The application of PBL combined with MDT and flipped classroom teaching method in the education of acute coronary syndrome

The application of PBL combined with MDT and flipped classroom teaching method in the education of acute coronary syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The application of PBL combined with MDT and flipped classroom teaching method in the education of acute coronary syndrome Yuhui Lin, Xiaoqing He, Wenjun Dai, Wenpeng Tang, Yunhong Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4964321/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Background: The development of medical education is rapidly evolving, with innovative teaching methods such as problem-based learning (PBL) and multidisciplinary treatment (MDT) combined with flipped classroom approaches gaining increasing attention in clinical medical education. However, the actual effectiveness of PBL combined with MDT and flipped classroom methods in the teaching of cardiovascular diseases has not been well studied. Considering that these two teaching methods can complement each other, this study explores the application and effectiveness of PBL combined with MDT and flipped classroom teaching method in the case-based teaching of acute coronary syndrome. Methods: A total of 100 undergraduate clinical medicine students aged 20--21 years from Guangzhou Medical University were selected as research subjects. They were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and flipped classroom teaching), which included 50 students, and the control group (traditional teaching methods), which included 50 students. After the clinical training, the theoretical examination scores and skill assessment results of the two groups were compared, and a questionnaire survey was conducted to evaluate teaching effectiveness. Results: The theoretical examination scores and skill assessment results of the experimental group were significantly better than those of the control group (P < 0.05). The questionnaire survey revealed that the students in the experimental group outperformed those in the traditional teaching group in terms of learning motivation, theoretical learning outcomes, clinical thinking ability, literature retrieval skills, self-directed learning ability, practical ability, and classroom satisfaction, with statistically significant differences (P < 0.05). Conclusion: PBL combined with MDT and the flipped classroom teaching method is effective in the clinical training of acute coronary syndrome patients, offers better teaching outcomes than traditional methods do and is worthy of further promotion and application. Flipped Classroom PBL MDT Acute Coronary Syndrome Introduction The problem-based learning (PBL) teaching method is currently a popular educational model in the field of medical education and first emerged in medical education in the 1950s[1]. The PBL teaching method is centered around problem-oriented learning, where the teacher guides students through a process that includes problem identification, analysis, discussion, and resolution to complete the learning content. PBL effectively captures students' attention and fosters their enthusiasm and initiative for learning. By encouraging students to participate in the formulation, analysis, and discussion of problems, PBL enhances effective classroom interaction between teachers and students as well as among students themselves. This approach not only aids in developing students' independent learning and thinking habits but also hones their communication and expression skills[2, 3]. The flipped classroom, also known as the flipped classroom teaching method[4], was first introduced by two chemistry teachers, Jonathan Bergmann and Aaron Sams, in 2006. The successful implementation of this approach has gained widespread attention from scholars both domestically and internationally, establishing it as an innovative teaching model across various disciplines. In medical education, the flipped classroom has led to significant changes in teacher and student roles, as well as in course teaching models. The core concept of this method is to encourage students to engage in knowledge acquisition outside the classroom while using class time for the internalization of knowledge and in-depth discussion of problems. This approach represents a "disruptive" or "transformative" shift from traditional teaching methods[5-7]. The flipped classroom model offers significant advantages in promoting personalized student development and enhancing students' self-directed learning abilities. It moves away from the monotonous and repetitive nature of traditional teaching methods, transforming into a more engaging, dynamic, and diverse teaching approach. By integrating modern multimedia technology, the flipped classroom facilitates autonomous learning and improves students' overall competencies, aligning with the developmental goals of modern medical education[8]. The concept of multidisciplinary treatment (MDT) was introduced by the MD Anderson Cancer Center in the United States. It advocates for the collaboration of multiple disciplines in the diagnosis and treatment decision-making process for cancer patients. This approach shifts the traditional disease-centered diagnostic and treatment model toward a more patient-centered model that emphasizes individualized, precise, comprehensive, and multidisciplinary care[9]. MDT has garnered widespread attention in both clinical practice and medical education because of its unique multidisciplinary approach to disease diagnosis and treatment, which aims to provide patients with the best treatment strategies. For medical educators, a long-standing challenge has been how to cultivate students' ability to understand diseases holistically and analyze and manage the individualized characteristics of patients' conditions. Applying the MDT model to case-based teaching helps overcome the limitations of the narrow and shallow knowledge often associated with a single-discipline perspective[10, 11]. In recent years, Guangzhou Medical University has vigorously promoted new teaching models such as "organ system-centered" education, PBL teaching methods, and flipped classrooms, achieving substantial results. These innovative approaches address the shortcomings of traditional medical education, significantly enhancing students' innovative thinking and practical skills. However, the implementation of these models has also faced some challenges, particularly during clinical clerkships. A considerable number of students still struggle to integrate knowledge effectively from disciplines such as pathophysiology, diagnostics, radiology, and internal medicine. They often lack logical thinking and judgment skills and rely passively on teachers to impart knowledge. To address these issues, it is necessary to integrate these new teaching models, leveraging their strengths and compensating for their weaknesses. This has led to timely reforms in clinical clerkship teaching methods. Given that acute coronary syndrome (ACS) presents characteristic symptoms that are easy for students to learn and understand, a typical case of ACS was selected as the teaching case. This study explored the application and effectiveness of PBL combined with an MDT and the flipped classroom teaching method in clinical clerkships for acute coronary syndrome. Methods 1.1 Participants The study selected 100 undergraduate clinical medicine students aged 20--21 years from Guangzhou Medical University. The students were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and the flipped classroom teaching method), which included 50 students, and the control group (traditional teaching method), which included 50 students. The same instructor conducted the theoretical courses for both groups. A team of three instructors, each with over 10 years of teaching experience, was responsible for supervising the clinical clerkship. 1.2 Study design The students who participated in the study had already completed foundational courses such as Human Anatomy, Physiology, Pathophysiology, Pathology, Pharmacology, Biochemistry, Molecular Biology, Cell Biology, and Diagnostics, providing them with a solid base of medical knowledge. The teaching was conducted according to the overall requirements of the Internal Medicine Teaching Syllabus of Guangzhou Medical University. The course began with foundational theoretical teaching on cardiovascular system diseases, helping students build a comprehensive understanding of the theory and diagnosis of cardiovascular diseases to facilitate clinical clerkship practices. Apart from the differences in teaching methods, the instructor, teaching content, and number of class hours for the experimental group were identical to those of the control group. The case-based teaching for acute coronary syndrome was conducted in two sessions, each lasting 120 minutes. Control Group: The traditional teaching method was implemented. Initially, basic knowledge of acute coronary syndrome was explained. Next, the students were guided to the patient's bedside to collect their medical history, including the chief complaint, history of present illness, past medical history, personal history, and family history. A thorough physical examination was then conducted, covering but not limited to the measurement of vital signs and examination of various systems. Students collect and analyze various auxiliary test results, such as blood biochemistry, electrocardiogram (ECG), X-ray, and ultrasound results. When specific procedures were needed for the patient, the students were instructed on performing basic medical operations, such as bedside ECGs. The information gathered was then integrated with textbook content to organize key knowledge points and analyze the patient's preliminary diagnosis, potential causes, clinical symptoms, interpretation of auxiliary test results, treatment plans, and subsequent medical management. Experimental Group: PBL combined with an MDT and a flipped classroom teaching method was employed. On the basis of the teaching syllabus and the key points of acute coronary syndrome, the core content and difficult areas of teaching were identified, and a problem-based learning (PBL) lesson plan was developed. Lecture videos and supplementary materials on acute coronary syndrome were prepared, and students were required to study these resources in advance. Additionally, the students were instructed to use databases such as PubMed and the university library to gather useful information and write study notes. The students were divided into groups of 5 to 6 members, with one student acting as the group leader. Each member took on the role of a doctor from different specialties, such as cardiology, critical care medicine, respiratory medicine, ultrasound medicine, and pharmacy, forming an MDT (multidisciplinary team). The group simulated an MDT team discussion, focusing on key issues related to acute coronary syndrome from the perspective of their respective disciplines. These issues include the following: (1) What is the pathogenesis of acute coronary syndrome? (2) How can the different types of acute coronary syndrome be distinguished? (3) What are the common clinical manifestations of acute coronary syndrome? (4) What are the treatment options for acute coronary syndrome, and how should they be chosen? The group discussed these questions and collected and recorded their findings. During the hospital clerkship, under the guidance of a supervising teacher, each group discussed how to "solve problems" by combining the patient's medical history, physical examination, and auxiliary test results. They conducted in-depth discussions on the diagnosis, differential diagnosis, and treatment plan for the patient. The group leader then presented their findings, with other members adding supplementary information. The focus was on analyzing and summarizing the diagnostic and therapeutic logic and strategies of the case. After the presentations, the instructor evaluated each group's report, pointed out areas for improvement, and guided the students to clarify the next steps in their learning, thereby stimulating their potential for self-directed learning. Additionally, for some typical cases, a 40-minute discussion session can be appropriately arranged during class. Specific questions are assigned in advance, with each group focusing on one question for research and analysis. Before the clerkship, students explore the optimal solutions through information gathering, team discussions, and literature reviews and then prepare a report. For example, in a case involving an elderly male patient with sudden chest pain and ST-T wave abnormalities on an ECG, the supervising teacher can include guiding questions in the PBL lesson plan, such as the following: What are the diagnostic criteria? What are the key points for differential diagnosis? What further tests are necessary? What is the best treatment strategy? During the preparation phase before the clerkship, group members can gather information through various means, such as online searches and library resources, to develop a solution. In the clerkship, after thoroughly understanding the theoretical knowledge and participating in classroom discussions, students can engage more deeply with patients, applying what they have learned to real clinical cases. 1.3 Evaluation of Teaching Effectiveness A test was designed on the basis of the teaching content, and a closed-book written exam was administered to assess the theoretical knowledge of the students in both groups. The exam consisted of multiple-choice questions, which were equally divided into two sections: basic theoretical knowledge (100 points) and clinical case analysis (100 points). All the questions in the test were based on Bloom's Taxonomy, which categorizes cognitive activities into six levels: remembering, understanding, applying, analyzing, evaluating, and creating. The "remembering" and "understanding" categories were combined into one section, referred to as "basic theoretical knowledge," while items from the other categories were classified under "clinical case analysis"[12, 13]. A survey was designed in advance and administered anonymously to both the experimental and control groups. The questionnaire included the following seven questions: learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. Each question was a multiple-choice format, with the options "Yes" or "No." The proportion of "Yes" responses was calculated for each question. Finally, a statistical analysis was conducted on the exam results and the responses from the teaching effectiveness survey for both the experimental and control groups. 1.4 Statistical analysis The data obtained from the study were statistically analyzed via SPSS 23.0 software. Categorical data are expressed as frequencies and percentages \(n(\%) \), and comparisons between groups were performed via the chi-square (χ²) test. Continuous data are expressed as the mean ± standard deviation \((\overline{x} \pm s)\), and comparisons between groups were made via t tests. A p value of less than 0.05 (P < 0.05) was considered statistically significant. Results 2.1 Comparison of general information between the two groups There was no statistically significant difference in age or sex between the two groups of students, as shown in Table 1. Table 1 Comparison of General Information Between the Two Groups Group Number Gender (male/female) Age (years old, x̅±s) Control group 50 31/19 20.96±0.83 Experimental group 50 26/24 21.02±0.84 T/χ2 value 1.020 0.358 P value 0.313 0.721 There were no statistically significant differences in age or sex between the control and experimental groups (P > 0.05). 2.2 Comparison of Exam Scores between the Two Groups The theoretical exam scores of the experimental group (86.10 ± 4.35) were higher than those of the control group (83.42 ± 5.06), and the skill exam scores of the experimental group (78.46 ± 4.97) were also higher than those of the control group (75.30 ± 4.29). These differences were statistically significant (P < 0.05), as shown in Table 2. Table 2 Comparison of Exam Scores Between the Two Groups Group Number Theoretical Exam Scores(𝑥‾±𝑠) Skills Exam Scores(𝑥‾±𝑠) Control group 50 83.42±5.06 75.30±4.29 Experimental group 50 86.10±4.35 78.46±4.97 T value 2.837 3.403 P value 0.006 0.001 The experimental group outperformed the control group in both theoretical and skills exams, with statistically significant differences (P < 0.05). 2.3 Comparison of Learning Outcomes Survey between the Two Groups A total of 100 questionnaires were distributed, containing seven questions: learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. Each question was answered with "yes" or "no" regarding satisfaction, and the proportion of "yes" responses was calculated. All questionnaires were completed successfully and were valid. The survey results revealed that the proportion of students in the experimental group who responded positively ("Yes") was greater than that in the control group across all aspects, including learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. These differences were statistically significant (P < 0.05), as shown in Table 3. 表3 Table 3: Comparison of Teaching Effectiveness Survey Results Between the Two Groups Group Number Learning Motivation Learning Effectiveness Reasoning Ability Search Skills Learning Ability Practical Skills Classroom Satisfaction Control group 50 39 35 36 33 32 41 37 Experimental Group 50 46 45 48 45 43 49 47 χ2值 5.138 6.250 10.714 8.392 6.453 7.111 7.440 p值 0.023 0.012 0.002 0.004 0.011 0.008 0.006 The results in Table 3 show that the experimental group outperformed the control group in all aspects, including learning motivation, theoretical learning effectiveness, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. The differences between the two groups were statistically significant (P < 0.05). Discussion With the development of medical education, many new educational methods have gradually emerged alongside the traditional classroom-based teaching approach. Among these methods, the problem-based learning (PBL) method and the flipped classroom are notable examples. These innovative teaching methods have increasingly been applied in cardiovascular disease education[14-16]. The problem-based learning (PBL) model is a teaching approach centered on the design of problems to achieve specific learning objectives. It involves problem formulation, classroom instruction, resolving doubts, and interactive discussions to promote learning. This method emphasizes active student engagement, leveraging students’ intrinsic motivation to enhance their learning ability and efficiency. The PBL model aims to address common issues in current teaching practices, such as unclear learning objectives, a lack of emphasis on problem awareness, minimal instructional design, and the disconnect between teaching and learning[17, 18]. The flipped classroom teaching model involves students watching instructional videos and engaging in self-directed learning before or outside of class. Instead of using classroom time for lectures, the class becomes a space for interaction between teachers and students, as well as among students themselves. This interaction includes answering questions, collaborative exploration, and completing academic tasks, ultimately leading to more effective educational outcomes[19, 20]. The concept of multidisciplinary treatment (MDT) was introduced by the MD Anderson Cancer Center in the United States. It advocates for the collaboration of multiple disciplines in the diagnosis and treatment decision-making process for cancer patients, shifting the traditional disease treatment model to a patient-centered approach that is personalized, precise, comprehensive, and multidisciplinary. The unique perspective of combining various disciplines for disease diagnosis and treatment, with the aim of providing patients with the most optimized treatment plans, has garnered significant attention from both clinical practitioners and medical educators. For medical educators, a longstanding challenge has been how to cultivate students' holistic understanding of diseases and their ability to analyze and manage the personalized characteristics of patients' conditions. Integrating the MDT model into case-based teaching can help overcome the limitations of a single-discipline perspective, which often lacks sufficient breadth and depth of knowledge[11]. Acute coronary syndrome is a common and critical condition that involves multidisciplinary knowledge for its diagnosis, differential diagnosis, and treatment[21]. The integration of the MDT-flipped classroom with the PBL teaching method provides a new teaching model for clinical cases of acute coronary syndrome. In this model, students are encouraged to engage in preclass preparation, allowing them to grasp relevant knowledge, identify problems, and seek solutions actively. During clinical practice, they apply the knowledge they have acquired to reason through the causes of disease and develop treatment plans. This approach encourages students to take on a more proactive role during clinical practice, enhancing their motivation and engagement in learning. The results of this study are consistent with findings reported in other studies, demonstrating that this teaching model achieves favorable educational outcomes. Before class, students utilize resources such as CNKI, PubMed, school databases, and libraries to stay updated on the latest medical advancements and cutting-edge knowledge, allowing them to engage in in-depth studies of case-related topics. During clinical practice, particularly in case discussions, students are encouraged to ask questions, share unique insights, and closely link theoretical learning with clinical practice. This process helps deepen their understanding of medical knowledge, accumulate clinical experience, and cultivate scientific thinking. On the basis of the results of this study, it is evident that the students in the experimental group outperformed those in the control group in both examination scores and classroom satisfaction. These findings confirm that the integration of MDT, flipped classroom, and PBL teaching methods can play a multifaceted role in clinical training. 1. Enhancing Self-Directed Learning Abilities**: The flipped classroom approach requires students to engage in self-directed learning of foundational knowledge through videos and reading materials before class. This method is highly effective in fostering students' self-learning and self-management skills, transforming the passive reception of knowledge into active learning[22]. The students in the experimental group who participated in this study were highly proactive in their preparation, actively searching for information and engaging in group discussions to develop their case reports. 2. Strengthening the Integration of Theory and Practice**: The PBL teaching method enhances the practical application of learning by presenting clinical problems that guide students in applying theoretical knowledge to real-world scenarios, thereby increasing the practicality and relevance of their learning[23]. Owing to their thorough preparation before the classes, the students in the experimental group were able to better grasp and absorb the relevant knowledge involved in the clinical cases. They could actively apply this knowledge to real-life cases, displaying confidence and competence during clinical case discussions. Promoting Critical Thinking**: In the combined teaching approach of the flipped classroom and PBL, students are required to analyze problems, propose hypotheses, and engage in discussions. This process fosters the development of critical thinking and problem-solving skills[24, 25]. The students in the experimental group, having been thoroughly prepared in advance, often encountered various questions during their self-study. They came to class with these questions and actively sought answers. Compared with the control group, they showed significantly greater enthusiasm in discussing problems and were more willing to engage with teachers or peers to explore the best solutions. 4. Enhancing Teacher‒Student Interaction and Personalized Teaching**: The flipped classroom approach provides more opportunities for interaction between teachers and students. Teachers can offer personalized guidance on the basis of the feedback and needs of students[26, 27]. Unlike traditional teaching methods, the MDT flipped classroom and PBL teaching approaches require students to actively engage in classroom discussions. This active participation fosters better absorption of knowledge and skills through teacher‒student interactions, allowing for real-time adjustments on the basis of students' comprehension levels. 5. Enhancing Clinical Thinking and Decision-Making Skills:** PBL teaching methodology enables students to hone their clinical thinking and decision-making abilities while solving clinical problems. This is particularly crucial for students in internal medicine clinical rotations, where the ability to think critically and make informed decisions is essential for effective patient care[28, 29]. Clinical thinking and decision-making skills cannot be simply acquired through passive knowledge transmission; they must be actively developed through clinical practice. The integration of the MDT flipped classroom with PBL teaching methods effectively addresses this challenge by encouraging students to engage in proactive learning. Students are driven to prepare in advance, identify problems independently, seek solutions, and interact with instructors. This active approach not only enhances knowledge acquisition but also fosters the development of clinical thinking. Improving Teaching Outcomes and Student Satisfaction:** Research indicates that the combination of the flipped classroom and PBL teaching methods can significantly improve students' examination performance and satisfaction, particularly in clinical practice courses. The results of this study demonstrate that students in the experimental group outperformed those in the control group in both theoretical and skills assessments and reported higher satisfaction with the course. Aligning with trends in medical education reform:** As medical education continues to evolve, the combination of the MDT flipped classroom and PBL teaching methods aligns well with modern educational needs. This approach effectively cultivates medical professionals with strong innovation capabilities and clinical practice skills, meeting the demands of contemporary medical education reform. The application of the MDT flipped classroom combined with PBL teaching methods in the clinical training of acute coronary syndrome patients not only enhances students' learning experience and teaching outcomes but also cultivates their clinical thinking and self-directed learning abilities. This approach holds significant importance and value in medical education and is worthy of further promotion and application. Conclusion In conclusion, the results of this study indicate that the use of the PBL combined with MDT and flipped classroom teaching method during cardiology internships, specifically in the study of acute coronary syndrome, can significantly improve students' theoretical knowledge and clinical skills. However, further large-scale studies are needed to evaluate how to optimize course design and management to facilitate broader application and enhance its effectiveness. Abbreviations MDT:multidisciplinary treatment; PBL: Problem-based learning. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board and Ethics Committee of The Third Affiliated Hospital, Guangzhou Medical University. Written informed consent was obtained from all the participating students. Consent for publication Written consent from the participants was obtained. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by Science and Technology Projectsin Guangzhou (Grant number 2023A03J0373), Plan on enhancing scientific research in GMU (grant 204). Authors' contributions YL and YX contributed to the design of the study. XH，WD and WT contributed to data collection and analysis, YX and YL contributed to data analysis and manuscript writing. WT and XH contributed to manuscript revisions. All authors contributed to the critical revision of the paper and approved the final manuscript for publication. Acknowledgements Not applicable. Clinical trial number Not applicable Authors' information (optional) Development of Cardiovascular Medicine; Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China. References Schmidt HG, Rotgans JI, Yew EH. The process of problem-based learning: what works and why. Med Educ. 2011;45(8):792-806. de Andrade Gomes J, Braga L, Cabral BP, Lopes RM, Mota FB. Problem-Based Learning in Medical Education: A Global Research Landscape of the Last Ten Years (2013-2022). Med Sci Educ. 2024;34(3):551-60. Jaganathan S, Bhuminathan S, Ramesh M. Problem-Based Learning - An Overview. J Pharm Bioallied Sci. 2024;16(Suppl 2):S1435-1435S1437. Tolks D, Schäfer C, Raupach T, et al. An Introduction to the Inverted/Flipped Classroom Model in Education and Advanced Training in Medicine and in the Healthcare Professions. GMS J Med Educ. 2016;33(3):Doc46. Li S. Flip the classroom. Educ Prim Care. 2015;26(6):438-40. Phillips J, Wiesbauer F. The flipped classroom in medical education: A new standard in teaching. Trends Anaesth Crit Care. 2022;42:4-8. Nunez FE, Monsivais DB. It Takes More Than One Somersault to Flip a Classroom. Nurse Educ. 2020;45(3):116-8. Sandrone S, Berthaud JV, Carlson C, et al. Strategic Considerations for Applying the Flipped Classroom to Neurology Education. Ann Neurol. 2020;87(1):4-9. Feng P, Wu J, Jin Z, Cui J, Zhang S, He L, Zhao H. Effect evaluation of competency-based education (CBE) combined with multidisciplinary team (MDT) teaching mode in respiratory rehabilitation nursing teaching：A randomized controlled trial. Nurse Educ Pract. 2024;76:103896. Li J, Du Y. Integration of MDT and CBL approaches in teaching anesthesiology residents about herpes zoster-associated pain. Asian J Surg. 2024;47(7):3314-5. Xu ZW, Liu NN, Zhang JL, et al. Application of symptom-based mind mapping combined with PBL teaching method in emergency trauma standardized resident training in MDT model. Medicine (Baltimore). 2022;101(38):e30822. Selina F, Hasan MF, Talha KA, Al-Muhaimin M, Momo FR, Debnath J, Begum S, Ahmad J. Assessing the Effectiveness of Clinical Skills Laboratory and Traditional Lecture in Teaching Basic Life Support and Performance Evaluation According to Different Domains of Revised Bloom's Taxonomy. Mymensingh Med J. 2023;32(1):207-12. Su WM, Osisek PJ, Starnes B. Using the Revised Bloom's Taxonomy in the clinical laboratory: thinking skills involved in diagnostic reasoning. Nurse Educ. 2005;30(3):117-22. Seki M, Fujinuma Y, Matsushima M, Joki T, Okonogi H, Miura Y, Ohno I. How a problem-based learning approach could help Japanese primary care physicians: a qualitative study. Int J Med Educ. 2019;10:232-40. Zhong Y, Zhang Y, Sun W, et al. An outcomes-based module education via flipped classroom enhances undergraduate oral histopathology learning. BMC Med Educ. 2023;23(1):848. Lu F, Luo Z, Huang T, Lv X, Wang H, Wang Y, Yin H. Effectiveness evaluation of flipped classroom in emergency medicine online teaching for medical undergraduates. Med Teach. 2024;46(5):689-96. Kulo V, Cestone C. A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education. Med Sci Educ. 2023;33(6):1409-26. Ren S, Li Y, Pu L, Feng Y. Effects of problem-based learning on delivering medical and nursing education: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs. 2023;20(5):500-12. Somaa F. The Flipped Classroom Approach: A Review of Cognitive Styles and Academic Performances. Cureus. 2024;16(7):e63729. Oudbier J, Spaai G, Timmermans K, Boerboom T. Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review. BMC Med Educ. 2022;22(1):34. Perona M, Cooklin A, Thorpe C, O'Meara P, Rahman MA. Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review. Eur Cardiol. 2024;19:e12. Kraut AS, Omron R, Caretta-Weyer H, et al. The Flipped Classroom: A Critical Appraisal. West J Emerg Med. 2019;20(3):527-36. Neville AJ, Norman GR. PBL in the undergraduate MD program at McMaster University: three iterations in three decades. Acad Med. 2007;82(4):370-4. Pluta WJ, Richards BF, Mutnick A. PBL and beyond: trends in collaborative learning. Teach Learn Med. 2013;25 Suppl 1:S9-16. Yang W, Zhang X, Chen X, Lu J, Tian F. Based case based learning and flipped classroom as a means to improve international students' active learning and critical thinking ability. BMC Med Educ. 2024;24(1):759. Xu Y, Chen C, Ji M, Xiang Y, Han Y, Feng D, Luo Z. An online flipped classroom approach improves the physiology score and subsequent course scores of the top-performing students. Adv Physiol Educ. 2023;47(3):538-47. Sultan AS, Ali R, Zahid N, et al. Experiences of Undergraduate Medical, Nursing Students and Faculty regarding Flipped Classroom: A Mixed Method Study at Private Medical University in Pakistan. BMJ Open. 2023;13(4):e070276. Sun L, Liu D, Lian J, Yang M. Application of flipped classroom combined with virtual simulation platform in clinical biochemistry practical course. BMC Med Educ. 2023;23(1):771. Zhou F, Sang A, Zhou Q, Wang QQ, Fan Y, Ma S. The impact of an integrated PBL curriculum on clinical thinking in undergraduate medical students prior to clinical practice. BMC Med Educ. 2023;23(1):460. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 05 Sep, 2024 Editor assigned by journal 03 Sep, 2024 Submission checks completed at journal 03 Sep, 2024 First submitted to journal 23 Aug, 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-4964321","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":350173018,"identity":"e9000334-de8c-4d9f-8f5e-e7b7f7e83e40","order_by":0,"name":"Yuhui Lin","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuhui","middleName":"","lastName":"Lin","suffix":""},{"id":350173019,"identity":"5965880f-0507-4ac0-994b-e256d3f4b369","order_by":1,"name":"Xiaoqing He","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqing","middleName":"","lastName":"He","suffix":""},{"id":350173020,"identity":"3ba6302b-63ad-4070-b2f9-cbeb9396d41e","order_by":2,"name":"Wenjun Dai","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjun","middleName":"","lastName":"Dai","suffix":""},{"id":350173021,"identity":"417b0408-14ef-4bb5-8151-221eba0277c9","order_by":3,"name":"Wenpeng Tang","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenpeng","middleName":"","lastName":"Tang","suffix":""},{"id":350173022,"identity":"f15662b8-7830-4512-bef7-881fe437119a","order_by":4,"name":"Yunhong Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACxvkHGw7/qGCrb2NvIFIL8wzmxscMZ/gY+3gOEKmFfQZ7szFjmxzjPIkEIrXwzm5sky44Y8bMJvl44w2GGptoglok5xxsk55RkcbGJp1WbMFwLC23gZAWw4bENgmeM8d42KRzzCQYGw4T1mJ/AKiFt+2/BJvkGSK1MM5IbDbmbWMzYJPgIVZLz8HGhzPOsCWw8QD9kkCMXxjb2x8c+FDBliDffnjjjQ81NoS1IAMDoqMGSQupOkbBKBgFo2BkAABJtkBVLpdz+AAAAABJRU5ErkJggg==","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yunhong","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-08-23 12:47:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4964321/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4964321/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08150-2","type":"published","date":"2025-11-06T15:58:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95564073,"identity":"d85cb8de-ede9-4d26-9589-e2060097e3df","added_by":"auto","created_at":"2025-11-10 16:07:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":490767,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4964321/v1/0cbae1d7-9885-4ff4-9523-3951449b6c14.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The application of PBL combined with MDT and flipped classroom teaching method in the education of acute coronary syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe problem-based learning (PBL) teaching method is currently a popular educational model in the field of medical education and first emerged in medical education in the 1950s[1]. The PBL teaching method is centered around problem-oriented learning, where the teacher guides students through a process that includes problem identification, analysis, discussion, and resolution to complete the learning content. PBL effectively captures students\u0026apos; attention and fosters their enthusiasm and initiative for learning. By encouraging students to participate in the formulation, analysis, and discussion of problems, PBL enhances effective classroom interaction between teachers and students as well as among students themselves. This approach not only aids in developing students\u0026apos; independent learning and thinking habits but also hones their communication and expression skills[2, 3].\u003c/p\u003e\n\u003cp\u003eThe flipped classroom, also known as the flipped classroom teaching method[4], was first introduced by two chemistry teachers, Jonathan Bergmann and Aaron Sams, in 2006. The successful implementation of this approach has gained widespread attention from scholars both domestically and internationally, establishing it as an innovative teaching model across various disciplines. In medical education, the flipped classroom has led to significant changes in teacher and student roles, as well as in course teaching models. The core concept of this method is to encourage students to engage in knowledge acquisition outside the classroom while using class time for the internalization of knowledge and in-depth discussion of problems. This approach represents a \u0026quot;disruptive\u0026quot; or \u0026quot;transformative\u0026quot; shift from traditional teaching methods[5-7]. The flipped classroom model offers significant advantages in promoting personalized student development and enhancing students\u0026apos; self-directed learning abilities. It moves away from the monotonous and repetitive nature of traditional teaching methods, transforming into a more engaging, dynamic, and diverse teaching approach. By integrating modern multimedia technology, the flipped classroom facilitates autonomous learning and improves students\u0026apos; overall competencies, aligning with the developmental goals of modern medical education[8].\u003c/p\u003e\n\u003cp\u003eThe concept of multidisciplinary treatment (MDT) was introduced by the MD Anderson Cancer Center in the United States. It advocates for the collaboration of multiple disciplines in the diagnosis and treatment decision-making process for cancer patients. This approach shifts the traditional disease-centered diagnostic and treatment model toward a more patient-centered model that emphasizes individualized, precise, comprehensive, and multidisciplinary care[9]. MDT has garnered widespread attention in both clinical practice and medical education because of its unique multidisciplinary approach to disease diagnosis and treatment, which aims to provide patients with the best treatment strategies. For medical educators, a long-standing challenge has been how to cultivate students\u0026apos; ability to understand diseases holistically and analyze and manage the individualized characteristics of patients\u0026apos; conditions. Applying the MDT model to case-based teaching helps overcome the limitations of the narrow and shallow knowledge often associated with a single-discipline perspective[10, 11].\u003c/p\u003e\n\u003cp\u003eIn recent years, Guangzhou Medical University has vigorously promoted new teaching models such as \u0026quot;organ system-centered\u0026quot; education, PBL teaching methods, and flipped classrooms, achieving substantial results. These innovative approaches address the shortcomings of traditional medical education, significantly enhancing students\u0026apos; innovative thinking and practical skills. However, the implementation of these models has also faced some challenges, particularly during clinical clerkships. A considerable number of students still struggle to integrate knowledge effectively from disciplines such as pathophysiology, diagnostics, radiology, and internal medicine. They often lack logical thinking and judgment skills and rely passively on teachers to impart knowledge. To address these issues, it is necessary to integrate these new teaching models, leveraging their strengths and compensating for their weaknesses. This has led to timely reforms in clinical clerkship teaching methods. Given that acute coronary syndrome (ACS) presents characteristic symptoms that are easy for students to learn and understand, a typical case of ACS was selected as the teaching case. This study explored the application and effectiveness of PBL combined with an MDT and the flipped classroom teaching method in clinical clerkships for acute coronary syndrome.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study selected 100 undergraduate clinical medicine students aged 20--21 years from Guangzhou Medical University. The students were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and the flipped classroom teaching method), which included 50 students, and the control group (traditional teaching method), which included 50 students. The same instructor conducted the theoretical courses for both groups. A team of three instructors, each with over 10 years of teaching experience, was responsible for supervising the clinical clerkship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe students who participated in the study had already completed foundational courses such as Human Anatomy, Physiology, Pathophysiology, Pathology, Pharmacology, Biochemistry, Molecular Biology, Cell Biology, and Diagnostics, providing them with a solid base of medical knowledge. The teaching was conducted according to the overall requirements of the Internal Medicine Teaching Syllabus of Guangzhou Medical University. The course began with foundational theoretical teaching on cardiovascular system diseases, helping students build a comprehensive understanding of the theory and diagnosis of cardiovascular diseases to facilitate clinical clerkship practices.\u003c/p\u003e\n\u003cp\u003eApart from the differences in teaching methods, the instructor, teaching content, and number of class hours for the experimental group were identical to those of the control group. The case-based teaching for acute coronary syndrome was conducted in two sessions, each lasting 120 minutes.\u003c/p\u003e\n\u003cp\u003eControl Group: The traditional teaching method was implemented. Initially, basic knowledge of acute coronary syndrome was explained. Next, the students were guided to the patient\u0026apos;s bedside to collect their medical history, including the chief complaint, history of present illness, past medical history, personal history, and family history. A thorough physical examination was then conducted, covering but not limited to the measurement of vital signs and examination of various systems. Students collect and analyze various auxiliary test results, such as blood biochemistry, electrocardiogram (ECG), X-ray, and ultrasound results. When specific procedures were needed for the patient, the students were instructed on performing basic medical operations, such as bedside ECGs. The information gathered was then integrated with textbook content to organize key knowledge points and analyze the patient\u0026apos;s preliminary diagnosis, potential causes, clinical symptoms, interpretation of auxiliary test results, treatment plans, and subsequent medical management.\u003c/p\u003e\n\u003cp\u003eExperimental Group: PBL combined with an MDT and a flipped classroom teaching method was employed. On the basis of the teaching syllabus and the key points of acute coronary syndrome, the core content and difficult areas of teaching were identified, and a problem-based learning (PBL) lesson plan was developed. Lecture videos and supplementary materials on acute coronary syndrome were prepared, and students were required to study these resources in advance. Additionally, the students were instructed to use databases such as PubMed and the university library to gather useful information and write study notes.\u003c/p\u003e\n\u003cp\u003eThe students were divided into groups of 5 to 6 members, with one student acting as the group leader. Each member took on the role of a doctor from different specialties, such as cardiology, critical care medicine, respiratory medicine, ultrasound medicine, and pharmacy, forming an MDT (multidisciplinary team). The group simulated an MDT team discussion, focusing on key issues related to acute coronary syndrome from the perspective of their respective disciplines. These issues include the following: (1) What is the pathogenesis of acute coronary syndrome? (2) How can the different types of acute coronary syndrome be distinguished? (3) What are the common clinical manifestations of acute coronary syndrome? (4) What are the treatment options for acute coronary syndrome, and how should they be chosen? The group discussed these questions and collected and recorded their findings. During the hospital clerkship, under the guidance of a supervising teacher, each group discussed how to \u0026quot;solve problems\u0026quot; by combining the patient\u0026apos;s medical history, physical examination, and auxiliary test results. They conducted in-depth discussions on the diagnosis, differential diagnosis, and treatment plan for the patient. The group leader then presented their findings, with other members adding supplementary information. The focus was on analyzing and summarizing the diagnostic and therapeutic logic and strategies of the case. After the presentations, the instructor evaluated each group\u0026apos;s report, pointed out areas for improvement, and guided the students to clarify the next steps in their learning, thereby stimulating their potential for self-directed learning.\u003c/p\u003e\n\u003cp\u003eAdditionally, for some typical cases, a 40-minute discussion session can be appropriately arranged during class. Specific questions are assigned in advance, with each group focusing on one question for research and analysis. Before the clerkship, students explore the optimal solutions through information gathering, team discussions, and literature reviews and then prepare a report. For example, in a case involving an elderly male patient with sudden chest pain and ST-T wave abnormalities on an ECG, the supervising teacher can include guiding questions in the PBL lesson plan, such as the following: What are the diagnostic criteria? What are the key points for differential diagnosis? What further tests are necessary? What is the best treatment strategy? During the preparation phase before the clerkship, group members can gather information through various means, such as online searches and library resources, to develop a solution. In the clerkship, after thoroughly understanding the theoretical knowledge and participating in classroom discussions, students can engage more deeply with patients, applying what they have learned to real clinical cases.\u003c/p\u003e\n\u003cp\u003e1.3 Evaluation of Teaching Effectiveness\u003c/p\u003e\n\u003cp\u003eA test was designed on the basis of the teaching content, and a closed-book written exam was administered to assess the theoretical knowledge of the students in both groups. The exam consisted of multiple-choice questions, which were equally divided into two sections: basic theoretical knowledge (100 points) and clinical case analysis (100 points). All the questions in the test were based on Bloom\u0026apos;s Taxonomy, which categorizes cognitive activities into six levels: remembering, understanding, applying, analyzing, evaluating, and creating. The \u0026quot;remembering\u0026quot; and \u0026quot;understanding\u0026quot; categories were combined into one section, referred to as \u0026quot;basic theoretical knowledge,\u0026quot; while items from the other categories were classified under \u0026quot;clinical case analysis\u0026quot;[12, 13].\u003c/p\u003e\n\u003cp\u003eA survey was designed in advance and administered anonymously to both the experimental and control groups. The questionnaire included the following seven questions: learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. Each question was a multiple-choice format, with the options \u0026quot;Yes\u0026quot; or \u0026quot;No.\u0026quot; The proportion of \u0026quot;Yes\u0026quot; responses was calculated for each question. Finally, a statistical analysis was conducted on the exam results and the responses from the teaching effectiveness survey for both the experimental and control groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data obtained from the study were statistically analyzed via SPSS 23.0 software. Categorical data are expressed as frequencies and percentages \\(n(\\%) \\), and comparisons between groups were performed via the chi-square (\u0026chi;\u0026sup2;) test. Continuous data are expressed as the mean \u0026plusmn; standard deviation \\((\\overline{x} \\pm s)\\), and comparisons between groups were made via t tests. A p value of less than 0.05 (P \u0026lt; 0.05) was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1 Comparison of general information between the two groups\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in age or sex between the two groups of students, as shown in Table 1.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"508\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 100%;\"\u003e\n \u003cp\u003eTable 1 Comparison of General Information Between the Two Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.3228%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.5197%;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.9213%;\"\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 35.2362%;\"\u003e\n \u003cp\u003eAge (years old, x̅\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.3228%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.5197%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.9213%;\"\u003e\n \u003cp\u003e31/19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 35.2362%;\"\u003e\n \u003cp\u003e20.96\u0026plusmn;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.3228%;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.5197%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.9213%;\"\u003e\n \u003cp\u003e26/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 35.2362%;\"\u003e\n \u003cp\u003e21.02\u0026plusmn;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.3228%;\"\u003e\n \u003cp\u003eT/\u0026chi;2 value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.5197%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.9213%;\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 35.2362%;\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.3228%;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.5197%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.9213%;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 35.2362%;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere were no statistically significant differences in age or sex between the control and experimental groups (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e2.2 Comparison of Exam Scores between the Two Groups\u003c/p\u003e\n\u003cp\u003eThe theoretical exam scores of the experimental group (86.10 \u0026plusmn; 4.35) were higher than those of the control group (83.42 \u0026plusmn; 5.06), and the skill exam scores of the experimental group (78.46 \u0026plusmn; 4.97) were also higher than those of the control group (75.30 \u0026plusmn; 4.29). These differences were statistically significant (P \u0026lt; 0.05), as shown in Table 2.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"536\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 100%;\"\u003e\n \u003cp\u003eTable 2 Comparison of Exam Scores Between the Two Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0149%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.2985%;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.5821%;\"\u003e\n \u003cp\u003eTheoretical Exam Scores(𝑥\u0026oline;\u0026plusmn;𝑠)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.1045%;\"\u003e\n \u003cp\u003eSkills Exam Scores(𝑥\u0026oline;\u0026plusmn;𝑠)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0149%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.2985%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.5821%;\"\u003e\n \u003cp\u003e83.42\u0026plusmn;5.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.1045%;\"\u003e\n \u003cp\u003e75.30\u0026plusmn;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0149%;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.2985%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.5821%;\"\u003e\n \u003cp\u003e86.10\u0026plusmn;4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.1045%;\"\u003e\n \u003cp\u003e78.46\u0026plusmn;4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0149%;\"\u003e\n \u003cp\u003eT value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.2985%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.5821%;\"\u003e\n \u003cp\u003e2.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.1045%;\"\u003e\n \u003cp\u003e3.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0149%;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.2985%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.5821%;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.1045%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe experimental group outperformed the control group in both theoretical and skills exams, with statistically significant differences (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e2.3 Comparison of Learning Outcomes Survey between the Two Groups\u003c/p\u003e\n\u003cp\u003eA total of 100 questionnaires were distributed, containing seven questions: learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. Each question was answered with \u0026quot;yes\u0026quot; or \u0026quot;no\u0026quot; regarding satisfaction, and the proportion of \u0026quot;yes\u0026quot; responses was calculated. All questionnaires were completed successfully and were valid. The survey results revealed that the proportion of students in the experimental group who responded positively (\u0026quot;Yes\u0026quot;) was greater than that in the control group across all aspects, including learning motivation, effectiveness of theoretical learning, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. These differences were statistically significant (P \u0026lt; 0.05), as shown in Table 3.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"792\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"bottom\" style=\"width: 792px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e表3 Table 3: Comparison of Teaching Effectiveness Survey Results Between the Two Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003eLearning Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003eLearning Effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003eReasoning Ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003eSearch Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eLearning Ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003ePractical Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eClassroom Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026chi;2值\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e6.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e10.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7.440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003ep值\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results in Table 3 show that the experimental group outperformed the control group in all aspects, including learning motivation, theoretical learning effectiveness, clinical reasoning ability, literature search skills, self-directed learning ability, practical skills, and classroom satisfaction. The differences between the two groups were statistically significant (P \u0026lt; 0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the development of medical education, many new educational methods have gradually emerged alongside the traditional classroom-based teaching approach. Among these methods, the problem-based learning (PBL) method and the flipped classroom are notable examples. These innovative teaching methods have increasingly been applied in cardiovascular disease education[14-16].\u003c/p\u003e\n\u003cp\u003eThe problem-based learning (PBL) model is a teaching approach centered on the design of problems to achieve specific learning objectives. It involves problem formulation, classroom instruction, resolving doubts, and interactive discussions to promote learning. This method emphasizes active student engagement, leveraging students\u0026rsquo; intrinsic motivation to enhance their learning ability and efficiency. The PBL model aims to address common issues in current teaching practices, such as unclear learning objectives, a lack of emphasis on problem awareness, minimal instructional design, and the disconnect between teaching and learning[17, 18]. The flipped classroom teaching model involves students watching instructional videos and engaging in self-directed learning before or outside of class. Instead of using classroom time for lectures, the class becomes a space for interaction between teachers and students, as well as among students themselves. This interaction includes answering questions, collaborative exploration, and completing academic tasks, ultimately leading to more effective educational outcomes[19, 20]. The concept of multidisciplinary treatment (MDT) was introduced by the MD Anderson Cancer Center in the United States. It advocates for the collaboration of multiple disciplines in the diagnosis and treatment decision-making process for cancer patients, shifting the traditional disease treatment model to a patient-centered approach that is personalized, precise, comprehensive, and multidisciplinary. The unique perspective of combining various disciplines for disease diagnosis and treatment, with the aim of providing patients with the most optimized treatment plans, has garnered significant attention from both clinical practitioners and medical educators. For medical educators, a longstanding challenge has been how to cultivate students\u0026apos; holistic understanding of diseases and their ability to analyze and manage the personalized characteristics of patients\u0026apos; conditions. Integrating the MDT model into case-based teaching can help overcome the limitations of a single-discipline perspective, which often lacks sufficient breadth and depth of knowledge[11].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Acute coronary syndrome is a common and critical condition that involves multidisciplinary knowledge for its diagnosis, differential diagnosis, and treatment[21]. The integration of the MDT-flipped classroom with the PBL teaching method provides a new teaching model for clinical cases of acute coronary syndrome. In this model, students are encouraged to engage in preclass preparation, allowing them to grasp relevant knowledge, identify problems, and seek solutions actively. During clinical practice, they apply the knowledge they have acquired to reason through the causes of disease and develop treatment plans. This approach encourages students to take on a more proactive role during clinical practice, enhancing their motivation and engagement in learning. The results of this study are consistent with findings reported in other studies, demonstrating that this teaching model achieves favorable educational outcomes. Before class, students utilize resources such as CNKI, PubMed, school databases, and libraries to stay updated on the latest medical advancements and cutting-edge knowledge, allowing them to engage in in-depth studies of case-related topics. During clinical practice, particularly in case discussions, students are encouraged to ask questions, share unique insights, and closely link theoretical learning with clinical practice. This process helps deepen their understanding of medical knowledge, accumulate clinical experience, and cultivate scientific thinking.\u003c/p\u003e\n\u003cp\u003eOn the basis of the results of this study, it is evident that the students in the experimental group outperformed those in the control group in both examination scores and classroom satisfaction. These findings confirm that the integration of MDT, flipped classroom, and PBL teaching methods can play a multifaceted role in clinical training. 1. Enhancing Self-Directed Learning Abilities**: The flipped classroom approach requires students to engage in self-directed learning of foundational knowledge through videos and reading materials before class. This method is highly effective in fostering students\u0026apos; self-learning and self-management skills, transforming the passive reception of knowledge into active learning[22]. The students in the experimental group who participated in this study were highly proactive in their preparation, actively searching for information and engaging in group discussions to develop their case reports. 2. Strengthening the Integration of Theory and Practice**: The PBL teaching method enhances the practical application of learning by presenting clinical problems that guide students in applying theoretical knowledge to real-world scenarios, thereby increasing the practicality and relevance of their learning[23]. Owing to their thorough preparation before the classes, the students in the experimental group were able to better grasp and absorb the relevant knowledge involved in the clinical cases. They could actively apply this knowledge to real-life cases, displaying confidence and competence during clinical case discussions. Promoting Critical Thinking**: In the combined teaching approach of the flipped classroom and PBL, students are required to analyze problems, propose hypotheses, and engage in discussions. This process fosters the development of critical thinking and problem-solving skills[24, 25]. The students in the experimental group, having been thoroughly prepared in advance, often encountered various questions during their self-study. They came to class with these questions and actively sought answers. Compared with the control group, they showed significantly greater enthusiasm in discussing problems and were more willing to engage with teachers or peers to explore the best solutions. 4. Enhancing Teacher‒Student Interaction and Personalized Teaching**: The flipped classroom approach provides more opportunities for interaction between teachers and students. Teachers can offer personalized guidance on the basis of the feedback and needs of students[26, 27]. Unlike traditional teaching methods, the MDT flipped classroom and PBL teaching approaches require students to actively engage in classroom discussions. This active participation fosters better absorption of knowledge and skills through teacher‒student interactions, allowing for real-time adjustments on the basis of students\u0026apos; comprehension levels. 5. Enhancing Clinical Thinking and Decision-Making Skills:** PBL teaching methodology enables students to hone their clinical thinking and decision-making abilities while solving clinical problems. This is particularly crucial for students in internal medicine clinical rotations, where the ability to think critically and make informed decisions is essential for effective patient care[28, 29]. Clinical thinking and decision-making skills cannot be simply acquired through passive knowledge transmission; they must be actively developed through clinical practice. The integration of the MDT flipped classroom with PBL teaching methods effectively addresses this challenge by encouraging students to engage in proactive learning. Students are driven to prepare in advance, identify problems independently, seek solutions, and interact with instructors. This active approach not only enhances knowledge acquisition but also fosters the development of clinical thinking. Improving Teaching Outcomes and Student Satisfaction:** Research indicates that the combination of the flipped classroom and PBL teaching methods can significantly improve students\u0026apos; examination performance and satisfaction, particularly in clinical practice courses. The results of this study demonstrate that students in the experimental group outperformed those in the control group in both theoretical and skills assessments and reported higher satisfaction with the course. Aligning with trends in medical education reform:** As medical education continues to evolve, the combination of the MDT flipped classroom and PBL teaching methods aligns well with modern educational needs. This approach effectively cultivates medical professionals with strong innovation capabilities and clinical practice skills, meeting the demands of contemporary medical education reform.\u003c/p\u003e\n\u003cp\u003eThe application of the MDT flipped classroom combined with PBL teaching methods in the clinical training of acute coronary syndrome patients not only enhances students\u0026apos; learning experience and teaching outcomes but also cultivates their clinical thinking and self-directed learning abilities. This approach holds significant importance and value in medical education and is worthy of further promotion and application.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the results of this study indicate that the use of the PBL combined with MDT and flipped classroom teaching method during cardiology internships, specifically in the study of acute coronary syndrome, can significantly improve students\u0026apos; theoretical knowledge and clinical skills. However, further large-scale studies are needed to evaluate how to optimize course design and management to facilitate broader application and enhance its effectiveness.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026nbsp;MDT:multidisciplinary treatment; PBL: Problem-based learning.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The study was approved by the Institutional Review Board and Ethics Committee of The Third Affiliated Hospital, Guangzhou Medical University. Written informed consent was obtained from all the participating students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Written consent from the participants was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;This work was supported by Science and Technology Projectsin Guangzhou (Grant number 2023A03J0373), Plan on enhancing scientific research in GMU (grant 204).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; YL and YX contributed to the design of the study. XH，WD and WT contributed to data collection and analysis, YX and YL contributed to data analysis and manuscript writing. WT and XH contributed to manuscript revisions. All authors contributed to the critical revision of the paper and approved the final manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Authors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDevelopment of Cardiovascular Medicine; Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchmidt HG, Rotgans JI, Yew EH. The process of problem-based learning: what works and why. Med Educ. 2011;45(8):792-806.\u003c/li\u003e\n\u003cli\u003ede Andrade Gomes J, Braga L, Cabral BP, Lopes RM, Mota FB. Problem-Based Learning in Medical Education: A Global Research Landscape of the Last Ten Years (2013-2022). Med Sci Educ. 2024;34(3):551-60.\u003c/li\u003e\n\u003cli\u003eJaganathan S, Bhuminathan S, Ramesh M. Problem-Based Learning - An Overview. J Pharm Bioallied Sci. 2024;16(Suppl 2):S1435-1435S1437.\u003c/li\u003e\n\u003cli\u003eTolks D, Sch\u0026auml;fer C, Raupach T, et al. An Introduction to the Inverted/Flipped Classroom Model in Education and Advanced Training in Medicine and in the Healthcare Professions. GMS J Med Educ. 2016;33(3):Doc46.\u003c/li\u003e\n\u003cli\u003eLi S. Flip the classroom. Educ Prim Care. 2015;26(6):438-40.\u003c/li\u003e\n\u003cli\u003ePhillips J, Wiesbauer F. The flipped classroom in medical education: A new standard in teaching. Trends Anaesth Crit Care. 2022;42:4-8.\u003c/li\u003e\n\u003cli\u003eNunez FE, Monsivais DB. It Takes More Than One Somersault to Flip a Classroom. Nurse Educ. 2020;45(3):116-8.\u003c/li\u003e\n\u003cli\u003eSandrone S, Berthaud JV, Carlson C, et al. Strategic Considerations for Applying the Flipped Classroom to Neurology Education. Ann Neurol. 2020;87(1):4-9.\u003c/li\u003e\n\u003cli\u003eFeng P, Wu J, Jin Z, Cui J, Zhang S, He L, Zhao H. Effect evaluation of competency-based education (CBE) combined with multidisciplinary team (MDT) teaching mode in respiratory rehabilitation nursing teaching：A randomized controlled trial. Nurse Educ Pract. 2024;76:103896.\u003c/li\u003e\n\u003cli\u003eLi J, Du Y. Integration of MDT and CBL approaches in teaching anesthesiology residents about herpes zoster-associated pain. Asian J Surg. 2024;47(7):3314-5.\u003c/li\u003e\n\u003cli\u003eXu ZW, Liu NN, Zhang JL, et al. Application of symptom-based mind mapping combined with PBL teaching method in emergency trauma standardized resident training in MDT model. Medicine (Baltimore). 2022;101(38):e30822.\u003c/li\u003e\n\u003cli\u003eSelina F, Hasan MF, Talha KA, Al-Muhaimin M, Momo FR, Debnath J, Begum S, Ahmad J. Assessing the Effectiveness of Clinical Skills Laboratory and Traditional Lecture in Teaching Basic Life Support and Performance Evaluation According to Different Domains of Revised Bloom\u0026apos;s Taxonomy. Mymensingh Med J. 2023;32(1):207-12.\u003c/li\u003e\n\u003cli\u003eSu WM, Osisek PJ, Starnes B. Using the Revised Bloom\u0026apos;s Taxonomy in the clinical laboratory: thinking skills involved in diagnostic reasoning. Nurse Educ. 2005;30(3):117-22.\u003c/li\u003e\n\u003cli\u003eSeki M, Fujinuma Y, Matsushima M, Joki T, Okonogi H, Miura Y, Ohno I. How a problem-based learning approach could help Japanese primary care physicians: a qualitative study. Int J Med Educ. 2019;10:232-40.\u003c/li\u003e\n\u003cli\u003eZhong Y, Zhang Y, Sun W, et al. An outcomes-based module education via flipped classroom enhances undergraduate oral histopathology learning. BMC Med Educ. 2023;23(1):848.\u003c/li\u003e\n\u003cli\u003eLu F, Luo Z, Huang T, Lv X, Wang H, Wang Y, Yin H. Effectiveness evaluation of flipped classroom in emergency medicine online teaching for medical undergraduates. Med Teach. 2024;46(5):689-96.\u003c/li\u003e\n\u003cli\u003eKulo V, Cestone C. A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education. Med Sci Educ. 2023;33(6):1409-26.\u003c/li\u003e\n\u003cli\u003eRen S, Li Y, Pu L, Feng Y. Effects of problem-based learning on delivering medical and nursing education: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs. 2023;20(5):500-12.\u003c/li\u003e\n\u003cli\u003eSomaa F. The Flipped Classroom Approach: A Review of Cognitive Styles and Academic Performances. Cureus. 2024;16(7):e63729.\u003c/li\u003e\n\u003cli\u003eOudbier J, Spaai G, Timmermans K, Boerboom T. Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review. BMC Med Educ. 2022;22(1):34.\u003c/li\u003e\n\u003cli\u003ePerona M, Cooklin A, Thorpe C, O\u0026apos;Meara P, Rahman MA. Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review. Eur Cardiol. 2024;19:e12.\u003c/li\u003e\n\u003cli\u003eKraut AS, Omron R, Caretta-Weyer H, et al. The Flipped Classroom: A Critical Appraisal. West J Emerg Med. 2019;20(3):527-36.\u003c/li\u003e\n\u003cli\u003eNeville AJ, Norman GR. PBL in the undergraduate MD program at McMaster University: three iterations in three decades. Acad Med. 2007;82(4):370-4.\u003c/li\u003e\n\u003cli\u003ePluta WJ, Richards BF, Mutnick A. PBL and beyond: trends in collaborative learning. Teach Learn Med. 2013;25 Suppl 1:S9-16.\u003c/li\u003e\n\u003cli\u003eYang W, Zhang X, Chen X, Lu J, Tian F. Based case based learning and flipped classroom as a means to improve international students\u0026apos; active learning and critical thinking ability. BMC Med Educ. 2024;24(1):759.\u003c/li\u003e\n\u003cli\u003eXu Y, Chen C, Ji M, Xiang Y, Han Y, Feng D, Luo Z. An online flipped classroom approach improves the physiology score and subsequent course scores of the top-performing students. Adv Physiol Educ. 2023;47(3):538-47.\u003c/li\u003e\n\u003cli\u003eSultan AS, Ali R, Zahid N, et al. Experiences of Undergraduate Medical, Nursing Students and Faculty regarding Flipped Classroom: A Mixed Method Study at Private Medical University in Pakistan. BMJ Open. 2023;13(4):e070276.\u003c/li\u003e\n\u003cli\u003eSun L, Liu D, Lian J, Yang M. Application of flipped classroom combined with virtual simulation platform in clinical biochemistry practical course. BMC Med Educ. 2023;23(1):771.\u003c/li\u003e\n\u003cli\u003eZhou F, Sang A, Zhou Q, Wang QQ, Fan Y, Ma S. The impact of an integrated PBL curriculum on clinical thinking in undergraduate medical students prior to clinical practice. BMC Med Educ. 2023;23(1):460.\u003c/li\u003e\n\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":"Flipped Classroom, PBL, MDT, Acute Coronary Syndrome","lastPublishedDoi":"10.21203/rs.3.rs-4964321/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4964321/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe development of medical education is rapidly evolving, with innovative teaching methods such as problem-based learning (PBL) and multidisciplinary treatment (MDT) combined with flipped classroom approaches gaining increasing attention in clinical medical education. However, the actual effectiveness of PBL combined with MDT and flipped classroom methods in the teaching of cardiovascular diseases has not been well studied. Considering that these two teaching methods can complement each other, this study explores the application and effectiveness of PBL combined with MDT and flipped classroom teaching method in the case-based teaching of acute coronary syndrome. \u003cstrong\u003eMethods:\u003c/strong\u003e A total of 100 undergraduate clinical medicine students aged 20--21 years from Guangzhou Medical University were selected as research subjects. They were randomly divided into two groups via a random number table: the experimental group (PBL combined with MDT and flipped classroom teaching), which included 50 students, and the control group (traditional teaching methods), which included 50 students. After the clinical training, the theoretical examination scores and skill assessment results of the two groups were compared, and a questionnaire survey was conducted to evaluate teaching effectiveness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The theoretical examination scores and skill assessment results of the experimental group were significantly better than those of the control group (P \u0026lt; 0.05). The questionnaire survey revealed that the students in the experimental group outperformed those in the traditional teaching group in terms of learning motivation, theoretical learning outcomes, clinical thinking ability, literature retrieval skills, self-directed learning ability, practical ability, and classroom satisfaction, with statistically significant differences (P \u0026lt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePBL combined with MDT and the flipped classroom teaching method is effective in the clinical training of acute coronary syndrome patients, offers better teaching outcomes than traditional methods do and is worthy of further promotion and application.\u003c/p\u003e","manuscriptTitle":"The application of PBL combined with MDT and flipped classroom teaching method in the education of acute coronary syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-04 18:21:05","doi":"10.21203/rs.3.rs-4964321/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-05T18:38:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-04T01:28:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-04T01:27:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-08-23T12:44:38+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":"cba444b2-0ee2-4b63-8350-d8072433d36d","owner":[],"postedDate":"October 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T16:03:06+00:00","versionOfRecord":{"articleIdentity":"rs-4964321","link":"https://doi.org/10.1186/s12909-025-08150-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-11-06 15:58:00","publishedOnDateReadable":"November 6th, 2025"},"versionCreatedAt":"2024-10-04 18:21:05","video":"","vorDoi":"10.1186/s12909-025-08150-2","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08150-2","workflowStages":[]},"version":"v1","identity":"rs-4964321","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4964321","identity":"rs-4964321","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}