Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in Psychiatric Clinical Practice Teaching: An Empirical Study

Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in Psychiatric Clinical Practice Teaching: An Empirical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in Psychiatric Clinical Practice Teaching: An Empirical Study Wenjie Shi, Xiangsong Shi, Lirong Zhuang, Tingting Zhu, Gongyin Li, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7223072/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Objective To assess the viability and effectiveness of combining Outcome-Based Education (OBE) with Problem-Based Learning (PBL) in the teaching of psychiatric clinical practice. Methods Overall, 43 fifth-year undergraduate psychiatry majors were enrolled in the study. Based on free will, 21 interns opted for the traditional lecture-based method and served as the Control Group while 22 interns participated in the OBE-PBL integrated teaching approach forming the Study Group. The two groups were compared in terms of theoretical assessment scores, practical assessment scores, teaching satisfaction, and the achievement of career plans (postgraduate entrance exam success or employment in tertiary hospitals) were compared between the two groups one year after graduation. Results There was no significant difference ( p > 0.05) between the groups with relation to baseline characteristics (age, gender, source institution, fourth-year GPA). The Study Group achieved significantly higher scores when compared with the Control Group on the final theoretical assessment (88.45 ± 4.76 vs. 83.81 ± 5.30, p < 0.05), overall practical assessment (84.68 ± 3.27 vs. 80.57 ± 3.20, p < 0.05), and teaching satisfaction (91% vs. 62%, p < 0.05). Similarly, the Study Group performed better when compared with the Control Group (91% vs. 57%, p < 0.05) in the achievement of the career plan one year after graduation. Conclusion Integrating OBE with PBL significantly enhances the effectiveness of psychiatric clinical practice teaching. Outcome-Based Education (OBE) Problem-Based Learning (PBL) Psychiatry Clinical Practice Teaching Medical education Career Plan Figures Figure 1 Figure 2 Figure 3 1 Background Psychiatry, an important subdiscipline of clinical medicine, poses significant challenges to clinical practice teaching due to its unique professional traits. These particularities are concentrated in three aspects: Firstly, mental illnesses are diagnosed based on clinical symptomatology and the characteristics of disease course evolution as clear unique biological markers are not present; Secondly, there exists significant heterogeneity in clinical manifestations within the same diagnostic category, resulting in different treatment approaches and prognostic outcomes; Thirdly, comorbidity, symptom overlap, and cross-application of treatment modalities are common among different mental illnesses [ 1 ]. These intricate clinical characteristics have led the conventional "lecture-based" teaching model into a dual predicament: Medical students often find themselves in the predicament of passively receiving fragmented knowledge, while educators struggle to teach dynamic clinical thinking through standardized methods. Consequently, this prevents these "future psychiatrists" from developing their clinical decision-making skills and humanistic care literacy [ 2 ]. In the process of reforming higher medical education, the iterative innovation of educational concepts and teaching models has consistently been a key path to overcoming the bottleneck in teaching quality. Notably, the concepts of Outcome-Based Education (OBE) and Problem-Based Learning (PBL) have been increasingly applied in teaching at institutions of higher education. The former constructs a system of learning objectives through the principle of "reverse design", emphasizing an orientation toward the competency of practicing physicians and systematically planning the knowledge construction, skill training, and professional value shaping of medical students [ 3 ]. The latter, grounded in clinical problems, motivates students to complete the cognitive loop of "identifying problems → analyzing problems → solving problems" through contextualized cases, which can effectively facilitate the transfer of theoretical knowledge to clinical practice [ 4 ]. Previous research has indicated that the individual implementation of both models in the field of psychiatric education has proven beneficial in terms of improving clinical reasoning skills and learning engagement. However, feedback from teaching practice has also highlighted the single models' fundamental limits. Extended instruction cycles and delayed formative evaluation frequently undermine the efficacy of OBE by creating a discrepancy between predetermined outcomes and attained competencies [ 5 ], while PBL faces operational challenges including demanding group coordination requirements, significant efficacy disparities among learners, and unidimensional assessment [ 6 ]. Consequently, even though both models have the potential to be more effective, these drawbacks limited their wider application in psychiatric clinical teaching. In light of this, the current study aims to adapt the PBL model to psychiatric practice instruction by integrating the OBE idea. It aims to use the dynamic feedback mechanism of the PBL model to quickly identify and resolve important difficulties that arise during the implementation of OBE, as well as to prevent the disadvantages of lengthy cycles and control issues in the OBE teaching process. Simultaneously, the OBE concept's goal-oriented approach, seeks to motivate students to engage in learning more actively, thereby reducing the challenges associated with PBL teaching in terms of teacher supervision, organizational leadership, student grouping, and communication. Additionally, it intends to integrate formative and summative evaluations to establish a multidimensional assessment model covering theoretical knowledge, clinical skills, scientific research thinking, and professional literacy. 2 Subjects and Methods 2.1 Study Subjects Overall, a total of 43 fifth-year undergraduate students majoring in psychiatry who completed their internships at the Huai'an Clinical College of Mental Health, Jining Medical University, from September 2022 to June 2024 were included as study subjects. They were divided into two groups based on their own willingness. The Control Group consisted of 21 students, including 11 males and 10 females, with 5 from Xuzhou Medical University and 16 from Jining Medical University, all aged 22–23 years. The conventional teaching model was adopted. The Study Group consisted of 22 students, including 12 males and 10 females, with 6 from Xuzhou Medical University and 16 from Jining Medical University, all aged 21–23 years. The OBE-integrated PBL teaching model was applied for clinical practice teaching during the internship. Baseline data were compared between the two groups, including gender (males: 12/23 vs. 11/21, χ² = 0.020), age (21.91 ± 0.75 vs. 21.81 ± 0.68, t = 0.455), school origin (students from Jining Medical University: 16/22 vs. 15/21, χ² = 0.068), and average course score in the 4th academic year (81.73 ± 8.18 vs. 81.38 ± 7.00, t = 0.149). No statistically significant differences were observed between the groups (all p > 0.05). The research received approval from the Ethics Committee of Huai’an NO.3 People’s Hospital (Approval Number: 2023002) and was executed in alignment with the principles of the Declaration of Helsinki. All participants provided informed consent. 2.2 Research Methods 2.2.1 Control Group The Control Group received conventional lecture-based instruction. The Psychiatry department allocated physicians with extensive teaching experience, who developed teaching plans based on the curriculum for the psychiatric clinical internship. They established clear teaching objectives, systematically delivered clinical practice knowledge in psychiatry, and addressed trainees' questions. Instructors remained in charge throughout the entire teaching process, while interns primarily participated through post-lecture Q&A sessions and passive listening. 2.2.2 Study Group The Study Group had their psychiatric practice teaching by integrating the OBE concept with the PBL teaching method, and the details of the implementation are described below. Teacher-student training: Both the instructors and the interns and clinical teaching teachers in the study group received systematic training to deeply interpret the core connotations and fundamental meanings of the OBE concept and the PBL teaching method. Analysis of learning situation and goal setting: Demographic data, past learning situation, and career development plans (postgraduate entrance examination success or employment in tertiary hospitals one year after graduation) of students were collected through self-designed questionnaires. Electronic files of students were created, a learning scenario analysis was carried out, and customized training objectives were developed based on the results. For the full survey questionnaire, please refer to Supplementary Material 1. Group teaching and dynamic adjustment: 4–5 students with similar self-development plans were divided into groups, and each group was assigned a responsible teacher. Teachers and students jointly formulated PBL teaching plans, which focused on English, theoretical learning, clinical practice, scientific research foundation, and other aspects according to the training goals. The responsible instructor led the students in discussing and learning about the specific subjects included in the lesson plan during the internship, and optimized teaching activities in real time according to students' feedback. Diversified assessment system: This study constructed a "process-formative-summative" three-dimensional evaluation system to assess teaching quality and learning effects comprehensively. Theoretical teaching and evaluation: Process evaluation was conducted via the Rain Classroom platform (an intelligent teaching tool integrating course presentation, real-time interaction and learning data statistics) and PBL qualitative/quantitative evaluation tools, enabling real-time teaching optimization. With a focus on evaluating students' thorough application of theoretical knowledge, the theoretical assessment used a "dual-track system" that integrated summative theoretical test results with PBL process evaluation scores. Clinical practice evaluation: Standardized patients (SP) and objective structured clinical examinations (OSCE) were added to clinical practice assessment to conduct summative comprehensive evaluation from the dimensions of knowledge application, professional quality, clinical thinking, and operational skills. Instructors conducted dynamic assessments based on students' daily diagnosis and treatment practice performance, with process and formative evaluation at the center. 2.3 Observation Indicators In this study, theoretical assessment scores, practical assessment scores, teaching satisfaction, and the achievement rate of career plans were chosen as observation indicators to assess the efficacy of instruction from a variety of angles, such as academic performance, subjective feedback, and long-term development. Theoretical assessment scores: Both groups of interns' thorough command of psychiatric theoretical knowledge was assessed using a standardized closed-book written exam. The test paper, covering core psychiatric theoretical knowledge with a total score of 100, was compiled by a chief psychiatrist who was not involved in this study. Questions were randomly selected from a pre-established question bank in line with the teaching syllabus. Higher scores indicated a more solid grasp of fundamental theories. Practical assessment scores: Multi-station clinical practice assessments were conducted using a combination of SP and OSCE with reference to the clinical competence assessment protocol for standardized psychiatric residency training. These assessments focused on clinical skills, clinical reasoning, interpretation of auxiliary examinations, and neurological examination. The primary diseases evaluated were schizophrenia and delusional disorders, mood disorders, and neurotic disorders, containing 10 clinical practice assessment questions distributed in a 5:3:2 ratio. One question was chosen at random by each intern to respond to. The assessment duration was 30 minutes (Station 1), 20 minutes (Station 2), 10 minutes (Station 3), and 10 minutes (Station 4), totaling 70 minutes. Each station was initially scored out of 100, and the total score was calculated using weights of 40% (Station 1), 30% (Station 2), 10% (Station 3), and 20% (Station 4). Teaching satisfaction: A self-designed questionnaire was used for an anonymous assessment, which was disseminated and gathered centrally following the interns' assessment. Three aspects were the emphasis of the questionnaire, which was created using the principles of content validity: teaching methods, teaching content, and assessment design. It included 20 Likert 5-point scale items (1 = extremely dissatisfied, 5 = very satisfied), with a total score of 100. Achievement rate of career plans one year after graduation: To ascertain whether the career plans created by interns at the beginning of the internship were realized, a follow-up was carried out a year after graduation using reserved contact information (phone calls, WeChat [a widely used social media and messaging application in China], or email). Those who successfully gained admission to postgraduate programs or secured employment in tertiary hospitals were considered to have completed their career goals; others who worked in a secondary hospital or had not yet secured a satisfactory position were not considered to have achieved their career plan. Per-group achievement rates of career plans were quantified as follows: 2.4 Statistical Methods SPSS 26.0 software was used to statistically evaluate all of the data after it was entered into Excel. Measurement data were expressed as (mean ± standard deviation), and categorical data as percentages. Normally distributed measurement data between the two groups were compared using the independent samples t-test while categorical data were compared using the chi-square test or Fisher's exact test. A p-value < 0.05 was considered to be statistically significant (α = 0.05). 3 Results​ 3.1 Comparison of Theoretical Assessment Scores between the Two Groups​ The theoretical assessment score of the Study Group (88.45 ± 4.76) was significantly higher ( p = 0.004) when compared with the Control Group (83.81 ± 5.30) (Fig. 1 ).​ 3.2 Comparison of Practical Assessment Scores between the Two Groups​ The scores of the study group in the three stations (clinical skills, clinical thinking, interpretation of auxiliary examinations) and the total score of practical assessment were significantly higher ( p 0.05) (Table 1 ). ​ Table 1 Comparison of practical assessment scores between the two groups (N = 43)​ Group Professional Skills Clinical Thinking Interpretation of Auxiliary Examinations Neurological Examination Total Practical Assessment Score Study group N = 22 83.73 ± 3.49 85.55 ± 6.77 86.45 ± 7.70 83.55 ± 7.45 84.68 ± 3.27 Control group N = 21 81.19 ± 4.08 78.76 ± 5.68 81.62 ± 7.47 81.14 ± 7.39 80.57 ± 3.20 t 2.193 3.549 2.089 1.061 4.161 P 0.034 0.001 0.043 0.295 <0.001 ​ 3.3 Comparison of Teaching Satisfaction between the Two Groups​ The recovery rate and effective rate of the teaching satisfaction questionnaire were 100%. Overall, 91% (20/22) in the Study Group were satisfied with the new OBE-integrated PBL education model. The results demonstrated that this model effectively promoted the development of autonomous learning ability, deepened the understanding of theoretical knowledge, and improved the ability to solve practical problems. Moreover, it strengthened the sense of teamwork which was shown by the significantly enhanced interaction between students, and between teachers and students. Additionally, it was also effective in training communication skills and broadening academic horizons, laying a solid foundation for subsequent clinical practice and scientific research. In contrast, only 62% (13/21) of the 21 interns in the Control Group acknowledged the conventional "lecture-based" educational approach they were given and provided comparable feedback. The Fisher's exact chi-square test showed that the difference in satisfaction between the two groups was statistically significant (χ² = 5.064, p = 0.024), as shown in Fig. 2 .​ 3.4 Comparison of the Achievement Rate of Career Plans between the Two Groups of Interns One Year after Graduation​ The achievement rate of career plans in the Study Group was 91% (20/22); 18 individuals were admitted to master's programs for further study, two were employed in tertiary hospitals, while one worked in a secondary hospital, and one participated in standardized training for psychiatric specialists. The achievement rate of career plans was much lesser at 57% (12/21) in the control group. Nine people successfully entered postgraduate programs, 3 were employed in tertiary hospitals, while 7 were employed in secondary hospitals, and 2 chose to participate in standardized training for psychiatric residents as they could not find satisfactory jobs. The Fisher's exact chi-square test showed that a significant difference (χ² = 4.560, p = 0.033), as shown in Fig. 3 . 3 Discussion​ This study integrated the OBE concept with the PBL model and applied it to clinical practice teaching in psychiatry, investigating its effects on improving medical students' theoretical level of knowledge, practical ability, teaching satisfaction, and the achievement rate of career plans. The findings demonstrated that students educated under this integrated approach showed significant gains in theoretical understanding, practical skills, and professional growth, suggesting that the OBE-integrated PBL teaching model offers substantial benefits in the teaching of psychiatric clinical subjects.​ 3.1 Improvement in Theoretical Assessment Scores​ The theoretical assessment score of the study group was significantly higher than that of the control group (88.45 ± 4.76 vs. 83.81 ± 5.30, P = 0.004). Although the improvement range in this study is more significant, this result is consistent with the tendency of improved theoretical scores when OBE or PBL is administered alone in other studies [ 7 , 8 ]. This may be attributed to the "reverse design" principle of the OBE concept, that is, starting from preset learning outcomes (such as the requirements of the licensing examination for practicing physicians), systematically planning teaching content, so that students can more clearly understand the clinical application value of knowledge points. Furthermore, through problem-oriented case discussions, the PBL model assists students in integrating disparate theoretical knowledge into a systematic clinical thinking framework, resulting in a higher capacity for thorough analysis in theoretical evaluations [ 9 ].​ 3.2 Comprehensive Optimization of Practical Ability​ In the practical assessments, the Study Group outperformed the Control Group in the three stations of clinical skills, clinical thinking, and interpretation of auxiliary examinations ( p < 0.05). Only the "Neurological Examination" station, which is a technical operation-oriented station, showed no significant difference between the groups in the practical assessments. These findings imply that the OBE-integrated PBL model is especially appropriate for fields that heavily rely on clinical reasoning and humanistic communication, such as psychiatry. Students can create customized treatment plans, perform differential diagnosis based on symptomatology, and develop good communication skills with patients and their families through PBL case discussions and SP simulation training [ 10 ].​ 3.3 Enhancement of Teaching Satisfaction and Learning Motivation​ The Study Group's 91% satisfaction percentage with the teaching paradigm was considerably greater than the Control Group's 62% ( p = 0.024). Student feedback indicated that the OBE-integrated PBL model effectively stimulated learning initiative through the dual mechanisms of "goal orientation" and "problem driving". For instance, OBE's explicit professional competency goals (such as the abilities required for a postgraduate entrance exam or a job) help students focus on their learning priorities [ 11 ], and PBL's case discussions and teamwork reduce the "passive acceptance" that is often observed in conventional teaching [ 12 ]. Additionally, the dynamically adjusted teaching plans and diversified evaluation systems (such as process-oriented evaluation) further enhanced students' sense of participation and accomplishment [ 13 ].​ 3.4 Long-term Benefits in the Achievement Rate of Career Plans​ The career plan achievement rate of the Study Group was significantly higher than that of the Control Group (91% vs. 57%, p = 0.033). This finding suggests that by fostering students' capacity for independent learning, clinical judgment, and professional identity, the OBE-integrated PBL approach may benefit their career development in addition to improving short-term educational impacts. For example, the higher success rate in the postgraduate entrance examination in the Study Group may be related to the research thinking developed during the internship (such as reading and researching literature and creating PowerPoint course materials in response to PBL case requirements) [ 14 ], and the employment advantage may stem from the direct connection between OBE goals and post competency [ 15 ].​ 4 Conclusion​ This study confirms that the OBE concept, integrated with the PBL model, has significant advantages in psychiatric clinical practice teaching, which can effectively improve students' theoretical and practical abilities, teaching satisfaction, and the achievement rate of their long-term career plans. Through goal-oriented top-level design and problem-driven process optimization, this model addresses the dual dilemmas of "passive indoctrination" and "disconnection from practice" in conventional teaching, offering a replicable and innovative path for clinical practice teaching in psychiatry. The study results suggest promoting this model in higher medical education and making dynamic adjustments in combination with the characteristics of institutional resources to cultivate psychiatric medical talents with stronger clinical competence and career development potential.​ The innovation of this study lies in the first systematic integration of the OBE concept and the PBL model, and their application to clinical teaching in psychiatry, thereby addressing the limitations of a single model through the complementary advantages of both. For example, the "goal orientation" of OBE compensates for the possible ambiguity in learning direction in PBL, while the "dynamic feedback" of PBL enables teachers to adjust deviations from the preset path of OBE timely. However, this study still has some limitations. The study might have had selection bias as the sample size was small (N = 43) from only two institutions, and the grouping was based on students' willingness rather than randomization. The effects were studied for only 1 year, and future studies need to extend the follow-up time and expand the sample size to verify the universality of the conclusions. Declarations Clinical trial number not applicable Competing interests The authors declare no competing interests. Consent to participate The research received approval from the Ethics Committee of Huai’an NO.3 People’s Hospital (Approval Number: 2023002). Written informed consent to participate and consent to publish were obtained from each patient. Consent to publish Not applicable. Funding This work was supported by Practice Teaching and Education Research Plan of Jining Medical University, JYSJ2022B60 Author Contribution HCB conceived and designed the study. SWJ, SXS, and ZLR collected data under the supervision of LGY. ZTT performed data analysis and created Figures 1-3. SWJ and SXS wrote the manuscript and contributed equally as joint first authors. All authors critically reviewed and approved the final manuscript. Acknowledgement We sincerely thank all participating intern students for their engagement—learning alongside you has enriched our teaching journey, and this mutual growth made this study possible. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Liston C, Roberts A, Dzirasa K, et al. Understanding the biological basis of psychiatric disease: What's next? Cell. 2022;185(1):1–3. Kallivayalil RA, Enara A. 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Problem-based projects in medical education: extending PBL practices and broadening learning perspectives. Adv Health Sci Educ Theory Pract. 2019;24(5):959–69. Abouzeid E, Harris P. Using AI to produce problem-based learning cases. Med Educ. 2023;57(11):1154–5. Khoshnevisasl P, Sadeghzadeh M, Mazloomzadeh S, et al. Comparison of Problem-based Learning With Lecture-based Learning. Iran Red Crescent Med J. 2014;16(5):e5186. Heinssen RK, Sherrill JT, Farber GK. Promoting outcome-oriented research in mental health. J Ment Health. 2023;32(6):1028–9. Ishizuka K, Shikino K, Tamura H, et al. Hybrid PBL and Pure PBL: Which one is more effective in developing clinical reasoning skills for general medicine clerkship?-A mixed-method study. PLoS ONE. 2023;18(1):e0279554. Song P, Shen X. Application of PBL combined with traditional teaching in the Immunochemistry course. BMC Med Educ. 2023;23(1):690. He J, Tang Q, Dai R, et al. Problem-, team- and evidence-based learning. Med Educ. 2012;46(11):1102–3. Li Athena B, Elif K, Amy et al. Does your group matter? How group function impacts educational outcomes in problem-based learning: a scoping review.[J].BMC medical education,2022,22(1):900. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1LearningSituationandCareerPlanningQuestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 17 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 23 Sep, 2025 Reviews received at journal 22 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviews received at journal 22 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers invited by journal 14 Aug, 2025 Editor assigned by journal 14 Aug, 2025 Editor invited by journal 11 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7223072","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502769188,"identity":"9be11416-795c-44d7-a23e-79551eb87e75","order_by":0,"name":"Wenjie Shi","email":"","orcid":"","institution":"Huai'an No. 3 People's Hospital, Huai'an Clinical College of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjie","middleName":"","lastName":"Shi","suffix":""},{"id":502769189,"identity":"8cd1de4e-e1c7-493e-bb2b-664e1ea4b120","order_by":1,"name":"Xiangsong Shi","email":"","orcid":"","institution":"Huai'an 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43)​\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7223072/v1/665548aed64f43fe4f127dfb.png"},{"id":89667552,"identity":"0cc646df-00dc-4a2f-929b-666db2af65d0","added_by":"auto","created_at":"2025-08-22 12:17:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12167,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of teaching satisfaction between the two groups (N = 43)​\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7223072/v1/395d429000e3e096c1568f47.png"},{"id":89667549,"identity":"fd100115-3bcd-4bb6-bf4c-8e0575be837a","added_by":"auto","created_at":"2025-08-22 12:17:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30596,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the achievement rate of career plans between the two groups of interns one year after graduation (N = 43)\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7223072/v1/54031548c8f54c02f17f78a5.png"},{"id":96650153,"identity":"a1baa9c9-5afd-462c-916c-2d6a05edd365","added_by":"auto","created_at":"2025-11-24 16:08:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":889368,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7223072/v1/69e4605c-553d-4570-8b1b-00a578812855.pdf"},{"id":89667003,"identity":"dad73669-be96-4572-8830-3e1423fefda2","added_by":"auto","created_at":"2025-08-22 12:09:30","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21356,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1LearningSituationandCareerPlanningQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7223072/v1/b935be5d504022740268cbfc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in Psychiatric Clinical Practice Teaching: An Empirical Study","fulltext":[{"header":"1 Background","content":"\u003cp\u003ePsychiatry, an important subdiscipline of clinical medicine, poses significant challenges to clinical practice teaching due to its unique professional traits. These particularities are concentrated in three aspects: Firstly, mental illnesses are diagnosed based on clinical symptomatology and the characteristics of disease course evolution as clear unique biological markers are not present; Secondly, there exists significant heterogeneity in clinical manifestations within the same diagnostic category, resulting in different treatment approaches and prognostic outcomes; Thirdly, comorbidity, symptom overlap, and cross-application of treatment modalities are common among different mental illnesses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese intricate clinical characteristics have led the conventional \"lecture-based\" teaching model into a dual predicament: Medical students often find themselves in the predicament of passively receiving fragmented knowledge, while educators struggle to teach dynamic clinical thinking through standardized methods. Consequently, this prevents these \"future psychiatrists\" from developing their clinical decision-making skills and humanistic care literacy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the process of reforming higher medical education, the iterative innovation of educational concepts and teaching models has consistently been a key path to overcoming the bottleneck in teaching quality. Notably, the concepts of Outcome-Based Education (OBE) and Problem-Based Learning (PBL) have been increasingly applied in teaching at institutions of higher education. The former constructs a system of learning objectives through the principle of \"reverse design\", emphasizing an orientation toward the competency of practicing physicians and systematically planning the knowledge construction, skill training, and professional value shaping of medical students [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The latter, grounded in clinical problems, motivates students to complete the cognitive loop of \"identifying problems \u0026rarr; analyzing problems \u0026rarr; solving problems\" through contextualized cases, which can effectively facilitate the transfer of theoretical knowledge to clinical practice [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous research has indicated that the individual implementation of both models in the field of psychiatric education has proven beneficial in terms of improving clinical reasoning skills and learning engagement.\u003c/p\u003e\u003cp\u003eHowever, feedback from teaching practice has also highlighted the single models' fundamental limits. Extended instruction cycles and delayed formative evaluation frequently undermine the efficacy of OBE by creating a discrepancy between predetermined outcomes and attained competencies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], while PBL faces operational challenges including demanding group coordination requirements, significant efficacy disparities among learners, and unidimensional assessment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Consequently, even though both models have the potential to be more effective, these drawbacks limited their wider application in psychiatric clinical teaching.\u003c/p\u003e\u003cp\u003eIn light of this, the current study aims to adapt the PBL model to psychiatric practice instruction by integrating the OBE idea. It aims to use the dynamic feedback mechanism of the PBL model to quickly identify and resolve important difficulties that arise during the implementation of OBE, as well as to prevent the disadvantages of lengthy cycles and control issues in the OBE teaching process. Simultaneously, the OBE concept's goal-oriented approach, seeks to motivate students to engage in learning more actively, thereby reducing the challenges associated with PBL teaching in terms of teacher supervision, organizational leadership, student grouping, and communication. Additionally, it intends to integrate formative and summative evaluations to establish a multidimensional assessment model covering theoretical knowledge, clinical skills, scientific research thinking, and professional literacy.\u003c/p\u003e"},{"header":"2 Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Study Subjects\u003c/h2\u003e\n \u003cp\u003eOverall, a total of 43 fifth-year undergraduate students majoring in psychiatry who completed their internships at the Huai\u0026apos;an Clinical College of Mental Health, Jining Medical University, from September 2022 to June 2024 were included as study subjects. They were divided into two groups based on their own willingness.\u003c/p\u003e\n \u003cp\u003eThe Control Group consisted of 21 students, including 11 males and 10 females, with 5 from Xuzhou Medical University and 16 from Jining Medical University, all aged 22\u0026ndash;23 years. The conventional teaching model was adopted.\u003c/p\u003e\n \u003cp\u003eThe Study Group consisted of 22 students, including 12 males and 10 females, with 6 from Xuzhou Medical University and 16 from Jining Medical University, all aged 21\u0026ndash;23 years. The OBE-integrated PBL teaching model was applied for clinical practice teaching during the internship.\u003c/p\u003e\n \u003cp\u003eBaseline data were compared between the two groups, including gender (males: 12/23 vs. 11/21, \u0026chi;\u0026sup2; = 0.020), age (21.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75 vs. 21.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68, t\u0026thinsp;=\u0026thinsp;0.455), school origin (students from Jining Medical University: 16/22 vs. 15/21, \u0026chi;\u0026sup2; = 0.068), and average course score in the 4th academic year (81.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.18 vs. 81.38\u0026thinsp;\u0026plusmn;\u0026thinsp;7.00, t\u0026thinsp;=\u0026thinsp;0.149). No statistically significant differences were observed between the groups (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003eThe research received approval from the Ethics Committee of Huai\u0026rsquo;an NO.3 People\u0026rsquo;s Hospital (Approval Number: 2023002) and was executed in alignment with the principles of the Declaration of Helsinki. All participants provided informed consent.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Research Methods\u003c/h2\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1 Control Group\u003c/h2\u003e\n \u003cp\u003eThe Control Group received conventional lecture-based instruction. The Psychiatry department allocated physicians with extensive teaching experience, who developed teaching plans based on the curriculum for the psychiatric clinical internship. They established clear teaching objectives, systematically delivered clinical practice knowledge in psychiatry, and addressed trainees\u0026apos; questions. Instructors remained in charge throughout the entire teaching process, while interns primarily participated through post-lecture Q\u0026amp;A sessions and passive listening.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2 Study Group\u003c/h2\u003e\n \u003cp\u003eThe Study Group had their psychiatric practice teaching by integrating the OBE concept with the PBL teaching method, and the details of the implementation are described below.\u003c/p\u003e\n \u003cp\u003eTeacher-student training: Both the instructors and the interns and clinical teaching teachers in the study group received systematic training to deeply interpret the core connotations and fundamental meanings of the OBE concept and the PBL teaching method.\u003c/p\u003e\n \u003cp\u003eAnalysis of learning situation and goal setting: Demographic data, past learning situation, and career development plans (postgraduate entrance examination success or employment in tertiary hospitals one year after graduation) of students were collected through self-designed questionnaires. Electronic files of students were created, a learning scenario analysis was carried out, and customized training objectives were developed based on the results. For the full survey questionnaire, please refer to Supplementary Material 1.\u003c/p\u003e\n \u003cp\u003eGroup teaching and dynamic adjustment: 4\u0026ndash;5 students with similar self-development plans were divided into groups, and each group was assigned a responsible teacher. Teachers and students jointly formulated PBL teaching plans, which focused on English, theoretical learning, clinical practice, scientific research foundation, and other aspects according to the training goals. The responsible instructor led the students in discussing and learning about the specific subjects included in the lesson plan during the internship, and optimized teaching activities in real time according to students\u0026apos; feedback.\u003c/p\u003e\n \u003cp\u003eDiversified assessment system: This study constructed a \u0026quot;process-formative-summative\u0026quot; three-dimensional evaluation system to assess teaching quality and learning effects comprehensively.\u003c/p\u003e\n \u003cp\u003eTheoretical teaching and evaluation: Process evaluation was conducted via the Rain Classroom platform (an intelligent teaching tool integrating course presentation, real-time interaction and learning data statistics) and PBL qualitative/quantitative evaluation tools, enabling real-time teaching optimization. With a focus on evaluating students\u0026apos; thorough application of theoretical knowledge, the theoretical assessment used a \u0026quot;dual-track system\u0026quot; that integrated summative theoretical test results with PBL process evaluation scores.\u003c/p\u003e\n \u003cp\u003eClinical practice evaluation: Standardized patients (SP) and objective structured clinical examinations (OSCE) were added to clinical practice assessment to conduct summative comprehensive evaluation from the dimensions of knowledge application, professional quality, clinical thinking, and operational skills. Instructors conducted dynamic assessments based on students\u0026apos; daily diagnosis and treatment practice performance, with process and formative evaluation at the center.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Observation Indicators\u003c/h2\u003e\n \u003cp\u003eIn this study, theoretical assessment scores, practical assessment scores, teaching satisfaction, and the achievement rate of career plans were chosen as observation indicators to assess the efficacy of instruction from a variety of angles, such as academic performance, subjective feedback, and long-term development.\u003c/p\u003e\n \u003cp\u003eTheoretical assessment scores: Both groups of interns\u0026apos; thorough command of psychiatric theoretical knowledge was assessed using a standardized closed-book written exam. The test paper, covering core psychiatric theoretical knowledge with a total score of 100, was compiled by a chief psychiatrist who was not involved in this study. Questions were randomly selected from a pre-established question bank in line with the teaching syllabus. Higher scores indicated a more solid grasp of fundamental theories.\u003c/p\u003e\n \u003cp\u003ePractical assessment scores: Multi-station clinical practice assessments were conducted using a combination of SP and OSCE with reference to the clinical competence assessment protocol for standardized psychiatric residency training. These assessments focused on clinical skills, clinical reasoning, interpretation of auxiliary examinations, and neurological examination. The primary diseases evaluated were schizophrenia and delusional disorders, mood disorders, and neurotic disorders, containing 10 clinical practice assessment questions distributed in a 5:3:2 ratio. One question was chosen at random by each intern to respond to. The assessment duration was 30 minutes (Station 1), 20 minutes (Station 2), 10 minutes (Station 3), and 10 minutes (Station 4), totaling 70 minutes. Each station was initially scored out of 100, and the total score was calculated using weights of 40% (Station 1), 30% (Station 2), 10% (Station 3), and 20% (Station 4).\u003c/p\u003e\n \u003cp\u003eTeaching satisfaction: A self-designed questionnaire was used for an anonymous assessment, which was disseminated and gathered centrally following the interns\u0026apos; assessment. Three aspects were the emphasis of the questionnaire, which was created using the principles of content validity: teaching methods, teaching content, and assessment design. It included 20 Likert 5-point scale items (1\u0026thinsp;=\u0026thinsp;extremely dissatisfied, 5\u0026thinsp;=\u0026thinsp;very satisfied), with a total score of 100.\u003c/p\u003e\n \u003cp\u003eAchievement rate of career plans one year after graduation: To ascertain whether the career plans created by interns at the beginning of the internship were realized, a follow-up was carried out a year after graduation using reserved contact information (phone calls, WeChat [a widely used social media and messaging application in China], or email). Those who successfully gained admission to postgraduate programs or secured employment in tertiary hospitals were considered to have completed their career goals; others who worked in a secondary hospital or had not yet secured a satisfactory position were not considered to have achieved their career plan.\u003c/p\u003e\n \u003cp\u003ePer-group achievement rates of career plans were quantified as follows:\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\" style=\"width: 552px;\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Statistical Methods\u003c/h2\u003e\n \u003cp\u003eSPSS 26.0 software was used to statistically evaluate all of the data after it was entered into Excel. Measurement data were expressed as (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation), and categorical data as percentages. Normally distributed measurement data between the two groups were compared using the independent samples t-test while categorical data were compared using the chi-square test or Fisher\u0026apos;s exact test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3 Results​","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Comparison of Theoretical Assessment Scores between the Two Groups​\u003c/h2\u003e\u003cp\u003eThe theoretical assessment score of the Study Group (88.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76) was significantly higher (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) when compared with the Control Group (83.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).​\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Comparison of Practical Assessment Scores between the Two Groups​\u003c/h2\u003e\u003cp\u003eThe scores of the study group in the three stations (clinical skills, clinical thinking, interpretation of auxiliary examinations) and the total score of practical assessment were significantly higher (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than those of the control group, In contrast, the 4th station \"Neurological Examination\" showed no statistically significant difference between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\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 practical assessment scores between the two groups (N\u0026thinsp;=\u0026thinsp;43)​\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"left\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Skills\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Thinking\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInterpretation of Auxiliary Examinations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeurological Examination\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal Practical Assessment Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.45\u0026thinsp;\u0026plusmn;\u0026thinsp;7.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83.55\u0026thinsp;\u0026plusmn;\u0026thinsp;7.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e84.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81.14\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.549\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e​\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Comparison of Teaching Satisfaction between the Two Groups​\u003c/h2\u003e\u003cp\u003eThe recovery rate and effective rate of the teaching satisfaction questionnaire were 100%. Overall, 91% (20/22) in the Study Group were satisfied with the new OBE-integrated PBL education model. The results demonstrated that this model effectively promoted the development of autonomous learning ability, deepened the understanding of theoretical knowledge, and improved the ability to solve practical problems. Moreover, it strengthened the sense of teamwork which was shown by the significantly enhanced interaction between students, and between teachers and students. Additionally, it was also effective in training communication skills and broadening academic horizons, laying a solid foundation for subsequent clinical practice and scientific research. In contrast, only 62% (13/21) of the 21 interns in the Control Group acknowledged the conventional \"lecture-based\" educational approach they were given and provided comparable feedback. The Fisher's exact chi-square test showed that the difference in satisfaction between the two groups was statistically significant (χ\u0026sup2; = 5.064, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.​\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e3.4 Comparison of the Achievement Rate of Career Plans between the Two Groups of Interns One Year after Graduation​\u003c/p\u003e\u003cp\u003eThe achievement rate of career plans in the Study Group was 91% (20/22); 18 individuals were admitted to master's programs for further study, two were employed in tertiary hospitals, while one worked in a secondary hospital, and one participated in standardized training for psychiatric specialists. The achievement rate of career plans was much lesser at 57% (12/21) in the control group. Nine people successfully entered postgraduate programs, 3 were employed in tertiary hospitals, while 7 were employed in secondary hospitals, and 2 chose to participate in standardized training for psychiatric residents as they could not find satisfactory jobs. The Fisher's exact chi-square test showed that a significant difference (χ\u0026sup2; = 4.560, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Discussion​","content":"\u003cp\u003eThis study integrated the OBE concept with the PBL model and applied it to clinical practice teaching in psychiatry, investigating its effects on improving medical students' theoretical level of knowledge, practical ability, teaching satisfaction, and the achievement rate of career plans. The findings demonstrated that students educated under this integrated approach showed significant gains in theoretical understanding, practical skills, and professional growth, suggesting that the OBE-integrated PBL teaching model offers substantial benefits in the teaching of psychiatric clinical subjects.​\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Improvement in Theoretical Assessment Scores​\u003c/h2\u003e\u003cp\u003eThe theoretical assessment score of the study group was significantly higher than that of the control group (88.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76 vs. 83.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30, P\u0026thinsp;=\u0026thinsp;0.004). Although the improvement range in this study is more significant, this result is consistent with the tendency of improved theoretical scores when OBE or PBL is administered alone in other studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This may be attributed to the \"reverse design\" principle of the OBE concept, that is, starting from preset learning outcomes (such as the requirements of the licensing examination for practicing physicians), systematically planning teaching content, so that students can more clearly understand the clinical application value of knowledge points. Furthermore, through problem-oriented case discussions, the PBL model assists students in integrating disparate theoretical knowledge into a systematic clinical thinking framework, resulting in a higher capacity for thorough analysis in theoretical evaluations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].​\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Comprehensive Optimization of Practical Ability​\u003c/h2\u003e\u003cp\u003eIn the practical assessments, the Study Group outperformed the Control Group in the three stations of clinical skills, clinical thinking, and interpretation of auxiliary examinations (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Only the \"Neurological Examination\" station, which is a technical operation-oriented station, showed no significant difference between the groups in the practical assessments. These findings imply that the OBE-integrated PBL model is especially appropriate for fields that heavily rely on clinical reasoning and humanistic communication, such as psychiatry. Students can create customized treatment plans, perform differential diagnosis based on symptomatology, and develop good communication skills with patients and their families through PBL case discussions and SP simulation training [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].​\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Enhancement of Teaching Satisfaction and Learning Motivation​\u003c/h2\u003e\u003cp\u003eThe Study Group's 91% satisfaction percentage with the teaching paradigm was considerably greater than the Control Group's 62% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024). Student feedback indicated that the OBE-integrated PBL model effectively stimulated learning initiative through the dual mechanisms of \"goal orientation\" and \"problem driving\". For instance, OBE's explicit professional competency goals (such as the abilities required for a postgraduate entrance exam or a job) help students focus on their learning priorities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and PBL's case discussions and teamwork reduce the \"passive acceptance\" that is often observed in conventional teaching [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, the dynamically adjusted teaching plans and diversified evaluation systems (such as process-oriented evaluation) further enhanced students' sense of participation and accomplishment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].​\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Long-term Benefits in the Achievement Rate of Career Plans​\u003c/h2\u003e\u003cp\u003eThe career plan achievement rate of the Study Group was significantly higher than that of the Control Group (91% vs. 57%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033). This finding suggests that by fostering students' capacity for independent learning, clinical judgment, and professional identity, the OBE-integrated PBL approach may benefit their career development in addition to improving short-term educational impacts. For example, the higher success rate in the postgraduate entrance examination in the Study Group may be related to the research thinking developed during the internship (such as reading and researching literature and creating PowerPoint course materials in response to PBL case requirements) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and the employment advantage may stem from the direct connection between OBE goals and post competency [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].​\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Conclusion​","content":"\u003cp\u003eThis study confirms that the OBE concept, integrated with the PBL model, has significant advantages in psychiatric clinical practice teaching, which can effectively improve students' theoretical and practical abilities, teaching satisfaction, and the achievement rate of their long-term career plans. Through goal-oriented top-level design and problem-driven process optimization, this model addresses the dual dilemmas of \"passive indoctrination\" and \"disconnection from practice\" in conventional teaching, offering a replicable and innovative path for clinical practice teaching in psychiatry. The study results suggest promoting this model in higher medical education and making dynamic adjustments in combination with the characteristics of institutional resources to cultivate psychiatric medical talents with stronger clinical competence and career development potential.​\u003c/p\u003e\u003cp\u003eThe innovation of this study lies in the first systematic integration of the OBE concept and the PBL model, and their application to clinical teaching in psychiatry, thereby addressing the limitations of a single model through the complementary advantages of both. For example, the \"goal orientation\" of OBE compensates for the possible ambiguity in learning direction in PBL, while the \"dynamic feedback\" of PBL enables teachers to adjust deviations from the preset path of OBE timely. However, this study still has some limitations. The study might have had selection bias as the sample size was small (N\u0026thinsp;=\u0026thinsp;43) from only two institutions, and the grouping was based on students' willingness rather than randomization. The effects were studied for only 1 year, and future studies need to extend the follow-up time and expand the sample size to verify the universality of the conclusions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent to participate\u003c/h2\u003e\u003cp\u003eThe research received approval from the Ethics Committee of Huai\u0026rsquo;an NO.3 People\u0026rsquo;s Hospital (Approval Number: 2023002). Written informed consent to participate and consent to publish were obtained from each patient.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by Practice Teaching and Education Research Plan of Jining Medical University, JYSJ2022B60\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHCB conceived and designed the study. SWJ, SXS, and ZLR collected data under the supervision of LGY. ZTT performed data analysis and created Figures 1-3. SWJ and SXS wrote the manuscript and contributed equally as joint first authors. All authors critically reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We sincerely thank all participating intern students for their engagement\u0026mdash;learning alongside you has enriched our teaching journey, and this mutual growth made this study possible.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eListon C, Roberts A, Dzirasa K, et al. Understanding the biological basis of psychiatric disease: What's next? Cell. 2022;185(1):1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKallivayalil RA, Enara A. Education and training in psychiatry in South Asian countries. Asia Pac Psychiatry. 2021;13(4):e12494.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGovaerts MJB, van der Vleuten CPM, Holmboe ES. Managing tensions in assessment: moving beyond either-or thinking. Med Educ. 2019;53(1):64\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePearson J. Investigating ICT using problem-based learning in face-to-face and online learning environments. Comput Educ. 2006;47(1):56\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGundle KR, Mickelson DT, Hanel DP. Reflections in a time of transition: orthopaedic faculty and resident understanding of accreditation schemes and opinions on surgical skills feedback. Med Educ Online. 2016;21:30584.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTudor Car L, Kyaw BM, Dunleavy G, et al. Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019;21(2):e12945.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeiss S, B\u0026ouml;hnisch M, Conscientiousness. Students' Goal Orientation, and Reasoning Ability: Significance for Educational Standards. J Intell. 2024;12(1):11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStentoft D. Problem-based projects in medical education: extending PBL practices and broadening learning perspectives. Adv Health Sci Educ Theory Pract. 2019;24(5):959\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbouzeid E, Harris P. Using AI to produce problem-based learning cases. Med Educ. 2023;57(11):1154\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhoshnevisasl P, Sadeghzadeh M, Mazloomzadeh S, et al. Comparison of Problem-based Learning With Lecture-based Learning. Iran Red Crescent Med J. 2014;16(5):e5186.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeinssen RK, Sherrill JT, Farber GK. Promoting outcome-oriented research in mental health. J Ment Health. 2023;32(6):1028\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIshizuka K, Shikino K, Tamura H, et al. Hybrid PBL and Pure PBL: Which one is more effective in developing clinical reasoning skills for general medicine clerkship?-A mixed-method study. PLoS ONE. 2023;18(1):e0279554.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong P, Shen X. Application of PBL combined with traditional teaching in the Immunochemistry course. BMC Med Educ. 2023;23(1):690.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe J, Tang Q, Dai R, et al. Problem-, team- and evidence-based learning. Med Educ. 2012;46(11):1102\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Athena B, Elif K, Amy et al. Does your group matter? How group function impacts educational outcomes in problem-based learning: a scoping review.[J].BMC medical education,2022,22(1):900.\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":"Outcome-Based Education (OBE), Problem-Based Learning (PBL), Psychiatry, Clinical Practice Teaching, Medical education, Career Plan","lastPublishedDoi":"10.21203/rs.3.rs-7223072/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7223072/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo assess the viability and effectiveness of combining Outcome-Based Education (OBE) with Problem-Based Learning (PBL) in the teaching of psychiatric clinical practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eOverall, 43 fifth-year undergraduate psychiatry majors were enrolled in the study. Based on free will, 21 interns opted for the traditional lecture-based method and served as the Control Group while 22 interns participated in the OBE-PBL integrated teaching approach forming the Study Group. The two groups were compared in terms of theoretical assessment scores, practical assessment scores, teaching satisfaction, and the achievement of career plans (postgraduate entrance exam success or employment in tertiary hospitals) were compared between the two groups one year after graduation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThere was no significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the groups with relation to baseline characteristics (age, gender, source institution, fourth-year GPA). The Study Group achieved significantly higher scores when compared with the Control Group on the final theoretical assessment (88.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76 vs. 83.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), overall practical assessment (84.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 vs. 80.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and teaching satisfaction (91% vs. 62%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the Study Group performed better when compared with the Control Group (91% vs. 57%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the achievement of the career plan one year after graduation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIntegrating OBE with PBL significantly enhances the effectiveness of psychiatric clinical practice teaching.\u003c/p\u003e","manuscriptTitle":"Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in Psychiatric Clinical Practice Teaching: An Empirical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 12:09:25","doi":"10.21203/rs.3.rs-7223072/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-23T06:31:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T02:59:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336239128843390171830871569931258577002","date":"2025-09-04T08:43:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-22T14:29:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14209136059088833467771570110196347407","date":"2025-08-18T04:44:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15839273965922842181180610691260464396","date":"2025-08-17T14:01:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T09:21:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T09:12:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T05:54:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T17:16:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-08T17:13:50+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":"52cb78b5-0d33-4861-8751-ec6692d62ddf","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:02:37+00:00","versionOfRecord":{"articleIdentity":"rs-7223072","link":"https://doi.org/10.1186/s12909-025-08212-5","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-11-17 15:58:14","publishedOnDateReadable":"November 17th, 2025"},"versionCreatedAt":"2025-08-22 12:09:25","video":"","vorDoi":"10.1186/s12909-025-08212-5","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08212-5","workflowStages":[]},"version":"v1","identity":"rs-7223072","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7223072","identity":"rs-7223072","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}