The application of blended teaching in non-pediatric specialty pediatric science education

The application of blended teaching in non-pediatric specialty pediatric science education | 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 The application of blended teaching in non-pediatric specialty pediatric science education Shu-fang Xue, Jinyan Zhang, Xiang-xiang Lin, Ahong Chen, Ying-jing Lian, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5918560/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Traditional pediatric education often uses a single teaching method, making theoretical knowledge abstract and difficult to grasp. This can lead to passive learning and limit students' understanding and research skills, failing to prepare them for modern challenges. We studied how blended teaching focused on job competency affects non-specialized pediatric science students. Methods A total of 133 students in our 2019 class on prevention medicine received blended teaching (reform group), and 143 students in the 2018 class on prevention medicine received traditional teaching (control group). Students records were analyzed retrospectively. Students also evaluated their teachers via questionnaires. Results Over 60% of students expressed satisfaction with blended learning across three metrics: overall satisfaction, preference for blended learning, and willingness to recommend the course and instructors to others.In the assessments, more than 75% of students in the reform group expressed satisfaction with their grades, which fell within the 95 to 100 range. In contrast, the majority of students in the control group scored between 91 to 95, constituting 34.2% of the sample. Following this, 18.9% achieved grades ranging from 96 to 100, and 17.5% attained scores between 86 to 90. Statistically significant differences were observed between the reform group and the control group in terms of student evaluations, exam scores, case writing and in-class quizzes. Conclusion We integrated preschool tutoring with classroom education in a non-specialized pediatric medicine course, finding it enhances learning, job readiness, academic performance, and student satisfaction. Tailor the approach to subjects, workload, and performance for best results. Education research Flipped classroom Case-based learning Blended learning Teaching reform Pediatric science Figures Figure 1 Figure 2 Figure 3 Introduction In October 2018, the Ministry of Education in China proposed the development of the "Four New" areas, namely, "New Engineering", "New Liberal Arts", "New Agriculture", and "New Medical Sciences", with the aim of addressing the ongoing technological revolution and industrial changes in the medical field. It has been proposed that highly qualified medical professionals are an important driving force for the development of the technological revolution, and enabling individuals to achieve job competence is the ultimate goal of cultivating medical talent. Pediatric medicine is an important course in clinical training and is one of the compulsory courses for preventive medical students. Preventive medical students（in non-pediatric specialties）have a different academic focus than do pediatric medical students. Preventive medical students are required to cultivate mastery of basic theories, fundamental knowledge, and basic skills pertaining to preventive medicine to work in the fields of disease prevention and control. Pediatric medical students are required to master and apply solid knowledge regarding pediatric medicine to work on the clinical frontlines. It is important to determine how to cultivate highly qualified medical professionals with high levels of job competence. In traditional pediatric science education, students are taught using PowerPoints[1], and a single teaching mode is used, thus making theoretical knowledge seem more abstract and obscure. This teaching style can lead to an inactive classroom atmosphere, low levels of student comprehension ability, and low levels of exploratory and research learning. Therefore, to cultivation highly qualified pediatric professionals, there is an urgent need to actively promote innovative medical education methods guided by competence. With the development of the internet and information technology, online learning has become a popular tool in medical education. In general, online learning refers to the use of new multimedia and communication technologies to teach part or all of a course [2]. The online learning environment can transcend institutional, temporal, and geographical boundaries, thus enabling students to learn at their own pace to achieve satisfactory learning outcomes, as they can easily access many learning resources. Therefore, online learning has become increasingly important in higher education and in medical institutions. However, online learning also has several disadvantages [3]. The largest obstacle to online learning is the high cost of the technical infrastructure and network equipment necessary for its implementation. In addition, students must rely on themselves in an online learning environment, but they may lack high levels of internal motivation and or time management skills, thereby reducing the efficacy of student learning. Furthermore, in terms of communication between students and teachers, traditional face-to-face interaction may be more effective than online learning. Therefore, a blended teaching model has emerged. As an innovative and flexible curriculum design method, blended teaching can integrate multiple teaching methods, theories, media, and environments, thus fully emphasizing the subjectivity of students in the learning process and highlighting the leading role of teachers in the teaching process [4]. Accumulating evidence suggests that blended learning is more effective than conventional learning in terms of knowledge acquisition [5]. Case-based learning (CBL) is an effective educational approach that may be used in combination with didactic lectures. CBL enables students to practice real- world clinical cases and promotes learning capabilities that enhance the academic experience of medical students. This method has been shown to enhance pre-class preparation, student comprehension, student-teacher interaction, communication skills, self-directed learning, and knowledge absorption[6]. The flipped classroom approach is a technology-supported educational approach that consists of two components: (1) individual and direct computer-centered education outside the classroom through video lectures; and (2) group interactive activities inside the classroom. Specifically, this definition of the flipped classroom approach emphasizes the need to use educational videos for learning outside the classroom[7]. Although many studies[8-9] have examined the combination of the flipped classroom approach with CBL in the context of non-pediatric specialty pediatric science education, few studies have focused on the effect of this combination approach among students in other medical professional fields. Our teaching laboratory has introduced a superstar platform (specifically, a mobile terminal learning platform that integrates course learning, knowledge dissemination, and management sharing; this platform includes information, notifications, assignments, exams, discussions, activities, and statistics across various modules as well as interactive functions such as classroom signatures, quizzes, and scoring, and it establishes a foundation and necessary conditions for flipping classroom practice) to flip the classroom based on a CBL model in the context of pediatrics education. We developed a blended teaching practice of pre-school tutoring, classroom education, and post-school tracking for preventive medicine students who were in our class in 2019. We aimed to examine whether the blended teaching approach was more effective with regard to improving job competence and both the quality and outcomes of non-pediatric specialty pediatric science education at local medical universities. Methods Participants The present study was conducted from July 2020 to December 2021. A total of 133 students in our 2019 cohort received blended teaching (reform group), while 143 students in the 2018 cohort received traditional teaching (control group). The differences in gender and the entrance exam scores between the two groups were not statistically significant (P>0.05). The "Pediatric Science (9th Edition)" textbook, which was edited by Wang Weiping, Sun Huan, and Chang Liwen, was used as a supporting material. The total duration of the course was 36 hours, and all lessons were taught by teachers from the same teaching team. Informed consent was obtained from all subjects. Study design The blended teaching model that was used in the reform group was divided into three stages: pre-school tutoring, classroom research, and post-school interaction (Figure 1). In the blended teaching model, online learning was mainly implemented in the pre-class tutoring and post-class interaction stages, while offline learning was mainly implemented in the classroom research stage. The teachers completed different and complementary learning tasks in the classroom. However, at all stages of the model, teachers maintained interaction with students and provided timely feedback. Group discussion implementation scoring: group self-assessment and inter-group scoring. Each group has a chairman and a secretary. The chairman is responsible for distributing scenario cases, discussing and refining keywords, digging and sorting out problems, determining learning objectives, and making every member have a chance to speak. The secretary is responsible for recording the discussion and writing a summary of the discussion. In order to show fairness, the chairman and secretary can take turns as team members. The intra-group self-assessment and group mutual assessment were divided into three levels: excellent (92 points), accounting for 30% of the total, good (86 points), accounting for 40% of the total, and qualified (79 points), accounting for 40% of the total. In the control group, the learning was implemented in accordance with the teaching syllabus, and PowerPoint templates were used for teaching. Furthermore, teaching videos and literature were used as post-class independent learning materials. Teaching Evaluation This study evaluated students' learning processes and learning outcomes. The final exam was considered to be the final evaluation. Passing through the paperless exam system platform accounted for 30% of the total course grade. In addition to the final exam, online learning tasks were considered formative evaluations and accounted for 30% of the total course grade. The grades were determined using the statistical analysis functions of the Superstar Learning Platform. The assessments included preclass online exercises, testing discussions, classroom check-ins, online testing, online answering, post-class online assignments, and regular exams. In addition, regular assessments were completed by the students to provide timely feedback about the teaching process, thus allowing teachers to adjust their teaching methods and contents in a timely manner, effectively standardize their teaching processes, and improve the quality of classroom teaching. Finally, the formal evaluation of offline group performance accounted for 40% of the total course grade, including not only offline exercises and independent group reports but also presentations for each group, the use of online platforms such as Learning Commons, and cooperation with teachers. Student evaluation After the theoretical lectures, students anonymously completed questionnaires to evaluate the teaching quality(see Table 1 ). Table 1 Student evaluation questionnaires Item Criteria for assessment Scoring Teaching attitude（20 points） The teacher exhibits a tidy appearance, gracious demeanor, a dedicated approach, thorough lesson preparation, adept lectures, and occasional improvisation during teaching sessions 10 The teacher instructs in Mandarin with a moderate and engaging speech pace, maintains a tidy and standardized board, and utilizes well-designed multimedia courseware 10 Teaching content（30 points） The teaching objectives are clearly defined, logically structured, hierarchical, and highly focused 5 Strong scientific rigor and a precise mastery of the discipline's knowledge and system 5 Capable of appropriately utilizing specialized foreign language vocabulary in teaching 5 Possesses a strong ideology, adept at teaching and educating, emphasizing the cultivation of students' humanistic and scientific spirits 5 Emphasizes the transfer of new knowledge and the application of new technologies in clinical practice 5 Teaching Methods （30 points） Utilizes heuristic teaching to encourage positive thinking, active exploration, and the development of students' problem- solving, communication, and innovation skills 10 Capable of selecting suitable teaching methods based on the content, and proficiently integrates multimedia and other instructional techniques 10 The classroom atmosphere is welcoming, fostering excellent interaction between teachers and students 10 Teaching Effectiveness （20 points） Students demonstrate mastery of fundamental theories and knowledge and can effectively apply their learning to solve practical problems 10 Promotes students' learning enthusiasm and achieve high levels of student satisfaction 10 Satisfaction with Blended Learning in the Reform Group After the theoretical lectures, students in the reform group were asked to report their level of satisfaction with the pediatric science teaching method in an anonymous manner(see Table 2) [10]. Exam scores The exam scores include three aspects: student evaluations, exam scores, and course grades .Student evaluations, i.e., online learning grades, were determined using the statistical analysis functions offered by the Superstar Learning Platform and group discussion scores. Exam scores, i.e., theoretical grades, were obtained using the same type of questions, similar content, moderate difficulty exam papers (with a maximum score of 100). Course grades included not only offline exercises and independent group reports but also the presentations made by each group via online platforms. We evaluated the advantages and disadvantages of two teaching modes based on the level of achievement. Clinical internship grades Students' clinical internship grades were divided into 4 aspects: attendance, quizzes, case writing, and usual grades. Both groups of students were assessed for the same content, and the total score for each of the 4 aspects was 100 points. Statistical analysis SPSS version 23.0 (Armonk, NY: IBM Corp.) was utilized to analyze and process the data. Nonnormally distributed continuous variables are expressed as medians (Q25-to-Q75 values), while normally distributed continuous variables are expressed as means ± SDs. Categorical variables are expressed as frequencies and rates. The Kruskal‒Wallis test or one-way analysis of variance was used to compare quantitative variables between groups. The χ2 test was used to compare categorical variables between groups. Results Satisfaction with Blended Learning in the Reform Group The questionnaire was designed to measure satisfaction with blended learning among students in the reform group. The response rate for the questionnaire administered to students in the reform group was 100%. The survey results are shown in Table 2 . More than 60% of the students agreed or strongly agreed with the three metrics, indicating good satisfaction with blended learning. A total of 61.7% of students agreed or strongly agreed with the following item: "I will recommend this blended learning course and its instructor to others". Most of the students also agreed or strongly agreed with the following item: "achieved expected learning goals or tasks through studying this course". A total of 50.3% of the students were dissatisfied with the completion of their learning goals and tasks after the course ended, which was a concerning issue. Table 2 Investigation of blended learning satisfaction in the reform group (%) Item Strongly disagree Disagree Neutral Agree Strongly agree Overall, I am satisfied with blended learning. 2.2 13.5 22.6 43.6 18.0 If possible, I would choose blended learning for learning. 1.5 13.5 24.8 44.4 15.8 I will recommend this blended course and its instructors to others. 1.5 16.5 20.3 40.6 21.1 Compared with traditional learning and online learning alone, blended learning has more advantages. 2.3 26.3 21.8 39.8 10.5 By taking this course, I have achieved my expected learning goals or tasks. 1.5 22.6 25.6 42.8 7.5 Comparison of student assessments between the two groups In the reform group, all 133 participants completed the student assessment survey. In the control group, 124 students completed the student assessment survey, yielding a participation rate of 86.7%. The survey results are shown in Fig. 2. More than 75% of students in the reform group were satisfied with their grades, which ranged from 95 to 100. In the control group, most of the students had grades ranging from 91 to 95, accounting for 34.2% of the sample, followed by grades ranging from 96 to 100 and grades ranging from 86–90, accounting for 18.9% and 17.5% of the sample, respectively. The two groups were compared for statistical significance (Table 3 ). Table 3 Comparison of teaching evaluations between the two groups Characteristic Reform group Control group F/Z/χ2 P-Value Theoretical study Student evaluation 97.46(96.0–99.0) 91.20(87.5–95.0) -10.721 0.000 Exam scores 70.05 ± 11.38 62.40 ± 12.20 27.048 0.000 Course grade 91.97 ± 3.86 92.30 ± 3.93 0.436 0.510 Clerkship Case writing 90.17(88.0–93.0) 80.73(80.0–80.0) -10.777 0.000 in-class quizzes 99.51(100.0-100.0) 86.04(80.0–90.0) -11.782 0.000 Course grade 89.89(90.0–90.0) 88.96(88.50–93.00) -1.930 0.054 Student performance Regarding student performance, students in the reform group had a better grasp of the course content than those in the control group. Among the 133 students in the reform group, 54 had scores above 80, accounting for 44.36% of the sample (Fig. 3 A). However, only 39 of the 143 students in the control group scored above 80, accounting for 27.27% of the sample (Fig. 3 B).The students’ average theoretical academic score was 70.05 ± 11.38 points, and the students’ average case writing and in-class quiz scores were 90.17 and 99.51 points, respectively, which were higher than the academic scores obtained by students who received traditional learning. There were statistically significant differences between the reform group and the control group in terms of student evaluation, exam scores, case writing and in-class quizzes (Table 3 ). However, no differences were observed between the reform group and the control group in terms of course grade. Discussion The educational system has undergone a substantial transition from traditional learning methods to methods involving self-directed learning and active participation among students [ 11 ]. Medical education and talent cultivation guided by job competence are currently important features in modern medical education. Although no studies examined the use of blended teaching in pediatric science for nonclinical specialties, this area needs more attention from researchers and practitioners. Competence among pediatric students in preventive medicine courses requires a solid knowledge of pediatric medicine and the ability to work in disease prevention and control. We explored the effects of blended teaching by combining CBL with a flipped classroom in a pediatric medicine course guided by job competency. We compared this blended teaching method with the traditional teaching method. To achieve the teaching goals of the pediatric science curriculum based on the competence of preventive medicine medical students, this team fully utilized the advantages of the blended teaching model and developed a diversified teaching design. Before class, knowledge guides, mini course videos, and chapter quizzes were provided to students; thus, students are encouraged to learn independently, thus fostering lifelong learning ability. Students had a high level of learning investment and a high completion rate. In class, quizzes, colliding ideas, the flipped classroom approach, and group discussions established a lively learning atmosphere, which was very helpful with regard to enhancing students' classroom attention. The students' immersive experience was significantly enhanced, and the students' learning quality was strongly improved. After class, in response to the teaching content, teachers and students posted explanation videos on the Learning Connect platform, interacted with questions, and practiced project-based case studies. This approach overcame temporal and geographical constraints, and teachers and students were able to exchange information more efficiently, thus helping the students consolidate and enhance their theoretical knowledge; this approach also led to enhanced emotions between teachers and students, thus indicating a high level of satisfaction with this approach, which is consistent with the extant literature on this topic[ 12 – 13 ]. After the blended learning course, the students’ average theoretical academic score was 70.05 ± 11.38 points, and the students’ average case writing and in-class quizzes were 90.17 and 99.51 points, respectively, which were higher than the academic scores of the students who received traditional learning. This finding indicates the effectiveness of blended teaching combined with joint case-based learning in the flipped classroom. In both theoretical studies and clinical internships, the usual score between the two groups was not significantly different. Therefore, we conclude that the difference in scores between the two groups was not due to the usual subjective score but can instead be attributed to the different characteristics of the two teaching methods. Specifically, given that the pre-class course materials are more abundant and more closely approximate clinical work in the blended teaching model, students reviewed learning materials at home and were ready to apply that information when they arrived at class. The teacher commenced the teaching process by checking students' degree of comprehension and reflecting on what was previously studied at home. However, the students in the traditional lecture group were more likely to have found and memorized knowledge points in their textbooks[ 14 – 15 ]. However, nearly half of the students were dissatisfied with the completion of their learning goals and tasks after the course ended. The majority of blended teaching models focus on pre-class and in-class activities. However, learning does not stop after the class session ends; learning is optimized through ongoing practice. Post-class work that is aligned with course objectives can support self- determination and promote intrinsic motivation. Post-class work should include feedback for students regarding areas of strength and improvement and opportunities for more practice [ 16 ]. Some students do not prefer the flipped classroom over the traditional classroom. This is likely because of the effort and engagement that are required for active learning[ 17 ]. As reported in the literature, “Outdated and disengaging science education, which teaches science as a body of facts, and assesses mainly on rote-memorization, does not only turn youth away from STEM disciplines but also degrades the overall learning and skill- outcomes of the graduates”[ 18 ]. We have been working hard to change the field of medical education. Seven practical strategies to add active learning to a science lecture[ 19 ] have been used, including increasing community with name tents, increasing equity with random calling, generating peer discussion with clickers, using multiple-choice questions outside exams, collaborative exams increase interaction and community, creating reading guides and pre-class quizzes, and encouraging students with pre-class videos. The results of active learning are gratifying, but it remains unclear how to motivate all students to take the initiative in learning. A study revealed that throughout the educational system, students who participate in active learning pedagogy perform better and fail less often than do students who are taught through direct instruction[ 20 ]. Another review of the literature revealed that the active learning methodology places the student at the heart of the learning process, thereby promoting critical thinking and decision-making ability[ 21 ]. Active learning is effective according to these studies, but the conditions under which it can be optimal are difficult to define. There is no set formula. However, some implicit expectations underlie this approach, including effort and trust. This applies to both teachers and students. Teachers need to trust their students to make efforts to learn, and the students in turn trust their teachers to make efforts to ensure that they are receiving a meaningful learning experience[ 22 ]. However, appropriate supervision and management of independent learning are also necessary[ 23 ]. Insufficient after- school time is also a significant barrier to active learning[ 24 ]. On the one hand, spending more time studying means that students can obtain more knowledge and deeper understanding. This might partially explain why students in the reform group had higher scores, especially in clinical case analysis, which requires students to understand the content in depth. On the other hand, spending more time studying means that this activity will consume too much spare time[ 25 ]. Third-year preventive medicine major students often study not only pediatrics but also other courses, taking up to 10 classes simultaneously. It is essential that incentives be added to encourage students to prepare after class (e.g., graded quizzes) [ 26 ]. There are many concepts in pediatrics that benefit from visual imagery and animations and that are difficult to reproduce in a textbook[ 27 ]. The average length of our pre-school videos is 15–20 minutes[ 28 ]. Shortening pre-school videos is the focus of our next reform. These videos should be shortened to 5–7 minutes or shorter, as brief videos are more engaging to watch. The combination of CBL and a flipped classroom may not be suitable for learning abstract and memorization-heavy concepts. Therefore, it is important to evaluate the effectiveness of the blended teaching model each time it is applied to a new setting[ 29 ]. This study had several limitations. First, there was a limited sample size. Second, there was only one teaching class per grade, so it was not possible to conduct a concurrent controlled trial. Third, after the end of the course, we did not follow up on the effectiveness of the course evaluation for a long period. Finally, we did not collect data on students’ preclass and after-class time, and the time spent on blended teaching is limited to theory and cannot be more accurately analyzed. Conclusions The findings of this study were promising and encouraging. We developed a blended teaching practices including pre-school tutoring, classroom education, and post-school tracking based on CBL for a pediatric medicine. The results revealed that this teaching model has the potential to create an autonomy- supportive learning environment, can reflect orientation toward job competence, improves academic performance, and is satisfactory among students. Blended teaching practices need to be further optimized in terms of specific subjects, students’ workloads, and the evaluation system of students’ performance. Declarations Acknowledgments We are grateful to the students who were willing to share their thoughts and experiences with us. Authors’ contributions Cheng-yi WANG planed and designed the study. Shu-fang Xue contributed equally to the writing and revision of the manuscript. Jinyan Zhang, Xiang-xiang Lin, Ahong Chen, Ying-jing Lian and Qi-lin Jiang contributed to the data collection and analysis. All authors contributed to the critical revision of the paper and approved the final manuscript for publication. Availability of data and materials Not applicable. Ethics approval and consent to participate The study was approved by the ethics committee of Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics & Gynecology & Pediatrics, Fujian Medical University. Written informed consent was obtained from all participating students. Consent for publication Written consent was obtained from the participants. Competing interests The authors declare that they have no competing interests. References Chen M, Ye L, Weng Y. Blended teaching of medical ethics during COVID-19: practice and reflection. BMC Med Educ. 2022 May 11;22(1):361. 10.1186/s12909-022-03431-6 Naciri A, Radid M, Kharbach A, Chemsi G. E-learning in health professions education during the COVID-19 pandemic: a systematic review. J Educ Eval Health Prof. 2021;18:27. 10.3352/jeehp.2021.18.27 . Wang D, Zhou J, Wu Q, Sheng G, Li X, Lu H, Tian J. 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Lowering barriers to active learning: a novel approach for online instructional environments. Adv Physiol Educ. 2021 Sep 1;45(3):547–553. Ma J, Jiang X, Wang J, Liang Z, Sun Z, Qian H, Gong A. The construction and application of a blended teaching model under the strategic background of healthy China. Biochem Mol Biol Educ. 2022 Jan;50(1):114–9. Tang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, Zhou L, Zou Y. Liang. D. Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online. 2017;22(1):1395679. 10.1080/10872981.2017.1395679 . Erratum in: Med Educ Online. 2017;22(1):1406198. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-5918560","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":414276049,"identity":"60f1fd77-7d47-490a-9e10-bb747bafbcea","order_by":0,"name":"Shu-fang Xue","email":"","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shu-fang","middleName":"","lastName":"Xue","suffix":""},{"id":414276050,"identity":"01512636-c3ef-4632-8ed6-c5ad90854bc0","order_by":1,"name":"Jinyan Zhang","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinyan","middleName":"","lastName":"Zhang","suffix":""},{"id":414276051,"identity":"5487cdc6-b3b3-40df-851c-cc52e7fd1ce4","order_by":2,"name":"Xiang-xiang Lin","email":"","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiang-xiang","middleName":"","lastName":"Lin","suffix":""},{"id":414276052,"identity":"14b0a7a7-e0c5-4c19-b73b-9481ec2859f5","order_by":3,"name":"Ahong Chen","email":"","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai Children's, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ahong","middleName":"","lastName":"Chen","suffix":""},{"id":414276056,"identity":"cad44c39-e329-42d0-943b-cdd52eb348ca","order_by":4,"name":"Ying-jing Lian","email":"","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai Children's, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ying-jing","middleName":"","lastName":"Lian","suffix":""},{"id":414276057,"identity":"8ff3abaa-0a31-4f4c-bdbd-7f60f95f465b","order_by":5,"name":"Qi-lin Jiang","email":"","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai Children's, Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qi-lin","middleName":"","lastName":"Jiang","suffix":""},{"id":414276058,"identity":"19f92542-e81b-4b94-8129-feac2c46ba33","order_by":6,"name":"Cheng-Yi WANG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYLACxgYw2f7jQ4WEHD8pWhokZ5yxMJZsIF4LA4M0b1tF4gZCWgyOnz384ucOmzz5iOQGY955EowbGJgfPrqBT8uZvDTL3jNpxYY3EhsS526TYDZnYDM2zsGjxexAjpkxY9vhxI0zEhsOvN0mwWbZwMMmjVfL+TcgLf9BWhobeOdI8BgcIKTlRo7xY8a2A4nzJRKbGXkbJCQIarG/8caMsbctOXEDz8M2xhnHJAwkmwn4RbI/x/jDzza7xPnt6c8YPtTU1fezNz98jE8LELBJgEiDCwlQPjN+5WAlH0CkfP8BwkpHwSgYBaNgZAIA6+9TUDm1YAEAAAAASUVORK5CYII=","orcid":"","institution":"Fujian Children's Hospital（Fujian Branch of Shanghai, Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Cheng-Yi","middleName":"","lastName":"WANG","suffix":""}],"badges":[],"createdAt":"2025-01-28 12:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5918560/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5918560/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76193583,"identity":"db86ba84-d840-417e-be9b-2d35f63b2a1e","added_by":"auto","created_at":"2025-02-13 10:00:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":130921,"visible":true,"origin":"","legend":"\u003cp\u003eThe blended teaching was divided into three stages: pre-school tutoring, classroom research, and post-school interaction . At all stages of the model, teachers maintained interaction with students and provided timely feedback.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5918560/v1/389f57dce11ad61630581695.png"},{"id":76194132,"identity":"abd3d6a3-1e74-4f04-a48a-84dbcb68b1df","added_by":"auto","created_at":"2025-02-13 10:08:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6779,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of student’s evaluation of teaching between the two groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5918560/v1/81f10992dfe52be07daa3d0c.png"},{"id":76193585,"identity":"3dbe2a9f-7f0a-4c84-ab7d-494017ad4ac8","added_by":"auto","created_at":"2025-02-13 10:00:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":127755,"visible":true,"origin":"","legend":"\u003cp\u003e3A Distribution of total end-period achievements in the reform group\u003c/p\u003e\n\u003cp\u003e3B Distribution of total end-period achievements in the control group\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5918560/v1/56f16a8a889561d7540ed087.png"},{"id":80610696,"identity":"b1462c74-8551-4703-8b21-a59b29a42a0b","added_by":"auto","created_at":"2025-04-15 07:46:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":951588,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5918560/v1/1492b78d-a681-49d7-948f-6db54c6e2fc0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The application of blended teaching in non-pediatric specialty pediatric science education","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn October 2018, the Ministry of Education in China proposed the development of the \u0026quot;Four New\u0026quot; areas, namely, \u0026quot;New Engineering\u0026quot;, \u0026quot;New Liberal Arts\u0026quot;, \u0026quot;New Agriculture\u0026quot;, and \u0026quot;New Medical Sciences\u0026quot;, with the aim of addressing the ongoing technological revolution and industrial changes in the medical field. It has been proposed that highly qualified medical professionals are an important driving force for the development of the technological revolution, and enabling individuals to achieve job competence is the ultimate goal of cultivating medical talent.\u003c/p\u003e\n\u003cp\u003ePediatric medicine is an important\u0026nbsp;course in\u0026nbsp;clinical training and is one of the compulsory courses for preventive medical students. Preventive medical students（in non-pediatric specialties）have a different academic focus than do pediatric medical students. Preventive medical students are required to cultivate mastery of basic theories, fundamental knowledge, and basic skills pertaining to preventive medicine to work in the fields of disease prevention and control.\u003c/p\u003e\n\u003cp\u003ePediatric medical students are required to master and apply solid knowledge regarding pediatric medicine to work on the clinical frontlines. It is important to determine how to cultivate highly qualified medical professionals with high levels of job competence. In traditional pediatric science education, students are taught using PowerPoints[1], and a single teaching mode is used, thus making theoretical knowledge seem more abstract and obscure. This teaching style can lead to an inactive classroom atmosphere, low levels of student comprehension ability, and low levels of exploratory and research learning. Therefore, to cultivation highly qualified pediatric professionals, there is an urgent need to actively promote innovative medical education methods guided by competence. With the development of the internet and information technology, online learning has become a popular tool in medical education. In general, online learning refers to the use of new multimedia and communication technologies to teach part or all of a course [2]. The online learning environment can transcend institutional, temporal, and geographical boundaries, thus enabling students to learn at their own pace to achieve satisfactory learning outcomes, as they can easily access many learning resources. Therefore, online learning has become increasingly important in higher education and in medical institutions. However, online learning also has several disadvantages [3]. The largest obstacle to online learning is the high cost of the technical infrastructure and network equipment necessary for its implementation. In addition, students must rely on themselves in an online learning environment, but they may lack high levels of internal motivation and or time management skills, thereby reducing the efficacy of student learning. Furthermore, in terms of communication between students and teachers, traditional face-to-face interaction may be more effective than online learning. Therefore, a blended teaching model has emerged. As an innovative and flexible curriculum design method, blended teaching can integrate multiple teaching methods, theories, media, and environments, thus fully emphasizing the subjectivity of students in the learning process and highlighting the leading role of teachers in the teaching process [4]. Accumulating evidence suggests that blended learning is more effective than conventional learning in terms of knowledge acquisition [5].\u003c/p\u003e\n\u003cp\u003eCase-based learning (CBL) is an effective educational approach that may be used in combination with didactic lectures. CBL enables students to practice real- world clinical cases and promotes learning capabilities that enhance the academic experience of medical students. This method has been shown to enhance pre-class preparation, student comprehension, student-teacher interaction, communication skills, self-directed learning, and knowledge absorption[6]. The flipped classroom approach is a technology-supported educational approach that consists of two components: (1) individual and direct computer-centered education outside the classroom through video lectures; and (2) group interactive activities inside the classroom. Specifically, this definition of the flipped classroom approach emphasizes the need to use educational videos for learning outside the classroom[7]. Although many studies[8-9] have examined the combination of the flipped classroom approach with CBL in the context of non-pediatric specialty pediatric science education, few studies have focused on the effect of this combination approach among students in other medical professional fields. Our teaching laboratory has introduced a superstar platform (specifically, a mobile terminal learning platform that integrates course learning, knowledge dissemination, and management sharing; this platform includes information, notifications, assignments, exams, discussions, activities, and statistics across various modules as well as interactive functions such as classroom signatures, quizzes, and scoring, and it establishes a foundation and necessary conditions for flipping classroom practice) to flip the classroom based on a CBL model in the context of pediatrics education. We developed a blended teaching practice of pre-school tutoring, classroom education, and post-school tracking for preventive medicine students who were in our class in 2019. We aimed to examine whether the blended teaching approach was more effective with regard to improving job competence and both the quality and outcomes of non-pediatric specialty pediatric science education at local medical universities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was conducted from July 2020 to December 2021. A total of 133 students in our 2019 cohort received blended teaching (reform group), while 143 students in the 2018 cohort received traditional teaching (control group). The differences in gender and the entrance exam scores between the two groups were not statistically significant (P\u0026gt;0.05). The \u0026quot;Pediatric Science (9th Edition)\u0026quot; textbook, which was edited by Wang Weiping, Sun Huan, and Chang Liwen, was used as a supporting material. The total duration of the course was 36 hours, and all lessons were taught by teachers from the same teaching team. Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThe blended teaching model that was used in the reform group was divided into three stages: pre-school tutoring, classroom research, and post-school interaction (Figure 1). In the blended teaching model, online learning was mainly implemented in the pre-class tutoring and post-class interaction stages, while offline learning was mainly implemented in the classroom research stage. The teachers completed different and complementary learning tasks in the classroom. However, at all stages of the model, teachers maintained interaction with students and provided timely feedback. Group discussion implementation scoring: group self-assessment and inter-group scoring. Each group has a chairman and a secretary. The chairman is responsible for distributing scenario cases, discussing and refining keywords, digging and sorting out problems, determining learning objectives, and making every member have a chance to speak. The secretary is responsible for recording the discussion and writing a summary of the discussion. In order to show fairness, the chairman and secretary can take turns as team members. The intra-group self-assessment and group mutual assessment were divided into three levels: excellent (92 points), accounting for 30% of the total, good (86 points), accounting for 40% of the total, and qualified (79 points), accounting for 40% of the total. In the control group, the learning was implemented in accordance with the teaching syllabus, and PowerPoint templates were used for teaching. Furthermore, teaching videos and literature were used as post-class independent learning materials.\u003c/p\u003e\n\u003ch2\u003eTeaching Evaluation\u003c/h2\u003e\n\u003cp\u003eThis study evaluated students\u0026apos; learning processes and learning outcomes. The final exam was considered to be the final evaluation. Passing through the paperless exam system platform accounted for 30% of the total course grade. In addition to the final exam, online learning tasks were considered formative evaluations and accounted for 30% of the total course grade. The grades were determined using the statistical analysis functions of the Superstar Learning Platform. The assessments included preclass online exercises, testing discussions, classroom check-ins, online testing, online answering, post-class online assignments, and regular exams. In addition, regular assessments were completed by the students to provide timely feedback about the teaching process, thus allowing teachers to adjust their teaching methods and contents in a timely manner, effectively standardize their teaching processes, and improve the quality of classroom teaching. Finally, the formal evaluation of offline group performance accounted for 40% of the total course grade, including not only offline exercises and independent group reports but also presentations for each group, the use of online platforms such as Learning Commons, and cooperation with teachers.\u003c/p\u003e\n\u003ch2\u003eStudent evaluation\u003c/h2\u003e\n\u003cp\u003eAfter the theoretical lectures, students anonymously completed questionnaires to evaluate the teaching quality(see Table 1 ).\u003c/p\u003e\n\u003cp\u003eTable 1 Student evaluation questionnaires\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eCriteria for assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eScoring\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4372%;\" rowspan=\"2\"\u003e\n \u003cp\u003eTeaching attitude（20 points）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.4743%;\"\u003e\n \u003cp\u003eThe teacher exhibits a tidy appearance, gracious demeanor, a dedicated approach, thorough lesson preparation, adept lectures, and occasional improvisation during teaching sessions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.1352%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eThe teacher instructs in Mandarin with a moderate and engaging speech pace, maintains a tidy and standardized board, and utilizes well-designed multimedia courseware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eTeaching content（30 points）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eThe teaching objectives are clearly defined, logically structured, hierarchical, and highly focused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eStrong scientific rigor and a precise mastery of the discipline\u0026apos;s knowledge and system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eCapable of appropriately utilizing specialized foreign language vocabulary in teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003ePossesses a strong ideology, adept at teaching and educating, emphasizing the cultivation of students\u0026apos; humanistic and scientific spirits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eEmphasizes the transfer of new knowledge and the application of new technologies in clinical practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eTeaching Methods\u003c/p\u003e\n \u003cp\u003e（30 points）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eUtilizes heuristic teaching to encourage positive thinking, active exploration, and the development of students\u0026apos; problem- solving, communication, and innovation skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eCapable of selecting suitable teaching methods based on the content, and proficiently integrates multimedia and other instructional techniques\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eThe classroom atmosphere is welcoming, fostering excellent interaction between teachers and students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eTeaching Effectiveness\u003c/p\u003e\n \u003cp\u003e（20 points）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003eStudents demonstrate mastery of fundamental theories and knowledge and can effectively apply their learning to solve practical problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 393px;\"\u003e\n \u003cp\u003ePromotes students\u0026apos; learning enthusiasm and achieve high levels of student satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eSatisfaction with Blended Learning in the Reform Group\u003c/h2\u003e\n\u003cp\u003eAfter the theoretical lectures, students in the reform group were asked to report their level of satisfaction with the pediatric science teaching method in an anonymous manner(see Table 2) [10].\u003c/p\u003e\n\u003ch2\u003eExam scores\u003c/h2\u003e\n\u003cp\u003eThe exam scores include three aspects: student evaluations, exam scores, and course grades .Student evaluations, i.e., online learning grades, were determined using the statistical analysis functions offered by the Superstar Learning Platform and group discussion scores. Exam scores, i.e., theoretical grades, were obtained using the same type of questions, similar content, moderate difficulty exam papers (with a maximum score of 100). Course grades included not only offline exercises and independent group reports but also the presentations made by each group via online platforms. We evaluated the advantages and disadvantages of two teaching modes based on the level of achievement.\u003c/p\u003e\n\u003ch2\u003eClinical internship grades\u003c/h2\u003e\n\u003cp\u003eStudents\u0026apos; clinical internship grades were divided into 4 aspects: attendance, quizzes, case writing, and usual grades. Both groups of students were assessed for the same content, and the total score for each of the 4 aspects was 100 points. \u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS version 23.0 (Armonk, NY: IBM Corp.) was utilized to analyze and process the data. Nonnormally distributed continuous variables are expressed as medians (Q25-to-Q75 values), while normally distributed continuous variables are expressed as means \u0026plusmn; SDs. Categorical variables are expressed as frequencies and rates. The Kruskal‒Wallis test or one-way analysis of variance was used to compare quantitative variables between groups. The \u0026chi;2 test was used to compare categorical variables between groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n \u003ch2\u003eSatisfaction with Blended Learning in the Reform Group\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe questionnaire was designed to measure satisfaction with blended learning among students in the reform group. The response rate for the questionnaire administered to students in the reform group was 100%. The survey results are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. More than 60% of the students agreed or strongly agreed with the three metrics, indicating good satisfaction with blended learning. A total of 61.7% of students agreed or strongly agreed with the following item: \u0026quot;I will recommend this blended learning course and its instructor to others\u0026quot;. Most of the students also agreed or strongly agreed with the following item: \u0026quot;achieved expected learning goals or tasks through studying this course\u0026quot;. A total of 50.3% of the students were dissatisfied with the completion of their learning goals and tasks after the course ended, which was a concerning issue.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInvestigation of blended learning satisfaction in the reform group (%)\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\u003eStrongly disagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStrongly agree\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\u003eOverall, I am satisfied with blended\u003c/p\u003e\n \u003cp\u003elearning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIf possible, I would choose blended\u003c/p\u003e\n \u003cp\u003elearning for learning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI will recommend this blended course\u003c/p\u003e\n \u003cp\u003eand its instructors to others.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompared with traditional learning and online learning alone, blended learning\u003c/p\u003e\n \u003cp\u003ehas more advantages.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBy taking this course, I have achieved\u003c/p\u003e\n \u003cp\u003emy expected learning goals or tasks.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.5\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\u003c/div\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of student assessments between the two groups\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eIn the reform group, all 133 participants completed the student assessment survey. In the control group, 124 students completed the student assessment survey, yielding a participation rate of 86.7%. The survey results are shown in Fig. 2. More than 75% of students in the reform group were satisfied with their grades, which ranged from 95 to 100. In the control group, most of the students had grades ranging from 91 to 95, accounting for 34.2% of the sample, followed by grades ranging from 96 to 100 and grades ranging from 86\u0026ndash;90, accounting for 18.9% and 17.5% of the sample, respectively. The two groups were compared for statistical significance (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of teaching evaluations between the 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\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReform group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF/Z/\u0026chi;2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-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\" colspan=\"5\"\u003e\n \u003cp\u003eTheoretical study\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.46(96.0\u0026ndash;99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.20(87.5\u0026ndash;95.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExam scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003eCourse grade\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e91.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eClerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCase writing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.17(88.0\u0026ndash;93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.73(80.0\u0026ndash;80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ein-class quizzes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99.51(100.0-100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.04(80.0\u0026ndash;90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-11.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003eCourse grade\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e89.89(90.0\u0026ndash;90.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.96(88.50\u0026ndash;93.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.054\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\u003ch3\u003eStudent performance\u003c/h3\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eRegarding student performance, students in the reform group had a better grasp of the course content than those in the control group. Among the 133 students in the reform group, 54 had scores above 80, accounting for 44.36% of the sample (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA). However, only 39 of the 143 students in the control group scored above 80, accounting for 27.27% of the sample (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB).The students\u0026rsquo; average theoretical academic score was 70.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38 points, and the students\u0026rsquo; average case writing and in-class quiz scores were 90.17 and 99.51 points, respectively, which were higher than the academic scores obtained by students who received traditional learning. There were statistically significant differences between the reform group and the control group in terms of student evaluation, exam scores, case writing and in-class quizzes (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). However, no differences were observed between the reform group and the control group in terms of course grade.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe educational system has undergone a substantial transition from traditional learning methods to methods involving self-directed learning and active participation among students [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Medical education and talent cultivation guided by job competence are currently important features in modern medical education. Although no studies examined the use of blended teaching in pediatric science for nonclinical specialties, this area needs more attention from researchers and practitioners. Competence among pediatric students in preventive medicine courses requires a solid knowledge of pediatric medicine and the ability to work in disease prevention and control. We explored the effects of blended teaching by combining CBL with a flipped classroom in a pediatric medicine course guided by job competency. We compared this blended teaching method with the traditional teaching method. To achieve the teaching goals of the pediatric science curriculum based on the competence of preventive medicine medical students, this team fully utilized the advantages of the blended teaching model and developed a diversified teaching design. Before class, knowledge guides, mini course videos, and chapter quizzes were provided to students; thus, students are encouraged to learn independently, thus fostering lifelong learning ability. Students had a high level of learning investment and a high completion\u003c/p\u003e \u003cp\u003erate. In class, quizzes, colliding ideas, the flipped classroom approach, and group discussions established a lively learning atmosphere, which was very helpful with regard to enhancing students' classroom attention. The students' immersive experience was significantly enhanced, and the students' learning quality was strongly improved. After class, in response to the teaching content, teachers and students posted explanation videos on the Learning Connect platform, interacted with questions, and practiced project-based case studies. This approach overcame temporal and geographical constraints, and teachers and students were able to exchange information more efficiently, thus helping the students consolidate and enhance their theoretical knowledge; this approach also led to enhanced emotions between teachers and students, thus indicating a high level of satisfaction with this approach, which is consistent with the extant literature on this topic[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter the blended learning course, the students\u0026rsquo; average theoretical academic score was 70.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38 points, and the students\u0026rsquo; average case writing and in-class quizzes were 90.17 and 99.51 points, respectively, which were higher than the academic scores of the students who received traditional learning. This finding indicates the effectiveness of blended teaching combined with joint case-based learning in the flipped classroom. In both theoretical studies and clinical internships, the usual score between the two groups was not significantly different. Therefore, we conclude that the difference in scores between the two groups was not due to the usual subjective score but can instead be attributed to the different characteristics of the two teaching methods. Specifically, given that the pre-class course materials are more abundant and more closely approximate clinical work in the blended teaching model, students reviewed learning materials at home and were ready to apply that information when they arrived at class. The teacher commenced the teaching process by checking students' degree of comprehension and reflecting on what was previously studied at home. However, the students in the traditional lecture group were more likely to have found and memorized knowledge points in their textbooks[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, nearly half of the students were dissatisfied with the completion of their learning goals and tasks after the course ended. The majority of blended teaching models focus on pre-class and in-class activities. However, learning does not stop after the class session ends; learning is optimized through ongoing practice. Post-class work that is aligned with course objectives can support self- determination and promote intrinsic motivation. Post-class work should include feedback for students regarding areas of strength and improvement and opportunities for more practice [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Some students do not prefer the flipped classroom over the traditional classroom. This is likely because of the effort and engagement that are required for active learning[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. As reported in the literature, \u0026ldquo;Outdated and disengaging science education, which teaches science as a body of facts, and assesses mainly on rote-memorization, does not only turn youth away from STEM disciplines but also degrades the overall learning and skill-\u003c/p\u003e \u003cp\u003eoutcomes of the graduates\u0026rdquo;[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. We have been working hard to change the field of medical education. Seven practical strategies to add active learning to a science lecture[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] have been used, including increasing community with name tents, increasing equity with random calling, generating peer discussion with clickers, using multiple-choice questions outside exams, collaborative exams increase interaction and community, creating reading guides and pre-class quizzes, and encouraging students with pre-class videos. The results of active learning are gratifying, but it remains unclear how to motivate all students to take the initiative in learning. A study revealed that throughout the educational system, students who participate in active learning pedagogy perform better and fail less often than do students who are taught through direct instruction[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Another review of the literature revealed that the active learning methodology places the student at the heart of the learning process, thereby promoting critical thinking and decision-making ability[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Active learning is effective according to these studies, but the conditions under which it can be optimal are difficult to define.\u003c/p\u003e \u003cp\u003eThere is no set formula. However, some implicit expectations underlie this approach, including effort and trust. This applies to both teachers and students. Teachers need to trust their students to make efforts to learn, and the students in turn trust their teachers to make efforts to ensure that they are receiving a meaningful learning experience[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, appropriate supervision and management of independent learning are also necessary[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Insufficient after- school time is also a significant barrier to active learning[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. On the one hand, spending more time studying means that students can obtain more knowledge and deeper understanding. This might partially explain why students in the reform group had higher scores, especially in clinical case analysis, which requires students to understand the content in depth. On the other hand, spending more time studying means that this activity will consume too much spare time[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Third-year preventive medicine major students often study not only pediatrics but also other courses, taking up to 10 classes simultaneously. It is essential that incentives be added to encourage students to prepare after class (e.g., graded quizzes) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. There are many concepts in pediatrics that benefit\u003c/p\u003e \u003cp\u003efrom visual imagery and animations and that are difficult to reproduce in a textbook[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The average length of our pre-school videos is 15\u0026ndash;20 minutes[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Shortening pre-school videos is the focus of our next reform. These videos should be shortened to 5\u0026ndash;7 minutes or shorter, as brief videos are more engaging to watch. The combination of CBL and a flipped classroom may not be suitable for learning abstract and memorization-heavy concepts. Therefore, it is important to evaluate the effectiveness of the blended teaching model each time it is applied to a new setting[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, there was a limited sample size. Second, there was only one teaching class per grade, so it was not possible to conduct a concurrent controlled trial. Third, after the end of the course, we did not follow up on the effectiveness of the course evaluation for a long period. Finally, we did not collect data on students\u0026rsquo; preclass and after-class time, and the time spent on blended teaching is limited to theory and cannot be more accurately analyzed.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study were promising and encouraging. We developed a blended teaching practices including pre-school tutoring, classroom education, and post-school tracking based on CBL for a pediatric medicine. The results revealed that this teaching model has the potential to create an autonomy- supportive learning environment, can reflect orientation toward job competence, improves academic performance, and is satisfactory among students. Blended teaching practices need to be further optimized in terms of specific subjects, students\u0026rsquo; workloads, and the evaluation system of students\u0026rsquo; performance.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgments \u003c/h2\u003e\n\u003cp\u003eWe are grateful to the students who were willing to share their thoughts and experiences with us.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eCheng-yi WANG\u0026nbsp;\u003c/em\u003eplaned and designed the study. Shu-fang Xue contributed equally to the writing and revision of the manuscript. Jinyan Zhang, Xiang-xiang Lin, Ahong Chen, Ying-jing Lian and Qi-lin Jiang contributed to the data collection and analysis. All authors contributed to the critical revision of the paper and approved the final manuscript for publication.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Fujian Children\u0026rsquo;s Hospital, College of Clinical Medicine for Obstetrics \u0026amp; Gynecology \u0026amp; Pediatrics, Fujian Medical University. Written informed consent was obtained from all participating students.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eWritten consent was obtained from the participants.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen M, Ye L, Weng Y. Blended teaching of medical ethics during COVID-19: practice and reflection. BMC Med Educ. 2022 May 11;22(1):361. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-022-03431-6\u003c/span\u003e\u003cspan address=\"10.1186/s12909-022-03431-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaciri A, Radid M, Kharbach A, Chemsi G. 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Erratum in: Med Educ Online. 2017;22(1):1406198.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Education research, Flipped classroom, Case-based learning, Blended learning, Teaching reform, Pediatric science","lastPublishedDoi":"10.21203/rs.3.rs-5918560/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5918560/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTraditional pediatric education often uses a single teaching method, making theoretical knowledge abstract and difficult to grasp. This can lead to passive learning and limit students' understanding and research skills, failing to prepare them for modern challenges. We studied how blended teaching focused on job competency affects non-specialized pediatric science students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA total of 133 students in our 2019 class on prevention medicine received blended teaching (reform group), and 143 students in the 2018 class on prevention medicine received traditional teaching (control group). Students records were analyzed retrospectively. Students also evaluated their teachers via questionnaires.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eOver 60% of students expressed satisfaction with blended learning across three metrics: overall satisfaction, preference for blended learning, and willingness to recommend the course and instructors to others.In the assessments, more than 75% of students in the reform group expressed satisfaction with their grades, which fell within the 95 to 100 range. In contrast, the majority of students in the control group scored between 91 to 95, constituting 34.2% of the sample. Following this, 18.9% achieved grades ranging from 96 to 100, and 17.5% attained scores between 86 to 90. Statistically significant differences were observed between the reform group and the control group in terms of student evaluations, exam scores, case writing and in-class quizzes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eWe integrated preschool tutoring with classroom education in a non-specialized pediatric medicine course, finding it enhances learning, job readiness, academic performance, and student satisfaction. Tailor the approach to subjects, workload, and performance for best results.\u003c/p\u003e","manuscriptTitle":"The application of blended teaching in non-pediatric specialty pediatric science education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-13 10:00:14","doi":"10.21203/rs.3.rs-5918560/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"644449ca-c4dd-4919-8322-3476e00764f1","owner":[],"postedDate":"February 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-15T07:38:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-13 10:00:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5918560","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5918560","identity":"rs-5918560","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}