Physiological pharmacology education: The effects of acombined problem‑based learning and flipped classroom teaching method

Physiological pharmacology education: The effects of acombined problem‑based learning and flipped classroom teaching method | 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 Physiological pharmacology education: The effects of acombined problem‑based learning and flipped classroom teaching method Junxia An This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3908442/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: Some studies have primarily implemented problem-based learning (PBL) or flipped classroom (FC) teaching models in different majors; however, research has not been conducted on the combined PBL-FC teaching method in physiological pharmacology education. Therefore, we investigated the effects of the combined PBL-FC method in teaching physiological pharmacology. Methods: A total of 102 second-year chemistry students and 93 third-year students majoring in pharmaceutical engineering at Northwest Normal University participated in this study. Antihypertensive agents were administered in this study. A total of 56 second-year chemistry students in Grade 2021 and 48 third-year students majoring in pharmaceutical engineering in Grade 2020 were allocated to the PBL-FC group, whereas 46 second-year chemistry students in Grade 2020 and 45 third-year students majoring in pharmaceutical engineering in Grade 2019 were allocated to the traditional lecture-based classroom group. A pre-quiz and a post-quiz were conducted before and after the classes. All quiz questions were classified into two categories based on Bloom’s taxonomy: basic theoretical knowledge and clinical case analyses. The results were compared and the students had to complete a questionnaire to evaluate their perceptions and experiences. Results: The average scorein the post-quiz was higher than that of the pre-quiz for both the PBL-FC and traditional groups. In addition, the post-quiz showed that the students in the PBL-FC group scored significantly higher than the students in the traditional group. Further analysis revealed that only the difference in clinical case analysis between the PBL-FC and the traditional group was significant after the course. Scores for all questionnaire items were higher in the PBL-FC group than in the traditional group. Most students agreed that the combined teaching method helped them to improve their performance, although it increased their workload. Conclusions: The combined flipped classroom and PBL teaching approach is a better option than the traditional lecture-based classroom for teaching antihypertensive medication during physiological pharmacology teaching, although it increases students’ workload. Further optimization is required to ensure a wider acceptance and implementation. Flipped classroom Problem-based learning Antihypertensive Physiological pharmacology Teaching Figures Figure 1 Figure 2 Figure 3 Introduction Physiological pharmacology at Northwest Normal University comprises two parts: physiology and pharmacology. The course is complex; when introducing therapeutic drugs for various systemic diseases, the knowledge of the pathophysiology of the corresponding diseases must be added. The course length of physiologic pharmacology is 48 hours, and a large amount of course content requires students to digest and absorb it in the classroom, which is not easy. Therefore, many students do not achieve ideal results in their final exams; their knowledge mastery is insufficient, and they cannot apply it proficiently. Furthermore, the content of physiological pharmacology is mostly theoretical, making it difficult for students to concentrate at all times in class. Their interest in the learning content is low, which leads to a decrease in their enthusiasm and naturally results in unsatisfactory grades. Although multimedia have been introduced into the teaching process, students generally find it difficult to systematically master knowledge in practical applications. The flipped classroom (FC) is a new form of teaching that transforms traditional in-class teaching processes into off-class learning activities. Students complete the learning of knowledge before class, and the classroom becomes a place for interaction between teachers and students and between students [ 1 , 2 ]. With the popularization of the Internet and the application of real-time communication technology in education, the "flipped classroom" teaching model has become more feasible and practical [ 3 ]. Research has found that compared to traditional classrooms, flipped classrooms can better stimulate students' interest and enhance their sense of cooperation [ 3 – 6 ]. However, flipped classrooms also have problems, such as individual students having poor learning outcomes and an inability to adapt well to this learning method [ 3 , 5 – 6 ]. Problem-based learning (PBL) is a problem-based learning approach that is a student-centered and problem-oriented teaching form for group discussions [ 7 ]. The core idea is to use problems as a starting point for learning and integrating new knowledge. The main goal of PBL teaching methods is to propose problems, analyze problems and solve problems, including problem identification, problem discovery, self-learning, evaluation of new knowledge, thinking and feedback, and other basic steps [ 7 – 9 ]. However, the PBL teaching method seriously hinders teaching progress because of the significant amount of classroom time spent on raising, thinking, solving, and discussing problems [ 9 ]. Therefore, integrating PBL with the "flipped classroom" teaching mode, and setting and raising questions before class is undoubtedly becoming a more reasonable mode. The resolution, further discussion, and summary report of problems are conducted in the classroom, which saves considerable classroom time and is beneficial for students to master and internalize knowledge. However, no research has been conducted on physiological pharmacology, which is one of the most important core courses for undergraduate majors. To clarify the effectiveness and acceptability of a pedagogy that combines the flipped classroom with PBL in physiological pharmacology teaching, we conducted the current study involving 195 students. We compared students’ performance, experience, and competence in learning about antihypertensive medications between this blended pedagogy and traditional lecture-based instruction. This study’s purpose was to guide instructors using this blended pedagogy in physiologic pharmacology classes. Methods Study Participants A total of 195 undergraduate students majoring in chemistry and pharmaceutical engineering at Northwest Normal University were included in this study. All students were given written informed consent and were informed that participation in the tests and completion of the surveys was voluntary. The students who participated in this study took the same national college entrance exam and had comparable scores for each major. Prior to this experiment, students with the same major took the same courses in their freshman or sophomore year; therefore, the baseline knowledge of students with the same major was similar. The experimental and control classes in the same major had the same curriculum. Two sets of students with different majors participated simultaneously in this study. In Group 1, 46 students majoring in chemistry in 2020 as the control group, and 56 students majoring in chemistry from 2021 were selected as the experimental group. In Group 2, 45 students majoring in pharmaceutical engineering in 2019 were selected as the control group, and 48 students majoring in pharmaceutical engineering from 2020 were selected as the experimental group. In the experimental teaching group, the content of antihypertensive drugs was taught by combining FC with PBL for 2 hours, while other teaching contents were taught in a traditional teaching mode for 46 hours. The control group adopted the traditional teaching mode. There were no significant differences in the early grades, age, or other factors between the two grades of students in the same major (P > 0.05), and the teaching hours, teachers, and textbooks were the same. In addition, no participants had previously completed PBL, FC, or PBL combined with FC teaching modes. Study design 1. FC with PBL We chose a chapter on antihypertensive drugs to apply the combination approach in this study. The FC with PBL combination group proceeded as follows: Two weeks before the course, the lecturer prepared the relevant online lecture videos and supplementary materials. Each student had to watch these in their own time. All videos were less than 10 minutes long and consisted of four parts: Introduction to the concept, explanation of the concept, classic examples and summary of knowledge. Simultaneously, the instructor presented several relevant questions: (1) What is the pathogenesis of hypertension? (2) What are the main organs that regulate blood pressure? (3) What are the types and characteristics of the first-line antihypertensive drugs? (4) What is the mechanism of action of first-line antihypertensive drugs? (5) What are the plans for combining medications with antihypertensive drugs? The 56 chemistry students were randomly divided into 12 groups, whereas the 48 pharmaceutical engineering students were randomly divided into ten groups. Each group consisted of 4–5 students, and the group members recommended that a group leader organize the discussions and participate in the evaluation. Each group had todiscuss these issues and understand the key points of knowledge. The lesson began with the lecturer introducing the topic and the agenda. Then, each group chose are presentative student to express their opinion about the lecture, propose their answers to the questions, and ask unresolved questions from their small group. The teacher and the students from the other groups graded the answers and the communication situation. Finally, the teacher summarized the class and answered difficult questions raised during the discussions. 2. Traditional classroom The traditional mode of teaching was primarily based on teacher lectures in class. Before the lecture, students were simply instructed to prepare for class using textbooks rather than watching videos or reading supplemental materials. These students accepted the equivalent content in the traditional teaching method, and the instructor gave a declarative statement of theoretical knowledge according to the syllabus instead of dividing the class into small groups to discuss the cases. Data evaluation 1. Pre-and post-tests To evaluate students’ understanding of the course on antihypertensive drugs, both a pre-quiz and a post-quiz were conducted before and after classes, respectively. These two quizzes had the same multiple-choice (60 points) and short-answer questions (40 points), which included two aspects: basic theoretical knowledge (80 points) and clinical case analyses (20 points). All the questions in the quizzes were based on Bloom’s taxonomy, which categorizes cognitive activitiesinto six hierarchical levels: remember, understand, apply, analyze, evaluate, and create [ 10 ]. 2. Questionnaire All students in the control and experimental groups were given a self-completed questionnaire after the lesson. The respondents were asked to complete the questionnaire anonymously and hand it to the teacher in the next lesson. The contents of the questionnaire and results are shown in Table 1 . Each indicator of the survey questionnaire was scored on a five-point Likert 5-component scale: very satisfied, 5 points; satisfied, 4 points; uncertain, 3 points; dissatisfied, 2 points; and extremely dissatisfied, 1 point. Furthermore, a score ≥ 4 was defined as satisfactory. A graphical overview of the study design is shown in Fig. 1 . Table 1 Comparison of students’ perspectives and self-perceived competence between PBL-FC group and traditional group Assessment Items Group 1 Group 2 PBL-FC Group (n = 56) Traditional Group (n = 46) p PBL-FC Group (n = 48) Traditional Group (n = 45) p Understanding and memorizing knowledge 3.38 ± 0.84 3.26 ± 0.80 0.488 3.44 ± 0.80 3.22 ± 0.70 0.172 Learning motivation 3.02 ± 0.86 2.93 ± 0.95 0.645 3.04 ± 0.71 2.96 ± 0.88 0.604 Clear course goals 3.43 ± 0.81 2.99 ± 0.86 0.007 3.52 ± 0.90 2.87 ± 0.89 0.001 Student-teacher interaction 2.70 ± 1.17 2.41 ± 0.88 0.179 2.96 ± 1.15 2.89 ± 0.80 0.738 Student-student interaction 3.21 ± 0.85 2.72 ± 1.05 0.009 3.42 ± 0.90 2.73 ± 0.99 0.001 Ability to ask and solve problems 2.82 ± 0.83 2.54 ± 0.84 0.097 2.50 ± 0.91 2.47 ± 0.89 0.775 Large workload 2.71 ± 0.80 2.61 ± 1.00 0.594 2.81 ± 1.12 2.87 ± 0.66 0.779 Occupies too much spare time 3.23 ± 1.09 2.39 ± 1.12 0.000 3.58 ± 0.99 3.09 ± 0.73 0.008 Self-learning ability 2.84 ± 0.76 2.67 ± 0.76 0.276 2.96 ± 0.65 2.20 ± 0.97 0.000 Teamwork ability 3.14 ± 0.84 2.48 ± 0.93 0.000 3.25 ± 1.78 2.60 ± 0.75 0.002 Presentation and expression ability 3.27 ± 0.88 2.98 ± 0.80 0.089 3.48 ± 1.24 2.27 ± 0.75 0.000 Interest in learning 2.91 ± 0.64 2.41 ± 0.83 0.001 2.33 ± 0.93 2.24 ± 0.83 0.629 Ability of independent thinking 2.91 ± 0.75 2.41 ± 0.93 0.003 2.79 ± 1.24 2.33 ± 0.90 0.045 Comprehensive evaluation 2.95 ± 0.96 2.87 ± 0.96 0.688 2.92 ± 0.99 2.82 ± 0.86 0.625 Statistical analysis We calculated the total score of the pre-test, post-test and questionnaire questions for each student. Scores were then compared between the two groups using an independent-samples t-test and between pre- and post-course using a paired-samples t-test. The chi-square test was used to compare rates. All statistical analyzes were performed using SPSS 22.0 (Chicago, USA). Alpha was set at 0.05, and p-values less than 0.05 were considered significant. Results Demographic characteristics of participants A total of 195 students from Northwest Normal Universitywere included in this study. In Group 1, 56 students majoring in chemistry were assigned to the PBL-FC group and 46 students were assigned to the traditional group. In Group 2, 48 students majoring in pharmaceutical engineeringwere assigned to the PBL-FC group and 45 students were assigned to the traditional group. The basic characteristics of the students are shown in Table 2 . There were no significant differences in grade or age between the two groups (p > 0.05), indicating that the baselinevalues between the two groups were comparable. Table 2 Demographic information of participants Assessment Items Group 1 Group 2 PBL-FC Group Traditional Group p PBL-FC Group Traditional Group p Number 56 46 48 45 Grade 0.146 0.701 male 36 (64.29%) 23 (50.00%) 17 (34.00%) 17 (37.78%) female 20 (35.71%) 23 (50.00%) 33 (66.00%) 28 (62.22%) Gender 2021 2020 2020 2019 Age at the time of the experiment (in years) 20.38 ± 1.34 20.09 ± 1.17 0.256 21.02 ± 1.14 21.02 ± 0.99 0.995 Participants’ feedback about the questionnaire The response rate to the questionnaire was 100% in both groups. Table 1 shows the comparison of the mean scores ofstudents’ perspectives and self-perceived competence between the PBL-FC and traditional groups. For chemistry students, the mean scores in terms of clear course goals (P = 0.007), student-student interaction (P = 0.009), excessive spare time (P = 0.000), teamwork ability (P = 0.000), interest in learning (P = 0.000),and independent thinking ability (P = 0.003) in the PBL-FC group were significantly higher than those in the traditional group. The scores for the other items in the PBL-FC group were higher than those in the traditional group; however, there were no statistical differences between the two groups. For pharmaceutical engineering students, the scores in terms of clear course goals (P = 0.001), student-student interaction (P = 0.001), excessive spare time (P = 0.008), self-learning ability (P = 0.000), teamwork ability (P = 0.002), and presentation and expression ability (P = 0.000) in the PBL-FC group were significantly higher than those in the traditional group. The scores of the other items in the PBL-FC group were higher than those in the traditional group; however, there were no statistical differences between the two groups (Table 1 ). Comparison of students’ degree of satisfaction A score higher than or equal to four points was defined as satisfactory. Compared with the traditional group, in Group 1 more students in the PBL-FC group agreed that the PBL-FC helped them understand and memorize knowledge e(P < 0.05), improved their learning motivationand interest in learning (P < 0.05), provided clear course goals and higher comprehensive evaluation (P < 0.05), enhanced student-teacher and student-student interaction (P < 0.05), and promoted their multi-abilities, including the ability to ask and solve problems (P < 0.05), self-learning ability (P < 0.05), teamwork ability (P < 0.05), presentation andexpression ability (P < 0.05), and the ability for independent thinking (P < 0.05) (Table 3 ). Identical results were obtained for Group 2, except for learning motivation and comprehensive evaluation (P < 0.05) (Table 3 ). However, more studentsin the traditional group argued that PBL-FC had a larger workload and took too much spare timein both groups 1 and 2 (P < 0.05) (Table 3 ). Table 3 Comparison of student’ s degree of satisfaction between PBL-FC group and traditional group Assessment Items Group 1 Group 2 PBL-FC Group (n = 56) Traditional Group (n = 46) p PBL-FC Group (n = 48) Traditional Group (n = 45) p Understanding and memorizing knowledge 27 (48.21%) 19 (41.30%) 0.000 22 (45.83%) 17 (37.78%) 0.000 Learning motivation 19 (33.93%) 15 (32.61%) 0.000 12 (25.00%) 14 (31.11%) 0.000 Clear course goals 35 (62.50%) 15 (32.61%) 0.000 24 (50.00%) 10 (22.22%) 0.000 Student-teacher interaction 15 (26.79%) 9 (19.57%) 0.000 14 (29.17%) 10 (22.22%) 0.000 Student-student interaction 27 (48.21%) 15 (32.61%) 0.000 19 (39.58%) 12 (26.67%) 0.000 Ability to ask and solve problems 14 (25.00%) 4 (8.70%) 0.000 7 (14.58%) 4 (8.89%) 0.000 Large workload 14 (25.00%) 8 (17.39%) 0.000 18 (37.50%) 5 (11.11%) 0.000 Occupies too much spare time 18 (32.14%) 10 (21.74%) 0.000 21 (43.75%) 12 (26.67%) 0.000 Self-learning ability 10 (17.86%) 6 (13.04%) 0.000 9 (18.75%) 3 (6.67%) 0.000 Teamwork ability 16 (28.57%) 7 (15.22%) 0.000 14 (29.17%) 3 (6.67%) 0.000 Presentation and expression ability 19 (33.93%) 11 (23.91%) 0.000 19 (39.58%) 2 (4.44%) 0.000 Interest in learning 7 (12.50%) 1 (2.17%) 0.000 3 (6.25%) 2 (4.44%) 0.000 Ability of independent thinking 10 (17.86%) 5 (10.87%) 0.000 10 (20.83%) 4 (8.89%) 0.000 Comprehensive evaluation 18 (32.14%) 14 (30.43%) 0.000 9 (18.75%) 10 (22.22%) 0.000 Comparison of students’ mean scores onthe pre- and post-quiz The mean total scores of the pre-and post-quiz for students in both groups are shown in Fig. 2 . In group 1, the student’s mean pre-quiz score of the PBL-FC group was 54.88 ± 6.76, and the mean pre-quiz score was 52.47 ± 3.40 in the traditional group (Fig. 2 A). In group 2, the mean pre-quiz score of the PBL-FC group was 59.65 ± 7.06, and the mean pre-quiz score was 59.34 ± 7.06 in the traditional group (Fig. 2 B). After the classes, the mean post-quiz score ofthePBL-FC group in group 1 increased by 18.3 to 73.18 (p < 0.05); in the traditional group, the mean post-quiz score increased by 16.75 to 69.22 (p < 0.05) (Fig. 2 A). After the classes, the mean post-quiz score of the PBL-FC group in group 2 increased by 19.89 to 79.54 (p < 0.05); in the traditional group, the mean post-quiz score increased by 17.0 to 76.3 (p < 0.05) (Fig. 2 B). The student’s quiz scores improved in both groups, and the enhancement in both groups was significant (Fig. 2 ). Additionally, the post-quiz showed that students in the PBL-FC group scored significantly higher than those in the traditional group (p < 0.05) (Fig. 2 ). Further analysis found that in both groups, compared with the pre-quiz scores, the post-quiz scores significantly improved, regardless of the teaching method adopted (p 0.05) (Fig. 2 A). However, the mean pre-quiz scores in the PBL-FC group were significantly higher than those in the traditional group (p < 0.05) (Fig. 2 B). The mean scores for basic theoretical knowledge and clinical case analyses of both groups' pre- and post-quiz were also compared. The results showed that for both basic theoretical knowledge and clinical case analysis, the results after the quiz were significantly improved compared to the pre-quiz, with the exception of the results for basic theoretical knowledge in group 2, regardless of which teaching method was used, with the exception of the results for theoretical knowledge in the PBL-FC group in group 2 (p < 0.05) (Fig. 3 ). The students in the PBL-FC groups had significantly higher mean pre-quiz scores inboth basic theoretical knowledge and clinical case analysis questions than those in the traditional groups, except for the clinical case analysis scores in group 1(p < 0.05) (Fig. 3 ). Students in the PBL-FC groups had significantly higher mean post-quiz scores onthe clinical case analysisquestions than those in the traditional groups (p < 0.05) (Fig. 3 ). However, for the post-test scores ofbasic theoretical knowledge questions, there was no obvious difference betweenthe PBL-FC and traditional groups, although students in the PBL-FC groups had higher scores(p > 0.05) (Fig. 3 ). Discussion The traditional teaching model is mainly teacher-centered, with a single teaching method and, generally,student interest in learning is low, which is not conducive to cultivating students’ ability to analyze and solve problems in practice, resulting in less-than-ideal teaching results [ 11 ]. The effective improvement of teaching quality and effectiveness are therefore urgent problems that need to be solved. The use of computers, information technology and artificial intelligence in education has driven the change and development of teaching models. In the context of the continuous deepening of “Internet + Education” application, the combination of PBL and flipped classroom teaching methods has become an increasingly important point for teachers to carry out teaching reform. PBL is a research-based learning approach focusing on problems and students [ 12 ]. However, the PBL teaching method seriously hinders teaching progress because of the significant amount of classroom time spent on raising, thinking, solving, and discussing problems [ 13 ]. Flipped classrooms are better at engaging students and strengthening their sense of collaboration than traditional classrooms. However, flipped classrooms also have problems, such as poor learning outcomes for individual students and the inability to adapt well to this learning method [ 13 – 15 ]. Therefore, combiningthe flipped classroom and PBL methods maybe the solution to overcome the difficulties and maximize the advanatges of both methods. In the classroom, teachers and students interact and communicate, jointly explore and solve problems, effectively improving students’ enthusiasm for participating in the classroom, transforming passive acceptance into active learning [ 15 – 17 ], fully reflecting the “student-centered” teaching philosophy. Antihypertension is one of the most important topics in physiological pharmacology; thus, it is necessary to develop effective teaching methods. In this study, we demonstrated that combining the flipped classroom with the PBL teaching approach could greatly improve the students’ scores, student-student communicative ability, and teamwork ability over the traditional lecture-based classroom in teaching antihypertensive in the teaching of physiological pharmacology. However, it can occupy too much students’ spare time. This combined method has not yet been used in physiological pharmacology education, especially in antihypertensive education. The average total score improved significantly after teaching, regardless of the teaching method used. Compared to the traditional groups, mean total scores, mean scores for basic theoretical knowledge and clinical case analysis were higher after the quiz in both PBL-FC groups (Fig. 2 A). Our findings are consistent with the results of several medical teaching studies that demonstrated improvement in examination scores or final grades associated with the flipped classroom combined with the PBL teaching mode [ 18 – 22 ]. These results show that this combined teaching method is more effective in helping students master and apply knowledge. The total score of chemistry students was lower than that of pharmaceutical engineeringstudents. This could be due to two factors. Chemistry students study physiologic pharmacology in their second year, while pharmaceutical engineering students study it in their third year. In the second year, many courses on physiologic pharmacology or antihypertensive drugs were not yet taken, which meant that antihypertensives were much more difficult for chemistry students. Second, chemistry students have lower admission rates than pharmaceutical engineering students, which means that students majoring in chemistry have poorer innate learning abilities or interests, resulting in lower grades. Notably, we further analyzed the types of quizzes and found that although the post-quiz scores in basic theoretical knowledge were higher in the PBL-FC groups, the difference was not significant(p > 0.05) (Fig. 3 ). However,the scores of post-quiz in the clinical case analysis significantly improved in the PBL-FC groups (P < 0.05) (Fig. 3 ). These results can be attributed to two factors. First, in our study, all quiz questions were based on Bloom’s taxonomy, which is widely used in educational research to stratify learning activities into different cognitive levels ranging from basic recall to higher educational objectives, including remembering, understanding, applying, analyzing, evaluate and create [ 10 ]. The “basic theoretical knowledge” consists of “remember” and “understand” categories, so it is considered a “low” level cognition [ 23 ]. Moreover, this type of knowledge is based on the same textbook; thus, little difference was found. Second, clinical case analysis, involving the other four categories, primarily investigated students’ ability to use basic theoretical knowledge to solve problems. Both the flipped classroom and PBL are problem-solving teaching methods, emphasizing self-study or self-directed learning [ 24 ] that belongs to a “high” level cognition [ 21 ]. The combination of these two methods can improve the understanding of theoretical knowledge and students’ abilities to analyze and resolve problems. In addition, we compared the students’ perspectives and self-perceived competence between the two groups using a questionnaire. All students completed the questionnaires at the end of the course, with a response rate of 100%. Based on the feedback to the questionnaires, we found that the PBL-FC teaching model was highly appreciated by all participating chemical and pharmaceutical engineering students (Table 3 ): 1) students in the PBL-FC groups felt that the course objectives in all groups were clearer than those in the traditional groups; 2) students in the PBL-FC groups felt that their skills improved more, such as communication and teamwork in both groups, self-learning and presentation and expression in group 2, and independent thinking in group 1. Similar to our findings, previous studies have shown that the PBL-FC teaching model improves students’ grades and multiple abilities in many courses, including medical nursing [ 21 ], physiology [ 22 ], and aging in Europe [ 25 ]. There are several possible explanations for this. First, the flipped classroom approach offers personalized study. Students can learn at their own pace, which is perfect for more flexible learning [ 26 , 27 ]. Second, through the combined PBL-FC approach, students interact independently with learning materials and increase interactions among classmates and between students and teachers [ 27 , 28 ]. Third, through e-learning applications, students can devote more time to extra curricular learning to acquire further knowledge that is unavailable in traditional teaching [ 29 ]. Finally, compared with the traditional teaching method, which focuses on how much knowledge can be absorbed in a class by students through reading and listening (emphasis on input), both flipped classrooms, and PBL encourages students to verbalize what they learnand exchange ideas through discussion or debate (emphasison output) [ 30 ]. Significantly, the questionnaire results showed that self-learning ability, presentation and expression ability, interest in learning, and the ability to think independently showed inconsistent results between Groups 1 and 2. This discrepancy between the groups can be caused by factors such as students’ majors, the knowledge background and the course choices of the students. Therefore, it is not surprising that the combined methodology can improve students’ perspectives and self-perceived competence. It is also worth noting that students in the PBL-FC group spent much more time preparing for class than students in the traditional groups (Table 1 ). These results suggest that while the combined approach can improve students’ performance, it can also increase their workload. On the one hand, spending more time means that students can acquire more knowledge and a deeper understanding. This could partly explain why students in the PBL-FC group scored higher. However, spending more time studying also means that they will take up too much free time. Limitations This study has several limitations. First, although both experiments were conducted simultaneously, the sample size was relatively small. Therefore, the results may not reflect the overall situation, which may lead to inaccuracies. Second, due to the small number of students, there was only one class per grade level in pharmaceutical engineering and chemistry. The experiments were conducted over two years and the students in the experimental and control groups were not in the same class. Therefore, differences between students in different grades may lead to differences in the experimental results. Third, we only examined the short-term results of the combined method. Therefore, further studies are needed to investigate whether the benefits of this combined method persist in the long term. Finally, this study was conducted in one of the poorest areas in China, and most of the students were from this province. Therefore, the results may not be transferable to schools in other socioeconomic strata. Conclusions To summarize, the results of our study suggest that a combination of flipped classroom and PBL teaching approaches can improve student performance.To improve their ability to learn about antihypertensive drugs in physiologic pharmacology. Further studies are needed to evaluate how course design and delivery can be optimized to allow wider implementation of the combined model in other curricula. Declarations Ethics approval and consent to participate This study was performed in accordance with the Helsinki Declaration and was approved by the Ethics committee of Northwest Normal University. All study participants were given written informed consent. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding This work was supported by Lanzhou Youth Science and Technology Talent Project. (Grant number 2023-QN-72). Author Contribution All work in this study was done by Junxia An alone. Acknowledgements Not applicable Availability of data and materials The datasets used and/or analysed in this study are available from the corresponding author on reasonable request. References Rotellar C, Cain J. Research, Perspectives, and Recommendations on Implementing the Flipped Classroom. Am J Pharm Educ. 2016;80(2):34. Pierce R, Fox J. 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Effectiveness of a combined problem-based learning and flipped classroom teaching method in ophthalmic clinical skill training. BMC Med Educ. 2022;22(1):487. Hu X, Zhang H, Song Y, Wu C, Yang Q, Shi Z, et al. Implementation of flipped classroom combined with problem-based learning: an approach to promote learning about hyperthyroidism in the endocrinology internship. BMC Med Educ. 2019;19(1):290. Chi M, Wang N, Wu Q, Cheng M, Zhu C, Wang X, et al. Implementation of the Flipped Classroom Combined with Problem-Based Learning in a Medical Nursing Course: A Quasi-Experimental Design. Healthc (Basel). 2022;10(12):2572. Zhou R, Li C, Chen L, Wu X. Application of flipped classroom combinedwith PBL in physiology teaching. Basic Med Educ. 2018;20(1):12–4. Morton DA, Colbert-Getz JM. Measuring the impact of the flipped anatomy classroom: The importance of categorizing an assessment by Bloom's taxonomy. Anat Sci Educ. 2017;10(2):170–5. Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture inneurology education. Semin Neurol. 2018;38(4):418–27. de Jong N, van Rosmalen P, Brancaccio MT, Bleijlevens MHC, Verbeek H, Peeters IGP. Flipped Classroom Formats in a Problem-Based Learning Course: Experiences of First-Year Bachelor European Public Health Students. Public Health Rev. 2022;43:1604795. Lin Y, Zhu Y, Chen C, Wang W, Chen T, Li T, et al. Facing the challenges in ophthalmology clerkship teaching: is flippedclassroom the answer? PLoS ONE. 2017;12(4):e0174829. Barranquero-Herbosa M, Abajas-Bustillo R, Ortego-Maté C. Effectiveness of flipped classroom in nursing education: A systematic review of systematic and integrative reviews. Int J Nurs Stud. 2022;135:104327. Limniou M, Schermbrucker I, Lyons M. Traditional and flipped classroom approaches delivered by two different teachers: the student perspective. Educ Inf Technol. 2018;23(2):797–817. Zheng M, Chu CC, Wu YJ, Gou W. The mapping of on-line learning to flippedclassroom: small private online course. Sustain. 2018;10(3):1–14. Kandi V, Basireddy PR. Creating a student-centered learning environment:implementation of problem-based learning to teach microbiology toundergraduate medical students. Cureus. 2018;10(1):e2029. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3908442","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":270523650,"identity":"b012ca2a-be5a-4141-a2ff-39c67f71cd8e","order_by":0,"name":"Junxia An","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFCCAwwMiX/Y5PiZmQ8/IF7LwwY+Y8l2tjQDou1hfNggl2hwnkdBgijl/I1nDD8k7jBLMD7Mw2DAUGMTTVCLxIFjyRKJZ9LyzA7zHnjAcCwtt4GgngOHD0gksB0rNjvMl2DA2HCYsBb5AwebfySw/U/c3MxjIEGUFoMDh49JJLaxJW5gJlaL4YFjaRYJZ9iMJQ4DAzmBGL/I3ThjfPNHBTAq+w8ffvChxoYI70scQOIkEFQOAvyETR0Fo2AUjIKRDgCsNkTnsMwODwAAAABJRU5ErkJggg==","orcid":"","institution":"School of Life Sciences of Northwest Normal University","correspondingAuthor":true,"prefix":"","firstName":"Junxia","middleName":"","lastName":"An","suffix":""}],"badges":[],"createdAt":"2024-01-29 08:17:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3908442/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3908442/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50578375,"identity":"eae0b8f7-0457-402f-908f-9714aaa78870","added_by":"auto","created_at":"2024-02-02 18:04:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":675667,"visible":true,"origin":"","legend":"\u003cp\u003eA graphical overview of the study design\u003c/p\u003e\n\u003cp\u003ePBL-FC: combination of flipped classroom andproblem-based learning\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3908442/v1/4b689531f1c44b86526384ba.png"},{"id":50578376,"identity":"27c3ee3b-a0c9-48c3-8474-372b6ba2038a","added_by":"auto","created_at":"2024-02-02 18:04:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":529541,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of mean pre- and post-quiz total scorebetween PBL-FC and traditional groups.\u003c/p\u003e\n\u003cp\u003ePBL-FC: combination of flipped classroom and problem-based learning\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3908442/v1/feef93c72054a07fbc81bdc3.png"},{"id":50578378,"identity":"cead9ace-034c-4114-82b0-80ad4900c270","added_by":"auto","created_at":"2024-02-02 18:04:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":884919,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the mean pre- and post-quizscore on basic theoretical knowledge and clinical case analysisbetween PBL-FC and traditional groups.\u003c/p\u003e\n\u003cp\u003ePBL-FC: combination of flipped classroom andproblem-based learning\u003c/p\u003e\n\u003cp\u003eData are presented as the means ±standard deviation (SD); * p \u0026lt; 0.05,** p \u0026lt; 0.01, *** p \u0026lt; 0.001,NS: no significant difference\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3908442/v1/ea9aee71053be9fd6a66ff2f.png"},{"id":50596530,"identity":"3527e625-f574-4f2a-9f92-777ea76edf44","added_by":"auto","created_at":"2024-02-03 08:52:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":876395,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3908442/v1/48ab1d57-8124-470f-acdb-4f2456f2ed17.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Physiological pharmacology education: The effects of acombined problem‑based learning and flipped classroom teaching method","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhysiological pharmacology at Northwest Normal University comprises two parts: physiology and pharmacology. The course is complex; when introducing therapeutic drugs for various systemic diseases, the knowledge of the pathophysiology of the corresponding diseases must be added. The course length of physiologic pharmacology is 48 hours, and a large amount of course content requires students to digest and absorb it in the classroom, which is not easy. Therefore, many students do not achieve ideal results in their final exams; their knowledge mastery is insufficient, and they cannot apply it proficiently. Furthermore, the content of physiological pharmacology is mostly theoretical, making it difficult for students to concentrate at all times in class. Their interest in the learning content is low, which leads to a decrease in their enthusiasm and naturally results in unsatisfactory grades. Although multimedia have been introduced into the teaching process, students generally find it difficult to systematically master knowledge in practical applications.\u003c/p\u003e \u003cp\u003eThe flipped classroom (FC) is a new form of teaching that transforms traditional in-class teaching processes into off-class learning activities. Students complete the learning of knowledge before class, and the classroom becomes a place for interaction between teachers and students and between students [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With the popularization of the Internet and the application of real-time communication technology in education, the \"flipped classroom\" teaching model has become more feasible and practical [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research has found that compared to traditional classrooms, flipped classrooms can better stimulate students' interest and enhance their sense of cooperation [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, flipped classrooms also have problems, such as individual students having poor learning outcomes and an inability to adapt well to this learning method [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProblem-based learning (PBL) is a problem-based learning approach that is a student-centered and problem-oriented teaching form for group discussions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The core idea is to use problems as a starting point for learning and integrating new knowledge. The main goal of PBL teaching methods is to propose problems, analyze problems and solve problems, including problem identification, problem discovery, self-learning, evaluation of new knowledge, thinking and feedback, and other basic steps [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the PBL teaching method seriously hinders teaching progress because of the significant amount of classroom time spent on raising, thinking, solving, and discussing problems [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, integrating PBL with the \"flipped classroom\" teaching mode, and setting and raising questions before class is undoubtedly becoming a more reasonable mode. The resolution, further discussion, and summary report of problems are conducted in the classroom, which saves considerable classroom time and is beneficial for students to master and internalize knowledge. However, no research has been conducted on physiological pharmacology, which is one of the most important core courses for undergraduate majors. To clarify the effectiveness and acceptability of a pedagogy that combines the flipped classroom with PBL in physiological pharmacology teaching, we conducted the current study involving 195 students. We compared students\u0026rsquo; performance, experience, and competence in learning about antihypertensive medications between this blended pedagogy and traditional lecture-based instruction. This study\u0026rsquo;s purpose was to guide instructors using this blended pedagogy in physiologic pharmacology classes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eA total of 195 undergraduate students majoring in chemistry and pharmaceutical engineering at Northwest Normal University were included in this study. All students were given written informed consent and were informed that participation in the tests and completion of the surveys was voluntary. The students who participated in this study took the same national college entrance exam and had comparable scores for each major. Prior to this experiment, students with the same major took the same courses in their freshman or sophomore year; therefore, the baseline knowledge of students with the same major was similar. The experimental and control classes in the same major had the same curriculum.\u003c/p\u003e \u003cp\u003eTwo sets of students with different majors participated simultaneously in this study. In Group 1, 46 students majoring in chemistry in 2020 as the control group, and 56 students majoring in chemistry from 2021 were selected as the experimental group. In Group 2, 45 students majoring in pharmaceutical engineering in 2019 were selected as the control group, and 48 students majoring in pharmaceutical engineering from 2020 were selected as the experimental group. In the experimental teaching group, the content of antihypertensive drugs was taught by combining FC with PBL for 2 hours, while other teaching contents were taught in a traditional teaching mode for 46 hours. The control group adopted the traditional teaching mode. There were no significant differences in the early grades, age, or other factors between the two grades of students in the same major (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and the teaching hours, teachers, and textbooks were the same. In addition, no participants had previously completed PBL, FC, or PBL combined with FC teaching modes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy design\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.\u003c/b\u003e \u003cb\u003eFC with PBL\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe chose a chapter on antihypertensive drugs to apply the combination approach in this study. The FC with PBL combination group proceeded as follows: Two weeks before the course, the lecturer prepared the relevant online lecture videos and supplementary materials. Each student had to watch these in their own time. All videos were less than 10 minutes long and consisted of four parts: Introduction to the concept, explanation of the concept, classic examples and summary of knowledge. Simultaneously, the instructor presented several relevant questions: (1) What is the pathogenesis of hypertension? (2) What are the main organs that regulate blood pressure? (3) What are the types and characteristics of the first-line antihypertensive drugs? (4) What is the mechanism of action of first-line antihypertensive drugs? (5) What are the plans for combining medications with antihypertensive drugs?\u003c/p\u003e \u003cp\u003eThe 56 chemistry students were randomly divided into 12 groups, whereas the 48 pharmaceutical engineering students were randomly divided into ten groups. Each group consisted of 4\u0026ndash;5 students, and the group members recommended that a group leader organize the discussions and participate in the evaluation. Each group had todiscuss these issues and understand the key points of knowledge.\u003c/p\u003e \u003cp\u003eThe lesson began with the lecturer introducing the topic and the agenda. Then, each group chose are presentative student to express their opinion about the lecture, propose their answers to the questions, and ask unresolved questions from their small group. The teacher and the students from the other groups graded the answers and the communication situation. Finally, the teacher summarized the class and answered difficult questions raised during the discussions.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.\u003c/b\u003e \u003cb\u003eTraditional classroom\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe traditional mode of teaching was primarily based on teacher lectures in class. Before the lecture, students were simply instructed to prepare for class using textbooks rather than watching videos or reading supplemental materials. These students accepted the equivalent content in the traditional teaching method, and the instructor gave a declarative statement of theoretical knowledge according to the syllabus instead of dividing the class into small groups to discuss the cases.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData evaluation\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.\u003c/b\u003e \u003cb\u003ePre-and post-tests\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo evaluate students\u0026rsquo; understanding of the course on antihypertensive drugs, both a pre-quiz and a post-quiz were conducted before and after classes, respectively. These two quizzes had the same multiple-choice (60 points) and short-answer questions (40 points), which included two aspects: basic theoretical knowledge (80 points) and clinical case analyses (20 points). All the questions in the quizzes were based on Bloom\u0026rsquo;s taxonomy, which categorizes cognitive activitiesinto six hierarchical levels: remember, understand, apply, analyze, evaluate, and create [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.\u003c/b\u003e \u003cb\u003eQuestionnaire\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAll students in the control and experimental groups were given a self-completed questionnaire after the lesson. The respondents were asked to complete the questionnaire anonymously and hand it to the teacher in the next lesson. The contents of the questionnaire and results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Each indicator of the survey questionnaire was scored on a five-point Likert 5-component scale: very satisfied, 5 points; satisfied, 4 points; uncertain, 3 points; dissatisfied, 2 points; and extremely dissatisfied, 1 point. Furthermore, a score\u0026thinsp;\u0026ge;\u0026thinsp;4 was defined as satisfactory. A graphical overview of the study design is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" 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\u003eComparison of students\u0026rsquo; perspectives and self-perceived competence between PBL-FC group and traditional group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssessment Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL-FC Group (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePBL-FC Group (n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding and memorizing knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClear course goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-teacher interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-student interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility to ask and solve problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupies too much spare time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-learning ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresentation and expression ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterest in learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility of independent thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe calculated the total score of the pre-test, post-test and questionnaire questions for each student. Scores were then compared between the two groups using an independent-samples t-test and between pre- and post-course using a paired-samples t-test. The chi-square test was used to compare rates. All statistical analyzes were performed using SPSS 22.0 (Chicago, USA). Alpha was set at 0.05, and p-values less than 0.05 were considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of participants\u003c/h2\u003e \u003cp\u003eA total of 195 students from Northwest Normal Universitywere included in this study. In Group 1, 56 students majoring in chemistry were assigned to the PBL-FC group and 46 students were assigned to the traditional group. In Group 2, 48 students majoring in pharmaceutical engineeringwere assigned to the PBL-FC group and 45 students were assigned to the traditional group. The basic characteristics of the students are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no significant differences in grade or age between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that the baselinevalues between the two groups were comparable.\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\u003eDemographic information of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssessment Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL-FC Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePBL-FC Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (64.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (34.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (37.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (35.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (66.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (62.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at the time of the experiment (in years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; feedback about the questionnaire\u003c/h2\u003e \u003cp\u003eThe response rate to the questionnaire was 100% in both groups. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the comparison of the mean scores ofstudents\u0026rsquo; perspectives and self-perceived competence between the PBL-FC and traditional groups. For chemistry students, the mean scores in terms of clear course goals (P\u0026thinsp;=\u0026thinsp;0.007), student-student interaction (P\u0026thinsp;=\u0026thinsp;0.009), excessive spare time (P\u0026thinsp;=\u0026thinsp;0.000), teamwork ability (P\u0026thinsp;=\u0026thinsp;0.000), interest in learning (P\u0026thinsp;=\u0026thinsp;0.000),and independent thinking ability (P\u0026thinsp;=\u0026thinsp;0.003) in the PBL-FC group were significantly higher than those in the traditional group. The scores for the other items in the PBL-FC group were higher than those in the traditional group; however, there were no statistical differences between the two groups. For pharmaceutical engineering students, the scores in terms of clear course goals (P\u0026thinsp;=\u0026thinsp;0.001), student-student interaction (P\u0026thinsp;=\u0026thinsp;0.001), excessive spare time (P\u0026thinsp;=\u0026thinsp;0.008), self-learning ability (P\u0026thinsp;=\u0026thinsp;0.000), teamwork ability (P\u0026thinsp;=\u0026thinsp;0.002), and presentation and expression ability (P\u0026thinsp;=\u0026thinsp;0.000) in the PBL-FC group were significantly higher than those in the traditional group. The scores of the other items in the PBL-FC group were higher than those in the traditional group; however, there were no statistical differences between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison of students\u0026rsquo; degree of satisfaction\u003c/h2\u003e \u003cp\u003eA score higher than or equal to four points was defined as satisfactory. Compared with the traditional group, in Group 1 more students in the PBL-FC group agreed that the PBL-FC helped them understand and memorize knowledge e(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), improved their learning motivationand interest in learning (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), provided clear course goals and higher comprehensive evaluation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), enhanced student-teacher and student-student interaction (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and promoted their multi-abilities, including the ability to ask and solve problems (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), self-learning ability (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), teamwork ability (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), presentation andexpression ability (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the ability for independent thinking (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Identical results were obtained for Group 2, except for learning motivation and comprehensive evaluation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, more studentsin the traditional group argued that PBL-FC had a larger workload and took too much spare timein both groups 1 and 2 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of student\u0026rsquo; s degree of satisfaction between PBL-FC group and traditional group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssessment Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBL-FC Group (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePBL-FC Group (n\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding and memorizing knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (48.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (41.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22 (45.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17 (37.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (33.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (32.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14 (31.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClear course goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (62.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (32.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24 (50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-teacher interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (26.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (19.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (29.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-student interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (48.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (32.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (39.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12 (26.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility to ask and solve problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (8.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (14.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (8.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (17.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (37.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupies too much spare time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (32.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (21.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21 (43.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12 (26.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-learning ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (17.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (13.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (18.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (15.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (29.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (6.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresentation and expression ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (33.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (23.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (39.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (4.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterest in learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (12.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (6.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (4.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility of independent thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (17.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (10.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (20.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (8.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensive evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (32.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (30.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (18.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10 (22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of students\u0026rsquo; mean scores onthe pre- and post-quiz\u003c/h2\u003e \u003cp\u003eThe mean total scores of the pre-and post-quiz for students in both groups are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In group 1, the student\u0026rsquo;s mean pre-quiz score of the PBL-FC group was 54.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76, and the mean pre-quiz score was 52.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40 in the traditional group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). In group 2, the mean pre-quiz score of the PBL-FC group was 59.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06, and the mean pre-quiz score was 59.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06 in the traditional group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). After the classes, the mean post-quiz score ofthePBL-FC group in group 1 increased by 18.3 to 73.18 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); in the traditional group, the mean post-quiz score increased by 16.75 to 69.22 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). After the classes, the mean post-quiz score of the PBL-FC group in group 2 increased by 19.89 to 79.54 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); in the traditional group, the mean post-quiz score increased by 17.0 to 76.3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The student\u0026rsquo;s quiz scores improved in both groups, and the enhancement in both groups was significant (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, the post-quiz showed that students in the PBL-FC group scored significantly higher than those in the traditional group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Further analysis found that in both groups, compared with the pre-quiz scores, the post-quiz scores significantly improved, regardless of the teaching method adopted (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Furthermore, there was no significant difference in the pre-quiz scores between the PBL-FC group and the traditional groupbefore class in group 2(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). However, the mean pre-quiz scores in the PBL-FC group were significantly higher than those in the traditional group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mean scores for basic theoretical knowledge and clinical case analyses of both groups' pre- and post-quiz were also compared. The results showed that for both basic theoretical knowledge and clinical case analysis, the results after the quiz were significantly improved compared to the pre-quiz, with the exception of the results for basic theoretical knowledge in group 2, regardless of which teaching method was used, with the exception of the results for theoretical knowledge in the PBL-FC group in group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The students in the PBL-FC groups had significantly higher mean pre-quiz scores inboth basic theoretical knowledge and clinical case analysis questions than those in the traditional groups, except for the clinical case analysis scores in group 1(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Students in the PBL-FC groups had significantly higher mean post-quiz scores onthe clinical case analysisquestions than those in the traditional groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, for the post-test scores ofbasic theoretical knowledge questions, there was no obvious difference betweenthe PBL-FC and traditional groups, although students in the PBL-FC groups had higher scores(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe traditional teaching model is mainly teacher-centered, with a single teaching method and, generally,student interest in learning is low, which is not conducive to cultivating students\u0026rsquo; ability to analyze and solve problems in practice, resulting in less-than-ideal teaching results [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The effective improvement of teaching quality and effectiveness are therefore urgent problems that need to be solved. The use of computers, information technology and artificial intelligence in education has driven the change and development of teaching models. In the context of the continuous deepening of \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Education\u0026rdquo; application, the combination of PBL and flipped classroom teaching methods has become an increasingly important point for teachers to carry out teaching reform.\u003c/p\u003e \u003cp\u003ePBL is a research-based learning approach focusing on problems and students [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the PBL teaching method seriously hinders teaching progress because of the significant amount of classroom time spent on raising, thinking, solving, and discussing problems [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Flipped classrooms are better at engaging students and strengthening their sense of collaboration than traditional classrooms. However, flipped classrooms also have problems, such as poor learning outcomes for individual students and the inability to adapt well to this learning method [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, combiningthe flipped classroom and PBL methods maybe the solution to overcome the difficulties and maximize the advanatges of both methods. In the classroom, teachers and students interact and communicate, jointly explore and solve problems, effectively improving students\u0026rsquo; enthusiasm for participating in the classroom, transforming passive acceptance into active learning [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], fully reflecting the \u0026ldquo;student-centered\u0026rdquo; teaching philosophy.\u003c/p\u003e \u003cp\u003eAntihypertension is one of the most important topics in physiological pharmacology; thus, it is necessary to develop effective teaching methods. In this study, we demonstrated that combining the flipped classroom with the PBL teaching approach could greatly improve the students\u0026rsquo; scores, student-student communicative ability, and teamwork ability over the traditional lecture-based classroom in teaching antihypertensive in the teaching of physiological pharmacology. However, it can occupy too much students\u0026rsquo; spare time. This combined method has not yet been used in physiological pharmacology education, especially in antihypertensive education. The average total score improved significantly after teaching, regardless of the teaching method used. Compared to the traditional groups, mean total scores, mean scores for basic theoretical knowledge and clinical case analysis were higher after the quiz in both PBL-FC groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eOur findings are consistent with the results of several medical teaching studies that demonstrated improvement in examination scores or final grades associated with the flipped classroom combined with the PBL teaching mode [\u003cspan additionalcitationids=\"CR19 CR20 CR21\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These results show that this combined teaching method is more effective in helping students master and apply knowledge. The total score of chemistry students was lower than that of pharmaceutical engineeringstudents. This could be due to two factors. Chemistry students study physiologic pharmacology in their second year, while pharmaceutical engineering students study it in their third year. In the second year, many courses on physiologic pharmacology or antihypertensive drugs were not yet taken, which meant that antihypertensives were much more difficult for chemistry students. Second, chemistry students have lower admission rates than pharmaceutical engineering students, which means that students majoring in chemistry have poorer innate learning abilities or interests, resulting in lower grades.\u003c/p\u003e \u003cp\u003eNotably, we further analyzed the types of quizzes and found that although the post-quiz scores in basic theoretical knowledge were higher in the PBL-FC groups, the difference was not significant(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However,the scores of post-quiz in the clinical case analysis significantly improved in the PBL-FC groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These results can be attributed to two factors. First, in our study, all quiz questions were based on Bloom\u0026rsquo;s taxonomy, which is widely used in educational research to stratify learning activities into different cognitive levels ranging from basic recall to higher educational objectives, including remembering, understanding, applying, analyzing, evaluate and create [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The \u0026ldquo;basic theoretical knowledge\u0026rdquo; consists of \u0026ldquo;remember\u0026rdquo; and \u0026ldquo;understand\u0026rdquo; categories, so it is considered a \u0026ldquo;low\u0026rdquo; level cognition [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Moreover, this type of knowledge is based on the same textbook; thus, little difference was found. Second, clinical case analysis, involving the other four categories, primarily investigated students\u0026rsquo; ability to use basic theoretical knowledge to solve problems. Both the flipped classroom and PBL are problem-solving teaching methods, emphasizing self-study or self-directed learning [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] that belongs to a \u0026ldquo;high\u0026rdquo; level cognition [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The combination of these two methods can improve the understanding of theoretical knowledge and students\u0026rsquo; abilities to analyze and resolve problems.\u003c/p\u003e \u003cp\u003eIn addition, we compared the students\u0026rsquo; perspectives and self-perceived competence between the two groups using a questionnaire. All students completed the questionnaires at the end of the course, with a response rate of 100%. Based on the feedback to the questionnaires, we found that the PBL-FC teaching model was highly appreciated by all participating chemical and pharmaceutical engineering students (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e): 1) students in the PBL-FC groups felt that the course objectives in all groups were clearer than those in the traditional groups; 2) students in the PBL-FC groups felt that their skills improved more, such as communication and teamwork in both groups, self-learning and presentation and expression in group 2, and independent thinking in group 1. Similar to our findings, previous studies have shown that the PBL-FC teaching model improves students\u0026rsquo; grades and multiple abilities in many courses, including medical nursing [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], physiology [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and aging in Europe [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. There are several possible explanations for this. First, the flipped classroom approach offers personalized study. Students can learn at their own pace, which is perfect for more flexible learning [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Second, through the combined PBL-FC approach, students interact independently with learning materials and increase interactions among classmates and between students and teachers [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Third, through e-learning applications, students can devote more time to extra curricular learning to acquire further knowledge that is unavailable in traditional teaching [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Finally, compared with the traditional teaching method, which focuses on how much knowledge can be absorbed in a class by students through reading and listening (emphasis on input), both flipped classrooms, and PBL encourages students to verbalize what they learnand exchange ideas through discussion or debate (emphasison output) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Significantly, the questionnaire results showed that self-learning ability, presentation and expression ability, interest in learning, and the ability to think independently showed inconsistent results between Groups 1 and 2. This discrepancy between the groups can be caused by factors such as students\u0026rsquo; majors, the knowledge background and the course choices of the students. Therefore, it is not surprising that the combined methodology can improve students\u0026rsquo; perspectives and self-perceived competence. It is also worth noting that students in the PBL-FC group spent much more time preparing for class than students in the traditional groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These results suggest that while the combined approach can improve students\u0026rsquo; performance, it can also increase their workload. On the one hand, spending more time means that students can acquire more knowledge and a deeper understanding. This could partly explain why students in the PBL-FC group scored higher. However, spending more time studying also means that they will take up too much free time.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, although both experiments were conducted simultaneously, the sample size was relatively small. Therefore, the results may not reflect the overall situation, which may lead to inaccuracies. Second, due to the small number of students, there was only one class per grade level in pharmaceutical engineering and chemistry. The experiments were conducted over two years and the students in the experimental and control groups were not in the same class. Therefore, differences between students in different grades may lead to differences in the experimental results. Third, we only examined the short-term results of the combined method. Therefore, further studies are needed to investigate whether the benefits of this combined method persist in the long term. Finally, this study was conducted in one of the poorest areas in China, and most of the students were from this province. Therefore, the results may not be transferable to schools in other socioeconomic strata.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo summarize, the results of our study suggest that a combination of flipped classroom and PBL teaching approaches can improve student performance.To improve their ability to learn about antihypertensive drugs in physiologic pharmacology. Further studies are needed to evaluate how course design and delivery can be optimized to allow wider implementation of the combined model in other curricula.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was performed in accordance with the Helsinki Declaration and was approved by the Ethics committee of Northwest Normal University. All study participants were given written informed consent.\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 Lanzhou Youth Science and Technology Talent Project. (Grant number 2023-QN-72).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll work in this study was done by Junxia An alone.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed in this study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRotellar C, Cain J. Research, Perspectives, and Recommendations on Implementing the Flipped Classroom. Am J Pharm Educ. 2016;80(2):34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePierce R, Fox J. Vodcasts and active-learning exercises in a flipped classroom model of a renal pharmacotherapy module. Am J Pharm Educ. 2012;76(10):196.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg EKL. 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Theory Into Practice. Taylor \u0026amp; Francis; 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmalba A, Abantanga FA, Scherpbier A, van Mook W. Trainees\u0026rsquo; preferences regarding choice of place of work after completing medicaltraining in traditional or problem-based learning/community-basededucation and service curricula: a study in Ghanaian medical schools. Rural Remote Health. 2019;19(3):5087.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrull\u0026agrave;s JC, Blay C, Sarri E, Pujol R. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC Med Educ. 2022;22(1):104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang R, Jia Q, Wang Y, Ma S, Gao Q, Guan S. Application of flippedclassroom combined with problem-based learning teaching mode in theteaching of the structure and function of human body. 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Healthc (Basel). 2022;10(12):2572.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou R, Li C, Chen L, Wu X. Application of flipped classroom combinedwith PBL in physiology teaching. Basic Med Educ. 2018;20(1):12\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorton DA, Colbert-Getz JM. Measuring the impact of the flipped anatomy classroom: The importance of categorizing an assessment by Bloom's taxonomy. Anat Sci Educ. 2017;10(2):170\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaefer SM, Dominguez M, Moeller JJ. The future of the lecture inneurology education. Semin Neurol. 2018;38(4):418\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Jong N, van Rosmalen P, Brancaccio MT, Bleijlevens MHC, Verbeek H, Peeters IGP. Flipped Classroom Formats in a Problem-Based Learning Course: Experiences of First-Year Bachelor European Public Health Students. Public Health Rev. 2022;43:1604795.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin Y, Zhu Y, Chen C, Wang W, Chen T, Li T, et al. Facing the challenges in ophthalmology clerkship teaching: is flippedclassroom the answer? PLoS ONE. 2017;12(4):e0174829.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarranquero-Herbosa M, Abajas-Bustillo R, Ortego-Mat\u0026eacute; C. Effectiveness of flipped classroom in nursing education: A systematic review of systematic and integrative reviews. Int J Nurs Stud. 2022;135:104327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLimniou M, Schermbrucker I, Lyons M. Traditional and flipped classroom approaches delivered by two different teachers: the student perspective. Educ Inf Technol. 2018;23(2):797\u0026ndash;817.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng M, Chu CC, Wu YJ, Gou W. The mapping of on-line learning to flippedclassroom: small private online course. Sustain. 2018;10(3):1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandi V, Basireddy PR. Creating a student-centered learning environment:implementation of problem-based learning to teach microbiology toundergraduate medical students. Cureus. 2018;10(1):e2029.\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":"Flipped classroom, Problem-based learning, Antihypertensive, Physiological pharmacology, Teaching","lastPublishedDoi":"10.21203/rs.3.rs-3908442/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3908442/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSome studies have primarily implemented problem-based learning (PBL) or flipped classroom (FC) teaching models in different majors; however, research has not been conducted on the combined PBL-FC teaching method in physiological pharmacology education. Therefore, we investigated the effects of the combined PBL-FC method in teaching physiological pharmacology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 102 second-year chemistry students and 93 third-year students majoring in pharmaceutical engineering at Northwest Normal University participated in this study. Antihypertensive agents were administered in this study. A total of 56 second-year chemistry students in Grade 2021 and 48 third-year students majoring in pharmaceutical engineering in Grade 2020 were allocated to the PBL-FC group, whereas 46 second-year chemistry students in Grade 2020 and 45 third-year students majoring in pharmaceutical engineering in Grade 2019 were allocated to the traditional lecture-based classroom group. A pre-quiz and a post-quiz were conducted before and after the classes. All quiz questions were classified into two categories based on Bloom’s taxonomy: basic theoretical knowledge and clinical case analyses. The results were compared and the students had to complete a questionnaire to evaluate their perceptions and experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe average scorein the post-quiz was higher than that of the pre-quiz for both the PBL-FC and traditional groups. In addition, the post-quiz showed that the students in the PBL-FC group scored significantly higher than the students in the traditional group. Further analysis revealed that only the difference in clinical case analysis between the PBL-FC and the traditional group was significant after the course. Scores for all questionnaire items were higher in the PBL-FC group than in the traditional group. Most students agreed that the combined teaching method helped them to improve their performance, although it increased their workload.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe combined flipped classroom and PBL teaching approach is a better option than the traditional lecture-based classroom for teaching antihypertensive medication during physiological pharmacology teaching, although it increases students’ workload. Further optimization is required to ensure a wider acceptance and implementation.\u003c/p\u003e","manuscriptTitle":"Physiological pharmacology education: The effects of acombined problem‑based learning and flipped classroom teaching method","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-02 18:04:09","doi":"10.21203/rs.3.rs-3908442/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":"5bbe5d09-b226-4b33-8f01-273036597b7c","owner":[],"postedDate":"February 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-03T08:44:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-02 18:04:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3908442","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3908442","identity":"rs-3908442","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}