Integrated CBL and PBL Teaching with Standardized Patients for Internal Medicine Education

Integrated CBL and PBL Teaching with Standardized Patients for Internal Medicine Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrated CBL and PBL Teaching with Standardized Patients for Internal Medicine Education Pengfei Shao, Junpeng Ran, Qin Long, Wei Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4570051/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study evaluates the effectiveness and efficiency of combining Case-Based Learning (CBL) utilizing Standardized Patients with Problem-Based Learning (PBL) in enhancing clinical education for internal medicine students. Methods A retrospective cohort study was performed involving 240 internal medicine students trained in our department between September 2021 and June 2023.Initially, students were divided into a traditional teaching group (n = 120) and a combined PBL-CBL group (n = 120). Baseline calculations revealed significant gender differences between the two groups. Subsequently, propensity score matching was employed to create a matched traditional teaching group (n = 93) and a PBL-CBL combined group (n = 120). Independent sample t-tests were utilized to compare the teaching performance between the two groups. Results Post propensity score matching, the integrated PBL-CBL group demonstrated significant enhancements (p < 0.05) across various metrics, including end-of-course assessment scores, skill assessments, dOPS scores, theoretical knowledge, practical skills, doctor-patient communication, self-directed learning, perceived learning burden, and overall competence. Conclusion Integrating CBL and PBL teaching methods with Standardized Patients proves to be an effective approach for enhancing the overall performance and clinical skills of medical students and resident physicians. PBL CBL Standardized Patients internal medicine education Background In the realm of medical education, as medical and clinical knowledge continues to accumulate and progress, schools have increasingly emphasized standardized medical education, with medical schools employing various methods to develop effective teaching approaches [ 1 ]. While a solid foundation in clinical knowledge and practical skills remains crucial, cultivating students' ability to analyze cases and navigate real-life situations has become increasingly important in recent years [ 2 ]. Case-based learning (CBL) is an educational approach based on the analysis of cases, aiming to simulate real clinical scenarios and encourage students to actively explore new areas of learning [ 3 ]. Problem-based learning (PBL), on the other hand, is a student-centered teaching methodology where students within small groups, under the guidance of tutors, work on tasks or challenges relevant to the actual work environment [ 4 ]. Compared to traditional methods, CBL emphasizes the development of students' logical reasoning abilities. Through real cases, teachers pose questions, and students apply their acquired knowledge to analyze and reason [ 5 ]. PBL, on the other hand, focuses on problem orientation, encourages divergent thinking, and emphasizes active participation from students within small groups, where they collaborate in problem-solving. CBL contributes to improving the clinical practice, problem-solving, and analytical abilities of resident physicians and medical students [ 6 ]. In comparison to traditional lectures, PBL programs have been shown to enhance student satisfaction and active engagement [ 7 ]. However, CBL and PBL each have their limitations. CBL requires considerable time investment from teachers in preparing cases and questions [ 8 ], while PBL demands students to invest time in preparing questions and materials before class [ 9 ]. Research has suggested that combining the strengths of PBL and CBL in teaching methodologies can facilitate effective and high-quality learning, while also contributing to the development of excellent teaching teams [ 10 ]. This study conducted a retrospective analysis on the role of the patient-based case-based learning (CBL) combined with problem-based learning (PBL) teaching method in clinical education within the field of internal medicine at our institution. Methods General Information This retrospective analysis included 240 internal medicine students who voluntarily participated in the teaching reform from September 2021 to June 2023 at our institution. They were randomly divided into two groups: the traditional teaching group (n = 120) and the teaching reform group (n = 120). Among them, there were 141 female students and 99 male students. Baseline calculations of the two groups revealed a significant difference in gender distribution. Subsequently, propensity score matching was performed to match students from both groups. After successful matching, the traditional teaching group consisted of 93 individuals, and the teaching reform group consisted of 120 individuals. Among them, there were 114 females and 99 males. Inclusion Criteria (1) Participants with an educational level of at least a college degree. (2) Participants with previous internship or apprenticeship experience. (3) Participants who signed an informed consent form. Exclusion Criteria (1) Participants with poor physical health. (2) Participants who demonstrated uncooperative behavior during the learning process. (3) Participants without previous internship or apprenticeship experience. Propensity Score Matching Propensity score matching (PSM) was conducted using the PSM extension program in SPSS. The process of PSM was as follows: Firstly, the teaching reform group was set as the dependent variable, while considering various covariates as independent variables. Logistic regression analysis was employed to predict individuals' propensity scores. Next, the nearest neighbor matching method was used to match each individual from the teaching reform group with an individual from the traditional teaching group who had the most similar propensity score value. A caliper value was introduced during the matching process to ensure the quality of the matches. Afterwards, the standard deviation change of covariates between the groups was compared. A smaller absolute value of the standard deviation after matching indicated a better matching effect. When the absolute value of the standard deviation was less than 0.1 (10%), it was considered that the covariates between the groups were well balanced. In the end, 93 individuals from the traditional teaching group were well-matched with the teaching reform group. Teaching Methods Traditional Teaching Group Prior to the start of the class, the teachers, based on the professional characteristics of internal medicine clinical work and the teaching syllabus, developed a detailed teaching plan for the internal medicine students. Through traditional lecture-style teaching, we provided training on the fundamental theory and basic skills for the internal medicine residents, with a particular focus on explaining the etiology, pathology, clinical manifestations, treatment issues, and corresponding measures for common internal medicine diseases. After completing the course content, the mentors assigned homework and provided feedback and summaries during the next ward round for the resident students. The teaching process was primarily conducted through teacher lectures with student participation as supplementary. Teaching Reform Group (1) Prior to the start of the course, a curriculum preparation group consisting of the medical education department, departmental teaching secretary, and teaching mentors prepared standardized cases, relevant course videos, and supplementary materials related to the specific disease. These materials included clinical scenarios of standardized cases, guidelines, research papers, or other references associated with the diagnosis and treatment of the disease, as well as approximately 30 minutes of skill training videos. Each student was required to study these materials during their spare time outside of class. To facilitate the in-class activities, students were asked to complete a pre-class quiz consisting of multiple-choice questions before the start of each session. The lecturer would provide a brief introduction to the topic and course agenda at the beginning of the session. (2) During the in-class activities, a series of steps were followed. Firstly, a patient case that had been standardized by the curriculum preparation group was presented using slideshow presentations, showcasing the clinical scenarios of the case. Next, under the guidance of the teacher, students engaged in small group discussions. These discussions encouraged students to raise relevant questions and actively utilize resources such as the internet and library databases to find answers. Subsequently, student representatives from each small group presented their findings, highlighting the key points of the course, sharing answers to the questions raised, and addressing any remaining unanswered questions. Finally, the teacher summarized the session and addressed challenging questions raised during the discussion. (3) At the end of the class activities, students were required to complete a post-class quiz consisting of the same questions related to internal medicine as the pre-class quiz. Through this interactive teaching approach, students deepened their understanding of the course content and enhanced their analytical and problem-solving abilities by engaging in lectures, small group discussions, and presentations from various perspectives. Assessment Methods (1) MINI-CEX Score: The Mini Clinical Evaluation Exercise (MINI-CEX) is a method used to assess the performance of medical students or residents in real clinical settings. It focuses on clinical skills, communication abilities, and professional demeanor. The assessment includes aspects such as the skills of medical professionals, communication with patients and the healthcare team, as well as professional ethics. (2) dOPS Score: Direct Observation of Procedural Skills (dOPS) is a method used to assess the practical procedural skills of medical students or healthcare professionals. Evaluators directly observe the procedural skills and assess their accuracy and safety based on predefined criteria. Feedback and suggestions are provided after the assessment to help students improve their procedural skills. (3) Comprehensive Evaluation: The comprehensive evaluation includes entrance and exit scores (100 points), skill assessment (100 points), theoretical knowledge (5 points), clinical reasoning (5 points), practical skills (5 points), doctor-patient communication (5 points), autonomous learning (5 points), learning burden (5 points), and overall competency (5 points). Statistical Methods The data analysis software utilized was SPSS 26.0. Count data were represented using numerical values or percentages, and differences were analyzed using the chi-square test. Normally distributed continuous data were presented as mean ± standard deviation (x ± s), and intergroup differences were examined using independent sample t-tests or analysis of variance (ANOVA). Propensity score matching (PSM) was employed to match the baseline characteristics of the two student groups based on the original data. A p-value of < 0.05 indicated a statistically significant difference. Results Baseline Characteristics of the Study Population before Propensity Score Matching Table 1 demonstrates significant differences between the two teaching groups in terms of gender (p 0.05). Table 1 Baseline Characteristics of the Study Population before Matching Assessment Category traditional teaching group teaching reform group t/χ2 p Gender Female 84(59.5%) 57 (40.5%) 12.53 0.001 Male 36(36.3%) 63(63.7%) Ethnicity Tibetan 100(50.5%) 98(49.5%) 0.11 0.433 The Han nationality 20(47.6%) 22(52.4%) Educational background Specialty 20(48.7%) 21(51.3%) 0.02 0.500 Undergraduate 100(50.2%) 99(49.8%) Age 22.96 ± 1.26 22.96 ± 1.33 0.00 1.000 Comparison of scores between groups before propensity score matching According to Table 2 , there were significant differences (p < 0.05) between the two groups before matching in terms of post-rotation scores, score improvement, score improvement ratio, skill assessment, dOPS, theoretical knowledge, practical skills, doctor-patient communication, and learning burden. However, no significant differences (p > 0.05) were observed in pre-rotation scores, min-cex, clinical reasoning, self-directed learning, and overall competence. Table 2 Comparison of Scores between Groups before Propensity Score Matching Assessment Category traditional teaching group teaching reform group t p Pre-rotation Scores 75.73 ± 5.44 75.39 ± 6.61 0.43 0.663 Post-rotation Scores 91.19 ± 5.04 80.43 ± 5.80 15.30 0.000 Score Improvement 15.46 ± 3.88 5.04 ± 2.51 24.63 0.000 Score Improvement Ratio 20.69 ± 6.26 6.88 ± 3.60 20.87 0.000 Skill Assessment 87.49 ± 5.88 83.51 ± 7.10 4.73 0.000 min-cex 7.52 ± 1.115 7.41 ± 0.930 0.81 0.415 dOPS 8.06 ± 0.84 7.37 ± 0.87 6.22 0.000 Theoretical Knowledge 4.53 ± 0.51 3.08 ± 0.90 15.18 0.000 Clinical Reasoning 3.95 ± 0.77 3.87 ± 0.92 0.75 0.450 Practical Skills 4.20 ± 0.82 3.27 ± 1.01 7.79 0.000 Doctor-Patient Communication 4.50 ± 0.59 2.91 ± 0.91 15.96 0.000 Self-directed Learning 3.92 ± 0.76 3.74 ± 0.90 1.62 0.106 Learning Burden 3.23 ± 0.94 3.86 ± 0.99 -5.06 0.000 Overall Competence 4.02 ± 0.60 3.85 ± 0.71 1.94 0.053 Baseline Characteristics of the Matched Population after Propensity Score Matching As shown in Table 3 , after propensity score matching, there were no significant differences (p > 0.05) between the two teaching groups in terms of gender, age, and academic background. These results indicate that the matching process effectively balanced these variables between the groups. Table 3 Baseline Characteristics of the Study Population before Matching Assessment Category traditional teaching group teaching reform group t/χ2 p Gender Female 57(50.0%) 57(50.0%) 4.00 0.053 Male 36(36.3%) 63(63.7%) Ethnicity Tibetan 73(42.6%) 98(57.3%) 0.33 0.605 The Han nationality 20(47.6%) 22(52.4%) Educational background Specialty 18(46.1%) 21(53.9%) 1.21 0.725 Undergraduate 75(43.1%) 99(56.9%) Age 23.14 ± 1.20 22.96 ± 1.33 -1.02 0.305 After Propensity Score Matching: Comparison of Group Performance As shown in Table 4 , after propensity score matching, there are significant differences in the performance between the two groups in terms of exit scores, score improvement, improvement ratio, skill assessment, dOPS, theoretical knowledge, skill operation, self-directed learning in doctor-patient communication, learning burden, and comprehensive ability (p 0.05). Table 4 Comparison of Scores between Groups afeter Propensity Score Matching Assessment Category traditional teaching group teaching reform group t p Pre-rotation Scores 75.73 ± 5.44 75.39 ± 6.61 0.43 0.663 Post-rotation Scores 91.19 ± 5.04 80.43 ± 5.80 15.30 0.000 Score Improvement 15.46 ± 3.88 5.04 ± 2.51 24.63 0.000 Score Improvement Ratio 20.69 ± 6.26 6.88 ± 3.60 20.87 0.000 Skill Assessment 87.49 ± 5.88 83.51 ± 7.10 4.73 0.000 min-cex 7.52 ± 1.115 7.41 ± 0.930 0.81 0.415 dOPS 8.06 ± 0.84 7.37 ± 0.87 6.22 0.000 Theoretical Knowledge 4.53 ± 0.51 3.08 ± 0.90 15.18 0.000 Clinical Reasoning 3.95 ± 0.77 3.87 ± 0.92 0.75 0.450 Practical Skills 4.20 ± 0.82 3.27 ± 1.01 7.79 0.000 Doctor-Patient Communication 4.50 ± 0.59 2.91 ± 0.91 15.96 0.000 Self-directed Learning 3.92 ± 0.76 3.74 ± 0.90 1.62 0.106 Learning Burden 3.23 ± 0.94 3.86 ± 0.99 -5.06 0.000 Overall Competence 4.02 ± 0.60 3.85 ± 0.71 1.94 0.053 Discussion The conventional lecture-style teaching method has long been considered the most economical and effective approach for theoretical instruction [ 11 ]. Nevertheless, traditional teaching methods may fall short for senior medical students, who require the development of robust communication and clinical reasoning abilities[ 12 , 13 ]. With the advent of the internet and the widespread use of personal computers and mobile devices, e-learning has become an integral part of higher medical education. It assists medical students in actively acquiring relevant information within limited time, fostering proactive thinking and questioning abilities, and guiding them towards obtaining new knowledge, all of which have become indispensable components of teaching [ 14 ]. Unlike traditional teaching methods, Problem-Based Learning (PBL) and Case-Based Learning (CBL) aim to establish authentic medical scenarios, encouraging students to transition from a "what I learned" approach to a "what I want to learn" mindset [ 15 , 16 ]. Previous studies have primarily focused on PBL or CBL individually and compared them with traditional lecture-based teaching methods, with some studies even demonstrating the advantages of PBL or CBL. For instance, PBL introduces a group-learning model that facilitates more effective communication between students and teachers, thereby achieving personalized educational objectives [ 17 , 18 ]. On the other hand, CBL emphasizes teacher guidance through the preparation of clinical case materials, aiding students in developing more effective integrated clinical thinking habits [ 19 , 20 ]. Considering the respective merits of these approaches, this study combines PBL and CBL teaching methods, allowing them to complement and reinforce each other. This study examines the effectiveness and acceptability of a hybrid CBL-PBL teaching approach based on standardized cases in an internal medicine clinical course, comparing it with traditional lecture-based instruction. The results demonstrate that, despite the outstanding performance of the traditional group in the pre-test, the teaching reform group shows significant improvement in post-test scores, confirming the effectiveness of the combined CBL and PBL teaching model based on standardized cases. Additionally, the teaching reform group exhibits more significant improvement in self-directed learning and comprehensive capabilities, indicating that this teaching model is more conducive to cultivating clinical thinking. Through survey analysis, students also recognize the positive impact of this approach on skill assessment, theoretical knowledge, practical procedures, and doctor-patient communication. By integrating CBL based on standardized cases with PBL, medical education can better cultivate students' clinical thinking, self-directed learning, and teamwork abilities, thus enriching and enhancing the teaching process. However, it is noteworthy that this study has certain limitations. Firstly, the research is limited to the results obtained from a specific department of internal medicine, which may not fully represent other specialties or teaching institutions. Secondly, due to the absence of a blind procedure, some analyses may be influenced by subjective factors. For example, assessments of the leadership traits of students by teaching assistants and mentors may be subject to personal biases, and the perceived improvement in perceptions and interpersonal relationships over time has not been validated in this study. Therefore, in the satisfaction survey of the teaching reform group and the traditional group, there may be a tendency towards favoring the teaching reform approach. Another limitation is that our study only focuses on clinical teaching within a specific department of internal medicine. To obtain more robust and reliable results, long-term observation and practice are required. Furthermore, although our study provides in-depth exploration of the effectiveness of a hybrid CBL-PBL teaching approach based on standardized cases in medical education, further research is needed to assess its applicability to students with different educational backgrounds and training types, as well as different educational fields. In summary, our study aims to investigate the application of a hybrid CBL-PBL teaching approach based on standardized cases in medical education. Despite some limitations, the results of this research indicate that this approach can enhance students' professional understanding, communication skills, clinical thinking abilities, self-directed learning capabilities, teamwork skills, and knowledge absorption. The successful implementation of this teaching model requires further research and support from practice to ensure its effectiveness and feasibility in different contexts. Declarations Author contributions Wei Li designed the study. Qin Long took on the responsibility of mentoring the traditional teaching group while Junpeng Ran mentored the other group. Pengfei Shao wrote the paper and analyzed the data. Wei Li reviewed and edited the paper. All of them read and approved the final manuscript. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Lhasa People’s Hospital.（SYKY2022010） Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Conflicts of interest No conflicts of interest were declared. Funding Lhasa People's Hospital Internal Medicine Research Initiating Fund(SYKY2022010) References DONG H, GUO C. Effectiveness of case-based learning in Chinese dental education: a systematic review and meta-analysis[J]. BMJ Open. 2022;12(2):e48497. LI Y L CAIL, HU X Y, et al. 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It is all about patients' stories: Case-based learning in residents' education[J]. Qatar Med J. 2019;2019(3):17. GARCIA-PONCE A L, MARTINEZ-POVEDA B, BLANCO-LOPEZ A, et al. A problem-/case-based learning approach as an useful tool for studying glycogen metabolism and its regulation[J]. Biochem Mol Biol Educ. 2021;49(2):236–41. ZHAO W, HE L, DENG W, et al. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease[J]. BMC Med Educ. 2020;20(1):381. WANG H, XUAN J, LIU L, et al. Problem-based learning and case-based learning in dental education[J]. Ann Transl Med. 2021;9(14):1137. MONTEPARA C A, WOODS A G. WOLFGANG K W. Problem-based learning case studies: Delivery of an educational method and perceptions at two schools of pharmacy in Italy[J]. Curr Pharm Teach Learn. 2021;13(6):717–22. REZAEE R, HAVESHKI F, BARATI-BOLDAJI R, et al. The effect of case-based e-learning on academic performance and problem-solving ability in nursing students: A pre- and post-test study[J]. J Educ Health Promot. 2022;11:302. REBBAPRAGADA N. Case-based learning: A student experience[J]. Clin Teach. 2020;17(5):571–2. GINZBURG S B, SCHWARTZ J, GERBER R, et al. Assessment of medical students' leadership traits in a problem/case-based learning program[J]. Med Educ Online. 2018;23(1):1542923. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4570051","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":332240361,"identity":"85de3bcb-1fc6-42f9-8b4b-a8917c156961","order_by":0,"name":"Pengfei Shao","email":"","orcid":"","institution":"Lhasa People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pengfei","middleName":"","lastName":"Shao","suffix":""},{"id":332240363,"identity":"8b6ca70d-ab9c-481b-9e34-14b31b542d94","order_by":1,"name":"Junpeng Ran","email":"","orcid":"","institution":"Lhasa People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junpeng","middleName":"","lastName":"Ran","suffix":""},{"id":332240364,"identity":"74c370e5-6fc3-48e9-824e-c87cc214511e","order_by":2,"name":"Qin Long","email":"","orcid":"","institution":"Lhasa People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Long","suffix":""},{"id":332240365,"identity":"a2f587db-6b3f-4265-8fe0-e33215ca35f3","order_by":3,"name":"Wei Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYBACPmYgkcDAIMfATKwWNqgWYxK0QOnEBqIdxsbOY/jgQc2d9PntvAc/MNTcIcZhPMYGCcee5W44zJcswXDsGTFaeLdJJDYczt3AzGMgwdhwmCgt238AtaTLN/MY/yBWyzag3w8nMBzmMSPWFv7PEgnHDhtuAGqxADIIa+HnP5b48UfNYXn5/jPGNz7UEKEFFSSQqmEUjIJRMApGAXYAAFDWMsik8djuAAAAAElFTkSuQmCC","orcid":"","institution":"Lhasa People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-06-12 11:59:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4570051/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4570051/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61480310,"identity":"f35e1eea-6c64-4cea-b2a4-c2a10ceaed70","added_by":"auto","created_at":"2024-07-31 08:42:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":565411,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4570051/v1/bc15fcb5-8144-4143-b210-b79bbb9e669c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integrated CBL and PBL Teaching with Standardized Patients for Internal Medicine Education","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the realm of medical education, as medical and clinical knowledge continues to accumulate and progress, schools have increasingly emphasized standardized medical education, with medical schools employing various methods to develop effective teaching approaches [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While a solid foundation in clinical knowledge and practical skills remains crucial, cultivating students' ability to analyze cases and navigate real-life situations has become increasingly important in recent years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Case-based learning (CBL) is an educational approach based on the analysis of cases, aiming to simulate real clinical scenarios and encourage students to actively explore new areas of learning [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Problem-based learning (PBL), on the other hand, is a student-centered teaching methodology where students within small groups, under the guidance of tutors, work on tasks or challenges relevant to the actual work environment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Compared to traditional methods, CBL emphasizes the development of students' logical reasoning abilities. Through real cases, teachers pose questions, and students apply their acquired knowledge to analyze and reason [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. PBL, on the other hand, focuses on problem orientation, encourages divergent thinking, and emphasizes active participation from students within small groups, where they collaborate in problem-solving. CBL contributes to improving the clinical practice, problem-solving, and analytical abilities of resident physicians and medical students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In comparison to traditional lectures, PBL programs have been shown to enhance student satisfaction and active engagement [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, CBL and PBL each have their limitations. CBL requires considerable time investment from teachers in preparing cases and questions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], while PBL demands students to invest time in preparing questions and materials before class [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Research has suggested that combining the strengths of PBL and CBL in teaching methodologies can facilitate effective and high-quality learning, while also contributing to the development of excellent teaching teams [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This study conducted a retrospective analysis on the role of the patient-based case-based learning (CBL) combined with problem-based learning (PBL) teaching method in clinical education within the field of internal medicine at our institution.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003eThis retrospective analysis included 240 internal medicine students who voluntarily participated in the teaching reform from September 2021 to June 2023 at our institution. They were randomly divided into two groups: the traditional teaching group (n\u0026thinsp;=\u0026thinsp;120) and the teaching reform group (n\u0026thinsp;=\u0026thinsp;120). Among them, there were 141 female students and 99 male students. Baseline calculations of the two groups revealed a significant difference in gender distribution. Subsequently, propensity score matching was performed to match students from both groups. After successful matching, the traditional teaching group consisted of 93 individuals, and the teaching reform group consisted of 120 individuals. Among them, there were 114 females and 99 males.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Participants with an educational level of at least a college degree.\u003c/p\u003e \u003cp\u003e(2) Participants with previous internship or apprenticeship experience.\u003c/p\u003e \u003cp\u003e (3) Participants who signed an informed consent form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Participants with poor physical health.\u003c/p\u003e \u003cp\u003e(2) Participants who demonstrated uncooperative behavior during the learning process.\u003c/p\u003e \u003cp\u003e(3) Participants without previous internship or apprenticeship experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePropensity Score Matching\u003c/h2\u003e \u003cp\u003ePropensity score matching (PSM) was conducted using the PSM extension program in SPSS. The process of PSM was as follows: Firstly, the teaching reform group was set as the dependent variable, while considering various covariates as independent variables. Logistic regression analysis was employed to predict individuals' propensity scores. Next, the nearest neighbor matching method was used to match each individual from the teaching reform group with an individual from the traditional teaching group who had the most similar propensity score value. A caliper value was introduced during the matching process to ensure the quality of the matches. Afterwards, the standard deviation change of covariates between the groups was compared. A smaller absolute value of the standard deviation after matching indicated a better matching effect. When the absolute value of the standard deviation was less than 0.1 (10%), it was considered that the covariates between the groups were well balanced. In the end, 93 individuals from the traditional teaching group were well-matched with the teaching reform group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTeaching Methods\u003c/h2\u003e \u003cp\u003eTraditional Teaching Group\u003c/p\u003e \u003cp\u003ePrior to the start of the class, the teachers, based on the professional characteristics of internal medicine clinical work and the teaching syllabus, developed a detailed teaching plan for the internal medicine students. Through traditional lecture-style teaching, we provided training on the fundamental theory and basic skills for the internal medicine residents, with a particular focus on explaining the etiology, pathology, clinical manifestations, treatment issues, and corresponding measures for common internal medicine diseases. After completing the course content, the mentors assigned homework and provided feedback and summaries during the next ward round for the resident students. The teaching process was primarily conducted through teacher lectures with student participation as supplementary.\u003c/p\u003e \u003cp\u003eTeaching Reform Group\u003c/p\u003e \u003cp\u003e(1) Prior to the start of the course, a curriculum preparation group consisting of the medical education department, departmental teaching secretary, and teaching mentors prepared standardized cases, relevant course videos, and supplementary materials related to the specific disease. These materials included clinical scenarios of standardized cases, guidelines, research papers, or other references associated with the diagnosis and treatment of the disease, as well as approximately 30 minutes of skill training videos. Each student was required to study these materials during their spare time outside of class. To facilitate the in-class activities, students were asked to complete a pre-class quiz consisting of multiple-choice questions before the start of each session. The lecturer would provide a brief introduction to the topic and course agenda at the beginning of the session.\u003c/p\u003e \u003cp\u003e(2) During the in-class activities, a series of steps were followed. Firstly, a patient case that had been standardized by the curriculum preparation group was presented using slideshow presentations, showcasing the clinical scenarios of the case. Next, under the guidance of the teacher, students engaged in small group discussions. These discussions encouraged students to raise relevant questions and actively utilize resources such as the internet and library databases to find answers. Subsequently, student representatives from each small group presented their findings, highlighting the key points of the course, sharing answers to the questions raised, and addressing any remaining unanswered questions. Finally, the teacher summarized the session and addressed challenging questions raised during the discussion.\u003c/p\u003e \u003cp\u003e(3) At the end of the class activities, students were required to complete a post-class quiz consisting of the same questions related to internal medicine as the pre-class quiz. Through this interactive teaching approach, students deepened their understanding of the course content and enhanced their analytical and problem-solving abilities by engaging in lectures, small group discussions, and presentations from various perspectives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Methods\u003c/h2\u003e \u003cp\u003e(1) MINI-CEX Score: The Mini Clinical Evaluation Exercise (MINI-CEX) is a method used to assess the performance of medical students or residents in real clinical settings. It focuses on clinical skills, communication abilities, and professional demeanor. The assessment includes aspects such as the skills of medical professionals, communication with patients and the healthcare team, as well as professional ethics.\u003c/p\u003e \u003cp\u003e(2) dOPS Score: Direct Observation of Procedural Skills (dOPS) is a method used to assess the practical procedural skills of medical students or healthcare professionals. Evaluators directly observe the procedural skills and assess their accuracy and safety based on predefined criteria. Feedback and suggestions are provided after the assessment to help students improve their procedural skills.\u003c/p\u003e \u003cp\u003e(3) Comprehensive Evaluation: The comprehensive evaluation includes entrance and exit scores (100 points), skill assessment (100 points), theoretical knowledge (5 points), clinical reasoning (5 points), practical skills (5 points), doctor-patient communication (5 points), autonomous learning (5 points), learning burden (5 points), and overall competency (5 points).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eThe data analysis software utilized was SPSS 26.0. Count data were represented using numerical values or percentages, and differences were analyzed using the chi-square test. Normally distributed continuous data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and intergroup differences were examined using independent sample t-tests or analysis of variance (ANOVA). Propensity score matching (PSM) was employed to match the baseline characteristics of the two student groups based on the original data. A p-value of \u0026lt;\u0026thinsp;0.05 indicated a statistically significant difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline Characteristics of the Study Population before Propensity Score Matching\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates significant differences between the two teaching groups in terms of gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there were no significant differences observed in terms of ethnicity, education level, and age (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\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\u003eBaseline Characteristics of the Study Population before Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003etraditional teaching group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eteaching reform group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et/χ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84(59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36(36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63(63.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibetan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100(50.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e98(49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe Han nationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22(52.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21(51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100(50.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99(49.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of scores between groups before propensity score matching\u003c/h2\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the two groups before matching in terms of post-rotation scores, score improvement, score improvement ratio, skill assessment, dOPS, theoretical knowledge, practical skills, doctor-patient communication, and learning burden. However, no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) were observed in pre-rotation scores, min-cex, clinical reasoning, self-directed learning, and overall competence.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Scores between Groups before Propensity Score Matching\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=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003etraditional teaching group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eteaching reform group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-rotation Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e75.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-rotation Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e80.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore Improvement Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkill Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e87.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e83.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emin-cex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edOPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Reasoning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor-Patient Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-directed Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning Burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Competence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\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\u003eBaseline Characteristics of the Matched Population after Propensity Score Matching\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, after propensity score matching, there were no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the two teaching groups in terms of gender, age, and academic background. These results indicate that the matching process effectively balanced these variables between the groups.\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\u003eBaseline Characteristics of the Study Population before Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003etraditional teaching group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eteaching reform group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et/χ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(63.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibetan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73(42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98(57.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe Han nationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(52.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(46.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(53.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(43.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99(56.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e-1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.305\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=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAfter Propensity Score Matching: Comparison of Group Performance\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, after propensity score matching, there are significant differences in the performance between the two groups in terms of exit scores, score improvement, improvement ratio, skill assessment, dOPS, theoretical knowledge, skill operation, self-directed learning in doctor-patient communication, learning burden, and comprehensive ability (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); there are no significant differences in entry scores, min-cex, and clinical thinking (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\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\u003eComparison of Scores between Groups afeter Propensity Score Matching\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\u003eAssessment Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003etraditional teaching group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eteaching reform group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-rotation Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-rotation Scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore Improvement Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkill Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emin-cex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edOPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Reasoning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor-Patient Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-directed Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning Burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Competence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.053\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":"Discussion","content":"\u003cp\u003eThe conventional lecture-style teaching method has long been considered the most economical and effective approach for theoretical instruction [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nevertheless, traditional teaching methods may fall short for senior medical students, who require the development of robust communication and clinical reasoning abilities[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. With the advent of the internet and the widespread use of personal computers and mobile devices, e-learning has become an integral part of higher medical education. It assists medical students in actively acquiring relevant information within limited time, fostering proactive thinking and questioning abilities, and guiding them towards obtaining new knowledge, all of which have become indispensable components of teaching [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Unlike traditional teaching methods, Problem-Based Learning (PBL) and Case-Based Learning (CBL) aim to establish authentic medical scenarios, encouraging students to transition from a \"what I learned\" approach to a \"what I want to learn\" mindset [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have primarily focused on PBL or CBL individually and compared them with traditional lecture-based teaching methods, with some studies even demonstrating the advantages of PBL or CBL. For instance, PBL introduces a group-learning model that facilitates more effective communication between students and teachers, thereby achieving personalized educational objectives [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, CBL emphasizes teacher guidance through the preparation of clinical case materials, aiding students in developing more effective integrated clinical thinking habits [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Considering the respective merits of these approaches, this study combines PBL and CBL teaching methods, allowing them to complement and reinforce each other.\u003c/p\u003e \u003cp\u003eThis study examines the effectiveness and acceptability of a hybrid CBL-PBL teaching approach based on standardized cases in an internal medicine clinical course, comparing it with traditional lecture-based instruction. The results demonstrate that, despite the outstanding performance of the traditional group in the pre-test, the teaching reform group shows significant improvement in post-test scores, confirming the effectiveness of the combined CBL and PBL teaching model based on standardized cases. Additionally, the teaching reform group exhibits more significant improvement in self-directed learning and comprehensive capabilities, indicating that this teaching model is more conducive to cultivating clinical thinking. Through survey analysis, students also recognize the positive impact of this approach on skill assessment, theoretical knowledge, practical procedures, and doctor-patient communication.\u003c/p\u003e \u003cp\u003eBy integrating CBL based on standardized cases with PBL, medical education can better cultivate students' clinical thinking, self-directed learning, and teamwork abilities, thus enriching and enhancing the teaching process. However, it is noteworthy that this study has certain limitations. Firstly, the research is limited to the results obtained from a specific department of internal medicine, which may not fully represent other specialties or teaching institutions. Secondly, due to the absence of a blind procedure, some analyses may be influenced by subjective factors. For example, assessments of the leadership traits of students by teaching assistants and mentors may be subject to personal biases, and the perceived improvement in perceptions and interpersonal relationships over time has not been validated in this study. Therefore, in the satisfaction survey of the teaching reform group and the traditional group, there may be a tendency towards favoring the teaching reform approach. Another limitation is that our study only focuses on clinical teaching within a specific department of internal medicine. To obtain more robust and reliable results, long-term observation and practice are required. Furthermore, although our study provides in-depth exploration of the effectiveness of a hybrid CBL-PBL teaching approach based on standardized cases in medical education, further research is needed to assess its applicability to students with different educational backgrounds and training types, as well as different educational fields.\u003c/p\u003e \u003cp\u003eIn summary, our study aims to investigate the application of a hybrid CBL-PBL teaching approach based on standardized cases in medical education. Despite some limitations, the results of this research indicate that this approach can enhance students' professional understanding, communication skills, clinical thinking abilities, self-directed learning capabilities, teamwork skills, and knowledge absorption. The successful implementation of this teaching model requires further research and support from practice to ensure its effectiveness and feasibility in different contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWei Li designed the study. Qin Long\u0026nbsp;took on the responsibility of mentoring the traditional teaching group\u0026nbsp;while Junpeng Ran mentored the other group. Pengfei Shao wrote the paper and analyzed the data. Wei Li reviewed and edited the paper. All of them read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the\u0026nbsp;Lhasa People\u0026rsquo;s Hospital.（SYKY2022010）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicts of interest were declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLhasa People\u0026apos;s Hospital Internal Medicine Research Initiating Fund(SYKY2022010)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDONG H, GUO C. Effectiveness of case-based learning in Chinese dental education: a systematic review and meta-analysis[J]. BMJ Open. 2022;12(2):e48497.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI Y L CAIL, HU X Y, et al. Implementation of flipped classroom combined with case-based learning: A promising and effective teaching modality in undergraduate pathology education[J]. Med (Baltim). 2022;101(5):e28782.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN J, GAO B, WANG K, et al. WeChat as a platform for blending problem/case-based learning and paper review methods in undergraduate paediatric orthopaedics internships: a feasibility and effectiveness study[J]. BMC Med Educ. 2023;23(1):322.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFARINA C, HRANCHOOK A M, BITTINGER A C, et al. The Flipped Classroom With Case-Based Learning in Graduate Nurse Anesthesia Education[J]. AANA J. 2021;89(3):254\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGURAYA S S, GURAYA S Y, DOUBELL F R, et al. Understanding medical professionalism using express team-based learning; a qualitative case-based study[J]. Med Educ Online. 2023;28(1):2235793.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBURGESS A, MATAR E, ROBERTS C, et al. Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL)[J]. BMC Med Educ. 2021;21(1):238.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKIRPALANI A, GRIMMER J, PEEBLES E R.. A Blended Model of Case-Based Learning in a Paediatric Clerkship Program[J]. Med Sci Educ. 2020;30(1):23\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIN R, CHEN J, XIE L, et al. Accelerating reinforcement learning with case-based model-assisted experience augmentation for process control[J]. Neural Netw. 2023;158:197\u0026ndash;215.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLODINOVA LM. [Corpuscular antigens in the blood neutrophil reaction (Neutrophil Injury Index test) in children with dysentery][J]. Lab Delo, 1979(8): 484\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTHIBAUT D, SCHROEDER K T.. A case-based learning approach to online biochemistry labs during COVID-19[J]. Biochem Mol Biol Educ. 2020;48(5):484\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYAN X, ZHU Y, FANG L, et al. Enhancing medical education in respiratory diseases: efficacy of a 3D printing, problem-based, and case-based learning approach[J]. BMC Med Educ. 2023;23(1):512.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNGUYEN B, ATHAUDA G. Osteoporosis: A Small-Group Case-Based Learning Activity[J]. MedEdPORTAL. 2021;17:11176.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSULIMAN S, AL-MOHAMMED A, AL M D, et al. It is all about patients' stories: Case-based learning in residents' education[J]. Qatar Med J. 2019;2019(3):17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGARCIA-PONCE A L, MARTINEZ-POVEDA B, BLANCO-LOPEZ A, et al. A problem-/case-based learning approach as an useful tool for studying glycogen metabolism and its regulation[J]. Biochem Mol Biol Educ. 2021;49(2):236\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHAO W, HE L, DENG W, et al. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease[J]. BMC Med Educ. 2020;20(1):381.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWANG H, XUAN J, LIU L, et al. Problem-based learning and case-based learning in dental education[J]. Ann Transl Med. 2021;9(14):1137.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMONTEPARA C A, WOODS A G. WOLFGANG K W. Problem-based learning case studies: Delivery of an educational method and perceptions at two schools of pharmacy in Italy[J]. Curr Pharm Teach Learn. 2021;13(6):717\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eREZAEE R, HAVESHKI F, BARATI-BOLDAJI R, et al. The effect of case-based e-learning on academic performance and problem-solving ability in nursing students: A pre- and post-test study[J]. J Educ Health Promot. 2022;11:302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eREBBAPRAGADA N. Case-based learning: A student experience[J]. Clin Teach. 2020;17(5):571\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGINZBURG S B, SCHWARTZ J, GERBER R, et al. Assessment of medical students' leadership traits in a problem/case-based learning program[J]. Med Educ Online. 2018;23(1):1542923.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PBL, CBL, Standardized Patients, internal medicine education","lastPublishedDoi":"10.21203/rs.3.rs-4570051/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4570051/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study evaluates the effectiveness and efficiency of combining Case-Based Learning (CBL) utilizing Standardized Patients with Problem-Based Learning (PBL) in enhancing clinical education for internal medicine students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was performed involving 240 internal medicine students trained in our department between September 2021 and June 2023.Initially, students were divided into a traditional teaching group (n\u0026thinsp;=\u0026thinsp;120) and a combined PBL-CBL group (n\u0026thinsp;=\u0026thinsp;120). Baseline calculations revealed significant gender differences between the two groups. Subsequently, propensity score matching was employed to create a matched traditional teaching group (n\u0026thinsp;=\u0026thinsp;93) and a PBL-CBL combined group (n\u0026thinsp;=\u0026thinsp;120). Independent sample t-tests were utilized to compare the teaching performance between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePost propensity score matching, the integrated PBL-CBL group demonstrated significant enhancements (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) across various metrics, including end-of-course assessment scores, skill assessments, dOPS scores, theoretical knowledge, practical skills, doctor-patient communication, self-directed learning, perceived learning burden, and overall competence.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIntegrating CBL and PBL teaching methods with Standardized Patients proves to be an effective approach for enhancing the overall performance and clinical skills of medical students and resident physicians.\u003c/p\u003e","manuscriptTitle":"Integrated CBL and PBL Teaching with Standardized Patients for Internal Medicine Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-31 08:34:27","doi":"10.21203/rs.3.rs-4570051/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc22fc2e-e91a-4fc5-8bf5-4c35d85a8e7c","owner":[],"postedDate":"July 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-01T11:08:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-31 08:34:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4570051","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4570051","identity":"rs-4570051","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}