Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training

Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training | 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 Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training Linna Wei, Xinyang Yu, Yiming Wang, Nan Shan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5352449/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 May, 2025 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Background/Aim To explore how a teaching model that integrates bridge-in, objective/outcome, pre-assessment, participatory learning, post-assessment, and summary (the BOPPPS model) and flipped classroom teaching will affect the clinical practice abilities of obstetrics and gynecology residents in standardized training. Methods Seventy standardized training residents from the obstetrics and gynecology training base of the First Affiliated Hospital of Chongqing Medical University from June 2023 to June 2024 were selected as research subjects. They were randomly and equally divided into an experimental group (adopting the BOPPPS model combined with the flipped classroom approach) and a control group (adopting traditional teaching methods). The effectiveness of the teaching model was assessed by comparing the performances of the two groups in clinical practice ability simulation assessments, clinical thinking ability, self-directed learning ability, and satisfaction with the teaching methods. Results The experimental group was scored significantly higher than the control group in patient reception, clinical thinking assessment, and practical skill assessment. The experimental group significantly outperformed the control group in clinical thinking ability scores, self-directed learning ability scores, and overall scores. The experimental group showed significantly higher satisfaction with the BOPPPS and flipped classroom teaching combined model in enhancing self-directed learning ability, learning interest, practical operation levels, teamwork, comprehensive quality, and doctor-patient communication skills, and in cultivating clinical thinking ability. Conclusions The BOPPPS combined with flipped classroom teaching in standardized training can effectively improve the assessment scores, clinical thinking and self-directed learning abilities of obstetrics and gynecology residents, stimulate their initiative and enthusiasm for learning, meet their teaching needs, and thus enhance teaching quality and assessment passing rates. BOPPPS teaching model flipped classroom obstetrics and gynecology teaching practice Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Standardized training for residents has become an effective way to train qualified clinicians, and is widely recognized by the international medical community. Through this training pattern, medical graduates can more effectively apply theoretical knowledge into clinical practice, improving their clinical thinking ability and operational skills, and ultimately become qualified clinicians[ 1 ]. Obstetrics and gynecology is a highly comprehensive discipline combining theory with practice, and requires extremely high clinical practice capabilities from clinicians. Thus, a theoretical learning method suitable for obstetrics and gynecology residents in China is particularly needed, which can effectively improve their clinical thinking and practical ability[ 2 ]. Recently, the BOPPPS teaching model has been widely used in Western countries. This new teaching model is student-centered and educationally goal-oriented. It divides the teaching process into six parts: bridge-in, objective/outcome, pre-assessment, participatory learning, post-assessment, and summary[ 3 ]. In this model, interactive communication between the teacher and students in the classroom is highly valued. Students are required to study independently before classes, re-think after classes, and feedback timely on teaching effectiveness. The entire teaching process is a complete and rigorous closed loop, and is highly operable and practical. It provides students with a scientific and reasonable theoretical and practical system, helps teachers more effectively teach courses, and makes the classroom teaching process logical and reasonable, thus achieving excellent teaching results[ 4 ]. The flipped classroom is a student-centered teaching model aimed to break through the time and space limitations of traditional classrooms and enhance students' communication and interaction abilities[ 5 ]. In view of the high requirements for students' clinical communication and operational skills in the standardized training of obstetrics and gynecology residents in recent years, effective teaching models are urgently needed to help them better master the theoretical and practical skills required for clinical practice, and to make them competent for the duties of obstetricians and gynecologists and successfully pass final examinations[ 6 ]. Therefore, we adopted a teaching pattern combining BOPPPS and the flipped classroom models in the clinical practice teaching of standardized training for obstetrics and gynecology residents, aiming to explore the impact of the combination of the two teaching models on teaching effectiveness. Methods 1.1 Participants The research participants were 70 residents who were trained in their first year from June 1, 2023 to June 1, 2024 at the standardized physician training base of the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University. Then they were equally and randomly divided into an experimental group and a control group, with 35 people in each group. The control group involved 25 females and 10 males, and the experimental group consisted of 24 females and 11 males. No significant difference between the two groups was found in age, gender, enrollment time, or unified academic performance by the base ( P > 0.05). Both groups of teaching staff consist of attending physicians and associate chief physicians with more than three years of teaching experience, who have undergone examiner training and examinations organized by the Chongqing Residency Training Office, and possess qualifications for residency training and examination. Residents were allocated via the envelope method. Exclusion criteria included: (1) serious disciplinary violations during the study period; (2) unwillingness to participate in this study. Before the training begins, the base will conduct a unified simulated examination of clinical practice abilities for obstetrics and gynecology residencies, which will be evaluated by supervising physicians. According to the "Standard Assessment Plan for Clinical Practice Abilities at the End of Residency Training (2023)" from Chongqing, the examination content includes clinical thinking ability stations (Station 1: patient interview and communication, Station 2: case presentation, diagnosis, differential diagnosis, and treatment plan) and practical operation station (Station 3). The thinking ability scores of the experimental group before teaching ranged from 45 to 75 points, with an average score of 63.43 ± 4.17 points; the clinical operation scores ranged from 57 to 76 points, with an average score of 58 ± 6.06 points. The thinking ability scores of the control group before teaching ranged from 47 to 72 points, with an average score of 62.09 ± 4.33 points; the clinical operation scores ranged from 56 to 75 points, with an average score of 57.2 ± 5.58 points. Comparison of thinking and clinical operation scores between the two groups before teaching showed no significant differences ( P > 0.05), indicating the data were comparable. 1.2 Teaching models The traditional teaching model was adopted in the training and teaching of residents in the control group. (1) Two weeks before the courses, the teacher distributed relevant materials about clinical practice ability assessment of standardized obstetrics and gynecology physician training, including consultation, clinical thinking and skill operation. A total of 9 items were included, such as: neonatal asphyxia resuscitation, fetal heart electronic monitoring technology and interpretation, normal delivery and midwifery, four-part palpation, perineal incision and suturing, obstetric history collection and emergency consultation, gynecological examination, vaginal bleeding, abdominal pain diagnostic and treatment approach, posterior fornix puncture, etc. (2) The teaching objectives of standardized obstetrics and gynecology physician training were clarified, and filmstrips and videos were provided to explain theoretical knowledge and practical operations in combination with cases. In the classroom, the teachers guided residents to master the key points and difficulties of the lesson and conducted on-site demonstrations. As shown in Fig. 1, the teaching pattern combining BOPPPS and flipped classroom was adopted in the experimental group. (1) Bridge-in: The teachers distributed assessment materials two weeks before the course and required the residents to preview relevant theoretical knowledge and operation videos, and prepared filmstrips. The teachers guided each group (N = 5) and answered questions. (2) Objective/outcome: The teachers clarified the teaching objectives of standardized obstetrics and gynecology physician training, and asked the residents to combine theory and practice to make filmstrip presentations, and to master the key points and difficulties of the course. (3) Pre-assessment: The teachers evaluated the residents’ filmstrips and preparations, and asked questions to understand the residents’ mastery of theoretical knowledge. (4) Participatory learning: Combining the flipped classroom format, with the presentation and skill operation of residents as the main focus, select a group of slides for reporting and discussion. Each resident is required to independently complete various operations of the practical course, while teachers participate in monitoring the discussion, timely supplementing theoretical knowledge and correcting any issues in the operations of the residents. (5) Post-assessment: The teachers simulated an assessment of the clinical practice ability of standardized physician training before residents left the department, and filled in the evaluation form of independent learning ability, clinical thinking ability and satisfaction with the teaching effect. (6) Summary: The teachers guided the residents to summarize their teaching and learning and deepen their understanding of the key points and difficulties of practical skills. Both groups of residents received 12 weeks of training, with one session per week, each lasting 2 class-hours and involving 3 teachers during training. 1.3 Observation indices The overview of our research design and training process were shown in Fig. 2. After all courses were completed and before the residents left the department, the teaching effect was evaluated by combining standardized simulation assessment of clinical practice ability of standardized obstetrics and gynecology physician training with a questionnaire. The evaluation time, method and standard were the same for the two groups. 1.3.1 Reception and clinical thinking assessment A unified mock examination was set up according to the standardized training outline for obstetricians and gynecologists. Residents in the experimental group and the control group were given simulation assessments. The assessment content for clinical diagnosis and clinical thinking includes 2 case histories each from obstetrics and gynecology, with 1 case selected for evaluation. Each item is scored out of 50 points, with a passing score of 30 points, for a total of 100 points. 1.3.2 Clinical practice skill assessment The test was based on the practical operations required by the standardized training outline for obstetricians and gynecologists, including gynecological examination, four-step palpation, perineal suture and curettage. Select one item for scoring. Each operation has detailed scoring criteria, and the difficulty and scoring criteria should be kept consistent. The full score is 100 points, and the passing score is 60 points. 1.3.3 Primary trait analysis (PTA) assessment of clinical thinking skills As shown in Fig. 3, both the experimental and control groups were evaluated with PTA, which covered logical thinking ability, systematic thinking ability, evidence-based thinking ability, critical thinking ability, imaginative thinking ability, network thinking ability, vertical thinking ability, and lateral thinking ability. Based on the downtrend of clinical medical thinking ability, a stepwise 3-2-1 method was used to assign points[ 7 ]. For example: In the evaluation of logical thinking ability, a score of 3 points is given for a strong logical sequence in clinical medicine diagnosis and treatment; 2 points for understanding the logical sequence of clinical medicine but not being able to apply it well; and 1 point for only having a basic understanding of logical thinking in clinical studies. Based on this, calculate the number of people in each score range and the average score for different indicators. 1.3.4 Self-learning ability assessment The learning ability of residents was assessed using the Self-directed Learning Readiness Scale (SDLRS), which includes three aspects: self-management, learning enthusiasm, and self-control. The total score of SDLRS is 200 points, and a higher score reflects a stronger self-directed learning ability[ 8 ]. 1.3.5 Teaching satisfaction evaluation The teaching satisfaction of the two groups of training residents was evaluated using a questionnaire, and 70 valid questionnaires were collected. A self-made satisfaction questionnaire was used to evaluate residents' teaching satisfaction in enhancing independent learning ability, learning interest, teamwork spirit, practical operation level, comprehensive quality, and doctor-patient communication ability, and in cultivating clinical thinking ability. The questionnaire has been tested for reliability and validity. The Cronbach α coefficient of the total questionnaire is 0.917, the split-half coefficient is 0.819, and the coefficients of each subscale are between 0.712 and 0.843, indicating the questionnaire and subscales of this experiment have high internal consistency and meet the standards. 1.4 Statistical analysis The relevant data were sorted in Excel, and statistical analysis was performed using SPSS 23.0. The measured data were expressed as x̄±s and analyzed using two-independent-sample mean t-test. Counting data were expressed as n(%) and examined via χ 2 test. P < 0.05 indicates statistical significance. Results 2.1 Comparison of medical consultation and clinical thinking assessment scores between groups The consultation score of the experimental group (36.51±5.13 points) was significantly higher than the control group (33.43±3.86 points) ( t =2.844, P =0.0059). The clinical thinking assessment score of the experimental group (41.11±4.886 points) also significantly exceeded that of the control group (33.69±5.251 points) ( t =6.127, P <0.0001, Table 1). 2.2 Comparison of clinical practice skills between groups The clinical practice skill assessment score of the experimental group (90.69±3.841) was significantly higher than that of the control group (79.77±4.426) ( P < 0.0001; Table 1, Fig.4 ). Table 1. Comparison of test scores between the experimental group and the control group (scores, x̄±s) Group Reception Clinical thinking assessment Clinical skill assessment Experimental 36.51±5.13 41.11±4.886 90.69±3.841 Control 33.43±3.86 33.69±5.251 79.77±4.426 t 2.844 6.127 11.02 P 0.0059 <0.0001 <0.0001 2.3 PTA evaluation of clinical thinking ability The residents in the experimental group had significantly better clinical thinking ability scores than the control group (P < 0.05, Table 2, Fig.5&Fig.6 ). Table 2. Clinical thinking ability PTA Group Logical thinking ability Systematic thinking ability Evidence-based thinking ability Critical thinking ability Experimental 2.486±0.6122 2.343±0.5913 2.314±0.6311 2.229±0.5983 Control 1.543±0.5054 1.629±0.5983 1.600±0.6039 1.486±0.5621 t 7.026 5.024 4.838 5.353 P <0.0001 <0.0001 <0.0001 <0.0001 Group Imaginative thinking ability Network thinking ability Vertical thinking ability Lateral thinking ability Experimental 2.429±0.6547 2.371±0.6456 2.400±0.5531 2.543±0.5606 Control 1.914±0.6122 1.857±0.6482 1.829±0.6177 1.886±0.5827 t 3.395 3.326 4.077 4.808 P 0.0012 0.0014 0.0001 <0.0001 2.4 Comparison of self-learning ability between groups The SDLRS scores of the experimental group were significantly higher than those of the control group (P < 0.0001; Table 3). Table 3. Self-learning ability SDLRS Group Self-management Passion for learning Self-control Total score Experimental 50.86±3.397 51.06±4.014 52.40±3.704 154.3±9.084 Control 47.09±3.641 46.00±4.022 46.34±3.629 139.4±10.41 t 4.481 5.265 6.910 6.374 P <0.0001 <0.0001 <0.0001 <0.0001 2.5 Comparison of teaching satisfaction between groups The residents in the experimental group were significantly more satisfied with the teaching than those in the control group ( P < 0.05, Table 4). Table 4. Comparison of teaching satisfaction Group Enhancing independent learning ability Improving learning interest Increasing teamwork Cultivating clinical thinking ability Experimental 30(85.71%) 30(85.71%) 32(91.43%) 32(91.43%) Control 18(51.43%) 20(57.14%) 17(48.57%) 16(45.71%) P 0.0041 0.0161 0.0002 <0.0001 Group Improving practical operation level Improving comprehensive quality Improving doctor-patient communication ability Experimental 34(97.14%) 30(85.71%) 30(85.71%) Control 19(54.29%) 16(45.71%) 12(34.29%) P <0.0001 0.0009 <0.0001 Discussion The traditional teaching model of clinical medicine often too much emphasizes residents' theoretical knowledge and test scores, resulting in insufficient mastery of clinical practice skills. This situation causes a disconnect between theory and practice for medical students entering clinical works, due to their unfamiliarity with the diagnosis and treatment process, which affects their ability to adapt to clinical work. In serious cases, this situation may lead to diagnosis and treatment errors and medical disputes. In addition, the passing rate of training examinations directly affects residents’ career prospects and is crucial to their future development[ 9 ]. In the clinical teaching of obstetrics and gynecology students in the past, teachers were usually the main bearers of skill transfer, and used a one-way information transmission method, which lacked feedback from the students or summary of educational effects. The learning outcomes and clinical practice skills of students were often evaluated through final examinations. Such lag made it impossible for teachers to correct students’ mistakes and solve their problems timely[ 10 ]. Thus, how to more effectively integrate the learned theoretical knowledge into clinical practice, encourage residents for sufficient preparation, stimulate their enthusiasm for learning, improve their learning outcomes, help them acquire good clinical skills and successfully pass the graduation examination of regular training are challenges that need to be urgently addressed in regular training and teaching for obstetrics and gynecology[ 11 ]. The BOPPPS teaching model is relatively mature in the world, but is still being gradually improved in China. This model can effectively enhance learners’ interest and train their independent learning, clinical thinking and teamwork abilities[ 12 – 14 ]. Traditional teaching methods cannot cope with changes in the teaching environment, which brings severe challenges to clinical teaching. Herein, the characteristics of obstetrics and gynecology were combined with the two teaching models of BOPPPS and flipped classroom, aiming to improve the passing rate of clinical practice ability assessment of regular training residents, enhance their self-learning and clinical thinking abilities and achieve good teaching results. In terms of the distribution of assessment scores, the residents in the experimental group had significantly higher scores than the control group in various aspects, such as reception, clinical thinking and skill assessment ( P < 0.05). Our research confirms that compared with the traditional teaching model, the BOPPPS combined with flipped classroom teaching model can effectively improve doctor-patient communication, and the clinical thinking and skill operation abilities of obstetrics and gynecology regular training residents. The BOPPPS and flipped classroom teaching model distributes teaching-related materials and assigns preview homework before each class, and guides residents to learn independently and complete preview. In the class, the teacher evaluates and asks questions based on residents' preparation and presentation filmstrips, helps them gradually and deeply understand the key points and difficulties of the learning contents, and guides them to set learning goals and actively participate in teaching. In addition, the residents' opportunities to practice their skills are enhanced, and they are encouraged to actively demonstrate their operations. The teacher organizes residents in discussion, analysis, participatory learning, and mutual question asking, so that they learn skill operations more purposefully and enthusiastically. This combined method also helps improve the clinical skills and teamwork ability of residents. Before residents left the department, their teacher will conduct a simulated assessment about the clinical practice ability of standardized obstetricians and gynecologists. The teaching effect was evaluated based on the assessment results and student feedback. The teacher guided residents to search books and related materials, and to summarize the theoretical contents, skill operations and examination points of each session to ensure that all teaching contents were mastered[ 15 , 16 ]. The cultivation of clinical thinking ability is the top priority of obstetrics and gynecology teaching. Only medical residents who master the correct clinical thinking mode can effectively respond to various clinical phenomena and carry out standardized diagnosis and treatment[ 17 ]. We used the PTA scale to evaluate residents' clinical thinking ability from multiple perspectives. The test scores of the experimental group were significantly higher than those in the control group. Through the joint teaching model, residents can systematically construct clinical knowledge. The discussions between teachers and residents and among residents in the flipped classroom helped residents further understand the logic of diagnosis and treatment of obstetrics and gynecology diseases, and guided them into practice. During the preparation and teaching process, residents can boldly question about the existing theoretical knowledge, gradually establish the concept of medical evidence, build a network thinking in obstetrics and gynecology, and fully connect theoretical knowledge with clinical skills. Finally, during regular training, they can establish a complete obstetrics and gynecology clinical knowledge system to better apply it to clinical work[ 18 ]. Moreover, the self-learning ability scores of the experimental group were higher than those in the control group, indicating the combined teaching model of BOPPPS and flipped classroom can more effectively improve the self-learning ability of regular training residents than traditional teaching. This joint teaching model requires residents to prepare with questions in mind, which helps them clarify their learning goals and recognize their shortcomings and thereby significantly improves their enthusiasm for learning. The teachers and residents conducted flipped classroom learning and discussions in the classroom, which improved the learning effect, helped residents consolidate the key points of skill operation and correct deficiencies[ 19 ]. At the same time, this process improved the coordination and cooperation ability among residents and enhanced the doctor-patient communication ability[ 20 , 21 ]. Therefore, the combination of the two teaching modes effectively improves residents' independent learning ability. Finally, we evaluated the teaching satisfaction. The overall satisfaction of the experimental group with teaching was significantly higher than that in the control group, suggesting the combined teaching model of BOPPPS and flipped classroom can significantly improve the recognition of teaching by residents in obstetrics and gynecology training. This combined teaching model is different from traditional teaching. It emphasizes residents' active thinking and practical operations, and helps them effectively improve their learning interest, teamwork, clinical thinking, operational skills, doctor-patient communication and comprehensive quality. Overall, the combined teaching model of BOPPPS and flipped classroom shows good teaching effects[ 22 – 24 ]. Conclusions In summary, the combined teaching model of BOPPPS and flipped classroom in the teaching of clinical practice ability in standardized training of obstetrics and gynecology residents can effectively promote residents to combine theoretical knowledge with clinical practice, improve their independent learning ability, clinical thinking ability and skill operation level, and ensure the teaching effect of teachers, thus significantly improving teaching satisfaction. During the application of this combined teaching model, we organized the participating physicians to conduct a simulated final examination of clinical practice skills. The residents in the experimental group achieved a better pass rate and the overall score was higher than that of the control group, which further verified the effectiveness of this combined teaching model. Therefore, the combined teaching model of BOPPPS and flipped classroom is expected to benefit resident residents, improve their clinical competence and final examination passing rate, and to provide innovative demonstrations for clinical teaching in resident training bases and promote the continuous optimization and improvement of obstetrics and gynecology teaching models. Declarations Acknowledgements The authors wish to acknowledge the contribution of all residents who took part in the research and completed the questionnaire. Author contributions Conceptualization: Writing-original draft preparation: N.S. and L.W.; Writing-review and editing: N.S. and Y.W.; Visualization: X.Y.; Supervision: Y.W.; Project administration: Y.W.; Funding acquisition: L.W. and X.Y. All authors have read and agreed to the published version of the manuscript. Funding Education and Teaching Research Project of Chongqing Medical University (Key Campus 20220207); Education and Teaching Reform Project of the First Clinical College of Chongqing Medical University (CMER202309); Chongqing Medical University Education and Teaching Research Project (JY180106)；Chongqing Natural Science Foundation General Project（CSTB2023NSCQ-MSX0624） Data availability The data displayed in our research are available on request from the corresponding author.Clinical trial number: not applicable. Ethics approval and consent to participate The research was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Board of The First hospital of Chongqing Medical University. Informed consent was obtained from all participants involved in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details Chongqing Heath Center for Women and Children Obstetrics; The First Affiliated Hospital of Chongqing Medical University, Department of Obstetrics, Chongqing 400016; The Affiliated Cancer Hospital of Chongqing University, Oncology Department, Chongqing 400030 References Zhu H, Zhang C, Li N, et al. Satisfaction survey on graduates of standardised training for resident residents in Guizhou Province, China[J]. BMJ Open. 2024;14(10):e085789. Dayan R, Quach TTT, With S et al. Classroom-Based Learning in an Academic Obstetrics and Gynecology Residency Training Program[J]. J Med Educ Curric Dev, 2023, 10(23821205231208790. Siqiang L, Kun H, Quanlan L, et al. Innovative integration of the W + Flipped Classroom and B + BOPPPS teaching models for enhanced learning outcomes[J]. BMC Med Educ. 2024;24(1):1050. Yao Q, Cheng Y, Wang W, et al. Human anatomy curriculum reform for undergraduate nursing residents: An exploratory study[J]. Clin Anat. 2024;37(5):522–33. 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Cite Share Download PDF Status: Published Journal Publication published 06 May, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 12 Nov, 2024 Editor assigned by journal 06 Nov, 2024 Submission checks completed at journal 06 Nov, 2024 First submitted to journal 29 Oct, 2024 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5352449","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377278110,"identity":"8dccbbe9-9e1f-4a9b-80ac-50fc6d0f1f84","order_by":0,"name":"Linna Wei","email":"","orcid":"","institution":"Chongqing Heath Center for Women and Children Obstetrics","correspondingAuthor":false,"prefix":"","firstName":"Linna","middleName":"","lastName":"Wei","suffix":""},{"id":377278111,"identity":"73a0634f-7be8-4fa4-80f6-ee45a3c50282","order_by":1,"name":"Xinyang Yu","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyang","middleName":"","lastName":"Yu","suffix":""},{"id":377278112,"identity":"978d14d9-b932-4ca4-8b15-2db7d53d6e65","order_by":2,"name":"Yiming Wang","email":"","orcid":"","institution":"The Affiliated Cancer Hospital of Chongqing University","correspondingAuthor":false,"prefix":"","firstName":"Yiming","middleName":"","lastName":"Wang","suffix":""},{"id":377278113,"identity":"67515c30-6c27-4c98-8bf5-aea91eb4d3a6","order_by":3,"name":"Nan Shan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACeWaGxAcfDGzs+InWYtjO8NhwRkFasmQD0XrOMz6T5vhwmHHDAWJ1MDYzJ0gzGBxmNj6evIHhR8U2wlrYmdkSjAsM0vnMzjwrYOw5c5sYW3gSkmcYWDOb3cgxYGZsI0ILw2H+D4d5gIo3zyBeC0NiM4+BM+MGCWK1GDYzJDPOMEhLlgD65SBRfpHnP5D+48MfYFS2J2988KOCGIchQILBAZLUg7WQqmMUjIJRMApGCAAA54M8V2PE7F4AAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Nan","middleName":"","lastName":"Shan","suffix":""}],"badges":[],"createdAt":"2024-10-29 08:23:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5352449/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5352449/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07246-z","type":"published","date":"2025-05-06T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70409583,"identity":"0b6ae573-3706-4570-839e-1d5b6f4889dd","added_by":"auto","created_at":"2024-12-03 01:19:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1110202,"visible":true,"origin":"","legend":"\u003cp\u003eOverall design of teaching pattern combining BOPPPS and flipped classroom for Obstetrics and Gynecology Residents\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/15b1b66805e45d4e4984eea1.jpg"},{"id":70409587,"identity":"cf6a8b58-ce0c-4619-9664-1f4bf67ca07d","added_by":"auto","created_at":"2024-12-03 01:19:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":930239,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of research design and training process\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/fbda945466aec6a145efab9d.jpg"},{"id":70409584,"identity":"eef9f578-cf4c-4545-aa6a-456ecbeaf8b0","added_by":"auto","created_at":"2024-12-03 01:19:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":276770,"visible":true,"origin":"","legend":"\u003cp\u003ePTA Assessment Scale for Medical Students' Clinical Thinking Abilities\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/3103510762d3c38650b3ca3c.png"},{"id":70409586,"identity":"b9670972-7b09-4619-8ee6-13d2d1213686","added_by":"auto","created_at":"2024-12-03 01:19:58","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":84579,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of comprehensive and skills exams between the two groups\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/83ed5b06fbd0d83729e13a12.jpg"},{"id":70409581,"identity":"36d1e1a2-0bc9-411b-b8d1-2ba9463671b3","added_by":"auto","created_at":"2024-12-03 01:19:58","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":200125,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of clinical thinking ability scores between the two groups\u003c/p\u003e","description":"","filename":"Fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/07634e08125cd76b3354579f.jpg"},{"id":70410612,"identity":"38912476-db18-44f6-a035-717b2b30e1cd","added_by":"auto","created_at":"2024-12-03 01:27:58","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":201613,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of clinical thinking ability scores between the two groups\u003c/p\u003e","description":"","filename":"Fig6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/41c2cc2b51c2b1ee817d922e.jpg"},{"id":82537947,"identity":"e8280012-5c7f-4763-9b7f-45b01a573e6a","added_by":"auto","created_at":"2025-05-12 16:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3601522,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5352449/v1/f1bcc0d6-0605-49b6-b81d-384a74275ee6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStandardized training for residents has become an effective way to train qualified clinicians, and is widely recognized by the international medical community. Through this training pattern, medical graduates can more effectively apply theoretical knowledge into clinical practice, improving their clinical thinking ability and operational skills, and ultimately become qualified clinicians[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Obstetrics and gynecology is a highly comprehensive discipline combining theory with practice, and requires extremely high clinical practice capabilities from clinicians. Thus, a theoretical learning method suitable for obstetrics and gynecology residents in China is particularly needed, which can effectively improve their clinical thinking and practical ability[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, the BOPPPS teaching model has been widely used in Western countries. This new teaching model is student-centered and educationally goal-oriented. It divides the teaching process into six parts: bridge-in, objective/outcome, pre-assessment, participatory learning, post-assessment, and summary[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this model, interactive communication between the teacher and students in the classroom is highly valued. Students are required to study independently before classes, re-think after classes, and feedback timely on teaching effectiveness. The entire teaching process is a complete and rigorous closed loop, and is highly operable and practical. It provides students with a scientific and reasonable theoretical and practical system, helps teachers more effectively teach courses, and makes the classroom teaching process logical and reasonable, thus achieving excellent teaching results[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe flipped classroom is a student-centered teaching model aimed to break through the time and space limitations of traditional classrooms and enhance students' communication and interaction abilities[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In view of the high requirements for students' clinical communication and operational skills in the standardized training of obstetrics and gynecology residents in recent years, effective teaching models are urgently needed to help them better master the theoretical and practical skills required for clinical practice, and to make them competent for the duties of obstetricians and gynecologists and successfully pass final examinations[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, we adopted a teaching pattern combining BOPPPS and the flipped classroom models in the clinical practice teaching of standardized training for obstetrics and gynecology residents, aiming to explore the impact of the combination of the two teaching models on teaching effectiveness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Participants\u003c/h2\u003e \u003cp\u003e The research participants were 70 residents who were trained in their first year from June 1, 2023 to June 1, 2024 at the standardized physician training base of the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University. Then they were equally and randomly divided into an experimental group and a control group, with 35 people in each group. The control group involved 25 females and 10 males, and the experimental group consisted of 24 females and 11 males. No significant difference between the two groups was found in age, gender, enrollment time, or unified academic performance by the base (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Both groups of teaching staff consist of attending physicians and associate chief physicians with more than three years of teaching experience, who have undergone examiner training and examinations organized by the Chongqing Residency Training Office, and possess qualifications for residency training and examination. Residents were allocated via the envelope method. Exclusion criteria included: (1) serious disciplinary violations during the study period; (2) unwillingness to participate in this study.\u003c/p\u003e \u003cp\u003eBefore the training begins, the base will conduct a unified simulated examination of clinical practice abilities for obstetrics and gynecology residencies, which will be evaluated by supervising physicians. According to the \"Standard Assessment Plan for Clinical Practice Abilities at the End of Residency Training (2023)\" from Chongqing, the examination content includes clinical thinking ability stations (Station 1: patient interview and communication, Station 2: case presentation, diagnosis, differential diagnosis, and treatment plan) and practical operation station (Station 3). The thinking ability scores of the experimental group before teaching ranged from 45 to 75 points, with an average score of 63.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17 points; the clinical operation scores ranged from 57 to 76 points, with an average score of 58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06 points. The thinking ability scores of the control group before teaching ranged from 47 to 72 points, with an average score of 62.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33 points; the clinical operation scores ranged from 56 to 75 points, with an average score of 57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58 points. Comparison of thinking and clinical operation scores between the two groups before teaching showed no significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating the data were comparable.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Teaching models\u003c/h3\u003e\n\u003cp\u003eThe traditional teaching model was adopted in the training and teaching of residents in the control group. (1) Two weeks before the courses, the teacher distributed relevant materials about clinical practice ability assessment of standardized obstetrics and gynecology physician training, including consultation, clinical thinking and skill operation. A total of 9 items were included, such as: neonatal asphyxia resuscitation, fetal heart electronic monitoring technology and interpretation, normal delivery and midwifery, four-part palpation, perineal incision and suturing, obstetric history collection and emergency consultation, gynecological examination, vaginal bleeding, abdominal pain diagnostic and treatment approach, posterior fornix puncture, etc. (2) The teaching objectives of standardized obstetrics and gynecology physician training were clarified, and filmstrips and videos were provided to explain theoretical knowledge and practical operations in combination with cases. In the classroom, the teachers guided residents to master the key points and difficulties of the lesson and conducted on-site demonstrations.\u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;1, the teaching pattern combining BOPPPS and flipped classroom was adopted in the experimental group. (1) Bridge-in: The teachers distributed assessment materials two weeks before the course and required the residents to preview relevant theoretical knowledge and operation videos, and prepared filmstrips. The teachers guided each group (N\u0026thinsp;=\u0026thinsp;5) and answered questions. (2) Objective/outcome: The teachers clarified the teaching objectives of standardized obstetrics and gynecology physician training, and asked the residents to combine theory and practice to make filmstrip presentations, and to master the key points and difficulties of the course. (3) Pre-assessment: The teachers evaluated the residents\u0026rsquo; filmstrips and preparations, and asked questions to understand the residents\u0026rsquo; mastery of theoretical knowledge. (4) Participatory learning: Combining the flipped classroom format, with the presentation and skill operation of residents as the main focus, select a group of slides for reporting and discussion. Each resident is required to independently complete various operations of the practical course, while teachers participate in monitoring the discussion, timely supplementing theoretical knowledge and correcting any issues in the operations of the residents. (5) Post-assessment: The teachers simulated an assessment of the clinical practice ability of standardized physician training before residents left the department, and filled in the evaluation form of independent learning ability, clinical thinking ability and satisfaction with the teaching effect. (6) Summary: The teachers guided the residents to summarize their teaching and learning and deepen their understanding of the key points and difficulties of practical skills.\u003c/p\u003e \u003cp\u003eBoth groups of residents received 12 weeks of training, with one session per week, each lasting 2 class-hours and involving 3 teachers during training.\u003c/p\u003e\n\u003ch3\u003e1.3 Observation indices\u003c/h3\u003e\n\u003cp\u003eThe overview of our research design and training process were shown in Fig.\u0026nbsp;2. After all courses were completed and before the residents left the department, the teaching effect was evaluated by combining standardized simulation assessment of clinical practice ability of standardized obstetrics and gynecology physician training with a questionnaire. The evaluation time, method and standard were the same for the two groups.\u003c/p\u003e\n\u003ch3\u003e1.3.1 Reception and clinical thinking assessment\u003c/h3\u003e\n\u003cp\u003eA unified mock examination was set up according to the standardized training outline for obstetricians and gynecologists. Residents in the experimental group and the control group were given simulation assessments. The assessment content for clinical diagnosis and clinical thinking includes 2 case histories each from obstetrics and gynecology, with 1 case selected for evaluation. Each item is scored out of 50 points, with a passing score of 30 points, for a total of 100 points.\u003c/p\u003e\n\u003ch3\u003e1.3.2 Clinical practice skill assessment\u003c/h3\u003e\n\u003cp\u003eThe test was based on the practical operations required by the standardized training outline for obstetricians and gynecologists, including gynecological examination, four-step palpation, perineal suture and curettage. Select one item for scoring. Each operation has detailed scoring criteria, and the difficulty and scoring criteria should be kept consistent. The full score is 100 points, and the passing score is 60 points.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1.3.3 Primary trait analysis (PTA) assessment of clinical thinking skills\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;3, both the experimental and control groups were evaluated with PTA, which covered logical thinking ability, systematic thinking ability, evidence-based thinking ability, critical thinking ability, imaginative thinking ability, network thinking ability, vertical thinking ability, and lateral thinking ability. Based on the downtrend of clinical medical thinking ability, a stepwise 3-2-1 method was used to assign points[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For example: In the evaluation of logical thinking ability, a score of 3 points is given for a strong logical sequence in clinical medicine diagnosis and treatment; 2 points for understanding the logical sequence of clinical medicine but not being able to apply it well; and 1 point for only having a basic understanding of logical thinking in clinical studies. Based on this, calculate the number of people in each score range and the average score for different indicators.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.3.4 Self-learning ability assessment\u003c/h3\u003e\n\u003cp\u003eThe learning ability of residents was assessed using the Self-directed Learning Readiness Scale (SDLRS), which includes three aspects: self-management, learning enthusiasm, and self-control. The total score of SDLRS is 200 points, and a higher score reflects a stronger self-directed learning ability[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e1.3.5 Teaching satisfaction evaluation\u003c/h3\u003e\n\u003cp\u003eThe teaching satisfaction of the two groups of training residents was evaluated using a questionnaire, and 70 valid questionnaires were collected. A self-made satisfaction questionnaire was used to evaluate residents' teaching satisfaction in enhancing independent learning ability, learning interest, teamwork spirit, practical operation level, comprehensive quality, and doctor-patient communication ability, and in cultivating clinical thinking ability. The questionnaire has been tested for reliability and validity. The Cronbach α coefficient of the total questionnaire is 0.917, the split-half coefficient is 0.819, and the coefficients of each subscale are between 0.712 and 0.843, indicating the questionnaire and subscales of this experiment have high internal consistency and meet the standards.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eThe relevant data were sorted in Excel, and statistical analysis was performed using SPSS 23.0. The measured data were expressed as x̄\u0026plusmn;s and analyzed using two-independent-sample mean t-test. Counting data were expressed as n(%) and examined via \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e test. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Comparison of medical consultation and clinical thinking assessment scores between groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe consultation score of the experimental group (36.51\u0026plusmn;5.13 points) was significantly higher than the control group (33.43\u0026plusmn;3.86 points) (\u003cem\u003et\u003c/em\u003e=2.844, \u003cem\u003eP\u003c/em\u003e=0.0059). The clinical thinking assessment score of the experimental group (41.11\u0026plusmn;4.886 points) \u0026nbsp;also significantly exceeded that of the control group (33.69\u0026plusmn;5.251 points) (\u003cem\u003et\u003c/em\u003e=6.127, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.0001, Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of clinical practice skills between groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical practice skill assessment score of the experimental group (90.69\u0026plusmn;3.841) was significantly higher than that of the control group (79.77\u0026plusmn;4.426) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001; Table 1, Fig.4 ).\u003c/p\u003e\n\u003cp\u003eTable 1. Comparison of test scores between the experimental group and the control group (scores, x̄\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.662%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003eReception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003eClinical thinking assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003eClinical skill assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.662%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e36.51\u0026plusmn;5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e41.11\u0026plusmn;4.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e90.69\u0026plusmn;3.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.662%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e33.43\u0026plusmn;3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e33.69\u0026plusmn;5.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e79.77\u0026plusmn;4.426\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.662%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e2.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e6.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e11.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.662%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.9437%;\"\u003e\n \u003cp\u003e0.0059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.6972%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 PTA evaluation of clinical thinking ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe residents in the experimental group had significantly better clinical thinking ability scores than the control group (P \u0026lt; 0.05, Table 2, Fig.5\u0026amp;Fig.6 ).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Clinical thinking ability PTA\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eGroup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eLogical thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eSystematic thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eEvidence-based thinking ability\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eCritical thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e2.486\u0026plusmn;0.6122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e2.343\u0026plusmn;0.5913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e2.314\u0026plusmn;0.6311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e2.229\u0026plusmn;0.5983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e1.543\u0026plusmn;0.5054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e1.629\u0026plusmn;0.5983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e1.600\u0026plusmn;0.6039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e1.486\u0026plusmn;0.5621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e7.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e5.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e4.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e5.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19.8594%;\"\u003e\n \u003cp\u003eGroup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003eImaginative thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003eNetwork thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003eVertical thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003eLateral thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19.8594%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e2.429\u0026plusmn;0.6547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e2.371\u0026plusmn;0.6456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e2.400\u0026plusmn;0.5531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e2.543\u0026plusmn;0.5606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19.8594%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e1.914\u0026plusmn;0.6122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e1.857\u0026plusmn;0.6482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e1.829\u0026plusmn;0.6177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e1.886\u0026plusmn;0.5827\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19.8594%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e3.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e3.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e4.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e4.808\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19.8594%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e0.0014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0351%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Comparison of self-learning ability between groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SDLRS scores of the experimental group were significantly higher than those of the control group (P \u0026lt; 0.0001; Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. Self-learning ability SDLRS\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eGroup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eSelf-management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003ePassion for learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eSelf-control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e50.86\u0026plusmn;3.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e51.06\u0026plusmn;4.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e52.40\u0026plusmn;3.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e154.3\u0026plusmn;9.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e47.09\u0026plusmn;3.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e46.00\u0026plusmn;4.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e46.34\u0026plusmn;3.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e139.4\u0026plusmn;10.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e4.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e5.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e6.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e6.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Comparison of teaching satisfaction between groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe residents in the experimental group were significantly more satisfied with the teaching than those in the control group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of teaching satisfaction\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.4505%;\"\u003e\n \u003cp\u003eGroup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6847%;\"\u003e\n \u003cp\u003eEnhancing independent learning ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003eImproving learning interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003eIncreasing teamwork\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7838%;\"\u003e\n \u003cp\u003eCultivating clinical thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.4505%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6847%;\"\u003e\n \u003cp\u003e30(85.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e30(85.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e32(91.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7838%;\"\u003e\n \u003cp\u003e32(91.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.4505%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6847%;\"\u003e\n \u003cp\u003e18(51.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e20(57.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e17(48.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7838%;\"\u003e\n \u003cp\u003e16(45.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.4505%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.6847%;\"\u003e\n \u003cp\u003e0.0041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e0.0161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5405%;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7838%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"469\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15.9915%;\"\u003e\n \u003cp\u003eGroup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.4094%;\"\u003e\n \u003cp\u003eImproving practical operation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.9616%;\"\u003e\n \u003cp\u003eImproving comprehensive quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.6375%;\"\u003e\n \u003cp\u003eImproving doctor-patient communication ability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15.9915%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.4094%;\"\u003e\n \u003cp\u003e34(97.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.9616%;\"\u003e\n \u003cp\u003e30(85.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.6375%;\"\u003e\n \u003cp\u003e30(85.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15.9915%;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.4094%;\"\u003e\n \u003cp\u003e19(54.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.9616%;\"\u003e\n \u003cp\u003e16(45.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.6375%;\"\u003e\n \u003cp\u003e12(34.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15.9915%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.4094%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.9616%;\"\u003e\n \u003cp\u003e0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.6375%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe traditional teaching model of clinical medicine often too much emphasizes residents' theoretical knowledge and test scores, resulting in insufficient mastery of clinical practice skills. This situation causes a disconnect between theory and practice for medical students entering clinical works, due to their unfamiliarity with the diagnosis and treatment process, which affects their ability to adapt to clinical work. In serious cases, this situation may lead to diagnosis and treatment errors and medical disputes. In addition, the passing rate of training examinations directly affects residents\u0026rsquo; career prospects and is crucial to their future development[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the clinical teaching of obstetrics and gynecology students in the past, teachers were usually the main bearers of skill transfer, and used a one-way information transmission method, which lacked feedback from the students or summary of educational effects. The learning outcomes and clinical practice skills of students were often evaluated through final examinations. Such lag made it impossible for teachers to correct students\u0026rsquo; mistakes and solve their problems timely[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Thus, how to more effectively integrate the learned theoretical knowledge into clinical practice, encourage residents for sufficient preparation, stimulate their enthusiasm for learning, improve their learning outcomes, help them acquire good clinical skills and successfully pass the graduation examination of regular training are challenges that need to be urgently addressed in regular training and teaching for obstetrics and gynecology[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe BOPPPS teaching model is relatively mature in the world, but is still being gradually improved in China. This model can effectively enhance learners\u0026rsquo; interest and train their independent learning, clinical thinking and teamwork abilities[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Traditional teaching methods cannot cope with changes in the teaching environment, which brings severe challenges to clinical teaching. Herein, the characteristics of obstetrics and gynecology were combined with the two teaching models of BOPPPS and flipped classroom, aiming to improve the passing rate of clinical practice ability assessment of regular training residents, enhance their self-learning and clinical thinking abilities and achieve good teaching results.\u003c/p\u003e \u003cp\u003eIn terms of the distribution of assessment scores, the residents in the experimental group had significantly higher scores than the control group in various aspects, such as reception, clinical thinking and skill assessment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Our research confirms that compared with the traditional teaching model, the BOPPPS combined with flipped classroom teaching model can effectively improve doctor-patient communication, and the clinical thinking and skill operation abilities of obstetrics and gynecology regular training residents.\u003c/p\u003e \u003cp\u003eThe BOPPPS and flipped classroom teaching model distributes teaching-related materials and assigns preview homework before each class, and guides residents to learn independently and complete preview. In the class, the teacher evaluates and asks questions based on residents' preparation and presentation filmstrips, helps them gradually and deeply understand the key points and difficulties of the learning contents, and guides them to set learning goals and actively participate in teaching. In addition, the residents' opportunities to practice their skills are enhanced, and they are encouraged to actively demonstrate their operations. The teacher organizes residents in discussion, analysis, participatory learning, and mutual question asking, so that they learn skill operations more purposefully and enthusiastically. This combined method also helps improve the clinical skills and teamwork ability of residents. Before residents left the department, their teacher will conduct a simulated assessment about the clinical practice ability of standardized obstetricians and gynecologists. The teaching effect was evaluated based on the assessment results and student feedback. The teacher guided residents to search books and related materials, and to summarize the theoretical contents, skill operations and examination points of each session to ensure that all teaching contents were mastered[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe cultivation of clinical thinking ability is the top priority of obstetrics and gynecology teaching. Only medical residents who master the correct clinical thinking mode can effectively respond to various clinical phenomena and carry out standardized diagnosis and treatment[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. We used the PTA scale to evaluate residents' clinical thinking ability from multiple perspectives. The test scores of the experimental group were significantly higher than those in the control group. Through the joint teaching model, residents can systematically construct clinical knowledge. The discussions between teachers and residents and among residents in the flipped classroom helped residents further understand the logic of diagnosis and treatment of obstetrics and gynecology diseases, and guided them into practice. During the preparation and teaching process, residents can boldly question about the existing theoretical knowledge, gradually establish the concept of medical evidence, build a network thinking in obstetrics and gynecology, and fully connect theoretical knowledge with clinical skills. Finally, during regular training, they can establish a complete obstetrics and gynecology clinical knowledge system to better apply it to clinical work[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, the self-learning ability scores of the experimental group were higher than those in the control group, indicating the combined teaching model of BOPPPS and flipped classroom can more effectively improve the self-learning ability of regular training residents than traditional teaching. This joint teaching model requires residents to prepare with questions in mind, which helps them clarify their learning goals and recognize their shortcomings and thereby significantly improves their enthusiasm for learning. The teachers and residents conducted flipped classroom learning and discussions in the classroom, which improved the learning effect, helped residents consolidate the key points of skill operation and correct deficiencies[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. At the same time, this process improved the coordination and cooperation ability among residents and enhanced the doctor-patient communication ability[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, the combination of the two teaching modes effectively improves residents' independent learning ability.\u003c/p\u003e \u003cp\u003eFinally, we evaluated the teaching satisfaction. The overall satisfaction of the experimental group with teaching was significantly higher than that in the control group, suggesting the combined teaching model of BOPPPS and flipped classroom can significantly improve the recognition of teaching by residents in obstetrics and gynecology training. This combined teaching model is different from traditional teaching. It emphasizes residents' active thinking and practical operations, and helps them effectively improve their learning interest, teamwork, clinical thinking, operational skills, doctor-patient communication and comprehensive quality. Overall, the combined teaching model of BOPPPS and flipped classroom shows good teaching effects[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the combined teaching model of BOPPPS and flipped classroom in the teaching of clinical practice ability in standardized training of obstetrics and gynecology residents can effectively promote residents to combine theoretical knowledge with clinical practice, improve their independent learning ability, clinical thinking ability and skill operation level, and ensure the teaching effect of teachers, thus significantly improving teaching satisfaction. During the application of this combined teaching model, we organized the participating physicians to conduct a simulated final examination of clinical practice skills. The residents in the experimental group achieved a better pass rate and the overall score was higher than that of the control group, which further verified the effectiveness of this combined teaching model. Therefore, the combined teaching model of BOPPPS and flipped classroom is expected to benefit resident residents, improve their clinical competence and final examination passing rate, and to provide innovative demonstrations for clinical teaching in resident training bases and promote the continuous optimization and improvement of obstetrics and gynecology teaching models.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to acknowledge the contribution of all residents who took part in the research and completed the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Writing-original draft preparation: N.S. and L.W.; Writing-review and editing: N.S. and Y.W.; Visualization: X.Y.; Supervision: Y.W.; Project administration: Y.W.; Funding acquisition: L.W. and X.Y. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEducation and Teaching Research Project of Chongqing Medical University (Key Campus 20220207); Education and Teaching Reform Project of the First Clinical College of Chongqing Medical University (CMER202309); Chongqing Medical University Education and Teaching Research Project (JY180106)；Chongqing Natural Science Foundation General Project（CSTB2023NSCQ-MSX0624）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data displayed in our research are available on request from the corresponding author.Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Board of The First hospital of Chongqing Medical University. Informed consent was obtained from all participants involved in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eChongqing Heath Center for Women and Children Obstetrics;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe First Affiliated Hospital of Chongqing Medical University, Department of Obstetrics, Chongqing 400016;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe Affiliated Cancer Hospital of Chongqing University, Oncology Department, Chongqing 400030\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhu H, Zhang C, Li N, et al. Satisfaction survey on graduates of standardised training for resident residents in Guizhou Province, China[J]. BMJ Open. 2024;14(10):e085789.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDayan R, Quach TTT, With S et al. Classroom-Based Learning in an Academic Obstetrics and Gynecology Residency Training Program[J]. J Med Educ Curric Dev, 2023, 10(23821205231208790.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiqiang L, Kun H, Quanlan L, et al. Innovative integration of the W\u0026thinsp;+\u0026thinsp;Flipped Classroom and B\u0026thinsp;+\u0026thinsp;BOPPPS teaching models for enhanced learning outcomes[J]. BMC Med Educ. 2024;24(1):1050.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao Q, Cheng Y, Wang W, et al. Human anatomy curriculum reform for undergraduate nursing residents: An exploratory study[J]. Clin Anat. 2024;37(5):522\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvakyan EI, Taylor DCM. 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BMC Med Educ. 2021;21(1):614.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDawod MS, Alswerki MN, Al-Takhaineh MA. Factors that influence medical residents' decision to pursue a career in orthopaedics: a comprehensive analysis[J]. Int Orthop. 2024;48(5):1139\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMengesha AK, Ayele HS, Misker MF, et al. Assessing the effectiveness of flipped classroom teaching-learning method among undergraduate medical residents at gondar university, college of medicine and health sciences: an interventional study[J]. BMC Med Educ. 2024;24(1):1108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRayburn WF. Emergencies in Obstetrics and Gynecology: Readiness, Recognition, Response, and Reporting[J]. Obstet Gynecol Clin North Am. 2022;49(3):xiii\u0026ndash;xiv.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Wei W, Li X, et al. 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J Prof Nurs. 2022;42:15\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaushik JS, Raghuraman K, Verma S, et al. Online Interactive Flipped Classroom Teaching in Pediatrics for Medical Undergraduates[J]. Cureus. 2023;15(4):e37603.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"BOPPPS teaching model, flipped classroom, obstetrics and gynecology, teaching practice","lastPublishedDoi":"10.21203/rs.3.rs-5352449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5352449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Aim\u003c/strong\u003e To explore how a teaching model that integrates bridge-in, objective/outcome, pre-assessment, participatory learning, post-assessment, and summary (the BOPPPS model) and flipped classroom teaching will affect the clinical practice abilities of obstetrics and gynecology residents in standardized training. \u003cstrong\u003eMethods\u003c/strong\u003e Seventy standardized training residents from the obstetrics and gynecology training base of the First Affiliated Hospital of Chongqing Medical University from June 2023 to June 2024 were selected as research subjects. They were randomly and equally divided into an experimental group (adopting the BOPPPS model combined with the flipped classroom approach) and a control group (adopting traditional teaching methods). The effectiveness of the teaching model was assessed by comparing the performances of the two groups in clinical practice ability simulation assessments, clinical thinking ability, self-directed learning ability, and satisfaction with the teaching methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The experimental group was scored significantly higher than the control group in patient reception, clinical thinking assessment, and practical skill assessment. The experimental group significantly outperformed the control group in clinical thinking ability scores, self-directed learning ability scores, and overall scores. The experimental group showed significantly higher satisfaction with the BOPPPS and flipped classroom teaching combined model in enhancing self-directed learning ability, learning interest, practical operation levels, teamwork, comprehensive quality, and doctor-patient communication skills, and in cultivating clinical thinking ability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e The BOPPPS combined with flipped classroom teaching in standardized training can effectively improve the assessment scores, clinical thinking and self-directed learning abilities of obstetrics and gynecology residents, stimulate their initiative and enthusiasm for learning, meet their teaching needs, and thus enhance teaching quality and assessment passing rates.\u003c/p\u003e","manuscriptTitle":"Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-03 01:19:53","doi":"10.21203/rs.3.rs-5352449/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-12T15:55:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-06T09:29:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-06T09:14:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-10-29T08:19:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06555836-1583-4c54-ade8-39d573fa07b1","owner":[],"postedDate":"December 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T16:07:34+00:00","versionOfRecord":{"articleIdentity":"rs-5352449","link":"https://doi.org/10.1186/s12909-025-07246-z","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-05-06 15:57:28","publishedOnDateReadable":"May 6th, 2025"},"versionCreatedAt":"2024-12-03 01:19:53","video":"","vorDoi":"10.1186/s12909-025-07246-z","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07246-z","workflowStages":[]},"version":"v1","identity":"rs-5352449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5352449","identity":"rs-5352449","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}