A Bridge Clinical Therapeutics Curriculum for Undergraduate Medical Students : a two-cohort pre–post educational study

A Bridge Clinical Therapeutics Curriculum for Undergraduate Medical Students : a two-cohort pre–post educational study | 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 A Bridge Clinical Therapeutics Curriculum for Undergraduate Medical Students : a two-cohort pre–post educational study Yixian Guo, Shuai Tan, Feifei Tan, Binan Zhang, Qingshuang Zhu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8982735/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The increasing diversity of therapeutic modalities has raised new demands for undergraduate medical education. Undergraduate medical students are expected to integrate pharmacologic and non-pharmacologic treatments in clinical decision-making, yet therapeutics teaching is frequently fragmented and concentrated in early pharmacology courses. We developed a structured Clinical Therapeutics course positioned between preclinical teaching and clerkships to present systematic approaches to treatment decision-making. Methods A two-cohort pre–post educational study was conducted among honours-track medical students. The course included modality-based teaching, case discussions, and student presentations requiring multimodal treatment planning. Outcomes were assessed using pre- and post-course questionnaires on interest and perceived learning outcomes, and a performance-based presentation assessment scored independently by three faculty raters using an analytic rubric. Questionnaire responses and presentation scores were summarized descriptively. Results Before the course, students reported limited familiarity with several therapeutic domains, particularly non-pharmacological treatments. After completion, most students rated the modules as helpful and reported improvements in interdisciplinary analysis (57.1%), treatment-planning ability (38.1%), and conceptual understanding (47.6%). Interest in clinical therapeutics was maintained or increased. Students demonstrated therapeutic reasoning in structured presentations, with a mean score of 92.0 ± 3.2. Conclusions A structured Clinical Therapeutics course delivered prior to clerkships may serve as a bridge curriculum that supports early development of therapeutic reasoning. Introducing systematic approaches to treatment decision-making before clinical immersion may help link preclinical knowledge with clinical application and improve preparedness for clinical learning. Further studies should examine long-term effects on clinical performance. Clinical therapeutics Medical education Curriculum development Educational intervention Figures Figure 1 Figure 2 Figure 3 1. Introduction The rapid expansion of therapeutic modalities and biomedical knowledge over recent decades has substantially increased the complexity of contemporary medical practice and, consequently, of undergraduate medical education. 1 – 3 As a result, students are often required to absorb large volumes of therapeutics-related information within compressed schedules, which poses considerable cognitive and educational challenges. 4 , 5 International teaching frameworks emphasize that clinical therapeutics should be taught not as isolated pharmacological knowledge, but as a structured problem-solving process integrating efficacy, safety, patient context, and evidence-based judgment. 6 – 8 while systematic training in therapeutic decision-making has received comparatively less attention. 9 , 10 This situation poses a particular challenge for students before they enter clinical clerkships. Several studies have sought to strengthen therapeutics and prescribing education through competency-based frameworks and curriculum reforms. 6 , 7 , 9 , 11 Nevertheless, existing literature indicates that clinical therapeutics education is fragmented in many medical schools, often delivered as short-term modules or narrowly focused prescribing courses, rather than a longitudinal, integrated curriculum that spans system-based teaching and clinical clerkships. Surveys of medical students further suggest a desire to better integrate pharmacology and therapeutics into later clinical disciplines, rather than restricting these topics to early, separate courses. 10 In China, therapeutic content is commonly distributed across specialty-based curricula, which may limit students’ opportunities to develop a clear structure for therapeutic reasoning. 12 To address this need, we developed a structured Clinical Therapeutics course as a bridge between basic and clinical education for honours-track medical students. The course introduces core principles of therapeutic decision-making across pharmacologic and non-pharmacologic modalities and engages students in performance-based tasks that integrate disease mechanisms, diagnostic considerations, and treatment planning. The aims of this study were (1) to describe the design and implementation of this bridge-type Clinical Therapeutics curriculum and (2) to evaluate its educational impact on student interest, self-reported learning outcomes, and therapeutic reasoning performance. 2. Methods 2.1 Study Design and Participants This was a single-center educational intervention study employing a two-cohort repeated pre–post design. The curriculum was implemented over two consecutive academic years at Capital Medical University. Participants were fourth-year Honours-track undergraduate medical students (Jieping Class) enrolled in the Clinical Therapeutics course during the study period. A total of 74 students participated in the study, including 46 students in cohort 1 and 28 students in cohort 2. All participants completed both the pre-course and post-course questionnaires. Participation in the course evaluation was voluntary, and all data were anonymized prior to analysis. This study was reviewed by the Institutional Review Board of Xuanwu Hospital, Capital Medical University. According to institutional policy, the study was classified as educational evaluation research involving anonymous questionnaires and did not require formal ethical approval with an approval number. 2.2 Curriculum Design and Intervention The Clinical Therapeutics curriculum was implemented as a compulsory standalone course comprising 54 total hours (3 credits), including 33 hours of didactic teaching and 21 hours of structured clinical observation. The curriculum was delivered over one academic semester. Rather than being organized by disease entities, the curriculum was structured by therapeutic modalities, including pharmacological, surgical, radiotherapeutic, interventional, biological, physical, psychological, organ replacement, gene-based, and adjunctive approaches. Didactic sessions focused on therapeutic principles, indications, contraindications, and risk–benefit evaluation. Clinical observation sessions delivered supervised exposure to actual therapeutic decision-making and multidisciplinary treatment planning. 2.3 Outcome Measures 2.3.1 Questionnaire-Based Evaluation Identical self-developed questionnaires were administered before and after the course in both cohorts. The pre-course questionnaire assessed baseline interest in learning, self-perceived understanding of therapeutic modalities, and learning expectations. The post-course questionnaire evaluated perceived course helpfulness, self-reported competency gains, perceived clinical relevance, and general satisfaction. Most items were rated using Likert-type scales. The questionnaires were developed specifically for this study to evaluate students’ perceptions of the newly developed curriculum. The original questionnaires were developed in Chinese and translated into English for publication (Supplementary File 1) 2.3.2 Performance-Based Therapeutic Reasoning Assessment Student presentations were evaluated using an analytic rubric with five domains. Content quality (40 points) was assessed based on the accuracy, internal consistency, and originality of the proposed therapeutic plan. Clinical reasoning (30 points) evaluated students’ justification of treatment selection. Presentation skills (20 points) assessed coherence and structure. Time management (5 points) evaluated adherence to the allotted presentation time, and overall performance (5 points) reflected a global faculty judgement. The maximum possible score was 100 points. Each presentation was independently scored by three faculty members experienced in clinical therapeutics. Raters reviewed the scoring criteria before assessment, and final scores were calculated as the mean of the three ratings. 2.4 Statistical Analysis Descriptive statistics were used to summarize questionnaire responses and performance-based assessment scores. Because the pre-course and post-course questionnaires were administered anonymously and not strictly paired at the individual level, the analysis concentrated on cohort-level changes rather than individual-level paired comparisons. Therefore, results are presented primarily as proportions and distributions to illustrate trends in learning interest, perceived helpfulness, and self-reported competency gains. Consistency of patterns between the two cohorts was examined descriptively. 3. Results 3.1 Participant Characteristics All 74 enrolled Honours-track students completed the course and both the pre-course and post-course evaluations. The two cohorts demonstrated comparable baseline characteristics and levels of academic engagement. 3.2 Student perceptions of the course 3.2.1 Learning interest Across both cohorts, students reported high levels of learning interest in clinical therapeutics prior to course initiation. In cohort 1, the proportion of students reporting being very interested increased from 17.3% (8/46) before the course to 21.7% (10/46) after completion, while those reporting interest increased from 63.1% (29/46) to 73.9% (34/46). Similar patterns were observed in cohort 2. These patterns were consistent across cohorts, signifying sustained or enhanced engagement with the subject after completing the curriculum (Table 1 ) Table 1 Changes in learning interest, perceived course difficulty, and overall satisfaction before and after the Clinical Therapeutics course across two cohort level Cohort 1 n(Pre)% N = 46 Cohort 1 n(Post)% N = 46 Cohort 2 n(Pre)% N = 28 Cohort 2 n(Post)% N = 28 Very interested 8(17.3) 10(21.7) 8(28.6) 8(28.6) Interested 29(63.1) 34(73.9) 17(60.7) 18(64.3) Neutral 9(19.6) 2(4.4) 3(10.7) 2(7.1) This table is intended to describe changes in learning interest before and after the course. No formal statistical hypothesis testing was performed for these descriptive outcomes. 3.2.2 Perceived course difficulty Post-course evaluations indicated that the majority of students in both cohorts perceived the overall course difficulty as appropriate. Only a small proportion of students rated the course as difficult or very difficult (8 out of 46 students [17.3%] in cohort 1 and 2 out of 28 students [7.2%] in cohort 2). Similarly, few students rated the course as easy (2 out of 46 students [4.3%] in cohort 1 and 1 out of 28 students [3.6%] in cohort 2). (Table 2 ). Table 2 Perceived course difficulty and overall satisfaction after course completion across two cohorts Perceived course difficulty (post-course, n %) Level Cohort 1 N = 46 Cohort 2 N = 28 Very difficult 2(4.3) 1(3.6) Difficult 6(13.0) 1(3.6) Appropriate 36(78.3) 25(89.3) Easy 2(4.3) 1(3.6) Overall course satisfaction (post-course, n %) Level Cohort 1 N = 46 Cohort 2 N = 28 Very satisfied 20(43.5) 8(28.6) Satisfied 19(41.3) 18(64.3) Neutral 7(15.2) 2(7.1) Dissatisfied 0 0 Very dissatisfied 0 0 The study was not designed to test statistical differences between cohorts; therefore, no hypothesis testing was performed for between-cohort comparisons. 3.2.3 Course satisfaction Overall course satisfaction was high across both cohorts. In cohort 1, 43.5% (20/46) of students reported being very satisfied with the course, 41.3% (19/46) satisfied, and 15.2% (7/46) neutral. In cohort 2, 28.6% (8/28) of students reported being very satisfied, 64.3% (18/28) reported being satisfied, and only 7.1% (2/28) reported neutral satisfaction. No students in either cohort reported dissatisfaction or very dissatisfaction. The distribution of satisfaction ratings was broadly similar between cohorts, indicating consistent acceptability of the curriculum across academic years (Table 2 ). 3.3 Perceived learning outcomes 3.3.1 Self-reported competency gains Post-course questionnaires indicated self-reported improvements across multiple competency domains in both cohorts (Fig. 1 ). Most students reported marked or moderate improvement in conceptual knowledge, ability to design treatment plans, interdisciplinary analytical ability, and communication and joint effort skills. Interdisciplinary analytical ability showed the highest proportion of marked improvement, followed by conceptual knowledge and communication skills. Improvements in clinical skills were more moderate, with a subset of students reporting no obvious change. 3.3.2 Evaluation of therapeutic domains Before course initiation, students reported limited familiarity with most therapeutic domains, with the majority indicating only basic awareness across both traditional and emerging treatment modalities (Fig. 2 ). After course completion, high levels of perceived helpfulness were reported across all therapeutic domains. Most students rated the curriculum modules as helpful or very helpful, particularly for psychological, radiological, biological, and interventional therapies (Fig. 3 ). 3.4 Performance-based therapeutic reasoning assessment Students selected presentation topics based on their individual clinical interests. Topics covered a wide range of therapeutic domains, including pharmacological, surgical, interventional, biological, genetic, cellular, psychological, and rehabilitative therapies, as well as both established clinical interventions and emerging translational approaches. Across both cohorts, post-course performance-based therapeutic reasoning scores demonstrated a relatively narrow distribution, with a mean of 92.0 (SD 3.2) and a range of 84 to 98. Scores were consistently high across all rubric domains, particularly in content quality and clinical reasoning, indicating that students were able to construct coherent, well-supported multimodal therapeutic plans. 4. Discussion This study examined a modality-based Clinical Therapeutics course implemented at the transition between preclinical education and clerkships. The results show that the course functioned as a bridge curriculum rather than as additional pharmacology instruction, intended to prepare students for participation in clinical decision-making. Students entered the course with limited familiarity across several therapeutic domains, particularly non-pharmacological modalities. After completion, modules were rated highly across domains. This pattern suggests that the course influenced how students organized therapeutic knowledge rather than simply increasing content coverage. This interpretation is consistent with educational models that emphasize explicit therapeutic reasoning frameworks and systematic problem-solving. 11 , 13 Domain-level analyses indicate that this organized method was notably useful in areas frequently fragmented or underrepresented in undergraduate curricula, including psychological, radiological, biological, and interventional therapies. 4,18 In contrast to traditional disease- or drug-centred teaching, the curriculum was structured around treatment approaches and decision processes. This shift may have provided a coherent structure for integrating pharmacological, surgical, interventional, radiotherapeutic, biological, and psychotherapeutic strategies within a unified decision framework. Such an approach aligns with contemporary competency frameworks, which conceptualize therapeutics as multidisciplinary decision-making rather than isolated drug selection. 4 , 11 , 16 The transition to clerkships requires students to move from a mechanistic understanding to the application of treatment decisions. Prior studies report that students often feel underprepared for prescribing despite completing pharmacology training. 4,11 Introducing explicit therapeutic reasoning before clerkships may help reduce this gap by providing an initial organizational framework for clinical learning. The high perceived usefulness of psychological, radiological, and interventional modules suggests that students valued explicit training in multimodal treatment planning and risk–benefit evaluation throughout options. The performance-based presentations provide complementary evidence. Students were able to justify multimodal treatment plans using authentic clinical cases, suggesting that they had begun to apply therapeutic reasoning rather than simply recalling drug information. Educational literature emphasizes that competence in therapeutics depends on context-specific decision-making rather than isolated factual knowledge, and that assessment in authentic situations is therefore essential. 7,14 The use of an analytic rubric and multiple independent raters strengthens confidence in these observations. However, the high overall scores suggest a possible ceiling effect and underscore the need for more selective assessment tools, as noted in reviews that call for competency-aligned evaluation methods. 15 These data are consistent with research showing that context-based pharmacotherapy programmes boost therapeutic reasoning when learners interact with complex clinical scenarios. 7 , 12 , 16 Aligning classroom teaching with observation of multidisciplinary case discussions may have supported the formation of more integrated models of patient management. 17 Compared with lecture-based, drug-centred pharmacology teaching, 4,6,18 organizing content by treatment modality appeared to provide a coherent cognitive framework across heterogeneous diseases and specialties and may have contributed to the high post-course interest and satisfaction. Several limitations should be noted. This was a single-centre study involving a small honours-track cohort, limiting generalizability. The pre–post design lacked a control group and objective baseline performance measures. Outcomes relied largely on self-reported perceptions, and long-term transfer to clerkships or postgraduate practice was not assessed. More rigorous study designs incorporating control groups, longitudinal follow-up, and objective performance measures are needed to clarify the educational impact of bridge-type therapeutics curricula. 5. Conclusions A structured Clinical Therapeutics course delivered before clerkships appears feasible and educationally relevant. Introducing explicit frameworks for therapeutic decision-making at this transitional stage may support the early development of therapeutic reasoning and preparedness for clinical learning. Rather than replacing traditional pharmacology or clinical teaching, a bridge-type curriculum may complement existing programmes by helping students organize biomedical knowledge into clinically applicable treatment strategies. Further research should examine its impact on performance during clerkships and subsequent prescribing practice. Declarations Ethics approval and consent to participate This study was reviewed by the Institutional Review Board of Xuanwu Hospital, Capital Medical University. According to institutional policy, the study was classified as educational evaluation research involving anonymous questionnaires and did not require formal ethical approval with an approval number. Participation in the questionnaires was voluntary and anonymous. Completion of the questionnaire was considered to imply informed consent to participate. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Educational Reform Project of Capital Medical University (Grant No. 2024JNZ015) and the Beijing Municipal Education Science Planning Project (Grant No. CDDB24224). Author Contribution YG conceptualized the study, contributed to curriculum implementation and data analysis, and drafted the manuscript.ST data analysis, and drafted the manuscript.WS led the overall curriculum design and development of the course syllabus.XL was responsible for curriculum review, approval, and institutional coordination.YW contributed to course content design and provided guidance on teaching methods.QZ coordinated the selection of teaching materials and the preparation of educational resources.BZ conducted the student course feedback surveys and analyzed the data.FT coordinated course implementation and contributed to teaching quality evaluation.All authors critically reviewed and approved the final manuscript. Acknowledgements The authors would like to thank the faculty members and students who participated in the Clinical Therapeutics course and contributed to the evaluation of the curriculum. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Ferrara F, Verduci C, Laconi E, et al. Therapeutic advances in psoriasis: from biologics to emerging oral small molecules. Antibodies (Basel Switzerland). 2024;13(3). 10.3390/antib13030076 . Westin J, Sehn LH. CAR T cells as a second-line therapy for large B-cell lymphoma: a paradigm shift? Blood. 2022;139(18):2737–46. 10.1182/blood.2022015789 . Liu Y, Wang C, Fu X, Ren M. The progress and evolving trends in nucleic-acid-based therapies. Biomolecules. 2025;15(3). 10.3390/biom15030376 . Brinkman D, Tichelaar J, Okorie M, et al. 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Design of a foundational sciences curriculum: applying the ICAP framework to pharmacology education in integrated medical curricula. Pharmacol Res Perspect. 2021;9(3):e00762. 10.1002/prp2.762 . Brinkman D, Teresa Monteiro E, Monteiro M, Richir MV, van Agtmael J. Tichelaar. Switching from a traditional undergraduate programme in (clinical) pharmacology and therapeutics to a problem-based learning programme. Eur J Clin Pharmacol. 2020;77:421–9. 10.1007/s00228-020-03027-3 . Steffen J, Lenski M, Herrmann F, Mückter H, Dimitriadis K, Fischer M. Improving the pharmacology curriculum at a German medical school: a structured plan based on a student-guided large-scale study. J Clin Pharmacol. 2019;59. 10.1002/jcph.1410 . Brinkman D, Tichelaar J, Mokkink L, et al. Key learning outcomes for clinical pharmacology and therapeutics education in Europe: a modified Delphi study. Clin Pharmacol Ther. 2018;104:317–25. 10.1002/cpt. 962 . Li J, Xiao C, Hou J, et al. 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Making better prescribers during a context-based pharmacotherapy learning programme: new insights into the improvement of a pharmacotherapy context-learning programme. Unkn J. Published online 2016. Maxwell S. An agenda for UK clinical pharmacology: how should teaching of undergraduates in clinical pharmacology and therapeutics be delivered and assessed? Br J Clin Pharmacol. 2012;73:893–9. 10.1111/J.1365-2125.2012.04232.X . Lucy McLellan M, Tully T, Dornan. How could undergraduate education prepare new graduates to be safer prescribers? Br J Clin Pharmacol. 2012;74. 10.1111/j.1365-2125.2012.04271.x . 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-8982735","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607025990,"identity":"99729932-3c83-4eb1-843a-b1a1f8408327","order_by":0,"name":"Yixian Guo","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yixian","middleName":"","lastName":"Guo","suffix":""},{"id":607025991,"identity":"cea55183-5efd-45a3-b5cf-29010b688e85","order_by":1,"name":"Shuai Tan","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Tan","suffix":""},{"id":607025992,"identity":"a9ba0b59-1a07-4536-9e7f-4c84c88d346b","order_by":2,"name":"Feifei Tan","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Tan","suffix":""},{"id":607025993,"identity":"4ccc551d-527f-4ee4-824a-0aa410d5938f","order_by":3,"name":"Binan Zhang","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Binan","middleName":"","lastName":"Zhang","suffix":""},{"id":607025994,"identity":"9ea26ce6-1ef0-46a6-b14e-aded94c03b04","order_by":4,"name":"Qingshuang Zhu","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qingshuang","middleName":"","lastName":"Zhu","suffix":""},{"id":607025995,"identity":"aa38a291-9a51-499c-bb5d-7dd569c8c649","order_by":5,"name":"Yajun Wang","email":"","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yajun","middleName":"","lastName":"Wang","suffix":""},{"id":607025996,"identity":"4e1bfc36-c59b-4f40-8d33-bc34e0085086","order_by":6,"name":"Xinsheng Liao","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinsheng","middleName":"","lastName":"Liao","suffix":""},{"id":607025997,"identity":"575fb254-84b0-4d00-8fe6-4821a57bca15","order_by":7,"name":"Wanling Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYHACxgMJYJr5AANjA5F6oFrYEkjQAqF4DIjTYnD87IEDD3fU2hvc7vkmzbvDxt6cgfnYxy/4tJzJSziQeOZ44oY7Zzcb855JS9zZwJY8WwaPFrMDOQYHEtuOJRjcyN34OLftcILBAR5jZgl8Ws6/AWuxN7iR8+AwUIs9YS03wLbUMG64kcMIsoVxA1AL4wc8WuxvgG05kDjzRpqx8d82oF+a2ZKZ8ehgkOzPMXz4s63Onu9G8jPJmW3AEGNvPsz4A58eCDiMYBoArWDmIaylDkkLEBNjyygYBaNgFIwcAACX8Ffmt2aHUQAAAABJRU5ErkJggg==","orcid":"","institution":"Xuanwu Hospital, Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Wanling","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2026-02-27 02:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8982735/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8982735/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104994536,"identity":"5ada3039-768e-451a-a84a-579a32c89924","added_by":"auto","created_at":"2026-03-19 16:00:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79829,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of self-reported competency gains across domains after completion of the Clinical Therapeutics course. \u0026nbsp;Bars represent the proportions of students reporting marked improvement, moderate improvement, or no obvious change in each competency domain.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8982735/v1/fa8242c3c333668b187ad3a5.jpg"},{"id":104994537,"identity":"93fbc2a2-1707-4419-933e-0dc6336c7c27","added_by":"auto","created_at":"2026-03-19 16:00:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":145918,"visible":true,"origin":"","legend":"\u003cp\u003eBaseline familiarity with therapeutic domains among undergraduate medical students before the Clinical Therapeutics course. Stacked bars represent the proportions of students reporting being very familiar, familiar, having basic awareness, or not familiar with each therapeutic domain.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8982735/v1/0e03c7e13a2140d3b15f7bea.jpg"},{"id":104994539,"identity":"059c46a0-caf2-4ea9-8d64-9c0fc5d28bdf","added_by":"auto","created_at":"2026-03-19 16:00:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":122347,"visible":true,"origin":"","legend":"\u003cp\u003ePerceived helpfulness of therapeutic domains after completion of the Clinical Therapeutics course\u003c/p\u003e\n\u003cp\u003eEach horizontal bar represents one therapeutic domain, with stacked segments indicating the percentage of responses across five categories: very helpful, helpful, neutral, slightly helpful, and not helpful at all. Data were calculated by combining responses from two consecutive student cohorts, as distribution patterns were consistent across cohorts. Across all therapeutic domains, the majority of students rated the course content as helpful or very helpful. Particularly high levels of perceived helpfulness were observed for psychological therapy, radiotherapy, biological therapy, and interventional therapy. In contrast, a higher proportion of neutral or lower helpfulness ratings was noted for nursing therapy and traditional Chinese medicine, indicating potential areas for future curriculum refinement.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8982735/v1/3c4e0e542f0f1c93410a8d8f.jpg"},{"id":107497037,"identity":"25762d48-ccfd-4b77-85b3-3f01e5a30d30","added_by":"auto","created_at":"2026-04-22 04:56:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":640433,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8982735/v1/b0a96732-7fd9-42ba-9de5-11d7423673e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Bridge Clinical Therapeutics Curriculum for Undergraduate Medical Students : a two-cohort pre–post educational study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe rapid expansion of therapeutic modalities and biomedical knowledge over recent decades has substantially increased the complexity of contemporary medical practice and, consequently, of undergraduate medical education.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e As a result, students are often required to absorb large volumes of therapeutics-related information within compressed schedules, which poses considerable cognitive and educational challenges.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e International teaching frameworks emphasize that clinical therapeutics should be taught not as isolated pharmacological knowledge, but as a structured problem-solving process integrating efficacy, safety, patient context, and evidence-based judgment.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e while systematic training in therapeutic decision-making has received comparatively less attention.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This situation poses a particular challenge for students before they enter clinical clerkships.\u003c/p\u003e \u003cp\u003eSeveral studies have sought to strengthen therapeutics and prescribing education through competency-based frameworks and curriculum reforms.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Nevertheless, existing literature indicates that clinical therapeutics education is fragmented in many medical schools, often delivered as short-term modules or narrowly focused prescribing courses, rather than a longitudinal, integrated curriculum that spans system-based teaching and clinical clerkships. Surveys of medical students further suggest a desire to better integrate pharmacology and therapeutics into later clinical disciplines, rather than restricting these topics to early, separate courses.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn China, therapeutic content is commonly distributed across specialty-based curricula, which may limit students\u0026rsquo; opportunities to develop a clear structure for therapeutic reasoning.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e To address this need, we developed a structured Clinical Therapeutics course as a bridge between basic and clinical education for honours-track medical students. The course introduces core principles of therapeutic decision-making across pharmacologic and non-pharmacologic modalities and engages students in performance-based tasks that integrate disease mechanisms, diagnostic considerations, and treatment planning. The aims of this study were (1) to describe the design and implementation of this bridge-type Clinical Therapeutics curriculum and (2) to evaluate its educational impact on student interest, self-reported learning outcomes, and therapeutic reasoning performance.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Participants\u003c/h2\u003e \u003cp\u003eThis was a single-center educational intervention study employing a two-cohort repeated pre\u0026ndash;post design. The curriculum was implemented over two consecutive academic years at Capital Medical University. Participants were fourth-year Honours-track undergraduate medical students (Jieping Class) enrolled in the Clinical Therapeutics course during the study period. A total of 74 students participated in the study, including 46 students in cohort 1 and 28 students in cohort 2. All participants completed both the pre-course and post-course questionnaires. Participation in the course evaluation was voluntary, and all data were anonymized prior to analysis. This study was reviewed by the Institutional Review Board of Xuanwu Hospital, Capital Medical University. According to institutional policy, the study was classified as educational evaluation research involving anonymous questionnaires and did not require formal ethical approval with an approval number.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Curriculum Design and Intervention\u003c/h2\u003e \u003cp\u003eThe Clinical Therapeutics curriculum was implemented as a compulsory standalone course comprising 54 total hours (3 credits), including 33 hours of didactic teaching and 21 hours of structured clinical observation. The curriculum was delivered over one academic semester. Rather than being organized by disease entities, the curriculum was structured by therapeutic modalities, including pharmacological, surgical, radiotherapeutic, interventional, biological, physical, psychological, organ replacement, gene-based, and adjunctive approaches. Didactic sessions focused on therapeutic principles, indications, contraindications, and risk\u0026ndash;benefit evaluation. Clinical observation sessions delivered supervised exposure to actual therapeutic decision-making and multidisciplinary treatment planning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome Measures\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Questionnaire-Based Evaluation\u003c/h2\u003e \u003cp\u003eIdentical self-developed questionnaires were administered before and after the course in both cohorts. The pre-course questionnaire assessed baseline interest in learning, self-perceived understanding of therapeutic modalities, and learning expectations. The post-course questionnaire evaluated perceived course helpfulness, self-reported competency gains, perceived clinical relevance, and general satisfaction. Most items were rated using Likert-type scales. The questionnaires were developed specifically for this study to evaluate students\u0026rsquo; perceptions of the newly developed curriculum. The original questionnaires were developed in Chinese and translated into English for publication (Supplementary File 1)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Performance-Based Therapeutic Reasoning Assessment\u003c/h2\u003e \u003cp\u003eStudent presentations were evaluated using an analytic rubric with five domains. Content quality (40 points) was assessed based on the accuracy, internal consistency, and originality of the proposed therapeutic plan. Clinical reasoning (30 points) evaluated students\u0026rsquo; justification of treatment selection. Presentation skills (20 points) assessed coherence and structure. Time management (5 points) evaluated adherence to the allotted presentation time, and overall performance (5 points) reflected a global faculty judgement. The maximum possible score was 100 points. Each presentation was independently scored by three faculty members experienced in clinical therapeutics. Raters reviewed the scoring criteria before assessment, and final scores were calculated as the mean of the three ratings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize questionnaire responses and performance-based assessment scores. Because the pre-course and post-course questionnaires were administered anonymously and not strictly paired at the individual level, the analysis concentrated on cohort-level changes rather than individual-level paired comparisons. Therefore, results are presented primarily as proportions and distributions to illustrate trends in learning interest, perceived helpfulness, and self-reported competency gains. Consistency of patterns between the two cohorts was examined descriptively.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participant Characteristics\u003c/h2\u003e \u003cp\u003eAll 74 enrolled Honours-track students completed the course and both the pre-course and post-course evaluations. The two cohorts demonstrated comparable baseline characteristics and levels of academic engagement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Student perceptions of the course\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Learning interest\u003c/h2\u003e \u003cp\u003eAcross both cohorts, students reported high levels of learning interest in clinical therapeutics prior to course initiation. In cohort 1, the proportion of students reporting being very interested increased from 17.3% (8/46) before the course to 21.7% (10/46) after completion, while those reporting interest increased from 63.1% (29/46) to 73.9% (34/46). Similar patterns were observed in cohort 2. These patterns were consistent across cohorts, signifying sustained or enhanced engagement with the subject after completing the curriculum (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in learning interest, perceived course difficulty, and overall satisfaction before and after the Clinical Therapeutics course across two cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003elevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohort 1\u003c/p\u003e \u003cp\u003en(Pre)%\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort 1\u003c/p\u003e \u003cp\u003en(Post)%\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort 2\u003c/p\u003e \u003cp\u003en(Pre)%\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohort 2\u003c/p\u003e \u003cp\u003en(Post)%\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery interested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8(28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29(63.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18(64.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2(7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThis table is intended to describe changes in learning interest before and after the course. No formal statistical hypothesis testing was performed for these descriptive outcomes.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Perceived course difficulty\u003c/h2\u003e \u003cp\u003ePost-course evaluations indicated that the majority of students in both cohorts perceived the overall course difficulty as appropriate. Only a small proportion of students rated the course as difficult or very difficult (8 out of 46 students [17.3%] in cohort 1 and 2 out of 28 students [7.2%] in cohort 2). Similarly, few students rated the course as easy (2 out of 46 students [4.3%] in cohort 1 and 1 out of 28 students [3.6%] in cohort 2). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerceived course difficulty and overall satisfaction after course completion across two cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePerceived course difficulty (post-course, n %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCohort 1\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort 2\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery difficult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppropriate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(89.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall course satisfaction (post-course, n %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCohort 1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCohort 2\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(64.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDissatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery dissatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eThe study was not designed to test statistical differences between cohorts; therefore, no hypothesis testing was performed for between-cohort comparisons.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Course satisfaction\u003c/h2\u003e \u003cp\u003eOverall course satisfaction was high across both cohorts. In cohort 1, 43.5% (20/46) of students reported being very satisfied with the course, 41.3% (19/46) satisfied, and 15.2% (7/46) neutral. In cohort 2, 28.6% (8/28) of students reported being very satisfied, 64.3% (18/28) reported being satisfied, and only 7.1% (2/28) reported neutral satisfaction. No students in either cohort reported dissatisfaction or very dissatisfaction. The distribution of satisfaction ratings was broadly similar between cohorts, indicating consistent acceptability of the curriculum across academic years (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Perceived learning outcomes\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Self-reported competency gains\u003c/h2\u003e \u003cp\u003ePost-course questionnaires indicated self-reported improvements across multiple competency domains in both cohorts (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most students reported marked or moderate improvement in conceptual knowledge, ability to design treatment plans, interdisciplinary analytical ability, and communication and joint effort skills. Interdisciplinary analytical ability showed the highest proportion of marked improvement, followed by conceptual knowledge and communication skills. Improvements in clinical skills were more moderate, with a subset of students reporting no obvious change.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Evaluation of therapeutic domains\u003c/h2\u003e \u003cp\u003eBefore course initiation, students reported limited familiarity with most therapeutic domains, with the majority indicating only basic awareness across both traditional and emerging treatment modalities (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After course completion, high levels of perceived helpfulness were reported across all therapeutic domains. Most students rated the curriculum modules as helpful or very helpful, particularly for psychological, radiological, biological, and interventional therapies (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Performance-based therapeutic reasoning assessment\u003c/h2\u003e \u003cp\u003eStudents selected presentation topics based on their individual clinical interests. Topics covered a wide range of therapeutic domains, including pharmacological, surgical, interventional, biological, genetic, cellular, psychological, and rehabilitative therapies, as well as both established clinical interventions and emerging translational approaches. Across both cohorts, post-course performance-based therapeutic reasoning scores demonstrated a relatively narrow distribution, with a mean of 92.0 (SD 3.2) and a range of 84 to 98. Scores were consistently high across all rubric domains, particularly in content quality and clinical reasoning, indicating that students were able to construct coherent, well-supported multimodal therapeutic plans.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study examined a modality-based Clinical Therapeutics course implemented at the transition between preclinical education and clerkships. The results show that the course functioned as a bridge curriculum rather than as additional pharmacology instruction, intended to prepare students for participation in clinical decision-making.\u003c/p\u003e \u003cp\u003eStudents entered the course with limited familiarity across several therapeutic domains, particularly non-pharmacological modalities. After completion, modules were rated highly across domains. This pattern suggests that the course influenced how students organized therapeutic knowledge rather than simply increasing content coverage. This interpretation is consistent with educational models that emphasize explicit therapeutic reasoning frameworks and systematic problem-solving.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDomain-level analyses indicate that this organized method was notably useful in areas frequently fragmented or underrepresented in undergraduate curricula, including psychological, radiological, biological, and interventional therapies. \u003csup\u003e4,18\u003c/sup\u003e In contrast to traditional disease- or drug-centred teaching, the curriculum was structured around treatment approaches and decision processes. This shift may have provided a coherent structure for integrating pharmacological, surgical, interventional, radiotherapeutic, biological, and psychotherapeutic strategies within a unified decision framework. Such an approach aligns with contemporary competency frameworks, which conceptualize therapeutics as multidisciplinary decision-making rather than isolated drug selection.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe transition to clerkships requires students to move from a mechanistic understanding to the application of treatment decisions. Prior studies report that students often feel underprepared for prescribing despite completing pharmacology training. \u003csup\u003e4,11\u003c/sup\u003e Introducing explicit therapeutic reasoning before clerkships may help reduce this gap by providing an initial organizational framework for clinical learning. The high perceived usefulness of psychological, radiological, and interventional modules suggests that students valued explicit training in multimodal treatment planning and risk\u0026ndash;benefit evaluation throughout options.\u003c/p\u003e \u003cp\u003eThe performance-based presentations provide complementary evidence. Students were able to justify multimodal treatment plans using authentic clinical cases, suggesting that they had begun to apply therapeutic reasoning rather than simply recalling drug information. Educational literature emphasizes that competence in therapeutics depends on context-specific decision-making rather than isolated factual knowledge, and that assessment in authentic situations is therefore essential. \u003csup\u003e7,14\u003c/sup\u003e The use of an analytic rubric and multiple independent raters strengthens confidence in these observations. However, the high overall scores suggest a possible ceiling effect and underscore the need for more selective assessment tools, as noted in reviews that call for competency-aligned evaluation methods.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese data are consistent with research showing that context-based pharmacotherapy programmes boost therapeutic reasoning when learners interact with complex clinical scenarios.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Aligning classroom teaching with observation of multidisciplinary case discussions may have supported the formation of more integrated models of patient management.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Compared with lecture-based, drug-centred pharmacology teaching, \u003csup\u003e4,6,18\u003c/sup\u003e organizing content by treatment modality appeared to provide a coherent cognitive framework across heterogeneous diseases and specialties and may have contributed to the high post-course interest and satisfaction.\u003c/p\u003e \u003cp\u003eSeveral limitations should be noted. This was a single-centre study involving a small honours-track cohort, limiting generalizability. The pre\u0026ndash;post design lacked a control group and objective baseline performance measures. Outcomes relied largely on self-reported perceptions, and long-term transfer to clerkships or postgraduate practice was not assessed. More rigorous study designs incorporating control groups, longitudinal follow-up, and objective performance measures are needed to clarify the educational impact of bridge-type therapeutics curricula.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eA structured Clinical Therapeutics course delivered before clerkships appears feasible and educationally relevant. Introducing explicit frameworks for therapeutic decision-making at this transitional stage may support the early development of therapeutic reasoning and preparedness for clinical learning. Rather than replacing traditional pharmacology or clinical teaching, a bridge-type curriculum may complement existing programmes by helping students organize biomedical knowledge into clinically applicable treatment strategies. Further research should examine its impact on performance during clerkships and subsequent prescribing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study was reviewed by the Institutional Review Board of Xuanwu Hospital, Capital Medical University. According to institutional policy, the study was classified as educational evaluation research involving anonymous questionnaires and did not require formal ethical approval with an approval number. Participation in the questionnaires was voluntary and anonymous. Completion of the questionnaire was considered to imply informed consent to participate. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Educational Reform Project of Capital Medical University (Grant No. 2024JNZ015) and the Beijing Municipal Education Science Planning Project (Grant No. CDDB24224).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYG conceptualized the study, contributed to curriculum implementation and data analysis, and drafted the manuscript.ST data analysis, and drafted the manuscript.WS led the overall curriculum design and development of the course syllabus.XL was responsible for curriculum review, approval, and institutional coordination.YW contributed to course content design and provided guidance on teaching methods.QZ coordinated the selection of teaching materials and the preparation of educational resources.BZ conducted the student course feedback surveys and analyzed the data.FT coordinated course implementation and contributed to teaching quality evaluation.All authors critically reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the faculty members and students who participated in the Clinical Therapeutics course and contributed to the evaluation of the curriculum.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerrara F, Verduci C, Laconi E, et al. 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Seeing the wood for the trees: approaches to teaching and assessing clinical pharmacology and therapeutics in a problem-based learning course. Ann Acad Med Singap. 2008;37(3):204\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.47102/annals-acadmedsg.V37N3p204\u003c/span\u003e\u003cspan address=\"10.47102/annals-acadmedsg.V37N3p204\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung NC, Quesnelle KM, Hung HS et al. Assessment of clinical pharmacology and competence during medicine clerkships. Br J Clin Pharmacol Published online 25 September 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/bcp.70290\u003c/span\u003e\u003cspan address=\"10.1002/bcp.70290\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTichelaar J. Making better prescribers during a context-based pharmacotherapy learning programme: new insights into the improvement of a pharmacotherapy context-learning programme. Unkn J. Published online 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaxwell S. An agenda for UK clinical pharmacology: how should teaching of undergraduates in clinical pharmacology and therapeutics be delivered and assessed? Br J Clin Pharmacol. 2012;73:893\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/J.1365-2125.2012.04232.X\u003c/span\u003e\u003cspan address=\"10.1111/J.1365-2125.2012.04232.X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucy McLellan M, Tully T, Dornan. How could undergraduate education prepare new graduates to be safer prescribers? Br J Clin Pharmacol. 2012;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2125.2012.04271.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2125.2012.04271.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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":"Clinical therapeutics, Medical education, Curriculum development, Educational intervention","lastPublishedDoi":"10.21203/rs.3.rs-8982735/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8982735/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe increasing diversity of therapeutic modalities has raised new demands for undergraduate medical education. Undergraduate medical students are expected to integrate pharmacologic and non-pharmacologic treatments in clinical decision-making, yet therapeutics teaching is frequently fragmented and concentrated in early pharmacology courses. We developed a structured Clinical Therapeutics course positioned between preclinical teaching and clerkships to present systematic approaches to treatment decision-making.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA two-cohort pre\u0026ndash;post educational study was conducted among honours-track medical students. The course included modality-based teaching, case discussions, and student presentations requiring multimodal treatment planning. Outcomes were assessed using pre- and post-course questionnaires on interest and perceived learning outcomes, and a performance-based presentation assessment scored independently by three faculty raters using an analytic rubric. Questionnaire responses and presentation scores were summarized descriptively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBefore the course, students reported limited familiarity with several therapeutic domains, particularly non-pharmacological treatments. After completion, most students rated the modules as helpful and reported improvements in interdisciplinary analysis (57.1%), treatment-planning ability (38.1%), and conceptual understanding (47.6%). Interest in clinical therapeutics was maintained or increased. Students demonstrated therapeutic reasoning in structured presentations, with a mean score of 92.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA structured Clinical Therapeutics course delivered prior to clerkships may serve as a bridge curriculum that supports early development of therapeutic reasoning. Introducing systematic approaches to treatment decision-making before clinical immersion may help link preclinical knowledge with clinical application and improve preparedness for clinical learning. Further studies should examine long-term effects on clinical performance.\u003c/p\u003e","manuscriptTitle":"A Bridge Clinical Therapeutics Curriculum for Undergraduate Medical Students : a two-cohort pre–post educational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:00:52","doi":"10.21203/rs.3.rs-8982735/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":"7a12f796-0292-4d24-a79d-0cf9e7ec47af","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T04:55:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:00:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8982735","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8982735","identity":"rs-8982735","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}