teacher corrected them appropriately and summarized the knowledge points. The traditional teaching plan was implemented as follows. The teacher prepared a lesson plan and distributed the lesson plan to the WeChat group class. Students previewed the textbook according to the lesson plan. In class, the teacher explained the content of the textbook and summarized the knowledge points. Students listened to the teachers’ interpretation (Fig. 1 ). After the course, we conducted a survey of students’ self-evaluation and their satisfaction with teaching methods and then arranged tests of theory and clinical practice abilities for the students. The clinical abilities test was completed in the neurosurgery ward. The teacher selected a typical case, and the students conducted medical history inquiry, physical examination, diagnosis and treatment. All the surveys and tests were performed and assessed by the teachers who were blind to this study. After the students finished all curriculums, we distributed a questionnaire of specialty selection to all students again to assess whether teaching reform increases students' interest in neurosurgery and medical student recruitment into neurosurgery. 2.3 Statistical analysis The differences between the two groups in gender, the student’s satisfaction with the course, and neurosurgery major selection in the pre- and postcurriculum were analyzed using Pearson’s chi-squared. The ages and scores of preclass basic knowledge, self-perceived competence, satisfaction with the course, postclass test and clinical practice abilities were presented as the means ± standard deviations and analyzed by using Student’s t test. P < 0.05 was considered statistically significant. Statistical analyses were all performed using SPSS (version 22.0, IBM Corp.). 3. Results 3.1 Baseline characteristics of the students A total of 120 fourth-year students in 4 classes from September 2020 to June 2021 were included in the study. There were 61 females (50.8%) and 59 males (49.2%), and the mean age of the students participating in the experiment was 24 years (range from 22 to 28 years). No student was lost to follow-up, and all the students completed the procedures of the study. There was no significant difference between the CBL-PBL group and the traditional model group in gender ( P = 0.36), age ( P = 0.11), or precurriculum basic knowledge scores ( P = 0.71) (Table 2 ). Table 2 Comparison of basic data between two groups. CBL-PBL group (N = 60) Traditional model group (N = 60) T (χ 2 ) value P value Sex 0.83 0.36 Male (n, %) 28 (46.7%) 33 (55.0%) Female (n, %) 32 (53.3%) 27 (45.0%) Age (years) 24.2 ± 1.4 23.8 ± 1.3 1.63 0.11 Pre-class basic knowledge score (point) 68.8 ± 7.9 69.3 ± 7.5 0.379 0.71 The total score for the pre-class exam is 100 points. 3.2 Comparison of self-perceived competence and satisfaction with the course between the two groups After the course, we conducted a questionnaire on students’ self-evaluation and satisfaction with the course. As shown in Table 3 , the learning motivation score in the CBL-PBL group was 4.2 ± 0.9, which was significantly more than the 3.6 ± 1.0 score in the traditional model group ( P = 0. 004). The scores of self-learning skills in the CBL-PBL group were 3.9 ± 1.0, significantly higher than the 3.5 ± 1.1 score in the traditional model group ( P = 0.019). The scores for learning through a more targeted and more interesting approach in the CBL-PBL group were 4.2 ± 0.9, higher than 3.5 ± 1.0 in the traditional model group ( P < 0.001). The scores on basic knowledge mastery were 4.0 ± 1.0 in the CBL-PBL group, higher than the 3.6 ± 1.1 score in the traditional model group ( P = 0.023). In the CBL-PBL group, the scores of teamwork skills, clinical thinking ability, and clinician-patient communication skills were significantly higher than those in the traditional model group ( P < 0.01, P < 0.01, and P = 0.009, respectively). In addition, the degree of satisfaction in the CBL-PBL group was also higher than that in the traditional model group ( P = 0. 007) (Table 4 ). Table 3 Comparison of self-perceived competence between two groups. Item CBL-PBL group (N = 60) Traditional model group (N = 60) T value P value Learning motivation (point) 4.2 ± 0.9 3.6 ± 1.0 2.92 0.004 Self-learning skills (point) 3.9 ± 1.0 3.5 ± 1.1 2.39 0.019 Learning more targetedlly and more interestingly (point) 4.2 ± 0.9 3.5 ± 1.0 3.62 < 0.01 Basic knowledge mastery (point) 4.0 ± 1.0 3.6 ± 1.1 2.31 0.023 Teamwork skills (point) 3.8 ± 1.1 3.1 ± 1.0 3.79 < 0.01 Clinical thinking ability (point) 4.1 ± 0.9 3.3 ± 0.9 4.60 < 0.01 Clinician-patient communication skills (point) 3.8 ± 0.9 3.4 ± 1.0 2.64 0.009 The maximum score for each item is 5 points. Table 4 Comparison of satisfaction with the course between two groups. Degree of satisfaction CBL-PBL group (N = 60) Traditional model group (N = 60) χ2 value P value Very satisfied (n, %) 35 (58.3%) 18(30.0%) 12.03 0.007 Satisfaction (n, %) 12(20%) 13(21.7%) General (n, %) 7(16.7%) 19(31.7%) Unsatisfactory (n, %) 6(10%) 10(16.6%) 3.3 Comparison of the postclass test scores between the two groups In the CBL-PBL group, elementary knowledge scores were 79.2 ± 9.3, significantly higher than 74.3 ± 10.0 in the traditional model group ( P = 0. 007), case analysis scores in the CBL-PBL group were 79.2 ± 6.9, more than 73.3 ± 7.8 in the traditional model group ( P < 0.01), and the total scores of the CBL-PBL group were 79.2 ± 6.8, also significantly higher than the 73.8 ± 7.7 score in the traditional model group ( P < 0.01 ) (Table 5 ). Table 5 Ccomparison of the post-class test scores between two groups. Item CBL-PBL group (N = 60) Traditional model group (N = 60) T value P value Elementary knowledge (point) 79.2 ± 9.3 74.3 ± 10.0 2.76 0.007 Case analysis (point) 79.2 ± 6.9 73.3 ± 7.8 4.40 < 0.01 Total scores (point) 79.2 ± 6.8 73.8 ± 7.7 4.04 < 0.01 The maximum score for each item is 100 points. 3.4 Comparison of the clinical practice abilities between the two groups After the course, we also conducted a clinical practice ability evaluation for the two groups of students. As shown in Table 6 , in the CBL-PBL group, medical history collection scores, physical examination scores, diagnosis scores, and treatment scores were 19.3 ± 2.9, 16.5 ± 3.1, 19.0 ± 2.3, and 19.1 ± 2.4, respectively, significantly more than 17.1 ± 3.3, 14.9 ± 3.0, 16.9 ± 2.5, and 17.3 ± 2.5 in the traditional model group ( P < 0.01, P = 0.006, P < 0.01, and P < 0.01, respectively). In the CBL-PBL group, the total score was 73.9 ± 7.0, which was more than the 66.2 ± 6.5 in the traditional model group ( P < 0.01). Table 6 Comparison of clinical practice abilities between two groups. Clinical practice ability CBL-PBL group (N = 60) Traditional model group (N = 60) T value P value Medical history collection (point) 19.3 ± 2.9 17.1 ± 3.3 3.99 < 0.01 Physical examination (point) 16.5 ± 3.1 14.9 ± 3.0 2.78 0.006 Diagnosis (point) 19.0 ± 2.3 16.9 ± 2.5 4.61 < 0.01 Treatment (point) 19.1 ± 2.4 17.3 ± 2.5 3.88 < 0.01 Total scores (point) 73.9 ± 7.0 66.2 ± 6.5 6.16 < 0.01 The maximum score for each item is 25 points, and for the total score is 100 points. 3.5 Neurosurgery specialty selection between the two groups of students pre- and postcurriculum. At pre- and postcurriculum, we surveyed the specialty selection of all the students. The results are presented in Table 7 . In the CBL-PBL group, only 3.4% of the students chose a neurosurgery major at the beginning of the semester, while 13.3% of the students chose a neurosurgery major at the end of the semester; the difference was statistically significant ( P = 0.048). In the traditional model group, 6.7% of students chose a neurosurgery major at the beginning of the semester, while 3.4% of students chose a neurosurgery major at the end of the semester; no significant difference was observed. Table 7 Neurosurgery specialty selection between the two groups of students pre- and postcurriculum. CBL-PBL group (N = 60) Traditional model group (N = 60) χ2 value P value At the beginning of the semester NA 0.679 Neurosurgery (n, %) 2 (3.4%) 4 (6.7%) Other majors (n, %) 58 (96.7%) 56 (93.3%) At the end of the semester 3.93 0.048 Neurosurgery (n, %) 8 (13.3%) 2 (3.4%) Other majors (n, %) 52 (86.7%) 58 (96.7%) NA, not available. 4. Discussion Although neurosurgery is very popular among medical students in other countries, in China, it is still a challenge to recruit high-quality students into neurosurgery [ 15 – 18 ]. How to recruit high-quality students into neurosurgery in China is an important question that needs to be addressed. In this study, we use CBL and PBL integrated methods to implement teaching, which makes it easier for students to master neurosurgery knowledge and thus boosts their interest in neurosurgery compared to the traditional teaching method. Meanwhile, students’ self-confidence was significantly increased, and more students were inclined to choose neurosurgery as a career. The traditional teaching method is the most efficient and economical way to deliver core knowledge and concepts [ 3 , 14 ]. It is very suitable for teaching in large, basic medical classes, such as physiology, biochemistry, and tissue embryology, because these courses are focused on students' mastery of knowledge points. However, in the teaching of clinical courses, such as internal medicine, surgery, gynecology, and pediatrics, more attention is given to the cultivation of students' ability to integrate theory with practice and clinical thinking ability. The traditional teaching model is not suitable for the teaching of these courses. However, thus far, there no standard teaching plan for clinical courses has been developed. Most instructors are constantly exploring new teaching methods for clinical courses. In this study, the results revealed that the scores of students' self-evaluation, theoretical examination, and the students' clinical application ability evaluation tests of those who received the CBL and PBL integrated methods were significantly higher than those students who received the traditional teaching method, suggesting that the CBL and PBL integrated method is more suitable for neurosurgery teaching. CBL and PBL integrated methods have been demonstrated to be significantly better than the traditional teaching method in the teaching of other clinical courses. Liu et al. adopted CBL-PBL teaching for maxillary sinus floor augmentation, and better results were obtained in terms of academic knowledge acquisition, case analysis ability, and student satisfaction compared to the traditional teaching method [ 12 ]. Zhao et al. also demonstrated that in teaching about thyroid disease, CBL and PBL integrated methods significantly improved residents' and medical students' performance and enhanced their clinical skills compared to the traditional teaching method [ 14 ]. However, some scholars' research shows that student performance has not been significantly improved with the new teaching method and that students prefer traditional lecture-style teaching [ 19 , 20 ]. In fact, CBL is considered a derivative of PBL, and the two are often confused [ 10 , 11 ]. Srinivasan et al. pointed out that, unlike PBL, CBL often requires a certain basic theoretical knowledge of the subject [ 21 ]. Obviously, it is inadequate if CBL is used alone for the clinical teaching of undergraduates because they do not have theoretical knowledge of various fields. In addition, CBL pays more attention to the analysis of clinical cases, not just to the mastery of professional knowledge. However, PBL can make up for these shortcomings of CBL. As in this study, when assigning cases, we summarize the knowledge points that students need to master in problems and let students analyze cases based on the type of problem. The students’ clinical skills improved significantly, and it was easier for them to master theoretical knowledge. Another advantage of CBL is that neurosurgery can be exposed to students early in the form of cases, and early exposure to neurosurgery contributes to medical student recruitment [ 22 , 23 ]. In this study, students' interests in neurosurgery increased through case teaching, and neurosurgery selection at the end of the semester increased significantly. However, the teaching methods of CBL and PBL integrated methods also have certain shortcomings. This teaching method is only suitable for small class teaching, which not only requires more neurosurgeons to participate in medical teaching but also requires neurosurgeons to have a great interest in teaching. Compared with the traditional teaching method, the PBL and CBL teaching methods require instructors to dedicate more time and energy. There are several inevitable limitations in this study. First, this is a single-institution, small-sample study, and a multi-institution, large sample size study is needed. Second, this study cannot be completed in a double-blind manner because students may communicate privately. Third, although the teaching procedures of CBL and PBL integrated methods are uniform, the teaching style of each teacher in the traditional teaching model is different. Therefore, the results obtained may be biased. Last, teachers of other majors may also choose some new teaching methods, which may impact students' major selection. This study did not capture these details. 5. Conclusion In conclusion, compared to the traditional teaching method, the CBL and PBL integrated method is more effective for improving medical students’ performance and enhancing their clinical capabilities when teaching neurosurgery. The students’ self-perceived competence and satisfaction with the course were obviously increased. Additionally, the CBL and PBL integrated methods effectively enhanced students’ interest in neurosurgery, potentially contributing to improving medical student recruitment into neurosurgery. Abbreviations CBL= case-based learning; PBL= problem-based learning. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board and Ethics Committee of The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College. We confirm that all experiments were performed in accordance with Declaration of Helsinki. Written informed consent was obtained from all participating students. We confirm that the consent was informed. Consent for publication Written consent was obtained from all participants. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests The author reports no conflicts of interest in this work. Funding This study was supported by grants from The Teaching Quality and Teaching Reform Project of Wannan Medical College (2020jyxm87, 2020jyxm79). Teaching and Research Project of Anhui Provincial Department of Education (2021jyxm1636, 2021jyxm1639). Author Contributions Jun Shen and Xuefei Shao designed the research; Lili Yuan and Ruixiang Ge designed all the questionnaires. Jun Shen, Lili Yuan, Ruixiang Ge, Xuefei Shao, and Xiaochun Jiang implemented clinical teaching. Jun Shen, Lili Yuan, and Ruixiang Ge assessed the students’ self-evaluation, their satisfaction with teaching methods., theory test and clinical practice abilities test. Lili Yuan and Ruixiang Ge performed the statistical analysis, completed the production of the tables and figures; Jun Shen prepared the manuscript; Xuefei Shao revised the statistical analysis and the manuscript. Acknowledgements We would like to acknowledge and thank the students who participated in this study and provided valuable feedback on questionnaires. References WINS White Paper Committee:, Benzil DL, Abosch A, Germano I, Gilmer H, Maraire JN, et al. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008;109:378–386. Barrow DL, Bendok BR. Introduction: What is Neurosurgery?. Oper Neurosurg (Hagerstown). 2019;17:S1-S2. Alaagib NA, Musa OA, Saeed AM. Comparison of the effectiveness of lectures based on problems and traditional lectures in physiology teaching in Sudan. BMC Med Educ. 2019;19(1):365. Wilson JA, Pegram AH, Battise DM, Robinson AM. Traditional lecture versus jigsaw learning method for teaching Medication Therapy Management (MTM) core elements. Curr Pharm Teach Learn. 2017;9:1151–1159. Chotiyarnwong P, Boonnasa W, Chotiyarnwong C, Unnanuntana A. Video-based learning versus traditional lecture-based learning for osteoporosis education: a randomized controlled trial. Aging Clin Exp Res. 2021;33:125–131. Spiegel D, Harrington A. What is the placebo worth? BMJ. 2008;336:967–968. Bodagh N, Bloomfield J, Birch P, Ricketts W. Problem-based learning: a review. Br J Hosp Med (Lond). 2017;78:C167-C170. Jones RW. Problem-based learning: description, advantages, disadvantages, scenarios and facilitation. Anaesth Intensive Care. 2006; 34:485–488. Chéron M, Ademi M, Kraft F, Löffler-Stastka H. Case-based learning and multiple choice questioning methods favored by students. BMC Med Educ. 2016;16:41. McLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377. Alhazmi A, Quadri MFA. Comparing case-based and lecture-based learning strategies for orthodontic case diagnosis: A randomized controlled trial. J Dent Educ. 2020;84:857–863. Liu Y, Xu Y, Li Y, Wu Q. Application of problem-based learning and case-based learning integrated method in the teaching of maxillary sinus floor augmentation in implant dentistry. Peer J. 2020;8:e8353. Bi M, Zhao Z, Yang J, Wang Y. Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology. Med Teach. 2019;41:1124–1128. Zhao W, He L, Deng W, Zhu J, Su A, Zhang Y. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease. BMC Med Educ. 2020;20(1):381. Huq S, Khalafallah AM, Ishida W, Porras JL, Lee RP, Rincon-Torroella J, et al. Recruiting Medical Students to Neurosurgery Through a Focused Neuroanatomy Lab Initiative. World Neurosurg. 2020;137:e535-e546. Lubelski D, Xiao R, Mukherjee D, Ashley WW, Witham T, Brem H, et al. Improving medical student recruitment to neurosurgery. J Neurosurg. 2019; 9:1–7. Bonney PA, Fujii T, Zada G. Recruitment of Medical Students in Neurosurgery. World Neurosurg. 2017;98:859. Stumpo V, Latour K, Traylor JI, Staartjes VE, Giordano M, Caccavella VM, et al. Medical Student Interest and Recruitment in Neurosurgery. World Neurosurg. 2020;141:448–454. Rivkin A, Gim S. Student preferences regarding teaching methods in a drug-induced diseases and clinical toxicology course. Am J Pharm Educ. 2013;77(6):123. Codd AM, Choudhury B. Virtual reality anatomy: is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy? Anat Sci Educ. 2011;4:119–125. Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 2007;82:74–82. Dallas J, Mummareddy N, Yengo-Kahn AM, Dambrino RJ 4th, Lopez AM, Chambless LB, et al. Neurosurgery Elective for Preclinical Medical Students with and without a Home Neurosurgery Program. World Neurosurg. 2019;131:e201-e210. Quintana LM. How to Improve the Attractiveness of Neurosurgery. World Neurosurg. 2016;86:63–64. Additional Declarations No competing interests reported. Supplementary Files Supplementarydata.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 27 Jul, 2022 Reviews received at journal 23 Jun, 2022 Reviewers agreed at journal 23 Jun, 2022 Reviewers invited by journal 12 May, 2022 Editor assigned by journal 12 May, 2022 Editor invited by journal 12 May, 2022 Submission checks completed at journal 12 May, 2022 First submitted to journal 04 May, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-1621655","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":105516015,"identity":"5e52d97b-41cd-4d07-a4c4-08b28a5cde33","order_by":0,"name":"Jun Shen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCRiDGURUSMjJk6jljIWxYQPRWkCAsa0ikeEAAR3ys5uPPeZts8uTb+cx/Fw4TyKBsYH54aMbeLQY3DmWbszbllzM2MxjLD1zm0QeOwObsXEOPi0SOWbSvG3Mic3MPAbSvNskihkbeNik8WmRn5H/DailPrGNmcf4N+8cicSGAwS0MNzIYQNqOZzYw8wDtK6BCC0GN9LMJOecO544g5mtzJrnmISxYTMBv8jPSH4m8aasOnF+/+HNt3lq6uTk2ZsfPsbrMCBg4gFTHAYQLjMB5SDA+ANMsT8gQu0oGAWjYBSMRAAArmBCAV49v6oAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Shen","suffix":""},{"id":105516016,"identity":"e4b38183-cd94-4931-a674-101d5519138e","order_by":1,"name":"Lili Yuan","email":"","orcid":"","institution":"The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lili","middleName":"","lastName":"Yuan","suffix":""},{"id":105516017,"identity":"ab8af6a5-7751-4df4-9889-6345e50a8d91","order_by":2,"name":"Ruixiang Ge","email":"","orcid":"","institution":"The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ruixiang","middleName":"","lastName":"Ge","suffix":""},{"id":105516018,"identity":"b74b3515-38b1-4ec1-a5c6-00a8905d5a68","order_by":3,"name":"Xuefei Shao","email":"","orcid":"","institution":"The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xuefei","middleName":"","lastName":"Shao","suffix":""},{"id":105516019,"identity":"67a857bb-ec12-4e36-b0b6-517d7f8ab17b","order_by":4,"name":"Xiaochun Jiang","email":"","orcid":"","institution":"The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaochun","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2022-05-04 10:14:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1621655/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1621655/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":21574614,"identity":"09fbdf36-9f69-48de-8d2b-4b98afe37793","added_by":"auto","created_at":"2022-05-17 17:41:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":641346,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of this study\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1621655/v1/82a17b4d4ba20a4e7b261c2f.png"},{"id":21574615,"identity":"faaff897-56c2-4feb-91b6-83e2759526a3","added_by":"auto","created_at":"2022-05-17 17:41:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":456670,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1621655/v1/c66a3fdf-5e8c-4e2b-93f6-68468f60c4de.pdf"},{"id":21574613,"identity":"12745560-ced0-4be6-8701-de87bb229bbc","added_by":"auto","created_at":"2022-05-17 17:41:40","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23603,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarydata.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1621655/v1/674f2405a1c889fb6a2ffb7e.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving medical student recruitment into neurosurgery through teaching reform","fulltext":[{"header":"1. Background","content":"\u003cp\u003eNeurosurgery must continue to attract the best and brightest talent to promote the continuous development and survivability of our profession [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, few medical students choose neurosurgery as a career in China. In postgraduate exams, in particular, neurosurgery is not usually the first choice of specialty, and some students were transferred to neurosurgery only when they were not accepted by other majors. There are several reasons for this phenomenon. First, neurosurgery requires comprehensive knowledge in the fields of neurology, anatomy, trauma care, critical care, and radiology [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], which is more difficult than other majors. Moreover, only eight class hours are scheduled in neurosurgery teaching, and it is impossible for students to master the complicated knowledge of neurosurgery in such a short time. Second, the income of neurosurgeons is lower than that of other majors in China. The imbalance between income and risk hardly arouses students\u0026rsquo; interests in the profession. Last, neurosurgery started late in China. Many county-level hospitals do not have neurosurgery departments, which makes it difficult for neurosurgery students to find jobs after graduation.\u003c/p\u003e \u003cp\u003eThe traditional teaching method is regarded as a teacher-centered educational approach, emphasizing the delivery of the syllabus and knowledge points. The teacher explains the theoretical knowledge while the students receive the knowledge passively. This method has been widely used in medical and clinical teaching in the past few decades [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the knowledge system of medical courses is complex, multifaceted and boring, which leads to students losing the motivation and the ability to self-learn. The combination of curriculum and clinical work is insufficient to develop students\u0026rsquo; clinical cognition. Therefore, traditional teaching methods have become increasingly unsuitable for modern medical education and have been gradually replaced by other teaching methods [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCase-based learning (CBL) is a patient-oriented and student-centered group discussion-style teaching approach, and problem-based learning (PBL) is an approach focused on the patients\u0026rsquo; problem, engaging students in learning problem-solving skills. Both CBL and PBL approaches integrate theory into practice, cultivate students in self-guided learning, collaborate with fellows and scientific inquiry, and develop critical thinking, decision-making and clinical problem-solving abilities [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The CBL and PBL integrated method is more effective than traditional teaching methods in the teaching of various clinical specialties [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, CBL and PBL integrated methods are rarely applied in neurosurgery teaching. In this study, we use the CBL and PBL integrated method in neurosurgery teaching to investigate whether students can benefit from teaching reforms that would change their perception of neurosurgery and increase their interest in neurosurgery.\u003c/p\u003e"},{"header":"2. Students And Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003e2.1 Students\u003c/h2\u003e\n \u003cp\u003eThis was a prospectively randomized controlled study. We enrolled four classes of fourth-year medical students at the Wannan Medical College (30 students per class). The four classes were randomly divided into two groups. The traditional model group received the traditional teaching method, and the CBL-PBL group received the combined teaching method of CBL-and PBL. All students were anonymous and blinded to this study, which was represented by numbers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003e2.2 Study design\u003c/h2\u003e\n \u003cp\u003eThe experimental flow of this study is shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Before fourth-year students started the curriculum (internal medicine, surgery, obstetrics and gynecology, pediatrics, etc., were completed in the fourth year), we distributed a questionnaire of specialty selection to all students to understand the students\u0026apos; interest in neurosurgery and arranged a basic knowledge test for them before the neurosurgery class.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe experimental flow of this study\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eA questionnaire of specialty selection when all courses have not yet started\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA basic knowledge test before the neurosurgery class\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTheory teaching: CB-PBL method vs Traditional teaching method\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA suvey of tudents\u0026apos; self-evaluation after the course\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA suvey of students\u0026rsquo; satisfaction with teaching methods at the end of the course\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA theory test to students after the course\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA test of clinical practice ability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA questionnaire of specialty selection when all courses were completed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe CBL-PBL teaching plan was implemented as follows. Before class, the teacher prepared a typical case and compiled the knowledge points into questions and then distributed the case and questions to the WeChat group class. The students were divided into 5 groups, and every group independently consulted textbooks, literature, and websites to determine the answers to the questions. In class, students formed a group discussion and reported the answers under the guidance of the teacher. After the student presentation, the teacher corrected them appropriately and summarized the knowledge points.\u003c/p\u003e\n \u003cp\u003eThe traditional teaching plan was implemented as follows. The teacher prepared a lesson plan and distributed the lesson plan to the WeChat group class. Students previewed the textbook according to the lesson plan. In class, the teacher explained the content of the textbook and summarized the knowledge points. Students listened to the teachers\u0026rsquo; interpretation (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAfter the course, we conducted a survey of students\u0026rsquo; self-evaluation and their satisfaction with teaching methods and then arranged tests of theory and clinical practice abilities for the students. The clinical abilities test was completed in the neurosurgery ward. The teacher selected a typical case, and the students conducted medical history inquiry, physical examination, diagnosis and treatment. All the surveys and tests were performed and assessed by the teachers who were blind to this study. After the students finished all curriculums, we distributed a questionnaire of specialty selection to all students again to assess whether teaching reform increases students\u0026apos; interest in neurosurgery and medical student recruitment into neurosurgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\n \u003cp\u003eThe differences between the two groups in gender, the student\u0026rsquo;s satisfaction with the course, and neurosurgery major selection in the pre- and postcurriculum were analyzed using Pearson\u0026rsquo;s chi-squared. The ages and scores of preclass basic knowledge, self-perceived competence, satisfaction with the course, postclass test and clinical practice abilities were presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and analyzed by using Student\u0026rsquo;s t test. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Statistical analyses were all performed using SPSS (version 22.0, IBM Corp.).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003e3.1 Baseline characteristics of the students\u003c/h2\u003e\n \u003cp\u003eA total of 120 fourth-year students in 4 classes from September 2020 to June 2021 were included in the study. There were 61 females (50.8%) and 59 males (49.2%), and the mean age of the students participating in the experiment was 24 years (range from 22 to 28 years). No student was lost to follow-up, and all the students completed the procedures of the study. There was no significant difference between the CBL-PBL group and the traditional model group in gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36), age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11), or precurriculum basic knowledge scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of basic data between two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT (\u0026chi;\u003csup\u003e2\u003c/sup\u003e) value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (55.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-class basic knowledge score (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eThe total score for the pre-class exam is 100 points.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003e3.2 Comparison of self-perceived competence and satisfaction with the course between the two groups\u003c/h2\u003e\n \u003cp\u003eAfter the course, we conducted a questionnaire on students\u0026rsquo; self-evaluation and satisfaction with the course. As shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the learning motivation score in the CBL-PBL group was 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, which was significantly more than the 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 score in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0. 004). The scores of self-learning skills in the CBL-PBL group were 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0, significantly higher than the 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 score in the traditional model group (\u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.019). The scores for learning through a more targeted and more interesting approach in the CBL-PBL group were 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, higher than 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 in the traditional model group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). The scores on basic knowledge mastery were 4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 in the CBL-PBL group, higher than the 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 score in the traditional model group (\u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.023). In the CBL-PBL group, the scores of teamwork skills, clinical thinking ability, and clinician-patient communication skills were significantly higher than those in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009, respectively). In addition, the degree of satisfaction in the CBL-PBL group was also higher than that in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0. 007) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of self-perceived competence between two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLearning motivation (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-learning skills (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLearning more targetedlly and more interestingly (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasic knowledge mastery (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTeamwork skills (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical thinking ability (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinician-patient communication skills (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eThe maximum score for each item is 5 points.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of satisfaction with the course between two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDegree of satisfaction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2 value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfaction (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnsatisfactory (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003e3.3 Comparison of the postclass test scores between the two groups\u003c/h2\u003e\n \u003cp\u003eIn the CBL-PBL group, elementary knowledge scores were 79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3, significantly higher than 74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0 in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0. 007), case analysis scores in the CBL-PBL group were 79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9, more than 73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 in the traditional model group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.01), and the total scores of the CBL-PBL group were 79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8, also significantly higher than the 73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 score in the traditional model group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e) (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab5\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCcomparison of the post-class test scores between two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary knowledge (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCase analysis (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal scores (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eThe maximum score for each item is 100 points.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003e3.4 Comparison of the clinical practice abilities between the two groups\u003c/h2\u003e\n \u003cp\u003eAfter the course, we also conducted a clinical practice ability evaluation for the two groups of students. As shown in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, in the CBL-PBL group, medical history collection scores, physical examination scores, diagnosis scores, and treatment scores were 19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9, 16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1, 19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3, and 19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4, respectively, significantly more than 17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3, 14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0, 16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5, and 17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively). In the CBL-PBL group, the total score was 73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0, which was more than the 66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5 in the traditional model group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab6\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical practice abilities between two groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClinical practice ability\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical history collection (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical examination (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiagnosis (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal scores (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eThe maximum score for each item is 25 points, and for the total score is 100 points.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003e3.5 Neurosurgery specialty selection between the two groups of students pre- and postcurriculum.\u003c/h2\u003e\n \u003cp\u003eAt pre- and postcurriculum, we surveyed the specialty selection of all the students. The results are presented in Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e. In the CBL-PBL group, only 3.4% of the students chose a neurosurgery major at the beginning of the semester, while 13.3% of the students chose a neurosurgery major at the end of the semester; the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048). In the traditional model group, 6.7% of students chose a neurosurgery major at the beginning of the semester, while 3.4% of students chose a neurosurgery major at the end of the semester; no significant difference was observed.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab7\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eNeurosurgery specialty selection between the two groups of students pre- and postcurriculum.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCBL-PBL group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional model group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2 value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt the beginning of the semester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurosurgery (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther majors (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (93.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt the end of the semester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurosurgery (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther majors (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eNA, not available.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAlthough neurosurgery is very popular among medical students in other countries, in China, it is still a challenge to recruit high-quality students into neurosurgery [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. How to recruit high-quality students into neurosurgery in China is an important question that needs to be addressed. In this study, we use CBL and PBL integrated methods to implement teaching, which makes it easier for students to master neurosurgery knowledge and thus boosts their interest in neurosurgery compared to the traditional teaching method. Meanwhile, students\u0026rsquo; self-confidence was significantly increased, and more students were inclined to choose neurosurgery as a career.\u003c/p\u003e \u003cp\u003eThe traditional teaching method is the most efficient and economical way to deliver core knowledge and concepts [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is very suitable for teaching in large, basic medical classes, such as physiology, biochemistry, and tissue embryology, because these courses are focused on students' mastery of knowledge points. However, in the teaching of clinical courses, such as internal medicine, surgery, gynecology, and pediatrics, more attention is given to the cultivation of students' ability to integrate theory with practice and clinical thinking ability. The traditional teaching model is not suitable for the teaching of these courses. However, thus far, there no standard teaching plan for clinical courses has been developed.\u003c/p\u003e \u003cp\u003eMost instructors are constantly exploring new teaching methods for clinical courses. In this study, the results revealed that the scores of students' self-evaluation, theoretical examination, and the students' clinical application ability evaluation tests of those who received the CBL and PBL integrated methods were significantly higher than those students who received the traditional teaching method, suggesting that the CBL and PBL integrated method is more suitable for neurosurgery teaching.\u003c/p\u003e \u003cp\u003eCBL and PBL integrated methods have been demonstrated to be significantly better than the traditional teaching method in the teaching of other clinical courses. Liu et al. adopted CBL-PBL teaching for maxillary sinus floor augmentation, and better results were obtained in terms of academic knowledge acquisition, case analysis ability, and student satisfaction compared to the traditional teaching method [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Zhao et al. also demonstrated that in teaching about thyroid disease, CBL and PBL integrated methods significantly improved residents' and medical students' performance and enhanced their clinical skills compared to the traditional teaching method [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, some scholars' research shows that student performance has not been significantly improved with the new teaching method and that students prefer traditional lecture-style teaching [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn fact, CBL is considered a derivative of PBL, and the two are often confused [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Srinivasan et al. pointed out that, unlike PBL, CBL often requires a certain basic theoretical knowledge of the subject [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Obviously, it is inadequate if CBL is used alone for the clinical teaching of undergraduates because they do not have theoretical knowledge of various fields. In addition, CBL pays more attention to the analysis of clinical cases, not just to the mastery of professional knowledge. However, PBL can make up for these shortcomings of CBL. As in this study, when assigning cases, we summarize the knowledge points that students need to master in problems and let students analyze cases based on the type of problem. The students\u0026rsquo; clinical skills improved significantly, and it was easier for them to master theoretical knowledge.\u003c/p\u003e \u003cp\u003eAnother advantage of CBL is that neurosurgery can be exposed to students early in the form of cases, and early exposure to neurosurgery contributes to medical student recruitment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, students' interests in neurosurgery increased through case teaching, and neurosurgery selection at the end of the semester increased significantly. However, the teaching methods of CBL and PBL integrated methods also have certain shortcomings. This teaching method is only suitable for small class teaching, which not only requires more neurosurgeons to participate in medical teaching but also requires neurosurgeons to have a great interest in teaching. Compared with the traditional teaching method, the PBL and CBL teaching methods require instructors to dedicate more time and energy.\u003c/p\u003e \u003cp\u003eThere are several inevitable limitations in this study. First, this is a single-institution, small-sample study, and a multi-institution, large sample size study is needed. Second, this study cannot be completed in a double-blind manner because students may communicate privately. Third, although the teaching procedures of CBL and PBL integrated methods are uniform, the teaching style of each teacher in the traditional teaching model is different. Therefore, the results obtained may be biased. Last, teachers of other majors may also choose some new teaching methods, which may impact students' major selection. This study did not capture these details.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, compared to the traditional teaching method, the CBL and PBL integrated method is more effective for improving medical students\u0026rsquo; performance and enhancing their clinical capabilities when teaching neurosurgery. The students\u0026rsquo; self-perceived competence and satisfaction with the course were obviously increased. Additionally, the CBL and PBL integrated methods effectively enhanced students\u0026rsquo; interest in neurosurgery, potentially contributing to improving medical student recruitment into neurosurgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBL= case-based learning; PBL= problem-based learning.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board and Ethics Committee of The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College. We confirm that all experiments were performed in accordance with Declaration of Helsinki. Written informed consent was obtained from all participating students. We confirm that the consent was informed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author reports no conflicts of interest in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grants from The Teaching Quality and Teaching Reform Project of Wannan Medical College (2020jyxm87, 2020jyxm79). Teaching and Research Project of Anhui Provincial Department of Education (2021jyxm1636, 2021jyxm1639).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJun Shen and Xuefei Shao designed the research; Lili Yuan and Ruixiang Ge designed all the questionnaires. Jun Shen, Lili Yuan, Ruixiang Ge, Xuefei Shao, \u0026nbsp;and Xiaochun Jiang implemented clinical teaching. Jun Shen, Lili Yuan, and Ruixiang Ge assessed the students\u0026rsquo; self-evaluation, their satisfaction with teaching methods., theory test and clinical practice abilities test. Lili Yuan and Ruixiang Ge\u0026nbsp;performed the statistical analysis, completed the production of the tables and figures; Jun Shen prepared the\u0026nbsp;manuscript; Xuefei Shao revised the statistical analysis and the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge and thank the students who participated in this study and provided valuable feedback on questionnaires.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWINS White Paper Committee:, Benzil DL, Abosch A, Germano I, Gilmer H, Maraire JN, et al. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008;109:378\u0026ndash;386.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrow DL, Bendok BR. Introduction: What is Neurosurgery?. Oper Neurosurg (Hagerstown). 2019;17:S1-S2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlaagib NA, Musa OA, Saeed AM. Comparison of the effectiveness of lectures based on problems and traditional lectures in physiology teaching in Sudan. BMC Med Educ. 2019;19(1):365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson JA, Pegram AH, Battise DM, Robinson AM. Traditional lecture versus jigsaw learning method for teaching Medication Therapy Management (MTM) core elements. Curr Pharm Teach Learn. 2017;9:1151\u0026ndash;1159.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChotiyarnwong P, Boonnasa W, Chotiyarnwong C, Unnanuntana A. Video-based learning versus traditional lecture-based learning for osteoporosis education: a randomized controlled trial. Aging Clin Exp Res. 2021;33:125\u0026ndash;131.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiegel D, Harrington A. What is the placebo worth? BMJ. 2008;336:967\u0026ndash;968.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBodagh N, Bloomfield J, Birch P, Ricketts W. Problem-based learning: a review. Br J Hosp Med (Lond). 2017;78:C167-C170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones RW. Problem-based learning: description, advantages, disadvantages, scenarios and facilitation. Anaesth Intensive Care. 2006; 34:485\u0026ndash;488.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCh\u0026eacute;ron M, Ademi M, Kraft F, L\u0026ouml;ffler-Stastka H. Case-based learning and multiple choice questioning methods favored by students. BMC Med Educ. 2016;16:41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhazmi A, Quadri MFA. Comparing case-based and lecture-based learning strategies for orthodontic case diagnosis: A randomized controlled trial. J Dent Educ. 2020;84:857\u0026ndash;863.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Xu Y, Li Y, Wu Q. Application of problem-based learning and case-based learning integrated method in the teaching of maxillary sinus floor augmentation in implant dentistry. Peer J. 2020;8:e8353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBi M, Zhao Z, Yang J, Wang Y. Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology. Med Teach. 2019;41:1124\u0026ndash;1128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao W, He L, Deng W, Zhu J, Su A, Zhang Y. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease. BMC Med Educ. 2020;20(1):381.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuq S, Khalafallah AM, Ishida W, Porras JL, Lee RP, Rincon-Torroella J, et al. Recruiting Medical Students to Neurosurgery Through a Focused Neuroanatomy Lab Initiative. World Neurosurg. 2020;137:e535-e546.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLubelski D, Xiao R, Mukherjee D, Ashley WW, Witham T, Brem H, et al. Improving medical student recruitment to neurosurgery. J Neurosurg. 2019; 9:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonney PA, Fujii T, Zada G. Recruitment of Medical Students in Neurosurgery. World Neurosurg. 2017;98:859.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStumpo V, Latour K, Traylor JI, Staartjes VE, Giordano M, Caccavella VM, et al. Medical Student Interest and Recruitment in Neurosurgery. World Neurosurg. 2020;141:448\u0026ndash;454.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivkin A, Gim S. Student preferences regarding teaching methods in a drug-induced diseases and clinical toxicology course. Am J Pharm Educ. 2013;77(6):123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCodd AM, Choudhury B. Virtual reality anatomy: is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy? Anat Sci Educ. 2011;4:119\u0026ndash;125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 2007;82:74\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDallas J, Mummareddy N, Yengo-Kahn AM, Dambrino RJ 4th, Lopez AM, Chambless LB, et al. Neurosurgery Elective for Preclinical Medical Students with and without a Home Neurosurgery Program. World Neurosurg. 2019;131:e201-e210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuintana LM. How to Improve the Attractiveness of Neurosurgery. World Neurosurg. 2016;86:63\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Case-based learning, Neurosurgery, Problem-based learning, Traditional teaching method","lastPublishedDoi":"10.21203/rs.3.rs-1621655/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1621655/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to determine whether a combination of case-based learning (CBL) and problem-based learning (PBL) methods in teaching can improve the academic performance and recruitment of medical students for neurosurgery.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFour classes of fourth-year medical students were randomly divided into two groups. The traditional model group received the traditional teaching method, and the CBL-PBL group received the combined teaching methods of CBL and PBL. After the courses, the differences between the two groups in self-perceived competence, satisfaction with the course, postclass test scores, and clinical practice abilities were compared, and the proportions of neurosurgery major selection in pre- and postcurriculum between the two groups were also analyzed.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSelf-perceived competence, postclass test scores, and clinical practice abilities in the CBL-PBL group were significantly better than those in the traditional model group. The students in the CBL-PBL group showed a higher degree of satisfaction with the course than those in the traditional model group. At the end of the semester, the proportion of students who chose neurosurgery majors in the CBL-PBL group increased significantly.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCompared with the traditional teaching method, the CBL and PBL integrated method is more effective for improving the performance of medical students and enhancing their clinical capabilities in neurosurgery teaching. The CBL-PBL method effectively improved students’ interests in neurosurgery, potentially contributing to increasing medical student recruitment into neurosurgery.\u003c/p\u003e","manuscriptTitle":"Improving medical student recruitment into neurosurgery through teaching reform","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-05-17 17:41:38","doi":"10.21203/rs.3.rs-1621655/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-07-27T09:04:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-06-23T08:28:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4adf565c-2fd1-4247-9911-89a5a2c40000","date":"2022-06-23T07:55:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-05-13T01:04:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-05-13T00:52:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-05-12T13:06:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-05-12T12:48:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2022-05-04T10:02:56+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":"5978b3ed-558d-4e78-b219-529d70e6961c","owner":[],"postedDate":"May 17th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-08-30T10:29:21+00:00","versionOfRecord":[],"versionCreatedAt":"2022-05-17 17:41:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1621655","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1621655","identity":"rs-1621655","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}