The application research of integrating tutor-network-seminar and team-based teaching strategies in clinical practice teaching of laboratory medicine

The application research of integrating tutor-network-seminar and team-based teaching strategies in clinical practice teaching of laboratory medicine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The application research of integrating tutor-network-seminar and team-based teaching strategies in clinical practice teaching of laboratory medicine Le Zhao, Guodong Yang, Fuqiang He, Yuhan Sun, Tao Jiang, Hongxia Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8538440/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Objective This study aims to investigate the feasibility and effectiveness of an integrated Tutor-Network-Seminar (TNS) and Team-Based Learning (TBL) teaching model in the clinical internship of Medical Laboratory Science. Methods A total of 60 students who completed their clinical internship in the Department of Clinical Laboratory Medicine at the First Affiliated Hospital of Henan University of Science and Technology between July 2024 and March 2025 were recruited as participants. They were randomly divided into two groups: the control group (n = 30) students received a traditional teacher-centered approach, and the study group (n = 30) instructed an integrated TNS and TBL approach. The effectiveness of the TNS-TBL teaching model was evaluated by comparing the differences between the two groups in theoretical assessment scores, practical skill assessment scores, teaching satisfaction, and overall teaching effectiveness ratings. Results There was no statistically significant difference in theoretical assessment scores between the two groups (46.60 ± 1.476 vs. 46.07 ± 1.837, p > 0.05). However, students in the study group demonstrated significantly higher scores in practical skill assessments (47.80 ± 0.961 vs. 40.40 ± 3.500, p < 0.001), teaching satisfaction (100% vs. 13.33%, p < 0.001), and overall teaching effectiveness ratings. Conclusion The integration of the TNS and TBL models into standardized medical laboratory science internship significantly enhances students’ clinical practical skills and learning engagement, while fostering greater teamwork awareness and self-directed learning abilities, and yields higher teaching satisfaction. The remarkable effectiveness of the integrated TNS-TBL teaching model provides a promising approach for optimizing clinical internship teaching in medical laboratory science. Tutor-Network-Seminar Team-Based Learning Clinical practice teaching Laboratory Medicine Active learning Figures Figure 1 Figure 2 1. Introduction Laboratory Medicine is an indispensable component of the modern healthcare system. Serving as a critical link between basic medical research and clinical practice, it provides accurate and timely diagnostic evidence for disease screening, differential diagnosis, treatment monitoring, and prognosis evaluation [ 1 ]. In China, undergraduate education in Medical Laboratory professions typically comprises three years of theoretical and experimental coursework, followed by a one-year clinical internship. Clinical internship, a pivotal phase in medical laboratory education, requires students to integrate theoretical knowledge and operational skills from multiple sub-disciplines (e.g., clinical routine testing, biochemistry, immunology, microbiology, and molecular testing) and to foster systematic clinical thinking. [ 2 – 5 ]. However, the traditional teaching model for clinical internship predominantly employs a teacher-centered approach that emphasizes theoretical knowledge and pre-service technical training, often neglecting the cultivation of comprehensive clinical competencies. This model compromises several key areas of student development, including the ability to integrate theory with clinical practice, self-directed learning initiative, adaptation to complex workflows, and teamwork and problem-solving skills [ 6 – 8 ]. With the advancement of laboratory technologies and the rising demand for interdisciplinary collaboration, there is an urgent need for medical educators to explore novel internship models to enhance teaching effectiveness and students’ overall competence. To address these challenges, innovative active learning strategies have been widely explored in medical education. Team-Based Learning (TBL) is an application-oriented active learning strategy that integrates individual preparation and team collaboration into classroom settings and has emerged as a highly effective instructional approach [ 9 , 10 ]. Compared with traditional teaching methods, TBL leads to superior knowledge acquisition due to thorough pre-class preparation and in-class discussion and application. Numerous studies have demonstrated that in health sciences education, TBL offers significant advantages in enhancing students’ knowledge retention, problem-solving abilities, and engagement, while also fostering interdisciplinary teamwork and communication [ 11 , 12 ]. For instance, Graham et al. [ 13 ] reported that TBL significantly improved knowledge application and clinical decision-making skills in transfusion medicine training for postgraduate physicians compared to traditional lectures. Similarly, Kim et al. [ 14 ] conducted a three-week TBL intervention for undergraduate nursing students which not only significantly enhanced the students' problem-solving capabilities but also contributed to improved acquisition of nursing knowledge and clinical performance. The Tutor-Network-Seminar (TNS) model has gained attention for its focus on individualized guidance and resource integration [ 15 – 17 ]. The TNS model adopts a student-centered approach that emphasizes the instructional responsibilities of tutors, utilizes online learning platforms to share teaching materials, videos, images, typical cases, as well as cutting-edge disciplinary information and technologies, and facilitates targeted guidance from instructors and peer interaction through regularly scheduled seminars [ 18 ]. The seminar component can be integrated with TBL to fully stimulate students’ learning initiative and enthusiasm, cultivate their verbal communication and teamwork skills, and enhance their clinical thinking capabilities [ 19 ]. Moreover, by providing sustained support for self-directed learning, the TNS model can address potential limitations of TBL, such as insufficient individualized feedback and fragmented learning resources. Therefore, the synergistic effect of TNS and TBL holds considerable promise: TNS provides a structured support system for resource sharing, professional guidance, and personalized learning, whereas TBL promotes teamwork, critical thinking, and practical application of knowledge. This integration is particularly relevant in medical laboratory education, where students must simultaneously master technical proficiency, clinical reasoning, and interdisciplinary collaboration. Based on this, the present study aims to investigate the feasibility and effectiveness of the TNS-TBL integrated teaching model in the internship training of medical laboratory science. This study seeks to determine whether this integrated model is more effective than traditional teaching methods in enhancing students’ practical skills, clinical thinking, teamwork competency, and teaching satisfaction, thereby providing evidence-based guidance for evaluating and optimizing teaching models of clinical internships in medical laboratory science. 2. Methods 2.1 Participants A total of 60 medical students who completed their clinical internship in the Department of Clinical Laboratory Medicine at the First Affiliated Hospital of Henan University of Science and Technology between July 2024 and March 2025 were enrolled in this study. The students were randomly divided into two groups: the control group consisted of 30 interns, including 7 males and 23 females, with an age range of 21 to 23 years and a mean age of (22.3 ± 0.61) years. The study group included another 30 students, comprising 9 males and 21 females, with the same age range as the control group and a mean age of (22.0 ± 0.67) years. There were no statistically significant differences in demographic and baseline information between the two groups ( p > 0.05), ensuring comparability for subsequent analyses. All participants provided informed consent prior to their inclusion in the study. 2.2 Study design To ensure consistency between the two groups, all teaching sessions were conducted by the same faculty members. In control group, the training was conducted using a teacher-centered approach wherein faculty set teaching objectives in accordance with the teaching syllabus focusing on the delivery of theoretical knowledge and basic clinical skills in medical laboratory science. The entire teaching process was directed by the teachers, with students passively receiving information. For clinical practice sessions, tutors first demonstrated the standard operations, followed by students conducting simulated practice. During the teaching process, necessary didactic questioning and practical error-correction sessions were implemented to ensure students proficiently mastered the theoretical knowledge and clinical procedures. Upon completion of the teaching period, students were administered theoretical and practical assessments. The study group adopted the integrated TNS-TBL teaching model, which was implemented as follows: (1) Systematic training was conducted for both tutors and interns to ensure an in-depth understanding of the fundamental principles and core concepts of the TNS and TBL teaching models. (2) Students were divided into three groups of ten, each with a designated group leader and a supervising tutor. The tutor released specimen information and relevant imaging materials via an online platform, requiring all students to engage in self-directed learning based on these materials and guiding questions. Students were encouraged to raise questions during the self-directed learning process. (3) The tutor organized group discussions based on the questions raised by the members and the syllabus content. Each group presented their discussion outcomes, followed by a comprehensive summary and commentary from the tutor, who also clarified key and challenging points of the course. (4) In clinical practice sessions, after tutors demonstrated standard operations, each team member performed the operation in turn while others observed and provided constructive feedback, thereby achieving peer assessment. The tutors actively supervised the entire operation process, offered targeted guidance when necessary, and re-demonstrated correct operations to address deficiencies. (5) Tutors provided extended learning materials through the online platform. This encouraged students to further explore relevant literature, thereby broadening their knowledge base and strengthening their ability to independently identify, analyze, and solve problems, which in turn fostered their clinical reasoning. Additionally, tutors maintained timely communication with each group, provided updated disciplinary information tailored to students’ learning progress, and assisted them in integrating theoretical knowledge with clinical practice. 2.3 Observation indicators 2.3.1 Achievement assessments Following the internship, students from both groups underwent evaluations in theoretical knowledge and practical skills. Theoretical knowledge assessment: A closed-book written examination was conducted to evaluate the students’ mastery of core professional knowledge in laboratory medicine. The test paper, which covering essential theoretical content of laboratory medicine, was compiled by a chief laboratory specialist not involved in the present study. The total score was 50 points, with higher scores indicating a more solid grasp of fundamental theoretical knowledge. Practical skills assessment: Practical skill competency was measured using a self-designed rating scale that included five domains: specimen collection and processing, instrument operation and maintenance, microorganism examination, molecular biological detection, and result interpretation and communication. Each dimension was scored out of 10 points, with a total score of 50 points. Higher total scores reflected a higher level of practical skill proficiency. Excellent rate: Based on the total assessment scores (full score = 100 points), student performance was categorized as follows: total scores ≥ 90 considered excellent, 80–89 considered good, 60–79 considered qualified, and < 60 considered unqualified. The excellence rate was calculated as (number of excellent students / 30) × 100%. The pass rate was calculated as (the total number of students with excellent, good, and pass scores / 30) × 100%. 2.3.2 Teaching satisfaction A self-designed questionnaire was used for an anonymous assessment, which consisted of four dimensions: teaching methods, teaching content, Teaching level, and classroom atmosphere (Supplementary material 1). Each dimension included five items rated on a 1–5 scale, with a total score of 100. Satisfaction levels were categorized as follows: very satisfied (total score ≥ 90), satisfied (80–89), moderate (60–79), or dissatisfied (<60). A total of 60 questionnaires was disseminated and gathered centrally following the interns’ assessment. 2.3.3 Teaching effectiveness assessments Teaching effectiveness was evaluated using a self-designed questionnaire developed by our hospital, which consisted of seven dimensions: self-directed learning ability, abilities to integration of theory and practice, teamwork ability, communication skills, summarization ability, and clinical competency (Supplementary material 2). Each dimension included 5 items, with each item scored on a 1–5 Likert scale, and the full score for each dimension was 25 points. Higher scores indicated better teaching effectiveness. A total of 60 questionnaires were distributed, with a 100% recovery and validity rate. 2.4 Statistical analysis All data in this study were recorded in Excel and analyzed statistically using SPSS 25.0 software. Measurement data were expressed as (mean ± standard deviation), and categorical data as percentages. Comparisons of normally distributed measurement data between the two groups were performed using independent-sample t-tests. Categorical data were compared using the chi-square test or Fisher’s exact test. A p -value < 0.05 was considered to be statistically significant. 3 Results 3.1 Comparison of achievement assessments scores between the two groups To evaluate the impact of the integrated TNS-TBL teaching model on learning outcomes, both groups of students were assessed in terms of theoretical basic knowledge and practical skills. The results showed that the total assessment score of the study group (94.40 ± 2.111) was significantly higher than that of the control group (86.47 ± 4.652), with a statistically significant difference ( p < 0.001). In the study group, the collaborative and interactive teaching approach enhanced students’ active learning and teamwork capabilities. Compared with the control group, students in the study group achieved significantly higher scores in practical skills (47.80 ± 0.961 vs. 40.40 ± 3.500, p < 0.001), whereas no significant difference was observed in theoretical basic knowledge ( p = 0.22) (Table 1 ). Table 1 Comparison of the assessments scores of students between the two groups Group n Theoretical knowledge Practical skills Score Study group 30 46.60 ± 1.476 47.80 ± 0.961 94.40 ± 2.111 Control group 30 46.070 ± 1.837 40.40 ± 3.500 86.47 ± 4.652 t value 1.24 11.168 8.507 p value 0.22 < 0.001 < 0.001 3.2 Comparison of excellent rate between the two groups The assessment results indicated that all students met the passing standard, resulting in a 100% qualified rate for both groups. However, the distribution of performance grades differed significantly between the two teaching models. The study group, which adopted the integrated TNS-TBL teaching approach, had a substantially higher excellent rate (28/30, 93.30%) compared with the control group receiving traditional teaching approach (9/30, 30.00%) (Table 2 ). Chi-square test revealed that the difference in the distribution of performance grades between the two groups was statistically significant (χ² = 26.337, p < 0.001), demonstrating that the integrated TNS-TBL teaching approach offers distinct advantages in enhancing students’ high-level academic performance. Table 2 The distribution of performance grades of students between the two groups Group n Excellent Good Qualified Unqualified Excellent rate Qualified rate Study group 30 28 2 0 0 93.30% 100% Control group 30 9 18 3 0 30.00% 100% \(\:{{\chi\:}}^{2}\) value 26.337 p value < 0.001 3.3 Comparison of teaching satisfaction between the two groups The recovery and validity rates of the teaching satisfaction questionnaire were both 100%. The results showed that overall satisfaction with the integrated TNS-TBL teaching model reached 100% in the study group, including 26 students who reported “very satisfied” and 4 who reported “satisfied.” In contrast, only 13.33% (4/30) of students in the control group expressed satisfaction with the traditional teaching approach, while 24 rated it as “average” and 2 as “dissatisfied.” Fisher’s exact chi-square test indicated a statistically significant difference in satisfaction between the two groups (χ² = 58.548, p < 0.001) (Fig. 1 ). Students in the study group demonstrated significantly higher satisfaction scores than the control group across all four dimensions: teaching methods (22.833 ± 2.167 vs. 12.433 ± 1.924, p < 0.001), teaching content (23.133 ± 0.860 vs. 21.333 ± 1.470, p < 0.001), Teaching level (23.467 ± 1.042 vs. 22.700 ± 1.236, p = 0.012), and classroom atmosphere (23.067 ± 1.437 vs. 16.600 ± 3.092, p < 0.001) (Table 3 ). Among these, teaching methods and classroom atmosphere were the two dimensions with the most significant differences between the groups. Student feedback indicated that the integrated TNS-TBL model played a significant role in stimulating learning interest, promoting independent thinking, and boosting enthusiasm for intra-group interaction and teamwork awareness. Table 3 The teaching satisfaction score of the two groups Study group (n = 30) Control group (n = 30) t Value p Value Teaching methods score 22.833 ± 2.167 12.433 ± 1.924 19.657 < 0.001 Teaching content score 23.133 ± 0.860 21.333 ± 1.470 5.788 < 0.001 Teaching level score 23.467 ± 1.042 22.700 ± 1.236 2.598 0.012 Classroom atmosphere Score 23.067 ± 1.437 16.600 ± 3.092 10.389 < 0.001 Total Score 92.500 ± 4.015 73.067 ± 5.936 14.853 < 0.001 3.4 Teaching Effectiveness Rating The results of the teaching effectiveness evaluation revealed that the total score was significantly higher in the study group than in the control group (85.667 ± 4.122 vs. 68.000 ± 5.388, p < 0.001). Compared with the control group, the tutor-guided and collaborative teaching approach adopted in the study group led to significantly greater improvements in students’ abilities to integration of theory and practice (13.267 ± 2.033 vs. 9.200 ± 1.324, p < 0.001), teamwork ability (16.733 ± 1.363 vs. 11.267 ± 1.363, p < 0.001), summarization ability (16.100 ± 1.447 vs. 13.267 ± 1.660, p < 0.001), and clinical competency (14.967 ± 1.771 vs. 13.633 ± 2.025, p = 0.009). However, no significant differences were observed between the two groups in self-directed learning ability (14.300 ± 1.343 vs. 13.533 ± 2.030, p = 0.090) or communication skills (14.467 ± 1.479 vs. 14.200 ± 1.846, p = 0.539) (Fig. 2 ). Further analysis revealed that the study group significantly outperformed the control group across multiple clinical practice-related survey items (Table 4 ). Specifically, students in the study group achieved significantly higher scores in the following key competencies: (1) ability to explain the correlation between test results and disease mechanisms (2.900 ± 0.712 vs. 2.433 ± 0.728, p = 0.0149); (2) ability to formulate and modify testing protocols in response to specific clinical scenarios (2.800 ± 0.714 vs. 1.567 ± 0.504, p < 0.001); (3) ability to critically evaluate and identify discrepancies between laboratory findings and clinical manifestations (2.800 ± 1.157 vs. 1.533 ± 0.507, p < 0.001); and (4) ability to optimize diagnostic testing panels through the critical integration of clinical information (3.000 ± 0.587 vs. 2.033 ± 0.890, p < 0.001). These results reflected the study group’s superior mastery of core technologies and critical comprehension skills. Collectively, these findings demonstrated the distinct advantages of the TNS-TBL teaching model in cultivating students’ professional competencies and higher-order cognitive abilities. Table 4 The assessment items with significant differences in results Survey items Study group Control group t Value p Value The ability to explain the correlation between test results and disease mechanisms. 2.900 ± 0.712 2.433 ± 0.728 2.510 0.0149 The ability to formulate and modify testing protocols in response to specific clinical scenarios. 2.800 ± 0.714 1.567 ± 0.504 7.727 < 0.001 The ability to critically evaluate and identify discrepancies between laboratory findings and clinical manifestations. 2.800 ± 1.157 1.533 ± 0.507 5.493 < 0.001 The ability to optimize diagnostic testing panels through the critical integration of clinical information. 3.000 ± 0.587 2.033 ± 0.890 4.966 < 0.001 4 Discussion The clinical internship in medical laboratory science serves as a crucial bridge connecting theoretical teaching and clinical practice, and its teaching quality directly influences the professional competence and career development prospects of future medical laboratory professionals [ 20 ]. This study compared the traditional teacher-centered approach with an integrated Tutor-Network-Seminar and Team-Based Learning teaching model in the context of medical laboratory science training. Our results demonstrated that the TNS-TBL integrated model significantly improved students’ practical skills, academic excellence rate, teaching satisfaction, and comprehensive professional competence. In particular, it exerted a prominent positive effect on the cultivation of several core competencies critical to clinical practice, including the integration of theoretical knowledge with practice, teamwork, and clinical skills. These findings not only verified the feasibility and effectiveness of the integrated TNS-TBL model in medical laboratory education but also provided valuable insights for addressing the long-standing challenges in traditional internship teaching. A notable finding of this study was that the practical skills scores of students in the TNS-TBL group were significantly improved (47.80 ± 0.961 vs. 40.40 ± 3.500, p < 0.001), which was consistent with the core objectives of clinical internship training. Traditional teaching primarily relies on teacher demonstration and passive simulated practice by students, a mechanized training model that struggles to adapt to complex clinical workflows [ 6 , 21 ]. In contrast, the TNS-TBL model optimizes the training process by promoting active learning, thereby enhancing the mastery of key competencies. The TNS framework provides sustained support for study group students in standardizing operational procedures and resolving practical difficulties through personalized tutor guidance, networked learning resources, and systematic seminar summaries [ 18 , 22 ]. For example, peer assessment and tutor supervision during clinical practice can provide timely feedback on operational errors, which is often lacking in traditional one-way demonstration-based teaching. Meanwhile, as an application-oriented teaching strategy, TBL focuses on the transformation of theoretical knowledge into problem-solving abilities through structured team collaboration, pre-class preparation, and real-scenario exercises, which has been shown to significantly improve medical students’ cognitive flexibility, analytical thinking, and problem-solving skills [ 12 , 23 – 25 ]. Haidet et al. [ 9 ] noted that TBL consistently enhances hands-on engagement and knowledge application capabilities in health sciences education, as students are required to actively participate in peer discussion, operational demonstration, and problem-solving, which deepen technical proficiency. Similarly, Zhang et al.’ study confirmed that the effectiveness of TBL in different settings. TBL could significantly improve students’ academic knowledge, self-leadership, clinical performance, competency skills, satisfaction, problem-solving ability, and critical thinking ability by integrating and applying their knowledge in team collaboration [ 26 ]. Our results revealed a significantly higher excellent rate in the study group (93.30% vs. 30.00%), indicating that the TNS-TBL model is more conducive to promoting students’ in-depth understanding and flexible application of theoretical knowledge, rather than mere rote memorization [ 14 , 27 , 28 ]. Unlike passive lecturing, task-driven learning and team discussions require students to actively participate and cultivate their ability to learn independently. Through self-directed inquiry, team-based discussions, and hands-on practice, acquired knowledge and skills are deepened, and lead to significant improvement in clinical proficiency. Furthermore, medical laboratory practice not only demands technical accuracy but also the ability to interpret test results in clinical context, adjust protocols according to patient needs, and collaborate effectively within interdisciplinary teams. As emphasized by Bossuyt et al. [ 29 ], laboratory professionals must master the correlations between test results and their clinical implications. The TNS-TBL model cultivates this ability precisely through case-based team discussions and tutor-guided integration of theory and practice. The overall satisfaction rate of the TNS-TBL group reached 100%, which was significantly higher than that of the control group (13.33%, p < 0.001). This reflects a strong alignment between this TNS-TBL teaching model and the learning needs of modern medical students. Students reported that task-driven learning, clearer learning objectives, and increased interaction with peers and tutors significantly enhanced their motivation and engagement. This finding is consistent with prior research on TBL in medical education [ 25 , 30 , 31 ]. Graham et al. [ 13 ] found that postgraduate physicians trained through TBL expressed higher satisfaction with the interactive and collaborative learning environment. Zgheib et al. [ 32 ] noted that TBL improves long-term team performance and learning engagement by fostering accountability and mutual support. The TNS framework further strengthened satisfaction by providing accessible online resources and personalized tutor guidance, effectively alleviating the tension and uncertainty often experienced by interns in traditional teaching [ 16 – 19 , 22 ]. A core value of this study lies in verifying the feasibility and synergistic effect of the combined application of the TNS and TBL teaching models, which addresses the limitations inherent in using either approach alone. Task quality critically influences the effectiveness of team-based learning because complex laboratory testing tasks typically involve multidisciplinary knowledge and require multi-step collaboration, which is difficult for individuals to solve efficiently. While TBL excels in fostering teamwork, communication, and critical thinking, it may lack personalized support for students with different learning ability. Michaelsen et al. [ 33 ] indicated that effective team learning relies on structured preparation and personalized feedback. The TNS framework complements the team-oriented teaching approach of TBL by providing systematic online resources, one-on-one tutor guidance, and structured group discussion [ 19 , 22 ]. The online resource sharing of the TNS model ensures that students have access to standardized procedural videos and typical cases before team discussions, laying a solid foundation for high-quality TBL interactions. Meanwhile, the teamwork in TBL further deepens seminar discussions in the TNS model, where students exchange diverse perspectives and jointly solve complex clinical problems. This synergy is particularly suitable for medical laboratory education, which demands both standardized technical operations and collaborative problem-solving [ 3 , 6 ]. Despite the positive outcomes, this study still has several limitations. First, the sample size was relatively small, limited to 60 students from a single hospital, which may restrict the generalizability of the research results. Larger multi-center studies involving diverse settings, such as different hospitals and medical schools, are needed to validate the effectiveness of TNS-TBL model across various educational contexts. Second, this study only evaluated the short-term effects of the students during the internship period. Long-term follow-up studies are warranted to assess the impact of this model on the clinical performance and career development of graduates. In addition, the implementation of the model relies on the high-level integration of quality resources. Developing a standardized repository of medical laboratory internship tasks covering sub-disciplines would facilitate the widespread promotion of the TNS-TBL model. The successful implementation of this initiative, which requires cross-institutional and interdisciplinary cooperation, will help enhance the coherence and quality of internship training. 5 Conclusion In summary, the integrated TNS-TBL teaching model represents a feasible and effective innovation for optimizing clinical internship training in medical laboratory science. By combining the advantages of TBL in teamwork and clinical practice with the strengths of TNS in personalized guidance and resource integration, this model not only significantly enhances students’ practical skills and clinical reasoning abilities but also increases learning engagement and teaching satisfaction. Consequently, it contributes to cultivating professionals who can meet the demands of interdisciplinary collaboration and evolving laboratory technologies [ 1 , 10 ]. The TNS-TBL model provides an evidence-based strategy with broad application prospects for reforming medical laboratory internship training. Future teaching reforms need to conduct more comprehensive, large-scale, and multi-center in-depth studies to keep pace with the rapid development of medical laboratory technology and the evolving demands for professional talents. Declarations Ethical Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committees of the First Affiliated Hospital of Henan University of Science and Technology (No.2024 − 0538). Informed oral consent to participate was obtained from all participants prior to their enrollment in the study. The ethics committee approved the use of oral consent as sufficient for this study due to it primarily involved routine educational activities and surveys without any invasive procedures or interventions. Conflict of Interest The authors have no conflicts of interest to disclose. Consent for Publication Not applicable. There are no details on individuals reported within the manuscript. Funding The word was supported by the Henan Provincial Medical Science and Technology Research Joint Construction Project(LHGJ20250557), and Henan Provincial Medical Education Research Project (Wjlx2020462). Author Contribution Le Zhao, Guo-dong Yang and Hong-xia Hu conceived this study; Le Zhao, Guo-dong Yang and Tao Jiang participated in the implementation of the theoretical framework and teaching methodologies. Le Zhao and Fu-qiang He conducted the data analysis and prepared the tables and figures; Le Zhao, Fu-qiang He and Yu-han Sun drafted the manuscript. All authors contributed to the study and read and approved the final version of the manuscript. Acknowledgments The author(s) would like to express their gratitude to the teaching staff and students of the First Affiliated Hospital of Henan University of Science and Technology for their cooperation and support during the research process. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Olver P, Bohn MK, Adeli K. Central role of laboratory medicine in public health and patient care. Clin Chem Lab Med. 2022;61(4):666–73. 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Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change. Nurse Educ Today. 2018;60:75–83. Zgheib NK, Dimassi Z, Bou Akl I, et al. The long-term impact of team-based learning on medical students' team performance scores and on their peer evaluation scores. Med Teach. 2016;38(10):1017–24. Michaelsen LK, Sweet M. The essential elements of team-based learning. New Dir Teach Learn. 2008;116:7–27. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1.docx SupplementaryMaterial2.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Feb, 2026 Reviews received at journal 20 Feb, 2026 Reviews received at journal 16 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers invited by journal 11 Feb, 2026 Editor assigned by journal 09 Feb, 2026 Editor invited by journal 21 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 20 Jan, 2026 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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Yang","email":"","orcid":"","institution":"The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Guodong","middleName":"","lastName":"Yang","suffix":""},{"id":592384238,"identity":"f2533e4c-c273-4416-a3a7-d8d8e91b9b7a","order_by":2,"name":"Fuqiang He","email":"","orcid":"","institution":"The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Fuqiang","middleName":"","lastName":"He","suffix":""},{"id":592384239,"identity":"b1cd3367-fca8-43ec-833a-c44442794cd1","order_by":3,"name":"Yuhan Sun","email":"","orcid":"","institution":"The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Yuhan","middleName":"","lastName":"Sun","suffix":""},{"id":592384240,"identity":"94099a58-1cf1-467b-9235-e25a6387558f","order_by":4,"name":"Tao Jiang","email":"","orcid":"","institution":"The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Jiang","suffix":""},{"id":592384241,"identity":"c2ca5bb1-c419-47dc-a94a-10aa1b461bd8","order_by":5,"name":"Hongxia 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08:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8538440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8538440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102854120,"identity":"4f223445-2bcb-4562-888e-8727bea2a6e0","added_by":"auto","created_at":"2026-02-17 14:47:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12269,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of teaching satisfaction between the two groups\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8538440/v1/f52f212b8ced8f8c8cde1357.png"},{"id":103049346,"identity":"aac34685-d1b4-410d-acb3-0eeb5de4c775","added_by":"auto","created_at":"2026-02-20 07:40:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20833,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of teaching effectiveness assessment between the two groups.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8538440/v1/7474c1887fc5cfac0c206c9d.png"},{"id":103050801,"identity":"9d842cce-b0c5-47de-b866-44685a42fb2e","added_by":"auto","created_at":"2026-02-20 07:55:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":892873,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8538440/v1/01b6a525-b99f-4383-a3be-730ec10ddd88.pdf"},{"id":102854122,"identity":"faa8ee28-2db7-4b76-9aaf-23823859cdec","added_by":"auto","created_at":"2026-02-17 14:47:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20606,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8538440/v1/f415dbafefeba436d6b8d9b6.docx"},{"id":102963193,"identity":"0bf28302-8288-4da9-bda5-1a613a1ac567","added_by":"auto","created_at":"2026-02-19 04:14:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21769,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8538440/v1/2c3bd396b7e11c14d8fa23cb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The application research of integrating tutor-network-seminar and team-based teaching strategies in clinical practice teaching of laboratory medicine","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLaboratory Medicine is an indispensable component of the modern healthcare system. Serving as a critical link between basic medical research and clinical practice, it provides accurate and timely diagnostic evidence for disease screening, differential diagnosis, treatment monitoring, and prognosis evaluation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, undergraduate education in Medical Laboratory professions typically comprises three years of theoretical and experimental coursework, followed by a one-year clinical internship. Clinical internship, a pivotal phase in medical laboratory education, requires students to integrate theoretical knowledge and operational skills from multiple sub-disciplines (e.g., clinical routine testing, biochemistry, immunology, microbiology, and molecular testing) and to foster systematic clinical thinking. [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the traditional teaching model for clinical internship predominantly employs a teacher-centered approach that emphasizes theoretical knowledge and pre-service technical training, often neglecting the cultivation of comprehensive clinical competencies. This model compromises several key areas of student development, including the ability to integrate theory with clinical practice, self-directed learning initiative, adaptation to complex workflows, and teamwork and problem-solving skills [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. With the advancement of laboratory technologies and the rising demand for interdisciplinary collaboration, there is an urgent need for medical educators to explore novel internship models to enhance teaching effectiveness and students\u0026rsquo; overall competence.\u003c/p\u003e \u003cp\u003eTo address these challenges, innovative active learning strategies have been widely explored in medical education. Team-Based Learning (TBL) is an application-oriented active learning strategy that integrates individual preparation and team collaboration into classroom settings and has emerged as a highly effective instructional approach [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Compared with traditional teaching methods, TBL leads to superior knowledge acquisition due to thorough pre-class preparation and in-class discussion and application. Numerous studies have demonstrated that in health sciences education, TBL offers significant advantages in enhancing students\u0026rsquo; knowledge retention, problem-solving abilities, and engagement, while also fostering interdisciplinary teamwork and communication [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For instance, Graham et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported that TBL significantly improved knowledge application and clinical decision-making skills in transfusion medicine training for postgraduate physicians compared to traditional lectures. Similarly, Kim et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] conducted a three-week TBL intervention for undergraduate nursing students which not only significantly enhanced the students' problem-solving capabilities but also contributed to improved acquisition of nursing knowledge and clinical performance.\u003c/p\u003e \u003cp\u003eThe Tutor-Network-Seminar (TNS) model has gained attention for its focus on individualized guidance and resource integration [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The TNS model adopts a student-centered approach that emphasizes the instructional responsibilities of tutors, utilizes online learning platforms to share teaching materials, videos, images, typical cases, as well as cutting-edge disciplinary information and technologies, and facilitates targeted guidance from instructors and peer interaction through regularly scheduled seminars [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The seminar component can be integrated with TBL to fully stimulate students\u0026rsquo; learning initiative and enthusiasm, cultivate their verbal communication and teamwork skills, and enhance their clinical thinking capabilities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Moreover, by providing sustained support for self-directed learning, the TNS model can address potential limitations of TBL, such as insufficient individualized feedback and fragmented learning resources. Therefore, the synergistic effect of TNS and TBL holds considerable promise: TNS provides a structured support system for resource sharing, professional guidance, and personalized learning, whereas TBL promotes teamwork, critical thinking, and practical application of knowledge. This integration is particularly relevant in medical laboratory education, where students must simultaneously master technical proficiency, clinical reasoning, and interdisciplinary collaboration.\u003c/p\u003e \u003cp\u003eBased on this, the present study aims to investigate the feasibility and effectiveness of the TNS-TBL integrated teaching model in the internship training of medical laboratory science. This study seeks to determine whether this integrated model is more effective than traditional teaching methods in enhancing students\u0026rsquo; practical skills, clinical thinking, teamwork competency, and teaching satisfaction, thereby providing evidence-based guidance for evaluating and optimizing teaching models of clinical internships in medical laboratory science.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eA total of 60 medical students who completed their clinical internship in the Department of Clinical Laboratory Medicine at the First Affiliated Hospital of Henan University of Science and Technology between July 2024 and March 2025 were enrolled in this study. The students were randomly divided into two groups: the control group consisted of 30 interns, including 7 males and 23 females, with an age range of 21 to 23 years and a mean age of (22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61) years. The study group included another 30 students, comprising 9 males and 21 females, with the same age range as the control group and a mean age of (22.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67) years. There were no statistically significant differences in demographic and baseline information between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), ensuring comparability for subsequent analyses. All participants provided informed consent prior to their inclusion in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study design\u003c/h2\u003e \u003cp\u003eTo ensure consistency between the two groups, all teaching sessions were conducted by the same faculty members. In control group, the training was conducted using a teacher-centered approach wherein faculty set teaching objectives in accordance with the teaching syllabus focusing on the delivery of theoretical knowledge and basic clinical skills in medical laboratory science. The entire teaching process was directed by the teachers, with students passively receiving information. For clinical practice sessions, tutors first demonstrated the standard operations, followed by students conducting simulated practice. During the teaching process, necessary didactic questioning and practical error-correction sessions were implemented to ensure students proficiently mastered the theoretical knowledge and clinical procedures. Upon completion of the teaching period, students were administered theoretical and practical assessments.\u003c/p\u003e \u003cp\u003eThe study group adopted the integrated TNS-TBL teaching model, which was implemented as follows: (1) Systematic training was conducted for both tutors and interns to ensure an in-depth understanding of the fundamental principles and core concepts of the TNS and TBL teaching models. (2) Students were divided into three groups of ten, each with a designated group leader and a supervising tutor. The tutor released specimen information and relevant imaging materials via an online platform, requiring all students to engage in self-directed learning based on these materials and guiding questions. Students were encouraged to raise questions during the self-directed learning process. (3) The tutor organized group discussions based on the questions raised by the members and the syllabus content. Each group presented their discussion outcomes, followed by a comprehensive summary and commentary from the tutor, who also clarified key and challenging points of the course. (4) In clinical practice sessions, after tutors demonstrated standard operations, each team member performed the operation in turn while others observed and provided constructive feedback, thereby achieving peer assessment. The tutors actively supervised the entire operation process, offered targeted guidance when necessary, and re-demonstrated correct operations to address deficiencies. (5) Tutors provided extended learning materials through the online platform. This encouraged students to further explore relevant literature, thereby broadening their knowledge base and strengthening their ability to independently identify, analyze, and solve problems, which in turn fostered their clinical reasoning. Additionally, tutors maintained timely communication with each group, provided updated disciplinary information tailored to students\u0026rsquo; learning progress, and assisted them in integrating theoretical knowledge with clinical practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Observation indicators\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Achievement assessments\u003c/h2\u003e \u003cp\u003eFollowing the internship, students from both groups underwent evaluations in theoretical knowledge and practical skills.\u003c/p\u003e \u003cp\u003eTheoretical knowledge assessment: A closed-book written examination was conducted to evaluate the students\u0026rsquo; mastery of core professional knowledge in laboratory medicine. The test paper, which covering essential theoretical content of laboratory medicine, was compiled by a chief laboratory specialist not involved in the present study. The total score was 50 points, with higher scores indicating a more solid grasp of fundamental theoretical knowledge.\u003c/p\u003e \u003cp\u003ePractical skills assessment: Practical skill competency was measured using a self-designed rating scale that included five domains: specimen collection and processing, instrument operation and maintenance, microorganism examination, molecular biological detection, and result interpretation and communication. Each dimension was scored out of 10 points, with a total score of 50 points. Higher total scores reflected a higher level of practical skill proficiency.\u003c/p\u003e \u003cp\u003eExcellent rate: Based on the total assessment scores (full score\u0026thinsp;=\u0026thinsp;100 points), student performance was categorized as follows: total scores\u0026thinsp;\u0026ge;\u0026thinsp;90 considered excellent, 80\u0026ndash;89 considered good, 60\u0026ndash;79 considered qualified, and \u0026lt;\u0026thinsp;60 considered unqualified. The excellence rate was calculated as (number of excellent students / 30) \u0026times; 100%. The pass rate was calculated as (the total number of students with excellent, good, and pass scores / 30) \u0026times; 100%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Teaching satisfaction\u003c/h2\u003e \u003cp\u003eA self-designed questionnaire was used for an anonymous assessment, which consisted of four dimensions: teaching methods, teaching content, Teaching level, and classroom atmosphere (Supplementary material 1). Each dimension included five items rated on a 1\u0026ndash;5 scale, with a total score of 100. Satisfaction levels were categorized as follows: very satisfied (total score\u0026thinsp;\u0026ge;\u0026thinsp;90), satisfied (80\u0026ndash;89), moderate (60\u0026ndash;79), or dissatisfied (\u0026lt;60). A total of 60 questionnaires was disseminated and gathered centrally following the interns\u0026rsquo; assessment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Teaching effectiveness assessments\u003c/h2\u003e \u003cp\u003eTeaching effectiveness was evaluated using a self-designed questionnaire developed by our hospital, which consisted of seven dimensions: self-directed learning ability, abilities to integration of theory and practice, teamwork ability, communication skills, summarization ability, and clinical competency (Supplementary material 2). Each dimension included 5 items, with each item scored on a 1\u0026ndash;5 Likert scale, and the full score for each dimension was 25 points. Higher scores indicated better teaching effectiveness. A total of 60 questionnaires were distributed, with a 100% recovery and validity rate.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eAll data in this study were recorded in Excel and analyzed statistically using SPSS 25.0 software. Measurement data were expressed as (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation), and categorical data as percentages. Comparisons of normally distributed measurement data between the two groups were performed using independent-sample t-tests. Categorical data were compared using the chi-square test or Fisher\u0026rsquo;s exact test. A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of achievement assessments scores between the two groups\u003c/h2\u003e \u003cp\u003eTo evaluate the impact of the integrated TNS-TBL teaching model on learning outcomes, both groups of students were assessed in terms of theoretical basic knowledge and practical skills. The results showed that the total assessment score of the study group (94.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.111) was significantly higher than that of the control group (86.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.652), with a statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the study group, the collaborative and interactive teaching approach enhanced students\u0026rsquo; active learning and teamwork capabilities. Compared with the control group, students in the study group achieved significantly higher scores in practical skills (47.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.961 vs. 40.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.500, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas no significant difference was observed in theoretical basic knowledge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the assessments scores of students between the two groups\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=\"char\" char=\".\" 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\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTheoretical knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePractical skills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.070\u0026thinsp;\u0026plusmn;\u0026thinsp;1.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;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 \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of excellent rate between the two groups\u003c/h2\u003e \u003cp\u003eThe assessment results indicated that all students met the passing standard, resulting in a 100% qualified rate for both groups. However, the distribution of performance grades differed significantly between the two teaching models. The study group, which adopted the integrated TNS-TBL teaching approach, had a substantially higher excellent rate (28/30, 93.30%) compared with the control group receiving traditional teaching approach (9/30, 30.00%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Chi-square test revealed that the difference in the distribution of performance grades between the two groups was statistically significant (χ\u0026sup2; = 26.337, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), demonstrating that the integrated TNS-TBL teaching approach offers distinct advantages in enhancing students\u0026rsquo; high-level academic performance.\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\u003eThe distribution of performance grades of students between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualified\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnqualified\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExcellent rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQualified rate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e93.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{{\\chi\\:}}^{2}\\)\u003c/span\u003e\u003c/span\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e26.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\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=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of teaching satisfaction between the two groups\u003c/h2\u003e \u003cp\u003eThe recovery and validity rates of the teaching satisfaction questionnaire were both 100%. The results showed that overall satisfaction with the integrated TNS-TBL teaching model reached 100% in the study group, including 26 students who reported \u0026ldquo;very satisfied\u0026rdquo; and 4 who reported \u0026ldquo;satisfied.\u0026rdquo; In contrast, only 13.33% (4/30) of students in the control group expressed satisfaction with the traditional teaching approach, while 24 rated it as \u0026ldquo;average\u0026rdquo; and 2 as \u0026ldquo;dissatisfied.\u0026rdquo; Fisher\u0026rsquo;s exact chi-square test indicated a statistically significant difference in satisfaction between the two groups (χ\u0026sup2; = 58.548, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStudents in the study group demonstrated significantly higher satisfaction scores than the control group across all four dimensions: teaching methods (22.833\u0026thinsp;\u0026plusmn;\u0026thinsp;2.167 vs. 12.433\u0026thinsp;\u0026plusmn;\u0026thinsp;1.924, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), teaching content (23.133\u0026thinsp;\u0026plusmn;\u0026thinsp;0.860 vs. 21.333\u0026thinsp;\u0026plusmn;\u0026thinsp;1.470, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Teaching level (23.467\u0026thinsp;\u0026plusmn;\u0026thinsp;1.042 vs. 22.700\u0026thinsp;\u0026plusmn;\u0026thinsp;1.236, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), and classroom atmosphere (23.067\u0026thinsp;\u0026plusmn;\u0026thinsp;1.437 vs. 16.600\u0026thinsp;\u0026plusmn;\u0026thinsp;3.092, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Among these, teaching methods and classroom atmosphere were the two dimensions with the most significant differences between the groups. Student feedback indicated that the integrated TNS-TBL model played a significant role in stimulating learning interest, promoting independent thinking, and boosting enthusiasm for intra-group interaction and teamwork awareness.\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\u003eThe teaching satisfaction score of the two groups\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\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;30)\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\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching methods score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.833\u0026thinsp;\u0026plusmn;\u0026thinsp;2.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.433\u0026thinsp;\u0026plusmn;\u0026thinsp;1.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching content score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.133\u0026thinsp;\u0026plusmn;\u0026thinsp;0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.333\u0026thinsp;\u0026plusmn;\u0026thinsp;1.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching level score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.467\u0026thinsp;\u0026plusmn;\u0026thinsp;1.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.700\u0026thinsp;\u0026plusmn;\u0026thinsp;1.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassroom atmosphere Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.067\u0026thinsp;\u0026plusmn;\u0026thinsp;1.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.600\u0026thinsp;\u0026plusmn;\u0026thinsp;3.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.500\u0026thinsp;\u0026plusmn;\u0026thinsp;4.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.067\u0026thinsp;\u0026plusmn;\u0026thinsp;5.936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;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 \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Teaching Effectiveness Rating\u003c/h2\u003e \u003cp\u003eThe results of the teaching effectiveness evaluation revealed that the total score was significantly higher in the study group than in the control group (85.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.122 vs. 68.000\u0026thinsp;\u0026plusmn;\u0026thinsp;5.388, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Compared with the control group, the tutor-guided and collaborative teaching approach adopted in the study group led to significantly greater improvements in students\u0026rsquo; abilities to integration of theory and practice (13.267\u0026thinsp;\u0026plusmn;\u0026thinsp;2.033 vs. 9.200\u0026thinsp;\u0026plusmn;\u0026thinsp;1.324, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), teamwork ability (16.733\u0026thinsp;\u0026plusmn;\u0026thinsp;1.363 vs. 11.267\u0026thinsp;\u0026plusmn;\u0026thinsp;1.363, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), summarization ability (16.100\u0026thinsp;\u0026plusmn;\u0026thinsp;1.447 vs. 13.267\u0026thinsp;\u0026plusmn;\u0026thinsp;1.660, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and clinical competency (14.967\u0026thinsp;\u0026plusmn;\u0026thinsp;1.771 vs. 13.633\u0026thinsp;\u0026plusmn;\u0026thinsp;2.025, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). However, no significant differences were observed between the two groups in self-directed learning ability (14.300\u0026thinsp;\u0026plusmn;\u0026thinsp;1.343 vs. 13.533\u0026thinsp;\u0026plusmn;\u0026thinsp;2.030, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.090) or communication skills (14.467\u0026thinsp;\u0026plusmn;\u0026thinsp;1.479 vs. 14.200\u0026thinsp;\u0026plusmn;\u0026thinsp;1.846, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.539) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFurther analysis revealed that the study group significantly outperformed the control group across multiple clinical practice-related survey items (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Specifically, students in the study group achieved significantly higher scores in the following key competencies: (1) ability to explain the correlation between test results and disease mechanisms (2.900\u0026thinsp;\u0026plusmn;\u0026thinsp;0.712 vs. 2.433\u0026thinsp;\u0026plusmn;\u0026thinsp;0.728, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0149); (2) ability to formulate and modify testing protocols in response to specific clinical scenarios (2.800\u0026thinsp;\u0026plusmn;\u0026thinsp;0.714 vs. 1.567\u0026thinsp;\u0026plusmn;\u0026thinsp;0.504, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); (3) ability to critically evaluate and identify discrepancies between laboratory findings and clinical manifestations (2.800\u0026thinsp;\u0026plusmn;\u0026thinsp;1.157 vs. 1.533\u0026thinsp;\u0026plusmn;\u0026thinsp;0.507, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); and (4) ability to optimize diagnostic testing panels through the critical integration of clinical information (3.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.587 vs. 2.033\u0026thinsp;\u0026plusmn;\u0026thinsp;0.890, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results reflected the study group\u0026rsquo;s superior mastery of core technologies and critical comprehension skills. Collectively, these findings demonstrated the distinct advantages of the TNS-TBL teaching model in cultivating students\u0026rsquo; professional competencies and higher-order cognitive abilities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe assessment items with significant differences in results\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 items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\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\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe ability to explain the correlation between test results and disease mechanisms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.900\u0026thinsp;\u0026plusmn;\u0026thinsp;0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.433\u0026thinsp;\u0026plusmn;\u0026thinsp;0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe ability to formulate and modify testing protocols in response to specific clinical scenarios.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.800\u0026thinsp;\u0026plusmn;\u0026thinsp;0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.567\u0026thinsp;\u0026plusmn;\u0026thinsp;0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe ability to critically evaluate and identify discrepancies between laboratory findings and clinical manifestations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.800\u0026thinsp;\u0026plusmn;\u0026thinsp;1.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.533\u0026thinsp;\u0026plusmn;\u0026thinsp;0.507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe ability to optimize diagnostic testing panels through the critical integration of clinical information.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.033\u0026thinsp;\u0026plusmn;\u0026thinsp;0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;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 \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe clinical internship in medical laboratory science serves as a crucial bridge connecting theoretical teaching and clinical practice, and its teaching quality directly influences the professional competence and career development prospects of future medical laboratory professionals [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study compared the traditional teacher-centered approach with an integrated Tutor-Network-Seminar and Team-Based Learning teaching model in the context of medical laboratory science training. Our results demonstrated that the TNS-TBL integrated model significantly improved students\u0026rsquo; practical skills, academic excellence rate, teaching satisfaction, and comprehensive professional competence. In particular, it exerted a prominent positive effect on the cultivation of several core competencies critical to clinical practice, including the integration of theoretical knowledge with practice, teamwork, and clinical skills. These findings not only verified the feasibility and effectiveness of the integrated TNS-TBL model in medical laboratory education but also provided valuable insights for addressing the long-standing challenges in traditional internship teaching.\u003c/p\u003e \u003cp\u003eA notable finding of this study was that the practical skills scores of students in the TNS-TBL group were significantly improved (47.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.961 vs. 40.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.500, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which was consistent with the core objectives of clinical internship training. Traditional teaching primarily relies on teacher demonstration and passive simulated practice by students, a mechanized training model that struggles to adapt to complex clinical workflows [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In contrast, the TNS-TBL model optimizes the training process by promoting active learning, thereby enhancing the mastery of key competencies. The TNS framework provides sustained support for study group students in standardizing operational procedures and resolving practical difficulties through personalized tutor guidance, networked learning resources, and systematic seminar summaries [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. For example, peer assessment and tutor supervision during clinical practice can provide timely feedback on operational errors, which is often lacking in traditional one-way demonstration-based teaching. Meanwhile, as an application-oriented teaching strategy, TBL focuses on the transformation of theoretical knowledge into problem-solving abilities through structured team collaboration, pre-class preparation, and real-scenario exercises, which has been shown to significantly improve medical students\u0026rsquo; cognitive flexibility, analytical thinking, and problem-solving skills [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Haidet et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] noted that TBL consistently enhances hands-on engagement and knowledge application capabilities in health sciences education, as students are required to actively participate in peer discussion, operational demonstration, and problem-solving, which deepen technical proficiency. Similarly, Zhang et al.\u0026rsquo; study confirmed that the effectiveness of TBL in different settings. TBL could significantly improve students\u0026rsquo; academic knowledge, self-leadership, clinical performance, competency skills, satisfaction, problem-solving ability, and critical thinking ability by integrating and applying their knowledge in team collaboration [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results revealed a significantly higher excellent rate in the study group (93.30% vs. 30.00%), indicating that the TNS-TBL model is more conducive to promoting students\u0026rsquo; in-depth understanding and flexible application of theoretical knowledge, rather than mere rote memorization [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Unlike passive lecturing, task-driven learning and team discussions require students to actively participate and cultivate their ability to learn independently. Through self-directed inquiry, team-based discussions, and hands-on practice, acquired knowledge and skills are deepened, and lead to significant improvement in clinical proficiency. Furthermore, medical laboratory practice not only demands technical accuracy but also the ability to interpret test results in clinical context, adjust protocols according to patient needs, and collaborate effectively within interdisciplinary teams. As emphasized by Bossuyt et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], laboratory professionals must master the correlations between test results and their clinical implications. The TNS-TBL model cultivates this ability precisely through case-based team discussions and tutor-guided integration of theory and practice.\u003c/p\u003e \u003cp\u003eThe overall satisfaction rate of the TNS-TBL group reached 100%, which was significantly higher than that of the control group (13.33%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This reflects a strong alignment between this TNS-TBL teaching model and the learning needs of modern medical students. Students reported that task-driven learning, clearer learning objectives, and increased interaction with peers and tutors significantly enhanced their motivation and engagement. This finding is consistent with prior research on TBL in medical education [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Graham et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] found that postgraduate physicians trained through TBL expressed higher satisfaction with the interactive and collaborative learning environment. Zgheib et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] noted that TBL improves long-term team performance and learning engagement by fostering accountability and mutual support. The TNS framework further strengthened satisfaction by providing accessible online resources and personalized tutor guidance, effectively alleviating the tension and uncertainty often experienced by interns in traditional teaching [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA core value of this study lies in verifying the feasibility and synergistic effect of the combined application of the TNS and TBL teaching models, which addresses the limitations inherent in using either approach alone. Task quality critically influences the effectiveness of team-based learning because complex laboratory testing tasks typically involve multidisciplinary knowledge and require multi-step collaboration, which is difficult for individuals to solve efficiently. While TBL excels in fostering teamwork, communication, and critical thinking, it may lack personalized support for students with different learning ability. Michaelsen et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] indicated that effective team learning relies on structured preparation and personalized feedback. The TNS framework complements the team-oriented teaching approach of TBL by providing systematic online resources, one-on-one tutor guidance, and structured group discussion [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The online resource sharing of the TNS model ensures that students have access to standardized procedural videos and typical cases before team discussions, laying a solid foundation for high-quality TBL interactions. Meanwhile, the teamwork in TBL further deepens seminar discussions in the TNS model, where students exchange diverse perspectives and jointly solve complex clinical problems. This synergy is particularly suitable for medical laboratory education, which demands both standardized technical operations and collaborative problem-solving [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the positive outcomes, this study still has several limitations. First, the sample size was relatively small, limited to 60 students from a single hospital, which may restrict the generalizability of the research results. Larger multi-center studies involving diverse settings, such as different hospitals and medical schools, are needed to validate the effectiveness of TNS-TBL model across various educational contexts. Second, this study only evaluated the short-term effects of the students during the internship period. Long-term follow-up studies are warranted to assess the impact of this model on the clinical performance and career development of graduates. In addition, the implementation of the model relies on the high-level integration of quality resources. Developing a standardized repository of medical laboratory internship tasks covering sub-disciplines would facilitate the widespread promotion of the TNS-TBL model. The successful implementation of this initiative, which requires cross-institutional and interdisciplinary cooperation, will help enhance the coherence and quality of internship training.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn summary, the integrated TNS-TBL teaching model represents a feasible and effective innovation for optimizing clinical internship training in medical laboratory science. By combining the advantages of TBL in teamwork and clinical practice with the strengths of TNS in personalized guidance and resource integration, this model not only significantly enhances students\u0026rsquo; practical skills and clinical reasoning abilities but also increases learning engagement and teaching satisfaction. Consequently, it contributes to cultivating professionals who can meet the demands of interdisciplinary collaboration and evolving laboratory technologies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The TNS-TBL model provides an evidence-based strategy with broad application prospects for reforming medical laboratory internship training. Future teaching reforms need to conduct more comprehensive, large-scale, and multi-center in-depth studies to keep pace with the rapid development of medical laboratory technology and the evolving demands for professional talents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committees of the First Affiliated Hospital of Henan University of Science and Technology (No.2024\u0026thinsp;\u0026minus;\u0026thinsp;0538). Informed oral consent to participate was obtained from all participants prior to their enrollment in the study. The ethics committee approved the use of oral consent as sufficient for this study due to it primarily involved routine educational activities and surveys without any invasive procedures or interventions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of Interest\u003c/strong\u003e \u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication\u003c/strong\u003e \u003cp\u003eNot applicable. There are no details on individuals reported within the manuscript.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe word was supported by the Henan Provincial Medical Science and Technology Research Joint Construction Project(LHGJ20250557), and Henan Provincial Medical Education Research Project (Wjlx2020462).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLe Zhao, Guo-dong Yang and Hong-xia Hu conceived this study; Le Zhao, Guo-dong Yang and Tao Jiang participated in the implementation of the theoretical framework and teaching methodologies. Le Zhao and Fu-qiang He conducted the data analysis and prepared the tables and figures; Le Zhao, Fu-qiang He and Yu-han Sun drafted the manuscript. All authors contributed to the study and read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe author(s) would like to express their gratitude to the teaching staff and students of the First Affiliated Hospital of Henan University of Science and Technology for their cooperation and support during the research process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOlver P, Bohn MK, Adeli K. Central role of laboratory medicine in public health and patient care. Clin Chem Lab Med. 2022;61(4):666\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong Y, Chen H, Wang Y, et al. 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J Excell Coll Teach. 2014;25(3\u0026ndash;4):303\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmeby SS, Lillebo B, Sl\u0026oslash;rdahl TS, et al. Express team-based learning (eTBL): a time-efficient tbl approach in neuroradiology. Acad Radiol. 2020;27(2):284\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSisk RJ. Team-based learning: systematic research review. J Nurs Educ. 2011;50(12):665\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlizadeh M, Masoomi R, Mafinejad MK, et al. Team-based learning in health professions education: an umbrella review. BMC Med Educ. 2024;24(1):1131.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraham J, Hayes C, Pendry K. Can team-based learning (TBL) be used to deliver postgraduate education in transfusion medicine for UK physicians? Med Sci Educ. 2019;30(1):631\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HR, Song Y, Lindquist R, et al. Effects of team-based learning on problem-solving, knowledge and clinical performance of Korean nursing students. Nurse Educ Today. 2016;38:115\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDang JH, Jin ZJ, Zhang J, et al. The application of TNS combined with CBL teaching method in the standardized training and teaching of obstetrics and gynecology. China High Med Educ. 2023;7:119\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu JS, Yu MJ, Feng J. Application of TNS joint case study teaching method in undergraduate neurology practice teaching. China Med Educ Technol. 2020;34(3):356\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng Y, Huang XH, Yang CM, et al. Study on effect of TNS combined with mind mapping in clinical teaching of neurology department. China Continuing Med Educ. 2024;16(8):116\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang H, Chen ZH, Chen AL, et al. The establishment of TNS model and its application in the training of medical laboratory interns. China Continuing Med Educ. 2018;10(16):18\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao J, Dai JW. Application of TNS combined with TBL teaching model in undergraduate clinical internship of neurology department. Health Vocat Educ. 2023;41(4):120\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi KF, Liu BZ, Wu FF, et al. Outcome-based student assessment enhances academic performance in basic medical laboratory course. Adv Physiol Educ. 2021;45(2):269\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashmi NR. Team Based Learning (TBL) in undergraduate medical education. 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Nat Rev Rheumatol. 2020;16(12):715\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConsidine J, Berry D, Allen J, et al. Team-based learning in nursing education: a scoping review. J Clin Nurs. 2021;30(7\u0026ndash;8):903\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDearnley C, Rhodes C, Roberts P, et al. Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change. Nurse Educ Today. 2018;60:75\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZgheib NK, Dimassi Z, Bou Akl I, et al. The long-term impact of team-based learning on medical students' team performance scores and on their peer evaluation scores. Med Teach. 2016;38(10):1017\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichaelsen LK, Sweet M. The essential elements of team-based learning. New Dir Teach Learn. 2008;116:7\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":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":"Tutor-Network-Seminar, Team-Based Learning, Clinical practice teaching, Laboratory Medicine, Active learning","lastPublishedDoi":"10.21203/rs.3.rs-8538440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8538440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to investigate the feasibility and effectiveness of an integrated Tutor-Network-Seminar (TNS) and Team-Based Learning (TBL) teaching model in the clinical internship of Medical Laboratory Science.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A total of 60 students who completed their clinical internship in the Department of Clinical Laboratory Medicine at the First Affiliated Hospital of Henan University of Science and Technology between July 2024 and March 2025 were recruited as participants. They were randomly divided into two groups: the control group (n\u0026thinsp;=\u0026thinsp;30) students received a traditional teacher-centered approach, and the study group (n\u0026thinsp;=\u0026thinsp;30) instructed an integrated TNS and TBL approach. The effectiveness of the TNS-TBL teaching model was evaluated by comparing the differences between the two groups in theoretical assessment scores, practical skill assessment scores, teaching satisfaction, and overall teaching effectiveness ratings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference in theoretical assessment scores between the two groups (46.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.476 vs. 46.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.837, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, students in the study group demonstrated significantly higher scores in practical skill assessments (47.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.961 vs. 40.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.500, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), teaching satisfaction (100% vs. 13.33%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and overall teaching effectiveness ratings.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe integration of the TNS and TBL models into standardized medical laboratory science internship significantly enhances students\u0026rsquo; clinical practical skills and learning engagement, while fostering greater teamwork awareness and self-directed learning abilities, and yields higher teaching satisfaction. The remarkable effectiveness of the integrated TNS-TBL teaching model provides a promising approach for optimizing clinical internship teaching in medical laboratory science.\u003c/p\u003e","manuscriptTitle":"The application research of integrating tutor-network-seminar and team-based teaching strategies in clinical practice teaching of laboratory medicine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:47:10","doi":"10.21203/rs.3.rs-8538440/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T15:53:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T13:06:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T11:40:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T16:33:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328983190888287392696447501361083189897","date":"2026-02-13T17:57:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210230064349766048515663741996147001690","date":"2026-02-12T23:41:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156721601243603661498550043701056311866","date":"2026-02-11T16:57:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T16:40:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T04:52:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-21T05:21:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T13:31:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-20T13:13:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8e5bae6-7fdb-4687-98cb-9047da393dca","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T12:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:47:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8538440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8538440","identity":"rs-8538440","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}