Bridging Theory and Practice: A KGs-CBL Blended Framework for Enhanced Medical Imaging Education

Bridging Theory and Practice: A KGs-CBL Blended Framework for Enhanced Medical Imaging Education | 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 Bridging Theory and Practice: A KGs-CBL Blended Framework for Enhanced Medical Imaging Education Yaqi Wang, Jing Deng, Ling Li, Hai Lin, Wei Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8013881/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: This study evaluated a novel blended teaching model for medical imaging experimental instruction, combining knowledge graphs with case-based learning (KGs-CBL). Methods: This study included a total of 240 undergraduate students majoring in five-year medical imaging from 2020 to 2021. 117 students from 2021 were chosen as the experimental group, using a blended teaching model based on KGs-CBL. In 2020, 122 students were selected as the control group and underwent the traditional teaching model. The teaching content was the experimental course on medical imaging of the circulatory system, in which the application effect of the two groups of teaching methods was evaluated by the assessment of theoretical examination, comprehensive case analysis, and questionnaire survey. Results: In the assessment of theoretical examination, and comprehensive case analysis (including identification of imaging examination techniques, description of imaging signs, diagnosis of imaging, differential diagnosis, report writing, and overall score), the experimental group demonstrated superior performance to the controls, with a statistically significant difference (p<0.05). The survey results indicated that students’ scores evaluating the blended teaching model were positive, with a considerable percentage expressing satisfaction and belief in its effectiveness. The experimental group were higher than those in the control group in the following eight aspects: “facilitating mastery of teaching content” (p=0.008), “aiding in acquiring and mastering extracurricular knowledge” (p=0.005), “enhancing thinking and analytical abilities” (p=0.003), “boosting learning interest” (p=0.001), “fostering independent learning capabilities” (p=0.006), “strengthening team collaboration skills” (p = 0.007), “promoting logical thinking and expressive abilities” (p＜0.001) and “adding to the learning burden” (p＜0.001). Conclusions: The blended teaching model based on KGs-CBL can improve students’ academic performance, cultivate students’ comprehensive ability, and improve their satisfaction. This method has been proven effective in enhancing the practical skills and diagnostic capabilities of undergraduates majoring in medical imaging, making it a valuable approach in medical education. Artificial intelligence Case-based learning Knowledge graphs Medical imaging Figures Figure 1 Figure 2 Introduction Medical imaging plays a critical role in disease screening, diagnosis, and treatment decision-making. Its high practicality, comprehensive diagnostic capabilities, and the complex demand for image interpretation place greater demands on medical education. With the rapid development of imaging technologies such as MRI, CT, and ultrasound, as well as the widespread application of artificial intelligence (AI) in image recognition and diagnostic assistance, the traditional teacher-centered, unidirectional teaching model has become inadequate to meet the disciplinary development needs. Although this model can systematically convey knowledge, it lacks deep integration with clinical practice, resulting in low student engagement, insufficient training in clinical thinking skills, and difficulty in translating knowledge into practical application. Modern medical student training emphasizes not only professional expertise and operational skills but also the enhancement of clinical analytical ability and adaptability. Therefore, there is an urgent need to introduce more efficient and interactive teaching methods. Case-based learning (CBL) is founded on clinical cases. Instructors design questions related to these cases and guide students to explore and solve problems independently through analysis and discussion [ 1 – 2 ] . Based on the characteristics of cases and the questions set before class, guiding students to learn knowledge related to diseases is beneficial for cultivating their clinical thinking ability. Numerous studies have shown that CBL effectively enhances the clinical competencies, critical thinking, and problem-solving skills of medical students [ 3 – 4 ] . However, no educational approach is flawless, and a drawback of CBL is its deficiency in providing comprehensive elucidations of fundamental principles and overall knowledge synthesis. The explicit and implicit connections among medical knowledge points are complex, posing a challenge for students to understand the inherent relationships and logic within medical knowledge during the learning process [ 5 ] . AI technology demonstrates significant advantages in image recognition, data processing, and diagnostic assistance. Integrating AI into education is not only an inevitable trend in technological development but also a crucial pathway to enhance students’ future professional capabilities [ 6 – 7 ] . The knowledge graphs (KGs) are an AI-based teaching assistance system. It integrates knowledge points into a centralized, accurate, complete, and concise network diagram, clearly showing the complex logical relationships between them. Additionally, various online resources like videos, learning materials, and test questions can connect to the knowledge nodes within the KGs. Another advantage of the KGs is their ability to recommend relevant resources and customize personalized learning paths based on learners’ needs, preferences, and other characteristics, allowing students to decide on the content and process of their learning independently. The single teaching model cannot meet the needs. In the context of the Internet-plus era, a blended teaching model combining offline teaching and online teaching has emerged [ 8 – 10 ] . A blended teaching model combining CBL and knowledge graphs (KGs-CBL) offers significant advantages: CBL serves as the core of offline teaching, strengthening cognitive training in clinical contexts, while the KGs act as an online support platform, enhancing students’ systematic understanding of medical knowledge and self-directed review capabilities. This model integrates the benefits of both online and offline instruction, improving the efficiency of educational resource utilization while ensuring the quality of clinical teaching [ 11 ] . It has the potential to shift medical imaging education from “knowledge transmission” to “capacity building”, providing a new pathway for cultivating medical talents with solid clinical competence and systematic thinking abilities [ 12 ] . This study integrates KGs-CBL and applies it to experimental teaching for undergraduates majoring in medical imaging, exploring the implementation effect of the new teaching model and providing the scientific basis for teaching reform. Methods Study population The study protocol was approved by the Ethics Committee of Hubei University of Science and Technology (No: 2024-02-002), and informed consent was obtained from all participants. We selected 240 undergraduates majoring in medical imaging at Hubei University of Science and Technology as the subjects of our study. The study cohorts comprised single, annual cohorts of the medical imaging major. The control cohort consisted of the entire class of 2020 (n=122), which received traditional teaching. The experimental cohort, comprising the whole class of 2021 (n=117), received the novel intervention—a blended approach combining KGs-CBL. Before the commencement of teaching, both groups underwent a comprehensive ability test of medical imaging. To ensure the validity of the comparison, key variables (including textbooks, training plans, syllabi, and instructors) were held constant across both groups. Teaching content The textbook used by the two groups of students was the 5th edition of ‘Medical Imaging Diagnostics’ published by People’s Medical Publishing House. The teaching content was the experimental course on medical imaging of the circulatory system. Teaching m ethod The experimental group adopted a blended teaching approach combining the KGs-CBL. The process unfolded as follows: 1. During the before class phase, the supervising instructor collected eight teaching cases in advance according to the teaching syllabus and disease types of the circulatory system. The cases included medical history, clinical manifestations and signs, laboratory examination, information on medical imaging, etc. Students were randomly divided into eight subgroups (approximately 15 students each). The group members elected a student to serve as the team leader, who then efficiently oversaw task distribution and fostered collaboration within the team. The supervising instructor distributed teaching cases and online courses focused on KGs to the experimental group. Students integrated the KGs with the teaching materials to facilitate online learning. According to the predetermined schedule, students accessed the online platform to view instructional videos for self-guided study before the CBL sessions, establishing the foundational knowledge network [1 3 ] . During the learning process, they need to watch the corresponding teaching videos and complete online exercises independently. Accompanying each instructional video were multiple single-choice questions for students to respond to, with the reference answers accessible upon submission of their responses. Students were encouraged to utilize the discussion forum to pose questions, facilitating collaborative learning through discussion with both instructors and peers. Students held offline group discussions using the teaching cases as a basis and subsequently created a PPT. The PPT content encompassed a comprehensive analysis of medical history, detailed descriptions of various imaging techniques, including X-ray, CT, MRI, and ultrasound, as well as the elucidation of imaging signs, thorough imaging diagnosis, differential diagnosis, and treatment strategies. Every group member was required to participate in either the PPT production or presentation. Each participant was required to complete the tasks through group discussion, and the group leader was subsequently responsible for documenting the collective study sessions. [1 4 ] . The group leaders submitted the PPT and the division of labor among group members to the instructor for summary one day before class. 2. In class, one member from each group was selected to deliver the PowerPoint presentation, articulating the team’s collective viewpoint on the topic derived from pre-class deliberations and clinical scenarios [1 5 ] . Subsequently, fellow students engaged in discussions, providing comments and posing inquiries. This process spanned approximately 135 minutes. The supervising instructor and group leaders scored based on the PPT and presentation. The last part was a centralized evaluation and Q&A session. Students were encouraged to apply the knowledge they had acquired in earlier instructional phases to address real-world challenges, thereby fostering their problem-solving abilities. The instructor presented complex prompts for immediate group deliberation to promote teamwork and encourage lively debates, continuing until the participants reached a consensus. Finally, the instructor announced the reference answers in class. This entire process lasted approximately 45 minutes. 3. In the post-class phase, teaching effectiveness was evaluated through a theoretical examination, a comprehensive case analysis, and student questionnaires. Additionally, the instructor assessed students on their online learning activities, the quality of their PPT presentations, their individual contributions to group work, and their performance on post-class assessments. The control group implemented the traditional teaching model, comprising the following steps: 1. During the before class phase, the supervising instructor prepared the relevant teaching materials, and students independently previewed the course content. 2. In class, the supervising instructor elucidated relevant theoretical knowledge and learning points, analyzed typical cases based on the teaching content. This procedure took about 45 minutes. Students analyzed the teaching cases through imaging film and engaged in free discussion. This process lasted approximately 90 minutes. The final segment involved a centralized evaluation and Q&A session. This process lasted approximately 45 minutes. 3. In the post-class phase, students took the theoretical examination, comprehensive case analysis, and questionnaire surveys to evaluate teaching effectiveness (the content of the test and questionnaire survey for both groups of students was the same). In Figure 1, we outline the flowcharts for the KGs-CBL blended teaching and traditional teaching modes to visualize their structures. Two groups of students underwent theoretical examination, comprehensive case analysis, and questionnaire survey. (1) For the theoretical examination, we randomly selected 50 questions from the medical imaging question bank based on the teaching syllabus. The exam had a maximum score of 100 points. (2) For the comprehensive case analysis, we selected two complete cases. The case materials included medical history, clinical manifestations and signs, laboratory results, and medical imaging findings. Each student independently completed the case analysis in the form of a written report, with a maximum score of 100 points. The assessment content encompassed recognition of imaging examination techniques, precise description of imaging signs, comprehensive medical imaging diagnosis, thorough differential diagnosis, and adherence to standard report writing protocols. Each part of the content scored 10%, 30%, 20%, 15%, and 25% respectively. (3) An anonymous questionnaire was administered, which covered the following eight aspects: “helping to master the teaching content”, “aiding in acquiring and mastering extracurricular knowledge”, “enhancing thinking and analytical abilities”, “boosting learning interest”, “fostering independent learning capabilities”, “strengthening team collaboration skills”, “promoting logical thinking and expressive abilities” and “adding to the learning burden”. The questionnaire was scored on a 5-point Likert scale, ranging from “completely disagree” (1 point) to “completely agree” (5 points), with higher scores indicating greater acceptance of the teaching model. Results Demographics This study included a total of 239 students. Table 1 shows the demographic characteristics of the participants. The average age of the control group was 21.06 (0.479) years, while the average age of the experimental group was 21.01 (0.464) years. In the control group, there were 39 males (31.97%) and 83 females (68.03%). The experimental groups consisted of 35 males (29.91%) and 82 females (70.09%). The average score of the control group’s comprehensive imaging ability test before teaching was 81.59 (6.173) points. In comparison, the average score of the experimental group’s comprehensive imaging ability test before teaching was 82.727 (9.293) points. Statistical analysis revealed no significant differences (p > 0.05) in demographic characteristics (such as gender and age) between the two student groups. Additionally, there was no significant difference in the comprehensive ability test scores for imaging diagnostics from the test administered before the teaching session, as detailed in Table 1 . All research subjects provided informed consent for this study. Table 1 The basic characteristics of all the participants. Experimental group (n = 117) Control group (n = 122) Statistics p value Gender Male 35 39 χ 2 = 0.342 0.733 Female 82 83 Age 21.01 ± 0.464 21.05 ± 0.479 T = 0.666 0.506 Pre-teaching test scores 82.727 ± 9.293 81.590 ± 6.173 T = 1.110 0.268 The online learning results All students in the experimental group watched the corresponding teaching videos and completed online exercises. The average viewing rate of the videos was 99.5%, and the accuracy rate of each online test question was 80–100%. A total of 111 students (94.8%) correctly answered all test questions. The comparison of quiz scores between two groups of students In the assessment of theoretical examination, and comprehensive case analysis (including recognition of imaging examination techniques, description of imaging signs, imaging diagnosis, differential diagnosis, report writing, and overall score), the experimental group performed better than the control group. Our analysis revealed statistically significant differences (p < 0.05), as detailed in Table 2 . Table 2 Comparison of test scores between the two groups (‾x ± s, ponits). Experimental group (n = 117) Control group (n = 122) t value p value Assessment of comprehensive case analysis Imaging examination techniques 8.14 ± 1.426 7.43 ± 1.488 3.767 <0.001 Description of imaging signs 24.95 ± 2.981 22.60 ± 2.652 6.458 <0.001 Diagnosis of imaging 17.22 ± 1.656 16.46 ± 2.238 3.005 0.003 Differential diagnosis 14.01 ± 0.876 12.90 ± 2.022 5.529 <0.001 Report writing 20.25 ± 2.282 19.48 ± 2.460 2.487 0.014 Overall score 84.56 ± 6.005 78.87 ± 6.426 7.072 <0.001 Assessment of theoretical examination 74.17 ± 10.094 61.01 ± 17.417 7.182 <0.001 Overall score 79.36 ± 6.208 69.93 ± 9.581 9.063 <0.001 The comparison of survey scores between two groups of students Upon the return of all 239 distributed questionnaires, we conducted a comparative analysis of the post-class assessment scores between the experimental and control groups. Research findings indicate that students in the experimental group, who experienced a blended teaching model, rated it higher than their counterparts in the control group across eight dimensions, including “facilitating mastery of teaching content” (p = 0.008), “aiding in acquiring and mastering extracurricular knowledge” (p = 0.005), “enhancing thinking and analytical abilities” (p = 0.003), “boosting learning interest” (p = 0.001), “fostering independent learning capabilities” (p = 0.006), “strengthening team collaboration skills” (p = 0.007), “promoting logical thinking and expressive abilities” (p<0.001) and “adding to the learning burden” (p<0.001). The results of the questionnaire, after careful design, collection, and analysis, are presented in Table 3 and Fig. 2 . Table 3 Comparison of questionnaire survey score between the two groups (‾x ± s, points). Survey content Experimental group (n = 117) Control group (n = 122) t value p value Facilitating mastery of teaching content 4.57 ± 0.497 4.36 ± 0.717 2.667 0.008 Aiding in acquiring and mastering extracurricular knowledge 4.50 ± 0.638 4.25 ± 0.764 2.831 0.005 Enhancing thinking and analytical abilities 4.67 ± 0.473 4.46 ± 0.591 3.003 0.003 Boosting learning interest 4.46 ± 0.580 4.15 ± 0.800 3.485 0.001 Fostering independent learning capabilities 4.61 ± 0.491 4.40 ± 0.638 2.793 0.006 Strengthening team collaboration skills 4.53 ± 0.535 4.30 ± 0.737 2.729 0.007 Promoting logical thinking and expressive abilities 4.61 ± 0.491 4.25 ± 0.809 4.096 < 0.001 Adding to the learning burden 4.32 ± 0.750 3.91 ± 0.881 3.831 < 0.001 Discussion The blended teaching model is an instructional method based on the strategic synthesis of online and face-to-face learning activities. By combining platforms such as CBL, PBL, and WeChat, it organically integrates traditional teaching methods with internet information, multimedia teaching, and practical content. This study designed an online KGs course to enhance self-directed learning throughout the entire learning cycle, encompassing both pre-class and post-class activities. We combined KGs with offline CBL teaching, creating a blended model that leveraged the best available classroom resources. This blended instructional approach significantly enhanced students’ problem-solving skills and clinical reasoning capabilities, thereby fostering a more systematic and comprehensive integration of knowledge. The traditional experimental teaching model of medical imaging is facing reform Medical imaging is a clinically-oriented discipline that requires students not only to acquire robust theoretical knowledge but also to proficiently apply it to the diagnosis and differential diagnosis of diseases. As an essential component of medical education, experimental teaching prepares students for clinical practice by bridging the gap between theory and application. It cultivates practical skills and deepens theoretical understanding, ultimately aligning student competencies with clinical standards. The traditional experimental teaching approach, which is offline and teacher-led, often results in student misdiagnosis or missed diagnosis due to insufficient information and unclear anatomical features in medical images. Besides describing the primary lesion, they may fail to represent the indirect signs of the disease accurately. With the development of the computer industry and digital technology, imaging examination equipment and techniques are constantly being updated, such as the application of cardiac cine MRI and four-dimensional blood flow MRI in the circulatory system, which has been explored, with 4D-Flow MRI showing promise in assessing blood flow dynamics, particularly in the context of hypertrophic cardiomyopathy. While traditional cardiac MRI provides valuable insights, the advent of 4D-Flow MRI technology offers a more comprehensive evaluation of blood flow by capturing temporal changes in three dimensions. Traditional imaging films cannot adequately meet teaching needs. During the process of disease diagnosis, most students frequently overlook clinical information such as symptoms, signs, and laboratory tests. Traditional teaching methods fail to enhance students’ systematic thinking and holistic perspective effectively. Therefore, it is essential to strengthen students’ theoretical knowledge, to improve their analytical skills, and to promote integration within and between disciplines in undergraduate medical imaging education [ 16 ] . The conventional teaching approach has inherent limitations, necessitating the development of innovative models that can comprehensively enhance students’ capabilities and foster high-caliber clinical expertise [ 17 ] . In the new era of medical education, the use of multimedia and network information technology is a way to cultivate a sense of innovation and creative thinking among medical specialists. Our research group takes undergraduates majoring in medical imaging as the research object to investigate the effectiveness of a blended teaching approach that integrates KGs with CBL in the context of medical imaging experimental teaching. Advantages of introducing blended teaching with KGs-CBL CBL has been widely applied in the field of medical education, as evidenced by its successful integration in undergraduate teaching [ 18 – 21 ] . This model, which integrates clinical cases into instruction, has been shown to effectively bridge theoretical knowledge with real-world scenarios, promote active reflective learning, and enhance critical thinking and problem-solving skills, thereby better preparing students for clinical practice [ 22 – 24 ] . Most undergraduates have the habit of summarizing and reorganizing knowledge points. However, they primarily focus on reorganizing them in a structured manner and rarely link knowledge points, essentially lacking consideration of knowledge architecture and logic. The application of the CBL teaching method alone lacks the induction and summarization of knowledge systems. A substantial body of academic research indicates that the integration of data analysis tools and diversified teaching strategies can significantly enhance instructional effectiveness, as evidenced by various studies [ 11 , 22 , 24 – 25 ] . The KGs can quickly establish a knowledge system framework through the logical relationships between knowledge points. Our teaching team has constructed a comprehensive KGs for medical imaging on the Wisdom Tree platform, encompassing 994 map nodes, 792 test questions, and 383 material resources, which are leveraged to enhance medical education and diagnostic capabilities. Knowledge points are connected through mutual relationships to form a knowledge network. KGs employ multimodal elements—such as graphics, text, audio, exercises, assessments, and hyperlinks—to structurally refine and reorganize knowledge points. This integrated approach enhances instructional efficiency and facilitates student comprehension and long-term retention of course material. Students identify problems and weak spots of knowledge in the process of learning CBL teaching cases. Through the KGs and guidance from instructors, students can find answers to their questions. Students have the flexibility to communicate with instructors and allocate fragmented time for self-directed study, demonstrating notable autonomy and educational independence. The intelligent teaching system based on KGs has recorded the entire learning process of students, allowing instructors to grasp the degree of students’ knowledge learning and the thinking process of image analysis in real-time, and to solve common problems in the students’ learning process promptly, realizing the transformation from experiential teaching to data-driven precision teaching. The combination of KGs-CBL employs real cases to shift knowledge transmission from a one-way to a multi-way model, closely connecting students’ pre-class, in-class, and post-class learning to create an always-interactive classroom. This study demonstrates that students in blended teaching environments exhibit improved learning outcomes, as blended learning integrates the strengths of traditional face-to-face instruction with the flexibility of online learning, fostering a more personalized and interactive educational experience. The blended teaching with KGs-CBL was positively received by students The results of the questionnaire survey in this study indicate that students are satisfied with the effectiveness of blended teaching that combines KGs with CBL. In case analysis exercises, students work through realistic clinical scenarios in an educational setting. This process requires them to apply their theoretical knowledge to navigate and solve complex medical problems [ 25 ] . By utilizing CBL teaching cases as a carrier, students are motivated to relearn during the analysis process. This educational approach is highly beneficial in stimulating students’ learning motivation and creating an environment that promotes inquiry. By participating in problem-solving activities and exchanging feedback, students actively engage in critical thinking, which in turn improves their understanding of knowledge. Once students identify the weak areas in their knowledge and related issues, they can revisit and resolve these problems using KGs. This process aids students in summarizing the knowledge systematically. Through consulting case-centered relevant literature, students can not only stay abreast of the latest research findings in related fields and broaden their clinical research perspectives, but also improve their literature reading skills. Numerous research findings indicate that students derive greater learning benefits from problem-solving activities compared to merely receiving predefined answers. Rather than passively receiving interpretations, they actively engage in constructing their own understanding [ 26 – 27 ] . By utilizing the blended teaching method, students are presented with chances to engage in both synchronous and asynchronous discussions, fostering teamwork and interactive communication to bolster their social engagement [ 28 ] . Collaborative efforts enable students to augment each other’s viewpoints, leading to more thorough problem analysis and resolution, thereby advancing critical thinking abilities. Through collaborative group discussions and participation in the development of presentations and subsequent delivery, students enhance their teamwork skills, slide design expertise, oral communication abilities, and expressive capacities. Moreover, the blended teaching approach underscores the central role of students in the teaching process and strengthens group unity. The enhancement of these comprehensive skills can better equip students for their future clinical practice. The blended teaching model demonstrates a positive influence on multiple student learning dimensions, including content mastery, extracurricular knowledge acquisition, analytical and critical thinking skills, learning motivation, self-directed learning capabilities, teamwork collaboration, logical reasoning, and expressive communication. Meanwhile, this teaching model was also well received by the participants themselves. Problems and countermeasures in implementing blended teaching Although the blended instructional model, which integrates KGs-CBL, has yielded positive results in medical imaging courses, this study was limited in scope, focusing exclusively on students majoring in medical imaging. Future research extend the application of this model to encompass learners from various academic disciplines, thereby comprehensively verifying its effectiveness. Furthermore, the findings of this study reveal that students perceive the new teaching model as increasing their learning burden. Students are required to allocate more time to engaging in a variety of teaching activities, including pre-class group discussions, independent learning, class presentations, post-class problem-solving sessions, and reflection. Nevertheless, the outcomes from examination scores and questionnaire surveys indicate that this blended teaching methodology significantly enhances students’ mastery and application of knowledge points. Consequently, future instructional designs could reallocate or reduce in-class hours to allow more time for these practical skill-building activities. The workload is reduced, with instructors encouraging students to engage with complex material actively and increasing the emphasis on self-directed learning components in final assessments. Furthermore, since most students have limited prior exposure to KGs, a structured orientation phase and ongoing support resources are crucial components for implementing this model, helping students acclimate effectively. Before teaching, instructors should enhance the explanation, application, and case analysis of the concepts related to the KGs. Once students are acclimated and have a solid understanding of the material, we recommend rolling out the full blended teaching model. However, it should be noted that this approach requires instructors to invest significant time and effort in developing appropriately challenging representative cases, continuously monitoring student progress to adjust instructional strategies, and providing guided support throughout discussions, analytical processes, and summary phases. This approach effectively fosters the innovative capacities of both instructors and students, unlocks their latent potential, and facilitates reciprocal development through collaborative learning and teaching. Conclusion The integration of KGs-CBL into a blended teaching framework allows diverse pedagogical methods to complement one another. This synergy not only improves the quality and efficiency of instruction but also bolsters students’ comprehensive competencies, nurtures their confidence and enthusiasm for clinical practice, and aligns more closely with the student-centered philosophy emphasized in contemporary education. Further investigation into this integrated framework is necessary to adapt to the evolving demands of medical training. Abbreviations AI Artificial intelligence CBL Case-based learning PBL Project-Based Learning KGs Knowledge graphs KGs-CBL Knowledge graphs with case-based learning Declarations Acknowledgement s The authors extend their heartfelt appreciation to all the undergraduate students whose participation and valuable feedback were essential to this research. We are also deeply grateful to our colleagues in the School of Biomedical Engineering and Imaging for their insightful discussions and collaborative spirit throughout the implementation of the blended teaching model. Authors’ contributions YQW and WY conceived and designed the study. YQW, HL, and JD were responsible for the acquisition, analysis, and interpretation of data, and drafted the manuscript. YQW and JD contributed to data collection. HL, LL and WY supervised the research. All authors reviewed and approved the final manuscript. Funding This work was supported by Hubei Provincial Teaching Reform Research Project (No.2024460); Hubei University of Science and Technology’s Intramural Research Project (NO.2025-26X03); and Hubei University of Science and Technology’s Teaching Research Project (NO.2023XY016). Data availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate All participants provided informed consent before enrolling in the study. The study was approved by the Ethics Committee of Hubei University of Science and Technology (No: 2024-02-002). Consent for publication I consent to the publication. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. References Lundegren N, Jönsson A, Lindberg P. An upgrade of the Malmö model by implementing case-based teaching and learning, in an undergraduate dental education. 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BMC Medical Education. 2024, 24(1):28. doi: 10.1186/s12909-023-04839-4. Burgess A, Matar E, Roberts C, Haq I, Wynter L, Singer J, et al. Scafolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL). BMC Med Educ. 2021, 21(1):238. doi: 10.1186/s12909-021-02638-3. Luo M, Zhang X, Liu W. Effect Evaluation of CBL Combined with Rain Classroom Teaching Method in Medical Statistics. Open Journal of Applied Sciences. 2024, 14(5):1204-1213. doi: 10.4236/ojapps.2024.145078. Dewi C A , Rahayu S. Implementation of case-based learning in science education: A systematic review. Journal of Turkish Science Education (TUSED). 2023, 20(4), 729-749. doi: 10.36681/tused.2023.041. Michael J. Where’s the evidence that active learning works? Adv Physiol Educ. 2006, 30(4):159–167. doi: 10.1152/advan.00053.2006. Zeng J, Liu L, Tong X, et al. Application of Blended Teaching Model Based on SPOC and TBL in Dermatology and Venereology. BMC Med Educ. 2021, 21:606. doi: 10.1186/s12909-021-03042-7. Cornelius S, Gordon C. Facilitating learning with web conferencing recommendations based on learners’ experiences. Educ Inf Technol. 2013, 18:275–285. Additional Declarations No competing interests reported. Supplementary Files Questionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 24 Dec, 2025 Editor invited by journal 27 Nov, 2025 Editor assigned by journal 12 Nov, 2025 Submission checks completed at journal 12 Nov, 2025 First submitted to journal 02 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8013881","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":565189532,"identity":"64c6ade5-a281-4c58-921c-5b85a336bda6","order_by":0,"name":"Yaqi Wang","email":"","orcid":"","institution":"Hubei University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Yaqi","middleName":"","lastName":"Wang","suffix":""},{"id":565189533,"identity":"ac40e5e3-d610-46c6-a403-9bc6ed475c22","order_by":1,"name":"Jing Deng","email":"","orcid":"","institution":"Hubei University of Science and 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1","display":"","copyAsset":false,"role":"figure","size":189041,"visible":true,"origin":"","legend":"\u003cp\u003eThe flowcharts of KGs-CBL blended teaching and traditional teaching modes.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8013881/v1/35f748f206f481187eebbe08.png"},{"id":99318849,"identity":"a897df82-d87a-4944-ae3c-caf8afff9690","added_by":"auto","created_at":"2025-12-31 16:35:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88341,"visible":true,"origin":"","legend":"\u003cp\u003eRating results of the experimental and control groups for self-evaluations and peer evaluations about group discussions.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8013881/v1/fc9864db1bc81de48b6ee103.png"},{"id":99788431,"identity":"2d54ace6-23bf-41f9-b378-4f21f49ac69c","added_by":"auto","created_at":"2026-01-08 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disease screening, diagnosis, and treatment decision-making. Its high practicality, comprehensive diagnostic capabilities, and the complex demand for image interpretation place greater demands on medical education. With the rapid development of imaging technologies such as MRI, CT, and ultrasound, as well as the widespread application of artificial intelligence (AI) in image recognition and diagnostic assistance, the traditional teacher-centered, unidirectional teaching model has become inadequate to meet the disciplinary development needs. Although this model can systematically convey knowledge, it lacks deep integration with clinical practice, resulting in low student engagement, insufficient training in clinical thinking skills, and difficulty in translating knowledge into practical application. Modern medical student training emphasizes not only professional expertise and operational skills but also the enhancement of clinical analytical ability and adaptability. Therefore, there is an urgent need to introduce more efficient and interactive teaching methods.\u003c/p\u003e \u003cp\u003eCase-based learning (CBL) is founded on clinical cases. Instructors design questions related to these cases and guide students to explore and solve problems independently through analysis and discussion\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Based on the characteristics of cases and the questions set before class, guiding students to learn knowledge related to diseases is beneficial for cultivating their clinical thinking ability. Numerous studies have shown that CBL effectively enhances the clinical competencies, critical thinking, and problem-solving skills of medical students\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. However, no educational approach is flawless, and a drawback of CBL is its deficiency in providing comprehensive elucidations of fundamental principles and overall knowledge synthesis. The explicit and implicit connections among medical knowledge points are complex, posing a challenge for students to understand the inherent relationships and logic within medical knowledge during the learning process\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAI technology demonstrates significant advantages in image recognition, data processing, and diagnostic assistance. Integrating AI into education is not only an inevitable trend in technological development but also a crucial pathway to enhance students\u0026rsquo; future professional capabilities\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The knowledge graphs (KGs) are an AI-based teaching assistance system. It integrates knowledge points into a centralized, accurate, complete, and concise network diagram, clearly showing the complex logical relationships between them. Additionally, various online resources like videos, learning materials, and test questions can connect to the knowledge nodes within the KGs. Another advantage of the KGs is their ability to recommend relevant resources and customize personalized learning paths based on learners\u0026rsquo; needs, preferences, and other characteristics, allowing students to decide on the content and process of their learning independently.\u003c/p\u003e \u003cp\u003eThe single teaching model cannot meet the needs. In the context of the Internet-plus era, a blended teaching model combining offline teaching and online teaching has emerged\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. A blended teaching model combining CBL and knowledge graphs (KGs-CBL) offers significant advantages: CBL serves as the core of offline teaching, strengthening cognitive training in clinical contexts, while the KGs act as an online support platform, enhancing students\u0026rsquo; systematic understanding of medical knowledge and self-directed review capabilities. This model integrates the benefits of both online and offline instruction, improving the efficiency of educational resource utilization while ensuring the quality of clinical teaching\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. It has the potential to shift medical imaging education from \u0026ldquo;knowledge transmission\u0026rdquo; to \u0026ldquo;capacity building\u0026rdquo;, providing a new pathway for cultivating medical talents with solid clinical competence and systematic thinking abilities\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. This study integrates KGs-CBL and applies it to experimental teaching for undergraduates majoring in medical imaging, exploring the implementation effect of the new teaching model and providing the scientific basis for teaching reform.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Hubei University of Science and Technology (No:\u0026nbsp;2024-02-002), and informed consent was obtained from all participants.\u0026nbsp;We selected 240 undergraduates majoring in medical imaging at Hubei University of Science and Technology as the subjects of our study. The study cohorts comprised single, annual cohorts of the medical imaging major. The control cohort consisted of the entire class of 2020 (n=122), which received traditional teaching. The experimental cohort, comprising the whole class of 2021 (n=117), received the novel intervention\u0026mdash;a blended approach combining KGs-CBL. Before the commencement of teaching, both groups underwent a comprehensive ability test of\u0026nbsp;medical imaging. To ensure the validity of the comparison, key variables\u0026nbsp;(including textbooks, training plans, syllabi, and instructors)\u0026nbsp;were held constant across both groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTeaching content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe textbook used by the two groups of students was the 5th edition of \u0026lsquo;Medical Imaging Diagnostics\u0026rsquo; published by People\u0026rsquo;s Medical Publishing House. The teaching content was the experimental course on medical imaging of the circulatory system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTeaching\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003em\u003c/strong\u003e\u003cstrong\u003eethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental group adopted a blended teaching approach combining the KGs-CBL. The process unfolded as follows:\u003c/p\u003e\n\u003cp\u003e1. During the\u0026nbsp;before class phase, the supervising instructor collected eight teaching cases in advance according to the teaching syllabus and disease types of the circulatory system. The cases included medical history, clinical manifestations and signs, laboratory examination, information on medical imaging, etc. Students were randomly divided into eight subgroups (approximately 15 students each). The group members elected a student to serve as the team leader, who then efficiently oversaw task distribution and fostered collaboration within the team. The supervising instructor distributed teaching cases and online courses focused on KGs to the experimental group. Students integrated the KGs with the teaching materials to facilitate online learning. According to the predetermined schedule, students accessed the online platform to view instructional videos for self-guided study before the CBL sessions, establishing the foundational knowledge network\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. During the learning process, they need to watch the corresponding teaching videos and complete online exercises independently.\u0026nbsp;Accompanying each instructional video were multiple single-choice questions for students to respond to, with the reference answers accessible upon submission of their responses.\u0026nbsp;Students were encouraged to utilize the discussion forum to pose questions, facilitating collaborative learning through discussion with both instructors and\u0026nbsp;peers.\u0026nbsp;Students held offline group discussions using the teaching cases as a basis and subsequently created a PPT. The PPT content encompassed a comprehensive analysis of medical history, detailed descriptions of various imaging techniques, including X-ray, CT, MRI, and ultrasound, as well as the elucidation of imaging signs, thorough imaging diagnosis, differential diagnosis, and treatment strategies. Every group member was required to participate in either the PPT production or presentation. Each participant was required to complete the tasks through group discussion, and\u0026nbsp;the group leader was subsequently responsible for documenting the collective study sessions.\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The group leaders submitted the PPT and the division of labor among group members to the instructor for summary one day before class.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;In class, one member from each group was selected to deliver the PowerPoint presentation, articulating the team\u0026rsquo;s collective viewpoint on the topic derived from pre-class deliberations and clinical scenarios\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Subsequently, fellow students engaged in discussions, providing comments and posing inquiries. This process spanned approximately 135 minutes. The supervising instructor and group leaders scored based on the PPT and presentation. The last part was a centralized evaluation and Q\u0026amp;A session.\u0026nbsp;Students were encouraged to apply the knowledge they had acquired in earlier instructional phases to address real-world challenges, thereby fostering their problem-solving abilities. The\u0026nbsp;instructor\u0026nbsp;presented complex prompts for immediate group deliberation to promote teamwork and encourage lively debates, continuing until the participants reached a consensus.\u0026nbsp;Finally, the instructor announced the reference answers in class. This entire process lasted approximately 45 minutes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;In the post-class phase, teaching effectiveness was evaluated through a theoretical examination, a comprehensive case analysis, and student questionnaires. Additionally, the instructor assessed students on their online learning activities, the quality of their PPT presentations, their individual contributions to group work, and their performance on post-class assessments.\u003c/p\u003e\n\u003cp\u003eThe control group implemented the traditional teaching model, comprising the following steps:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. During the\u0026nbsp;before class phase, the supervising instructor prepared the relevant teaching materials, and students independently previewed the course content.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;In class, the supervising instructor elucidated relevant theoretical knowledge and learning points, analyzed typical cases based on the teaching content. This procedure took about 45 minutes. Students analyzed the teaching cases through imaging film and engaged in free discussion. This process lasted approximately 90 minutes. The final segment involved a centralized evaluation and Q\u0026amp;A session. This process lasted approximately 45 minutes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. \u0026nbsp; \u0026nbsp; \u0026nbsp;In the post-class phase, students took the theoretical examination, comprehensive case analysis, and questionnaire surveys to evaluate teaching effectiveness (the content of the test and questionnaire survey for both groups of students was the same). In Figure 1, we outline the flowcharts for the KGs-CBL blended teaching and traditional teaching modes to visualize their structures.\u003c/p\u003e\n\u003cp\u003eTwo groups of students underwent theoretical examination, comprehensive case analysis, and questionnaire survey. (1) For the theoretical examination, we randomly selected 50 questions from the medical imaging question bank based on the teaching syllabus. The exam had a maximum score of 100 points. (2) For the comprehensive case analysis, we selected two complete cases. The case materials included medical history, clinical manifestations and signs, laboratory results, and medical imaging findings. Each student independently completed the case analysis in the form of a written report, with a maximum score of 100 points. The assessment content encompassed recognition of imaging examination techniques, precise description of imaging signs, comprehensive medical imaging diagnosis, thorough differential diagnosis, and adherence to standard report writing protocols. Each part of the content scored 10%, 30%, 20%, 15%, and 25% respectively. (3) An anonymous questionnaire was administered, which covered the following eight aspects: \u0026ldquo;helping to master the teaching content\u0026rdquo;, \u0026ldquo;aiding in acquiring and mastering extracurricular knowledge\u0026rdquo;, \u0026ldquo;enhancing thinking and analytical abilities\u0026rdquo;, \u0026ldquo;boosting learning interest\u0026rdquo;, \u0026ldquo;fostering independent learning capabilities\u0026rdquo;, \u0026ldquo;strengthening team collaboration skills\u0026rdquo;, \u0026ldquo;promoting logical thinking and expressive abilities\u0026rdquo; and \u0026ldquo;adding to the learning burden\u0026rdquo;. The questionnaire was scored on a 5-point Likert scale, ranging from \u0026ldquo;completely disagree\u0026rdquo; (1 point) to \u0026ldquo;completely agree\u0026rdquo; (5 points), with higher scores indicating greater acceptance of the teaching model.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographics\u003c/h2\u003e \u003cp\u003eThis study included a total of 239 students. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the participants. The average age of the control group was 21.06 (0.479) years, while the average age of the experimental group was 21.01 (0.464) years. In the control group, there were 39 males (31.97%) and 83 females (68.03%). The experimental groups consisted of 35 males (29.91%) and 82 females (70.09%). The average score of the control group\u0026rsquo;s comprehensive imaging ability test before teaching was 81.59 (6.173) points. In comparison, the average score of the experimental group\u0026rsquo;s comprehensive imaging ability test before teaching was 82.727 (9.293) points. Statistical analysis revealed no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) in demographic characteristics (such as gender and age) between the two student groups. Additionally, there was no significant difference in the comprehensive ability test scores for imaging diagnostics from the test administered before the teaching session, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All research subjects provided informed consent for this study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe basic characteristics of all the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;117)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePre-teaching test scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.727\u0026thinsp;\u0026plusmn;\u0026thinsp;9.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.590\u0026thinsp;\u0026plusmn;\u0026thinsp;6.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;1.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe online learning results\u003c/h2\u003e \u003cp\u003eAll students in the experimental group watched the corresponding teaching videos and completed online exercises. The average viewing rate of the videos was 99.5%, and the accuracy rate of each online test question was 80\u0026ndash;100%. A total of 111 students (94.8%) correctly answered all test questions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe comparison of quiz scores between two groups of students\u003c/h3\u003e\n\u003cp\u003eIn the assessment of theoretical examination, and comprehensive case analysis (including recognition of imaging examination techniques, description of imaging signs, imaging diagnosis, differential diagnosis, report writing, and overall score), the experimental group performed better than the control group. Our analysis revealed statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of test scores between the two groups (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, ponits).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;117)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAssessment of comprehensive case analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImaging examination techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription of imaging signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiagnosis of imaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDifferential diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReport writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAssessment of theoretical examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.01\u0026thinsp;\u0026plusmn;\u0026thinsp;17.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eThe comparison of survey scores between two groups of students\u003c/h3\u003e\n\u003cp\u003eUpon the return of all 239 distributed questionnaires, we conducted a comparative analysis of the post-class assessment scores between the experimental and control groups. Research findings indicate that students in the experimental group, who experienced a blended teaching model, rated it higher than their counterparts in the control group across eight dimensions, including \u0026ldquo;facilitating mastery of teaching content\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.008), \u0026ldquo;aiding in acquiring and mastering extracurricular knowledge\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.005), \u0026ldquo;enhancing thinking and analytical abilities\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.003), \u0026ldquo;boosting learning interest\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.001), \u0026ldquo;fostering independent learning capabilities\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.006), \u0026ldquo;strengthening team collaboration skills\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.007), \u0026ldquo;promoting logical thinking and expressive abilities\u0026rdquo; (p\u0026lt;0.001) and \u0026ldquo;adding to the learning burden\u0026rdquo; (p\u0026lt;0.001). The results of the questionnaire, after careful design, collection, and analysis, are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of questionnaire survey score between the two groups (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, points).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;117)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacilitating mastery of teaching content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAiding in acquiring and mastering extracurricular knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhancing thinking and analytical abilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoosting learning interest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFostering independent learning capabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrengthening team collaboration skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePromoting logical thinking and expressive abilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdding to the learning burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe blended teaching model is an instructional method based on the strategic synthesis of online and face-to-face learning activities. By combining platforms such as CBL, PBL, and WeChat, it organically integrates traditional teaching methods with internet information, multimedia teaching, and practical content. This study designed an online KGs course to enhance self-directed learning throughout the entire learning cycle, encompassing both pre-class and post-class activities. We combined KGs with offline CBL teaching, creating a blended model that leveraged the best available classroom resources. This blended instructional approach significantly enhanced students\u0026rsquo; problem-solving skills and clinical reasoning capabilities, thereby fostering a more systematic and comprehensive integration of knowledge.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe traditional experimental teaching model of medical imaging is facing reform\u003c/h2\u003e \u003cp\u003eMedical imaging is a clinically-oriented discipline that requires students not only to acquire robust theoretical knowledge but also to proficiently apply it to the diagnosis and differential diagnosis of diseases. As an essential component of medical education, experimental teaching prepares students for clinical practice by bridging the gap between theory and application. It cultivates practical skills and deepens theoretical understanding, ultimately aligning student competencies with clinical standards. The traditional experimental teaching approach, which is offline and teacher-led, often results in student misdiagnosis or missed diagnosis due to insufficient information and unclear anatomical features in medical images. Besides describing the primary lesion, they may fail to represent the indirect signs of the disease accurately. With the development of the computer industry and digital technology, imaging examination equipment and techniques are constantly being updated, such as the application of cardiac cine MRI and four-dimensional blood flow MRI in the circulatory system, which has been explored, with 4D-Flow MRI showing promise in assessing blood flow dynamics, particularly in the context of hypertrophic cardiomyopathy. While traditional cardiac MRI provides valuable insights, the advent of 4D-Flow MRI technology offers a more comprehensive evaluation of blood flow by capturing temporal changes in three dimensions. Traditional imaging films cannot adequately meet teaching needs. During the process of disease diagnosis, most students frequently overlook clinical information such as symptoms, signs, and laboratory tests. Traditional teaching methods fail to enhance students\u0026rsquo; systematic thinking and holistic perspective effectively. Therefore, it is essential to strengthen students\u0026rsquo; theoretical knowledge, to improve their analytical skills, and to promote integration within and between disciplines in undergraduate medical imaging education\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The conventional teaching approach has inherent limitations, necessitating the development of innovative models that can comprehensively enhance students\u0026rsquo; capabilities and foster high-caliber clinical expertise\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In the new era of medical education, the use of multimedia and network information technology is a way to cultivate a sense of innovation and creative thinking among medical specialists. Our research group takes undergraduates majoring in medical imaging as the research object to investigate the effectiveness of a blended teaching approach that integrates KGs with CBL in the context of medical imaging experimental teaching.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAdvantages of introducing blended teaching with KGs-CBL\u003c/h2\u003e \u003cp\u003eCBL has been widely applied in the field of medical education, as evidenced by its successful integration in undergraduate teaching\u003csup\u003e[\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This model, which integrates clinical cases into instruction, has been shown to effectively bridge theoretical knowledge with real-world scenarios, promote active reflective learning, and enhance critical thinking and problem-solving skills, thereby better preparing students for clinical practice\u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Most undergraduates have the habit of summarizing and reorganizing knowledge points. However, they primarily focus on reorganizing them in a structured manner and rarely link knowledge points, essentially lacking consideration of knowledge architecture and logic. The application of the CBL teaching method alone lacks the induction and summarization of knowledge systems.\u003c/p\u003e \u003cp\u003eA substantial body of academic research indicates that the integration of data analysis tools and diversified teaching strategies can significantly enhance instructional effectiveness, as evidenced by various studies\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The KGs can quickly establish a knowledge system framework through the logical relationships between knowledge points. Our teaching team has constructed a comprehensive KGs for medical imaging on the Wisdom Tree platform, encompassing 994 map nodes, 792 test questions, and 383 material resources, which are leveraged to enhance medical education and diagnostic capabilities. Knowledge points are connected through mutual relationships to form a knowledge network. KGs employ multimodal elements\u0026mdash;such as graphics, text, audio, exercises, assessments, and hyperlinks\u0026mdash;to structurally refine and reorganize knowledge points. This integrated approach enhances instructional efficiency and facilitates student comprehension and long-term retention of course material. Students identify problems and weak spots of knowledge in the process of learning CBL teaching cases. Through the KGs and guidance from instructors, students can find answers to their questions. Students have the flexibility to communicate with instructors and allocate fragmented time for self-directed study, demonstrating notable autonomy and educational independence. The intelligent teaching system based on KGs has recorded the entire learning process of students, allowing instructors to grasp the degree of students\u0026rsquo; knowledge learning and the thinking process of image analysis in real-time, and to solve common problems in the students\u0026rsquo; learning process promptly, realizing the transformation from experiential teaching to data-driven precision teaching. The combination of KGs-CBL employs real cases to shift knowledge transmission from a one-way to a multi-way model, closely connecting students\u0026rsquo; pre-class, in-class, and post-class learning to create an always-interactive classroom. This study demonstrates that students in blended teaching environments exhibit improved learning outcomes, as blended learning integrates the strengths of traditional face-to-face instruction with the flexibility of online learning, fostering a more personalized and interactive educational experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe blended teaching with KGs-CBL was positively received by students\u003c/h2\u003e \u003cp\u003eThe results of the questionnaire survey in this study indicate that students are satisfied with the effectiveness of blended teaching that combines KGs with CBL. In case analysis exercises, students work through realistic clinical scenarios in an educational setting. This process requires them to apply their theoretical knowledge to navigate and solve complex medical problems\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. By utilizing CBL teaching cases as a carrier, students are motivated to relearn during the analysis process. This educational approach is highly beneficial in stimulating students\u0026rsquo; learning motivation and creating an environment that promotes inquiry. By participating in problem-solving activities and exchanging feedback, students actively engage in critical thinking, which in turn improves their understanding of knowledge. Once students identify the weak areas in their knowledge and related issues, they can revisit and resolve these problems using KGs. This process aids students in summarizing the knowledge systematically.\u003c/p\u003e \u003cp\u003eThrough consulting case-centered relevant literature, students can not only stay abreast of the latest research findings in related fields and broaden their clinical research perspectives, but also improve their literature reading skills. Numerous research findings indicate that students derive greater learning benefits from problem-solving activities compared to merely receiving predefined answers. Rather than passively receiving interpretations, they actively engage in constructing their own understanding\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBy utilizing the blended teaching method, students are presented with chances to engage in both synchronous and asynchronous discussions, fostering teamwork and interactive communication to bolster their social engagement\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Collaborative efforts enable students to augment each other\u0026rsquo;s viewpoints, leading to more thorough problem analysis and resolution, thereby advancing critical thinking abilities. Through collaborative group discussions and participation in the development of presentations and subsequent delivery, students enhance their teamwork skills, slide design expertise, oral communication abilities, and expressive capacities. Moreover, the blended teaching approach underscores the central role of students in the teaching process and strengthens group unity. The enhancement of these comprehensive skills can better equip students for their future clinical practice. The blended teaching model demonstrates a positive influence on multiple student learning dimensions, including content mastery, extracurricular knowledge acquisition, analytical and critical thinking skills, learning motivation, self-directed learning capabilities, teamwork collaboration, logical reasoning, and expressive communication. Meanwhile, this teaching model was also well received by the participants themselves.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eProblems and countermeasures in implementing blended teaching\u003c/h2\u003e \u003cp\u003eAlthough the blended instructional model, which integrates KGs-CBL, has yielded positive results in medical imaging courses, this study was limited in scope, focusing exclusively on students majoring in medical imaging. Future research extend the application of this model to encompass learners from various academic disciplines, thereby comprehensively verifying its effectiveness.\u003c/p\u003e \u003cp\u003eFurthermore, the findings of this study reveal that students perceive the new teaching model as increasing their learning burden. Students are required to allocate more time to engaging in a variety of teaching activities, including pre-class group discussions, independent learning, class presentations, post-class problem-solving sessions, and reflection. Nevertheless, the outcomes from examination scores and questionnaire surveys indicate that this blended teaching methodology significantly enhances students\u0026rsquo; mastery and application of knowledge points.\u003c/p\u003e \u003cp\u003eConsequently, future instructional designs could reallocate or reduce in-class hours to allow more time for these practical skill-building activities. The workload is reduced, with instructors encouraging students to engage with complex material actively and increasing the emphasis on self-directed learning components in final assessments. Furthermore, since most students have limited prior exposure to KGs, a structured orientation phase and ongoing support resources are crucial components for implementing this model, helping students acclimate effectively. Before teaching, instructors should enhance the explanation, application, and case analysis of the concepts related to the KGs. Once students are acclimated and have a solid understanding of the material, we recommend rolling out the full blended teaching model. However, it should be noted that this approach requires instructors to invest significant time and effort in developing appropriately challenging representative cases, continuously monitoring student progress to adjust instructional strategies, and providing guided support throughout discussions, analytical processes, and summary phases. This approach effectively fosters the innovative capacities of both instructors and students, unlocks their latent potential, and facilitates reciprocal development through collaborative learning and teaching.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe integration of KGs-CBL into a blended teaching framework allows diverse pedagogical methods to complement one another. This synergy not only improves the quality and efficiency of instruction but also bolsters students\u0026rsquo; comprehensive competencies, nurtures their confidence and enthusiasm for clinical practice, and aligns more closely with the student-centered philosophy emphasized in contemporary education. Further investigation into this integrated framework is necessary to adapt to the evolving demands of medical training.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAI \u0026nbsp;Artificial intelligence\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCBL\u0026nbsp;\u0026nbsp;Case-based learning\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePBL\u0026nbsp;\u0026nbsp;Project-Based Learning\u003c/p\u003e\n\u003cp\u003eKGs \u0026nbsp;Knowledge graphs\u003c/p\u003e\n\u003cp\u003eKGs-CBL \u0026nbsp;Knowledge graphs with case-based learning\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their heartfelt appreciation to all the undergraduate students whose participation and valuable feedback were essential to this research. We are also deeply grateful to our colleagues in the School of Biomedical Engineering and Imaging for their insightful discussions and collaborative spirit throughout the implementation of the blended teaching model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYQW and WY conceived and designed the study. YQW, HL, and JD were responsible for the acquisition, analysis, and interpretation of data, and drafted the manuscript. YQW and JD contributed to data collection. HL, LL and WY supervised the research. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Hubei Provincial Teaching Reform Research Project (No.2024460); Hubei University of Science and Technology\u0026rsquo;s Intramural Research Project\u0026nbsp;(NO.2025-26X03);\u0026nbsp;and Hubei University of Science and Technology\u0026rsquo;s Teaching Research Project (NO.2023XY016).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent before enrolling in the study. The study was approved by the Ethics Committee of\u0026nbsp;Hubei University of Science and Technology\u0026nbsp;(No:\u0026nbsp;2024-02-002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI consent to the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLundegren N, J\u0026ouml;nsson A, Lindberg P. An upgrade of the Malm\u0026ouml; model by implementing case-based teaching and learning, in an undergraduate dental education. Eur J Dent Educ. 2021, 25(4):649-656. doi: 10.1111/eje.12642.\u003c/li\u003e\n \u003cli\u003eLi S, Su L, Lou R, et al. 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Practice and effectiveness of web-based problem-based learning approach in a large class-size system: A comparative study. Nurse Education in Practice. 2018, 31(12):161-164. doi: 10.1016/j.nepr.2018.06.009.\u003c/li\u003e\n \u003cli\u003eLuo P, Pang W, Wang Y, Liu M, Zhou S, Liu S, Zhang X, Liu L, Liu Y, Zhou F. WeChat as a Platform for Problem-Based Learning Among Hematological Postgraduates: Feasibility and Acceptability Study. J Med Internet Res. 2021, 23(5):e16463. doi: 10.2196/16463.\u003c/li\u003e\n \u003cli\u003eVall\u0026eacute;e A, Blacher J, Cariou A, Sorbets E. Blended learning compared to traditional learning in medical education: systematic review and metaanalysis. J Med Internet Res. 2020, 22(8): e16504. doi: 10.2196/16504.\u003c/li\u003e\n \u003cli\u003eChi M, Wang N, Wu Q, Cheng M, Zhu C, Wang X, Hou Y. Implementation of the Flipped Classroom Combined with Problem-Based Learning in a Medical Nursing Course: A Quasi-Experimental Design. Healthcare. 2022, 10(12):2572. doi: 10.3390/healthcare10122572.\u003c/li\u003e\n \u003cli\u003eChen J. Exploration and application of SPOC-based blended teaching mode in comprehensive English course. J Phys Conf Ser. 2019, 1237(2):022115. doi: 10.1088/1742-6596/1237/2/022115.\u003c/li\u003e\n \u003cli\u003eMinges KE. Team-based learning in the clinical setting: Perspectives of doctor of nursing practice students. J Doctoral Nurs Pract. 2019, 12(1):41\u0026ndash;45. doi: 10.1891/2380-9418.12.1.41.\u003c/li\u003e\n \u003cli\u003eLiu H. Teaching of college mathematics culture course based on JITT and TBL teaching method. Creat Educ Stud. 2019, 7(1):111-114. doi: 10.12677/CES.2019.71020.\u003c/li\u003e\n \u003cli\u003eMorrice R, Buckeldee O, Leedham-Green K. Perspectives of Clinical Teaching Fellows on preparedness for practice: a mixed-methods exploration of what needs to change. Medical Education Online. 2021, 26(1):1-12. doi: 10.1080/10872981.2021.1976443.\u003c/li\u003e\n \u003cli\u003eHuang L, Cai Q, Cheng L, et al. Analysis of Curricular Reform Practices at Chinese Medical Schools. Teaching and Learning in Medicine. 2014, 26(4):412-419. doi: 10.1080/10401334.2014.910463.\u003c/li\u003e\n \u003cli\u003eSTARK R, KOPP V, FISCHER M R. Case-based learning with worked examples in complex domains: Two experimental studies in undergraduate medical education. Learning and Instruction. 2011, 21(1):22-23. doi: 10.1016/j.learninstruc.2009.10.001.\u003c/li\u003e\n \u003cli\u003eThistlethwaite J E, Davies D, Ekeocha S, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher. 2012, 34(6):e421\u0026ndash;e444. doi: 10.3109/0142159X.2012.680939.\u003c/li\u003e\n \u003cli\u003eSrinivasan M. 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Facilitating learning with web conferencing recommendations based on learners\u0026rsquo; experiences. Educ Inf Technol. 2013, 18:275\u0026ndash;285.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"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":"Artificial intelligence, Case-based learning, Knowledge graphs, Medical imaging","lastPublishedDoi":"10.21203/rs.3.rs-8013881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8013881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis study evaluated a novel blended teaching model for medical imaging experimental instruction, combining knowledge graphs with case-based learning (KGs-CBL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included a total of 240 undergraduate students majoring in five-year medical imaging from 2020 to 2021. 117 students from 2021 were chosen as the experimental group, using a blended teaching model based on KGs-CBL. In 2020, 122 students were selected as the control group and underwent the traditional teaching model. The teaching content was the experimental course on medical imaging of the circulatory system, in which the application effect of the two groups of teaching methods was evaluated by the assessment of theoretical examination, comprehensive case analysis, and questionnaire survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn the assessment of theoretical examination, and comprehensive case analysis (including identification of imaging examination techniques, description of imaging signs, diagnosis of imaging, differential diagnosis, report writing, and overall score), the experimental group demonstrated superior performance to the controls, with a statistically significant difference (p\u0026lt;0.05). The survey results indicated that students’ scores evaluating the blended teaching model were positive, with a considerable percentage expressing satisfaction and belief in its effectiveness. The experimental group were higher than those in the control group in the following eight aspects: “facilitating mastery of teaching content” (p=0.008), “aiding in acquiring and mastering extracurricular knowledge” (p=0.005), “enhancing thinking and analytical abilities” (p=0.003), “boosting learning interest” (p=0.001), “fostering independent learning capabilities” (p=0.006), “strengthening team collaboration skills” (p = 0.007), “promoting logical thinking and expressive abilities” (p＜0.001) and “adding to the learning burden” (p＜0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe blended teaching model based on KGs-CBL can improve students’ academic performance, cultivate students’ comprehensive ability, and improve their satisfaction. This method has been proven effective in enhancing the practical skills and diagnostic capabilities of undergraduates majoring in medical imaging, making it a valuable approach in medical education.\u003c/p\u003e","manuscriptTitle":"Bridging Theory and Practice: A KGs-CBL Blended Framework for Enhanced Medical Imaging Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:51:22","doi":"10.21203/rs.3.rs-8013881/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-13T09:51:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7433490278183460864927243670345480454","date":"2026-01-07T07:19:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T11:14:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-27T10:53:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-12T13:11:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-12T13:07:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-03T02:01:22+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":"ff0a9e8b-d3e1-4f93-afe8-b2df96cff973","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T09:51:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:51:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8013881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8013881","identity":"rs-8013881","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}