From skills competitions to curriculum reform: a document-based qualitative case study of competition-driven teaching in a Chinese vocational rehabilitation therapy technology program

From skills competitions to curriculum reform: a document-based qualitative case study of competition-driven teaching in a Chinese vocational rehabilitation therapy technology program | 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 From skills competitions to curriculum reform: a document-based qualitative case study of competition-driven teaching in a Chinese vocational rehabilitation therapy technology program Shuguang Yin, Ye Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8616709/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Vocational skills competitions are widely promoted as levers for competition-driven teaching, learning, and curriculum reform in health professions education, yet evidence remains limited on how competitions systematically reshape rehabilitation education in higher vocational colleges. Methods We conducted a document-based qualitative case study of a Rehabilitation Therapy Technology (RTT) program in China. We built a multi-source document dataset including national and regional policy texts, competition rules and scoring rubrics, training plans, post-competition reflections, coach/teacher training materials, and teaching feedback cases. Data were analyzed using reflexive thematic analysis with triangulation and an evidence-chain approach. Results Four mechanisms explained how competitions contributed to program development: (1) competition–curriculum–assessment alignment through task decomposition and competency mapping; (2) coach–teacher capacity building via structured coach training and routine competition–teaching co-development; (3) scenario-based training that strengthened students’ clinical reasoning, communication, and teamwork; and (4) resource transformation and diffusion, whereby competition outputs were converted into reusable teaching cases and task packages and disseminated through hosting and regional training. Conclusions Skills competitions can operate as a systemic reform apparatus linking standards, curriculum iteration, faculty development, quality evaluation, and regional collaboration. We propose a Competition–Teaching–Coach Training–Instructional Feedback closed-loop model and outline actionable implications for governance and quality enhancement in vocational rehabilitation education. Vocational skills competitions Higher vocational education Rehabilitation Therapy Technology Competition-driven teaching Competency-based education Background Rehabilitation services have gained increasing prominence in China’s healthcare system amid accelerated population ageing and the rising prevalence of chronic disease. National strategies and sectoral plans repeatedly emphasize strengthening rehabilitation service capacity, improving the accessibility of rehabilitation at primary and community levels, and expanding the rehabilitation workforce. Against this backdrop, Rehabilitation Therapy Technology (RTT)—a core healthcare-related major in China’s higher vocational education—carries the responsibility of cultivating application-oriented practitioners who can deliver assessment, intervention, and health education in diverse service settings. [ 1 , 2 , 3 ]. Despite rapid expansion, RTT programs face persistent challenges. First, curriculum content and teaching tasks may lag behind job requirements that are quickly evolving with new service models and an increasing emphasis on functional assessment and individualized planning. Second, practical teaching resources are often constrained by limited access to clinical settings, insufficient standardized practice platforms, and uneven equipment availability. Third, faculty clinical competence and instructional design capacity can vary substantially, particularly when teachers transition from academic training to a practice-intensive curriculum. Finally, pathways for developing student competency are often insufficiently specified—competencies such as clinical reasoning, communication, teamwork, and professional ethics are difficult to cultivate and assess using conventional classroom-centered instruction. [ 3 , 4 ]. Vocational skills competitions have been widely promoted in China as instruments for improving vocational education quality. Under the policy orientation of competition-driven teaching, competition-driven learning, and competition-driven reform, competitions are expected to align vocational programs with industry standards, upgrade curricula, strengthen faculty capacity, and enhance student employability. Competitions can provide high-fidelity scenarios and clear performance criteria, enabling programs to translate abstract competency requirements into observable tasks and assessable behaviors. [ 4 , 5 , 6 ]. In rehabilitation-related disciplines, competitions typically involve contextualized tasks and compound competency structures. Participants must complete continuous task chains—assessment, planning, intervention, and communication—while reasoning and making decisions under time constraints and contextual variability. Such high-challenge task systems can catalyze curriculum updates, improvements in training platforms, and optimization of faculty development mechanisms, thereby advancing competition–education integration. [ 7 , 8 ]. However, within RTT education, the literature still lacks replicable explanations and richly documented cases on how competitions generate sustained and systemic change. In particular, evidence is limited on how competitions (a) reshape curriculum and assessment beyond ad hoc training; (b) support faculty development through institutional routines, coach training, and teaching-research integration; and (c) transform competition outcomes into reusable teaching resources that diffuse across cohorts and institutions. [ 4 , 9 ]. Accordingly, this study examines an RTT program in a Chinese higher vocational college as a single-case study to address three research questions: RQ1: How do rehabilitation skills competitions trigger adjustments in curriculum systems and assessment methods? RQ2: How do competitions and teacher–coach training jointly promote teachers’ professional development and sustain teaching-research mechanisms? RQ3: How does competition training strengthen students’ clinical competency and soft skills, and through what pathways does it generate instructional feedback and spillover effects? Our contributions are threefold. First, we propose and refine a Competition–Teaching–Coach Training–Instructional Feedback closed-loop model for RTT programs. Second, we articulate four mechanisms of competition-driven program development using an evidence-chain approach, linking standards, institutional routines, and resource outputs. Third, we provide actionable implications for vocational education governance and quality enhancement in rehabilitation talent cultivation. Conceptual background and framework 2.1 From Events to Mechanisms: Skills Competitions as Educational Levers International scholarship on competitions and performance-based learning suggests that challenging tasks and authentic performance contexts can enhance motivation, support the development of professional identity, and increase the transferability of skills to workplace settings. In vocational education, skills competitions are often discussed as catalysts for curriculum modernization and assessment reform, because competition tasks tend to embody up-to-date occupational standards and emphasize demonstrable performance. At the institutional level, competitions can also serve as boundary objects that connect schools with industry partners, professional associations, and regional training ecosystems. [ 5 , 9 ]. Within the Chinese vocational education context, skills competitions have been positioned not only as talent showcases but also as policy instruments to steer program quality. The core claim is that competitions can drive reforms in three domains: teaching (curriculum and instruction), learning (student motivation and competency development), and reform (institutional governance and resource allocation). Yet, the extent to which such reforms become institutionalized depends on whether competition practices are embedded into routine curriculum design, teaching-research activities, and faculty development systems. [ 4 , 10 , 11 ]. 2.2 Competency-Based Education and Situated Learning in RTT Programs RTT education requires a competency structure that is inherently interdisciplinary and scenario-dependent. Students must integrate anatomy, kinesiology, pathology, and clinical reasoning with hands-on techniques, patient safety, and communication. Competency-based education emphasizes observable performance standards and progressive mastery, while situated learning highlights the role of authentic contexts and participation in communities of practice. For RTT programs, this implies that instruction should be organized around task chains (assessment → planning → intervention → education/communication), with explicit performance criteria and feedback loops. [ 4 ]. Competition settings resemble high-fidelity simulations of clinical encounters. They often include time pressure, complex patient presentations, and multi-step decision-making. Such settings can help translate competencies into performance tasks. However, competitions also introduce risks: teaching may become narrowly aligned with winning strategies, and resources may be concentrated on a small group of competitors unless outcomes are systematically transformed into curriculum resources. [ 7 , 8 ]. 2.3 Conceptual Framework: A Competition-Driven Closed-Loop Model Integrating the above perspectives, we propose a competition-driven closed-loop model comprising four interlinked components. (1) Standards and tasks: occupational competency lists and competition task packages operationalize standards. (2) Curriculum and assessment: tasks are mapped to curriculum modules and assessed via process-oriented and performance-based evaluation. (3) Faculty development and teaching research: coach training, peer training, and reflective routines support teacher growth and knowledge codification. (4) Resource transformation and diffusion: competition outcomes are codified into reusable teaching cases, task packages, and training resources, and diffused through hosting, regional training, and collaborative networks [ 4 , 9 , 12 ]. This framework guided data coding, theme development, and the presentation of findings. Rationale and contribution: Single-institution studies are sometimes viewed as descriptive; however, case-based medical education research can contribute when it specifies mechanisms, boundary conditions, and implementation routines that are transferable beyond the local context. In VET and health professions education, external performance standards and assessment regimes are increasingly used to drive curriculum improvement, yet there remains limited empirical description of how such regimes are translated into sustained curriculum–assessment alignment and faculty development in vocational rehabilitation education [ 4 , 11 , 5 ]. This study addresses this gap by using a document-based qualitative single-case design and evidence-chain tracing to explain how skills competitions can function as a reform apparatus, producing a practical closed-loop model that links standards, teaching and assessment redesign, coach/teacher development, and instructional feedback. We report actionable implementation components and boundary conditions to support adaptation by other vocational health programs [ 13 ]. Methods Study design We conducted a document-based qualitative single-case study to explore how vocational skills competitions were institutionalized as a reform apparatus within one Rehabilitation Therapy Technology (RTT) program. The design followed established case study principles, emphasizing a bounded system, multiple sources of evidence, and an evidence-chain logic [ 13 ]. Context and case boundary The case was a higher vocational health college in China offering an RTT program. The case boundary covered (i) competition participation and preparation activities, (ii) curriculum and assessment redesign linked to competition tasks, and (iii) coach/teacher training and post-competition instructional feedback. The analytic period focused on two consecutive annual cycles of provincial and national-level skills competitions. Data sources and sampling We constructed a multi-source document dataset including: (1) national/regional policies related to vocational education, skills competitions, and rehabilitation workforce development; (2) competition documents (rules, task manuals, scoring rubrics, and implementation plans); (3) internal training plans and schedules; (4) post-competition reflections and improvement reports; (5) coach/teacher training materials; and (6) teaching feedback artefacts (e.g., revised task packages, case-based teaching resources, and training checklists). Documents were included if they directly described competition tasks/standards, preparation processes, evaluation criteria, curriculum/assessment changes, faculty development activities, or post-competition instructional feedback. We excluded duplicative versions and documents without substantive content relevant to these mechanisms. Document inclusion and screening: We included documents that (a) directly specified competition tasks, assessment criteria, or implementation rules; (b) described preparation or training processes; (c) recorded post-competition reflections and improvement actions; or (d) evidenced translation of competition outputs into routine teaching (e.g., revised task packages, lesson plans, assessment checklists). Documents that were purely administrative without relevance to teaching/assessment or lacked traceable provenance were excluded. Each document was logged with its source, date, document type, and its role in the evidence chain (standard → curriculum/assessment artifact → training routine → teaching feedback). Evidence-chain tracing and audit trail: For each major claim, we traced supporting evidence across at least two document types (e.g., policy or rules → scoring rubric → training plan → reflection report) and recorded the trace in an audit trail. This procedure strengthened internal validity for a single-case design and allowed readers to evaluate how interpretations were grounded in documentary artefacts [ 13 ]. Data analysis Data were analyzed using reflexive thematic analysis. We iteratively familiarized ourselves with the dataset, generated initial codes, developed candidate themes, reviewed and refined themes, and produced an interpretive narrative with an evidence-chain structure [ 14 ]. Coding and theme development were iterative, moving between documents and emerging interpretations. To enhance interpretive rigor, we maintained an audit trail of coding decisions and used triangulation across policy, competition, and institutional documents. We also searched for disconfirming evidence to refine theme boundaries and avoid over-generalization. Trustworthiness We used four strategies to strengthen trustworthiness: (1) source triangulation (policy vs. competition vs. institutional documents); (2) evidence-chain tracing (linking claims to specific documentary artefacts); (3) peer debriefing among authors to challenge interpretations and refine themes; and (4) transparent reporting of analytic procedures and boundary conditions of the case. Document dataset overview Our analysis identified four interrelated mechanisms through which skills competitions catalyzed competition-driven teaching in the RTT program. Each mechanism is presented with an evidence-chain logic, moving from competition standards and assessment criteria to curriculum redesign, learning activities, and reusable educational resources. In reporting results, we focus on descriptive mechanisms and documentary evidence chains. Interpretive implications and transferability considerations are developed in the Discussion. The primary dataset consisted of institutional and policy documents. Materials included: national and provincial policy/regulation texts related to vocational education and competitions; competition implementation plans and scoring rubrics; program-level competition proposals and training plans; post-competition summaries and reflective reports; teacher–coach training materials (program proposals, training notices, syllabi, and feedback summaries); competition task/operation manuals (e.g., stroke, spinal cord injury, cervical spondylosis, lumbar disc herniation); and teaching feedback cases documenting how competition outcomes were integrated into routine teaching. To enhance transparency, Table 1 summarizes document categories and analytic purposes. Table 1 Document dataset used for analysis (illustrative categories). Document category Examples (from case context) Primary analytic purpose Typical outputs derived Policy & regulation texts National/provincial vocational education & competition documents; implementation plans; scoring rubrics Identify policy orientation, standards, and evaluation requirements Competency elements list; rubric anchors; alignment statements Competition process documents Competition proposals; training plans; simulation schedules; judging calibration notes Trace program routines and institutional embedding Task packages; training protocols; process assessment items Post-competition reflections Post-event summaries; reflective reports; improvement plans Capture iterative improvement and knowledge codification Error libraries; improvement checklists; revised teaching plans Teacher–coach training materials Program proposals; training notices/syllabi; feedback summaries Explain faculty development mechanism and diffusion Coach training modules; peer-training routines; calibration exemplars Competition task/operation manuals Scenario tasks (e.g., stroke, SCI, cervical/lumbar disorders); operation steps and safety standards Specify task chains and performance criteria Task decomposition map; module-level learning outcomes Teaching feedback cases & resources Task-based lesson cases; resource packages; assessment rubrics Show translation of outcomes into routine teaching Case library; resource packages; teaching-research artifacts Results 4.1 Mechanism 1: Competition–Curriculum–Assessment Alignment via Task Decomposition and Competency Mapping Competition tasks in rehabilitation typically center on complex clinical scenarios and require a complete chain from functional assessment to intervention planning and implementation. In the case program, competition tasks were decomposed into teachable task packages. Each package was mapped to job competency elements (e.g., assessment literacy, safety management, intervention selection, patient education) and then aligned with curriculum modules. This mapping enabled modular curriculum reconstruction around an organizing backbone: functional assessment → rehabilitation techniques → plan development and communication [ 12 , 15 ]. An illustrative mapping template is provided in Table 2 . This template is conceptually aligned with OSCE-informed assessment design, where different scoring methods (e.g., checklist- and global rating-based approaches) have been compared to strengthen reliability and interpretability [ 17 ]. Table 2 Example mapping from competition task chain to curriculum modules and assessment (adaptable template). Competition task chain Competency elements Curriculum module (examples) Assessment approach (examples) Functional assessment (history, tests, safety screening) Assessment literacy; safety management; documentation Assessment & measurement; clinical reasoning basics; patient safety Checklist + rubric; OSCE-style station; documentation scoring Intervention planning (goal setting, prioritization) Clinical reasoning; goal negotiation; evidence awareness Rehab planning; condition-specific pathways; shared decision-making Plan quality rubric; oral defense; peer-review Intervention delivery (techniques, progression) Technique execution; dosage/progression; risk control Therapeutic exercise; manual therapy; functional training Performance rubric; time control; fidelity/quality scoring Communication & education (instructions, empathy, teamwork) Communication; empathy; teamwork; professionalism Therapeutic communication; interprofessional collaboration SP rating scale; teamwork rubric; reflective note 4.2 Mechanism 2: Coach–Teacher–Teaching-Research Growth through Coach Training and Joint Competition–Teaching Routines Competition preparation demanded that teachers integrate clinical skills, instructional design, mentoring strategies, and psychological support. The program leveraged teacher–coach training initiatives and established an on-campus competition–teaching joint training routine. Key practices included: (a) cross-training among teachers on task packages, scoring anchors, and common errors; (b) routine micro-teaching and simulated judging to improve instructional precision; (c) reflective meetings after each training cycle to document improvements and convert tacit know-how into teachable artifacts; and (d) integration of competition-derived materials into teaching-research outputs such as lesson plans, case libraries, and assessment rubrics [ 4 , 11 , 20 ]. These routines supported teachers’ development from single-role instructors to multi-capability professionals who combine teaching, mentoring, and practice. Importantly, coach training did not remain a one-off event; it was embedded into local teaching-research routines, enabling sustainable faculty development [ 10 , 12 ]. 4.3 Mechanism 3: Scenario-Based Competition Training Strengthening Student Competency and Soft Skills Competition training strengthened students’ systematic mastery of assessment and intervention procedures while developing clinical reasoning and decision-making under pressure. Training emphasized scenario authenticity through multi-step tasks and time control. In addition, because rehabilitation competitions evaluate communication, empathy, and professionalism, training incorporated standardized patients (SP) and multi-role collaboration (e.g., consultation, assessment, intervention, documentation, and communication). Students were required to articulate reasoning, negotiate goals with patients, deliver safety instructions, and coordinate roles within teams [ 7 , 8 , 21 ]. As a result, competency growth extended beyond technical skills. Students developed communication clarity, teamwork, professional ethics, and stress management. This mechanism explains why competition-driven training can yield employability gains if translated into routine teaching, rather than being limited to a small group of competitors [ 9 , 22 ]. 4.4 Mechanism 4: Achievement Accumulation and Resource Transformation Enabling Instructional Feedback and Diffusion A critical distinction between short-term competition success and long-term program reform lies in resource transformation. In the case program, competition outcomes were codified into reusable teaching feedback cases, task packages, checklists, and rubrics. These resources were used for collective lesson preparation and task-based instruction in regular cohorts. Furthermore, by hosting competitions and delivering regional teacher training, the program diffused its resources and experience to other institutions. This supported inter-institutional collaboration and regional capacity building, turning competition achievements into educational public goods. Table 3 summarizes the four mechanisms and typical evidence types in document-based studies [ 12 , 23 ]. Discussion Principal findings This document-based case study shows how skills competitions can be institutionalized as a reform apparatus in vocational rehabilitation education. Rather than functioning as one-off events, competitions shaped a repeatable cycle that linked external standards, internal curriculum and assessment design, faculty development, and the transformation of outputs into reusable educational resources. Collectively, these findings provide a mechanism-focused and transferable account that is relevant to international readers interested in how external performance assessments can be leveraged for sustained educational improvement in vocational health training. Relationship to prior literature Our findings align with broader evidence that vocational education reforms benefit from clear standards, assessment coherence, and teacher professional learning infrastructures [ 4 , 5 , 11 ]. The scenario-based training component is consistent with the wider health professions education literature on structured practice with feedback and performance assessment [ 7 , 8 ]. Contribution to the international literature First, we extend international discussions on competition-driven teaching by specifying an evidence chain that links external standards (competition tasks and rubrics) to internal assessment blueprints, curriculum modules, and learning activities, thereby operationalizing curriculum–assessment alignment in a vocational rehabilitation context [ 4 , 11 ]. Second, we conceptualize coach training as a faculty development intervention that supports shared pedagogical routines and communities of practice, and we position the conversion of competition outputs into version-controlled teaching assets as a quality enhancement cycle. Together, these elements integrate perspectives from competency-based education, simulation-based learning, and quality improvement into a coherent governance framework that can be adapted by other vocational health programs [ 20 , 7 , 8 , 9 , 6 ]. Implications for practice and policy For program leaders, the closed-loop model suggests actionable governance routines: (1) build an explicit competency map that connects competition tasks to course outcomes and assessment blueprints; (2) formalize coach training as a faculty development intervention with defined learning objectives; (3) adopt structured feedback cycles (briefing–practice–debriefing) for scenario-based training; and (4) implement resource governance (version control, repositories, and periodic review) so that competition outputs become stable curricular assets. For policy makers and organizers, designing competition standards and rubrics with transparency and educational validity can increase their value as curriculum anchors and reduce unintended teaching-to-the-test behaviours. Evidence from OSCE research suggests that structured rater training can improve scoring consistency and assessment validity [ 18 ]. Transferability The mechanisms reported here may be transferable to other vocational health programs (e.g., nursing, medical imaging, and aged care) under three conditions: (1) availability of performance standards or rubrics that can anchor assessment blueprints; (2) a faculty development pathway that supports shared pedagogical routines; and (3) an organizational structure that converts event outputs into curriculum and resource updates. Readers should consider local policy environments, practice placement capacity, and workload constraints when adapting the model. International relevance: Although the case is situated in China’s vocational education and training (VET) system, the mechanisms identified are not country-specific per se. Many VET and health professions education systems use performance standards and external assessments to drive curriculum improvement. Our findings contribute to this international discussion by specifying how a high-stakes, task-based assessment regime can be translated into curriculum–assessment alignment, structured faculty development, and routine quality-enhancement cycles [ 4 , 11 , 5 ]. Practical transfer package: Programs seeking to replicate the closed-loop model may start with four implementable components: (1) an assessment blueprint that maps competition tasks (or external standards) to course outcomes and observable performance criteria; (2) a faculty development pathway that trains teachers as coaches around shared rubrics and scenario-based routines; (3) structured practice and feedback cycles (brief–practice–debrief) consistent with simulation-based education; and (4) resource governance that converts event outputs into version-controlled teaching assets and periodically reviews them for curricular fit [ 4 , 7 , 8 , 9 , 6 ]. Boundary conditions: Transferability is most plausible where (a) standards/rubrics are available and trusted; (b) institutions can allocate protected time for coaching and iterative resource development; and (c) there is an organizational mechanism for integrating competition-derived outputs into routine teaching and assessment. Where clinical placement capacity is constrained, scenario-based training may partially compensate, but it should be aligned with local scope-of-practice expectations and quality assurance procedures. Strengths Strengths of this study include (1) the use of a multi-source documentary corpus spanning policy, competition, and institutional artefacts; (2) explicit evidence-chain tracing that supports internal validity for a single-case design; and (3) a mechanism-focused explanation that makes the model actionable for educators and program leaders beyond the case institution. Limitations and future research This study is limited by its single-case, document-based design and does not include primary data from learners or faculty (e.g., interviews, observations, or outcome measures). Future studies could employ mixed methods to examine learner outcomes, assessment reliability, and the cost–benefit profile of competition-driven teaching. Comparative multi-site research would further clarify which mechanisms are context-dependent and which are broadly generalizable. Skills competitions can function as a systemic reform apparatus in vocational rehabilitation education, linking standards, curriculum–assessment alignment, faculty development, scenario-based learning, and the standardization and diffusion of teaching resources. The proposed closed-loop model offers a practical framework for converting event-based initiatives into sustained quality-enhancement routines. 5.1 Competitions as Reform Apparatuses: From Activity Logic to Mechanism Logic Our findings suggest that the educational value of skills competitions lies less in one-off achievements than in institutional embedding. Competitions become reform mechanisms only when task decomposition, curriculum mapping, assessment reform, faculty development, and resource transformation are linked into a closed loop. In this sense, competitions operate as high-challenge task systems that stimulate coordinated improvement across teaching, learning, and governance. [ 4 , 5 ] [ 4 , 12 ]. 5.2 Distinctive Features of RTT Competitions: Complex Task Chains and Assessment Consistency Rehabilitation competitions emphasize complex task chains and scenario-based judgment, which increases the need for clear scoring anchors and judge training. To reduce subjectivity and regional disparities, future work should strengthen: (a) competency element definitions; (b) exemplar repositories and anchor performances; (c) judge calibration and training; and (d) digital assessment tools that capture process data. [ 1 , 2 ] [ 15 , 16 , 19 ]. [ 15 , 16 , 17 , 18 , 19 ]. 5.3 Practical Implications for Program Governance For policymakers and program leaders, three implications stand out. First, align standards across occupational competency models, curriculum standards, and competition standards. Second, institutionalize coach training within teacher development systems and connect it to teaching-research routines. Third, build resource transformation pipelines so that competition outcomes become reusable curriculum resources, benefiting regular cohorts and facilitating regional sharing [ 4 , 12 ]. 5.4 Theoretical Implications This study contributes to the literature by operationalizing competition–education integration as a closed-loop system rather than a set of event-based activities. By specifying four mechanisms and linking them to institutional artifacts, we provide a replicable analytic framework for future comparative studies [ 5 , 6 ]. Conclusions This paper proposes and substantiates a Competition–Teaching–Coach Training–Instructional Feedback closed-loop model for higher vocational RTT programs. Skills competitions can drive curriculum iteration and quality enhancement through four mechanisms: standards alignment via task decomposition, faculty growth via coach training and teaching-research routines, competency cultivation via scenario-based training, and diffusion via resource transformation. By articulating concrete mechanisms and boundary conditions, this study provides a transferable framework for vocational health programs seeking to turn episodic competition initiatives into sustained curriculum, assessment, and faculty-development improvements. Limitations include reliance on document-based evidence and a single-case design, which constrains generalizability. Future research could extend to multi-institution comparative studies incorporating interviews, questionnaires, and student outcome data (e.g., performance assessments, internship evaluations, employment indicators). Further attention is warranted to how educational technologies (VR/AI, digital rubrics, learning analytics) reshape competition formats, assessment consistency, and teaching innovation in rehabilitation education. Abbreviations RTT, Rehabilitation Therapy Technology; SP, standardized patient; OSCE, Objective Structured Clinical Examination; VET, vocational education and training; LLM, large language model. Declarations Ethics approval and consent to participate Not applicable. This study relied exclusively on document-based materials and did not involve human participants, interventions, or identifiable personal data. Consent for publication Not applicable. Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Key non-public institutional documents can be made available from the corresponding author upon reasonable request, subject to institutional permissions. Competing interests SY and YZ declare that they have no competing interests. Funding This work was supported by Suzhou Vocational Health College (Grant No. SZWZY202419), project titled “A Study on the Reliability and Validity of Portable 3D Spinal Scanning Devices in Measuring Adolescent Idiopathic Scoliosis.” The funder had no role in the design, analysis, interpretation, or writing of this manuscript. Authors' contributions SY: Conceptualization, Methodology, Data curation, Formal analysis, Writing—original draft. YZ: Supervision, Resources, Writing—review & editing. All authors read and approved the final manuscript. Acknowledgements Not applicable. Authors' information SY is a lecturer at Suzhou Vocational Health College. YZ is a physical therapist at Suzhou Municipal Hospital and affiliated with Nanjing Medical University. References Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2021). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0 Tian, T., Zhu, L., Fu, Q., Tan, S., Cao, Y., Zhang, D., Wang, M., Zheng, T., Gao, L., Volontovich, D., Wang, Y., Zhang, J., Jiang, Z., Qiu, H., Wang, F., & Zhao, Y. (2025). Needs for rehabilitation in China: Estimates based on the Global Burden of Disease Study 1990–2019. Chinese Medical Journal, 138(1), 49–59. https://doi.org/10.1097/CM9.0000000000003245 Sun, L., et al. (2022). Education and development of rehabilitation therapy in China under the background of aging. Frontiers in Public Health, 10, 1000048. https://doi.org/10.3389/fpubh.2022.1000048 OECD. (2021). Teachers and leaders in vocational education and training. OECD Publishing. https://doi.org/10.1787/59d4fbb1-en McGrath, S., & Yamada, S. (2023). Skills for development and vocational education and training: Current and emergent trends. International Journal of Educational Development, 102, 102853. https://doi.org/10.1016/j.ijedudev.2023.102853 Weijzen, S. M. G., Onck, C., Wals, A. E., Tassone, V. C., & Kuijer-Siebelink, W. (2024). Vocational education for a sustainable future: Unveiling the collaborative learning narratives to make space for learning. Journal of Vocational Education & Training, 76(2), 331–353. https://doi.org/10.1080/13636820.2023.2270468 Ma, J. (2023). Standardized patient simulation for more effective undergraduate nursing education: A systematic review and meta-analysis. Clinical Simulation in Nursing, 74, 19–37. https://doi.org/10.1016/j.ecns.2022.10.002 Dawood, E., Alshutwi, S. S., Alshareif, S., & Shereda, H. A. (2024). Evaluation of the effectiveness of standardized patient simulation as a teaching method in psychiatric and mental health nursing. Nursing Reports, 14(2), 1424–1438. https://doi.org/10.3390/nursrep14020107 McGuire, M. (2025). Impact of competition-based learning on student engagement and performance. International Journal of Construction Education and Research. Advance online publication. https://doi.org/10.1080/15578771.2025.2512348 Zhou, N., Tigelaar, D. E. H., & Admiraal, W. (2023). Understanding vocational teachers’ professional development in work placement: Learning goals, activities, and outcomes. Studies in Continuing Education, 1–19. https://doi.org/10.1080/0158037X.2021.1960496 Zhou, N., Tigelaar, D. E. H., & Admiraal, W. (2022). Vocational teachers' professional learning: A systematic literature review of the past decade. Teaching and Teacher Education, 119, 103856. https://doi.org/10.1016/j.tate.2022.103856 WorldSkills Global Research Council. (2024). WorldSkills as a catalyst for system-level change. WorldSkills. https://api.worldskills.org/resources/download/24040 Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE. Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE. Dewan, P., Khalil, S., & Gupta, P. (2024). Objective structured clinical examination for teaching and assessment: Evidence-based critique. Clinical Epidemiology and Global Health, 25, 101477. https://doi.org/10.1016/j.cegh.2023.101477 Garcia-Ros, R., Ruescas-Nicolau, M.-A., Cezón-Serrano, N., Flor-Rufino, C., San Martin-Valenzuela, C., & Sánchez-Sánchez, M. L. (2024). Improving assessment of procedural skills in health sciences education: A validation study of a rubrics system in neurophysiotherapy. BMC Psychology, 12(1), 147. https://doi.org/10.1186/s40359-024-01643-7 Elabd, K., Abdul-Kadir, H., Alkhenizan, A., & Alkhalifa, M. K. (2023). A comparison of the checklist scoring systems, global rating systems, and borderline regression method for an objective structured clinical examination for a small cohort in a Saudi medical school. Cureus, 15(6), e39968. https://doi.org/10.7759/cureus.39968 Guerrero, J. G., Alqarni, A. S., Turiano Estadilla, L., Benjamin, L. S., & Innocent Rani, V. (2024). Raters and examinees training for objective structured clinical examination: Comparing the effectiveness of three instructional methodologies. BMC Nursing, 23(1), 500. https://doi.org/10.1186/s12912-024-02183-6 Peng, Q., Luo, J., Wang, C., Chen, L., & Tan, S. (2025). Impact of station number and duration time per station on the reliability of Objective Structured Clinical Examination (OSCE) scores: A systematic review and meta-analysis. BMC Medical Education, 25(1), 84. https://doi.org/10.1186/s12909-025-06691-0 Njenga, M. (2023). Continuing professional development of vocational teachers in Kenya: Motivations, practices and teacher profiles. International Journal of Educational Research Open, 5, 100282. https://doi.org/10.1016/j.ijedro.2023.100282 Galdames-Calderón, M. G., Stavnskær Pedersen, A., & Rodriguez-Gomez, D. (2024). Systematic review: Revisiting principles of vocational education competitions. Education Sciences, 14(9), 1008. https://doi.org/10.3390/educsci14091008 Ma, C., & Chen, B.-C. (2025). The impact of competitive and collaborative environments on vocational students’ competitive attitudes, task motivation, and adaptability: A multilevel structural equation modeling analysis. Behavioral Sciences, 15(4), 433. https://doi.org/10.3390/bs15040433 Goller, D., & Wolter, S. C. (2025). Reaching for gold! The impact of a positive reputation shock on career choice. European Economic Review, 175, 105017. https://doi.org/10.1016/j.euroecorev.2025.105017 Table Table 3. Four mechanisms and evidence-chain indicators (for document-based studies). Mechanism Key practices Evidence indicators (examples) M1: Competition–Curriculum–Assessment alignment Task decomposition; competency mapping; modular curriculum; process assessment Curriculum maps; updated syllabi; rubrics; process assessment records M2: Coach–Teacher–Teaching-Research growth Coach training; peer cross-training; simulated judging; reflective routines Training syllabi; calibration notes; meeting minutes; teaching-research artifacts M3: Scenario-based training for competency SP-based simulation; multi-role teamwork; reasoning articulation under time pressure Scenario scripts; SP forms; teamwork rubrics; reflective logs M4: Resource transformation & diffusion Case library; task packages; hosting and regional training dissemination Teaching feedback cases; resource packages; training notices; collaboration records Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor invited by journal 21 Apr, 2026 Reviewers invited by journal 22 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 16 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8616709","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578838961,"identity":"f8869b14-a54a-4eae-9595-793c8bc51cb7","order_by":0,"name":"Shuguang Yin","email":"","orcid":"","institution":"Suzhou Vocational Health College","correspondingAuthor":false,"prefix":"","firstName":"Shuguang","middleName":"","lastName":"Yin","suffix":""},{"id":578838962,"identity":"442bb965-2bb2-4f1f-b931-d8aaf1ff5844","order_by":1,"name":"Ye Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYDACCRBhwCZn397Y+PAD8Voq+IwNeA43G0sQr+WMXOIGifQ2AR5idMjP7jGT+Nhmxrhd8mEbUL+dnG4DAS2Mc86YSc5sS2O2nJ3Y9qCAIdnY7AABLcwSOWbSvG3H2BhuJ7YbSDAcSNxGSAsbSMvftv88DDcPtknwEKOFB6SF4QybhMENRiK1SEikFVv2VLAZSPYkAgPZgAi/yM9I3njjhwFbfT/78YcPP1TYyRHUAgQsSBFoQFg5CDATl0xGwSgYBaNg5AIAUkQ+7+GSU3cAAAAASUVORK5CYII=","orcid":"","institution":"Suzhou Vocational Health College","correspondingAuthor":true,"prefix":"","firstName":"Ye","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2026-01-16 08:41:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8616709/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8616709/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101248907,"identity":"675ede46-980a-41ba-8747-9da19091aef6","added_by":"auto","created_at":"2026-01-27 17:10:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1095263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8616709/v1/48ced999-e781-450b-a8f9-470aafde6f7a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From skills competitions to curriculum reform: a document-based qualitative case study of competition-driven teaching in a Chinese vocational rehabilitation therapy technology program","fulltext":[{"header":"Background","content":"\u003cp\u003eRehabilitation services have gained increasing prominence in China\u0026rsquo;s healthcare system amid accelerated population ageing and the rising prevalence of chronic disease. National strategies and sectoral plans repeatedly emphasize strengthening rehabilitation service capacity, improving the accessibility of rehabilitation at primary and community levels, and expanding the rehabilitation workforce. Against this backdrop, Rehabilitation Therapy Technology (RTT)\u0026mdash;a core healthcare-related major in China\u0026rsquo;s higher vocational education\u0026mdash;carries the responsibility of cultivating application-oriented practitioners who can deliver assessment, intervention, and health education in diverse service settings. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite rapid expansion, RTT programs face persistent challenges. First, curriculum content and teaching tasks may lag behind job requirements that are quickly evolving with new service models and an increasing emphasis on functional assessment and individualized planning. Second, practical teaching resources are often constrained by limited access to clinical settings, insufficient standardized practice platforms, and uneven equipment availability. Third, faculty clinical competence and instructional design capacity can vary substantially, particularly when teachers transition from academic training to a practice-intensive curriculum. Finally, pathways for developing student competency are often insufficiently specified\u0026mdash;competencies such as clinical reasoning, communication, teamwork, and professional ethics are difficult to cultivate and assess using conventional classroom-centered instruction. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVocational skills competitions have been widely promoted in China as instruments for improving vocational education quality. Under the policy orientation of competition-driven teaching, competition-driven learning, and competition-driven reform, competitions are expected to align vocational programs with industry standards, upgrade curricula, strengthen faculty capacity, and enhance student employability. Competitions can provide high-fidelity scenarios and clear performance criteria, enabling programs to translate abstract competency requirements into observable tasks and assessable behaviors. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn rehabilitation-related disciplines, competitions typically involve contextualized tasks and compound competency structures. Participants must complete continuous task chains\u0026mdash;assessment, planning, intervention, and communication\u0026mdash;while reasoning and making decisions under time constraints and contextual variability. Such high-challenge task systems can catalyze curriculum updates, improvements in training platforms, and optimization of faculty development mechanisms, thereby advancing competition\u0026ndash;education integration. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, within RTT education, the literature still lacks replicable explanations and richly documented cases on how competitions generate sustained and systemic change. In particular, evidence is limited on how competitions (a) reshape curriculum and assessment beyond ad hoc training; (b) support faculty development through institutional routines, coach training, and teaching-research integration; and (c) transform competition outcomes into reusable teaching resources that diffuse across cohorts and institutions. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccordingly, this study examines an RTT program in a Chinese higher vocational college as a single-case study to address three research questions: RQ1: How do rehabilitation skills competitions trigger adjustments in curriculum systems and assessment methods? RQ2: How do competitions and teacher\u0026ndash;coach training jointly promote teachers\u0026rsquo; professional development and sustain teaching-research mechanisms? RQ3: How does competition training strengthen students\u0026rsquo; clinical competency and soft skills, and through what pathways does it generate instructional feedback and spillover effects?\u003c/p\u003e \u003cp\u003eOur contributions are threefold. First, we propose and refine a Competition\u0026ndash;Teaching\u0026ndash;Coach Training\u0026ndash;Instructional Feedback closed-loop model for RTT programs. Second, we articulate four mechanisms of competition-driven program development using an evidence-chain approach, linking standards, institutional routines, and resource outputs. Third, we provide actionable implications for vocational education governance and quality enhancement in rehabilitation talent cultivation.\u003c/p\u003e"},{"header":"Conceptual background and framework","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 From Events to Mechanisms: Skills Competitions as Educational Levers\u003c/h2\u003e \u003cp\u003eInternational scholarship on competitions and performance-based learning suggests that challenging tasks and authentic performance contexts can enhance motivation, support the development of professional identity, and increase the transferability of skills to workplace settings. In vocational education, skills competitions are often discussed as catalysts for curriculum modernization and assessment reform, because competition tasks tend to embody up-to-date occupational standards and emphasize demonstrable performance. At the institutional level, competitions can also serve as boundary objects that connect schools with industry partners, professional associations, and regional training ecosystems. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin the Chinese vocational education context, skills competitions have been positioned not only as talent showcases but also as policy instruments to steer program quality. The core claim is that competitions can drive reforms in three domains: teaching (curriculum and instruction), learning (student motivation and competency development), and reform (institutional governance and resource allocation). Yet, the extent to which such reforms become institutionalized depends on whether competition practices are embedded into routine curriculum design, teaching-research activities, and faculty development systems. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Competency-Based Education and Situated Learning in RTT Programs\u003c/h2\u003e \u003cp\u003eRTT education requires a competency structure that is inherently interdisciplinary and scenario-dependent. Students must integrate anatomy, kinesiology, pathology, and clinical reasoning with hands-on techniques, patient safety, and communication. Competency-based education emphasizes observable performance standards and progressive mastery, while situated learning highlights the role of authentic contexts and participation in communities of practice. For RTT programs, this implies that instruction should be organized around task chains (assessment \u0026rarr; planning \u0026rarr; intervention \u0026rarr; education/communication), with explicit performance criteria and feedback loops. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCompetition settings resemble high-fidelity simulations of clinical encounters. They often include time pressure, complex patient presentations, and multi-step decision-making. Such settings can help translate competencies into performance tasks. However, competitions also introduce risks: teaching may become narrowly aligned with winning strategies, and resources may be concentrated on a small group of competitors unless outcomes are systematically transformed into curriculum resources. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Conceptual Framework: A Competition-Driven Closed-Loop Model\u003c/h2\u003e \u003cp\u003eIntegrating the above perspectives, we propose a competition-driven closed-loop model comprising four interlinked components. (1) Standards and tasks: occupational competency lists and competition task packages operationalize standards. (2) Curriculum and assessment: tasks are mapped to curriculum modules and assessed via process-oriented and performance-based evaluation. (3) Faculty development and teaching research: coach training, peer training, and reflective routines support teacher growth and knowledge codification. (4) Resource transformation and diffusion: competition outcomes are codified into reusable teaching cases, task packages, and training resources, and diffused through hosting, regional training, and collaborative networks [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis framework guided data coding, theme development, and the presentation of findings.\u003c/p\u003e \u003cp\u003eRationale and contribution: Single-institution studies are sometimes viewed as descriptive; however, case-based medical education research can contribute when it specifies mechanisms, boundary conditions, and implementation routines that are transferable beyond the local context. In VET and health professions education, external performance standards and assessment regimes are increasingly used to drive curriculum improvement, yet there remains limited empirical description of how such regimes are translated into sustained curriculum\u0026ndash;assessment alignment and faculty development in vocational rehabilitation education [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study addresses this gap by using a document-based qualitative single-case design and evidence-chain tracing to explain how skills competitions can function as a reform apparatus, producing a practical closed-loop model that links standards, teaching and assessment redesign, coach/teacher development, and instructional feedback. We report actionable implementation components and boundary conditions to support adaptation by other vocational health programs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eWe conducted a document-based qualitative single-case study to explore how vocational skills competitions were institutionalized as a reform apparatus within one Rehabilitation Therapy Technology (RTT) program. The design followed established case study principles, emphasizing a bounded system, multiple sources of evidence, and an evidence-chain logic [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContext and case boundary\u003c/p\u003e \u003cp\u003eThe case was a higher vocational health college in China offering an RTT program. The case boundary covered (i) competition participation and preparation activities, (ii) curriculum and assessment redesign linked to competition tasks, and (iii) coach/teacher training and post-competition instructional feedback. The analytic period focused on two consecutive annual cycles of provincial and national-level skills competitions.\u003c/p\u003e \u003cp\u003eData sources and sampling\u003c/p\u003e \u003cp\u003eWe constructed a multi-source document dataset including: (1) national/regional policies related to vocational education, skills competitions, and rehabilitation workforce development; (2) competition documents (rules, task manuals, scoring rubrics, and implementation plans); (3) internal training plans and schedules; (4) post-competition reflections and improvement reports; (5) coach/teacher training materials; and (6) teaching feedback artefacts (e.g., revised task packages, case-based teaching resources, and training checklists). Documents were included if they directly described competition tasks/standards, preparation processes, evaluation criteria, curriculum/assessment changes, faculty development activities, or post-competition instructional feedback. We excluded duplicative versions and documents without substantive content relevant to these mechanisms.\u003c/p\u003e \u003cp\u003eDocument inclusion and screening: We included documents that (a) directly specified competition tasks, assessment criteria, or implementation rules; (b) described preparation or training processes; (c) recorded post-competition reflections and improvement actions; or (d) evidenced translation of competition outputs into routine teaching (e.g., revised task packages, lesson plans, assessment checklists). Documents that were purely administrative without relevance to teaching/assessment or lacked traceable provenance were excluded. Each document was logged with its source, date, document type, and its role in the evidence chain (standard \u0026rarr; curriculum/assessment artifact \u0026rarr; training routine \u0026rarr; teaching feedback).\u003c/p\u003e \u003cp\u003eEvidence-chain tracing and audit trail: For each major claim, we traced supporting evidence across at least two document types (e.g., policy or rules \u0026rarr; scoring rubric \u0026rarr; training plan \u0026rarr; reflection report) and recorded the trace in an audit trail. This procedure strengthened internal validity for a single-case design and allowed readers to evaluate how interpretations were grounded in documentary artefacts [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using reflexive thematic analysis. We iteratively familiarized ourselves with the dataset, generated initial codes, developed candidate themes, reviewed and refined themes, and produced an interpretive narrative with an evidence-chain structure [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Coding and theme development were iterative, moving between documents and emerging interpretations. To enhance interpretive rigor, we maintained an audit trail of coding decisions and used triangulation across policy, competition, and institutional documents. We also searched for disconfirming evidence to refine theme boundaries and avoid over-generalization.\u003c/p\u003e \u003cp\u003eTrustworthiness\u003c/p\u003e \u003cp\u003eWe used four strategies to strengthen trustworthiness: (1) source triangulation (policy vs. competition vs. institutional documents); (2) evidence-chain tracing (linking claims to specific documentary artefacts); (3) peer debriefing among authors to challenge interpretations and refine themes; and (4) transparent reporting of analytic procedures and boundary conditions of the case.\u003c/p\u003e \u003cp\u003eDocument dataset overview\u003c/p\u003e \u003cp\u003eOur analysis identified four interrelated mechanisms through which skills competitions catalyzed competition-driven teaching in the RTT program. Each mechanism is presented with an evidence-chain logic, moving from competition standards and assessment criteria to curriculum redesign, learning activities, and reusable educational resources.\u003c/p\u003e \u003cp\u003eIn reporting results, we focus on descriptive mechanisms and documentary evidence chains. Interpretive implications and transferability considerations are developed in the Discussion.\u003c/p\u003e \u003cp\u003eThe primary dataset consisted of institutional and policy documents. Materials included: national and provincial policy/regulation texts related to vocational education and competitions; competition implementation plans and scoring rubrics; program-level competition proposals and training plans; post-competition summaries and reflective reports; teacher\u0026ndash;coach training materials (program proposals, training notices, syllabi, and feedback summaries); competition task/operation manuals (e.g., stroke, spinal cord injury, cervical spondylosis, lumbar disc herniation); and teaching feedback cases documenting how competition outcomes were integrated into routine teaching.\u003c/p\u003e \u003cp\u003eTo enhance transparency, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes document categories and analytic purposes.\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\u003eDocument dataset used for analysis (illustrative categories).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocument category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExamples (from case context)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimary analytic purpose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTypical outputs derived\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolicy \u0026amp; regulation texts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational/provincial vocational education \u0026amp; competition documents; implementation plans; scoring rubrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIdentify policy orientation, standards, and evaluation requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompetency elements list; rubric anchors; alignment statements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompetition process documents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompetition proposals; training plans; simulation schedules; judging calibration notes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrace program routines and institutional embedding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTask packages; training protocols; process assessment items\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-competition reflections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-event summaries; reflective reports; improvement plans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCapture iterative improvement and knowledge codification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eError libraries; improvement checklists; revised teaching plans\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher\u0026ndash;coach training materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgram proposals; training notices/syllabi; feedback summaries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExplain faculty development mechanism and diffusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCoach training modules; peer-training routines; calibration exemplars\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompetition task/operation manuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScenario tasks (e.g., stroke, SCI, cervical/lumbar disorders); operation steps and safety standards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecify task chains and performance criteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTask decomposition map; module-level learning outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching feedback cases \u0026amp; resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTask-based lesson cases; resource packages; assessment rubrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShow translation of outcomes into routine teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCase library; resource packages; teaching-research artifacts\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":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Mechanism 1: Competition\u0026ndash;Curriculum\u0026ndash;Assessment Alignment via Task Decomposition and Competency Mapping\u003c/h2\u003e \u003cp\u003eCompetition tasks in rehabilitation typically center on complex clinical scenarios and require a complete chain from functional assessment to intervention planning and implementation. In the case program, competition tasks were decomposed into teachable task packages. Each package was mapped to job competency elements (e.g., assessment literacy, safety management, intervention selection, patient education) and then aligned with curriculum modules. This mapping enabled modular curriculum reconstruction around an organizing backbone: functional assessment \u0026rarr; rehabilitation techniques \u0026rarr; plan development and communication [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. An illustrative mapping template is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This template is conceptually aligned with OSCE-informed assessment design, where different scoring methods (e.g., checklist- and global rating-based approaches) have been compared to strengthen reliability and interpretability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExample mapping from competition task chain to curriculum modules and assessment (adaptable template).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompetition task chain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompetency elements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCurriculum module (examples)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment approach (examples)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional assessment (history, tests, safety screening)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssessment literacy; safety management; documentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssessment \u0026amp; measurement; clinical reasoning basics; patient safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChecklist\u0026thinsp;+\u0026thinsp;rubric; OSCE-style station; documentation scoring\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention planning (goal setting, prioritization)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical reasoning; goal negotiation; evidence awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRehab planning; condition-specific pathways; shared decision-making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePlan quality rubric; oral defense; peer-review\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention delivery (techniques, progression)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnique execution; dosage/progression; risk control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTherapeutic exercise; manual therapy; functional training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePerformance rubric; time control; fidelity/quality scoring\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication \u0026amp; education (instructions, empathy, teamwork)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication; empathy; teamwork; professionalism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTherapeutic communication; interprofessional collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSP rating scale; teamwork rubric; reflective note\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=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Mechanism 2: Coach\u0026ndash;Teacher\u0026ndash;Teaching-Research Growth through Coach Training and Joint Competition\u0026ndash;Teaching Routines\u003c/h2\u003e \u003cp\u003eCompetition preparation demanded that teachers integrate clinical skills, instructional design, mentoring strategies, and psychological support. The program leveraged teacher\u0026ndash;coach training initiatives and established an on-campus competition\u0026ndash;teaching joint training routine. Key practices included: (a) cross-training among teachers on task packages, scoring anchors, and common errors; (b) routine micro-teaching and simulated judging to improve instructional precision; (c) reflective meetings after each training cycle to document improvements and convert tacit know-how into teachable artifacts; and (d) integration of competition-derived materials into teaching-research outputs such as lesson plans, case libraries, and assessment rubrics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese routines supported teachers\u0026rsquo; development from single-role instructors to multi-capability professionals who combine teaching, mentoring, and practice. Importantly, coach training did not remain a one-off event; it was embedded into local teaching-research routines, enabling sustainable faculty development [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Mechanism 3: Scenario-Based Competition Training Strengthening Student Competency and Soft Skills\u003c/h2\u003e \u003cp\u003eCompetition training strengthened students\u0026rsquo; systematic mastery of assessment and intervention procedures while developing clinical reasoning and decision-making under pressure. Training emphasized scenario authenticity through multi-step tasks and time control. In addition, because rehabilitation competitions evaluate communication, empathy, and professionalism, training incorporated standardized patients (SP) and multi-role collaboration (e.g., consultation, assessment, intervention, documentation, and communication). Students were required to articulate reasoning, negotiate goals with patients, deliver safety instructions, and coordinate roles within teams [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a result, competency growth extended beyond technical skills. Students developed communication clarity, teamwork, professional ethics, and stress management. This mechanism explains why competition-driven training can yield employability gains if translated into routine teaching, rather than being limited to a small group of competitors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Mechanism 4: Achievement Accumulation and Resource Transformation Enabling Instructional Feedback and Diffusion\u003c/h2\u003e \u003cp\u003eA critical distinction between short-term competition success and long-term program reform lies in resource transformation. In the case program, competition outcomes were codified into reusable teaching feedback cases, task packages, checklists, and rubrics. These resources were used for collective lesson preparation and task-based instruction in regular cohorts.\u003c/p\u003e \u003cp\u003eFurthermore, by hosting competitions and delivering regional teacher training, the program diffused its resources and experience to other institutions. This supported inter-institutional collaboration and regional capacity building, turning competition achievements into educational public goods. Table\u0026nbsp;3 summarizes the four mechanisms and typical evidence types in document-based studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrincipal findings\u003c/p\u003e \u003cp\u003eThis document-based case study shows how skills competitions can be institutionalized as a reform apparatus in vocational rehabilitation education. Rather than functioning as one-off events, competitions shaped a repeatable cycle that linked external standards, internal curriculum and assessment design, faculty development, and the transformation of outputs into reusable educational resources. Collectively, these findings provide a mechanism-focused and transferable account that is relevant to international readers interested in how external performance assessments can be leveraged for sustained educational improvement in vocational health training.\u003c/p\u003e \u003cp\u003eRelationship to prior literature\u003c/p\u003e \u003cp\u003eOur findings align with broader evidence that vocational education reforms benefit from clear standards, assessment coherence, and teacher professional learning infrastructures [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The scenario-based training component is consistent with the wider health professions education literature on structured practice with feedback and performance assessment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContribution to the international literature\u003c/p\u003e \u003cp\u003eFirst, we extend international discussions on competition-driven teaching by specifying an evidence chain that links external standards (competition tasks and rubrics) to internal assessment blueprints, curriculum modules, and learning activities, thereby operationalizing curriculum\u0026ndash;assessment alignment in a vocational rehabilitation context [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, we conceptualize coach training as a faculty development intervention that supports shared pedagogical routines and communities of practice, and we position the conversion of competition outputs into version-controlled teaching assets as a quality enhancement cycle. Together, these elements integrate perspectives from competency-based education, simulation-based learning, and quality improvement into a coherent governance framework that can be adapted by other vocational health programs [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplications for practice and policy\u003c/p\u003e \u003cp\u003eFor program leaders, the closed-loop model suggests actionable governance routines: (1) build an explicit competency map that connects competition tasks to course outcomes and assessment blueprints; (2) formalize coach training as a faculty development intervention with defined learning objectives; (3) adopt structured feedback cycles (briefing\u0026ndash;practice\u0026ndash;debriefing) for scenario-based training; and (4) implement resource governance (version control, repositories, and periodic review) so that competition outputs become stable curricular assets. For policy makers and organizers, designing competition standards and rubrics with transparency and educational validity can increase their value as curriculum anchors and reduce unintended teaching-to-the-test behaviours. Evidence from OSCE research suggests that structured rater training can improve scoring consistency and assessment validity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTransferability\u003c/p\u003e \u003cp\u003eThe mechanisms reported here may be transferable to other vocational health programs (e.g., nursing, medical imaging, and aged care) under three conditions: (1) availability of performance standards or rubrics that can anchor assessment blueprints; (2) a faculty development pathway that supports shared pedagogical routines; and (3) an organizational structure that converts event outputs into curriculum and resource updates. Readers should consider local policy environments, practice placement capacity, and workload constraints when adapting the model.\u003c/p\u003e \u003cp\u003eInternational relevance: Although the case is situated in China\u0026rsquo;s vocational education and training (VET) system, the mechanisms identified are not country-specific per se. Many VET and health professions education systems use performance standards and external assessments to drive curriculum improvement. Our findings contribute to this international discussion by specifying how a high-stakes, task-based assessment regime can be translated into curriculum\u0026ndash;assessment alignment, structured faculty development, and routine quality-enhancement cycles [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePractical transfer package: Programs seeking to replicate the closed-loop model may start with four implementable components: (1) an assessment blueprint that maps competition tasks (or external standards) to course outcomes and observable performance criteria; (2) a faculty development pathway that trains teachers as coaches around shared rubrics and scenario-based routines; (3) structured practice and feedback cycles (brief\u0026ndash;practice\u0026ndash;debrief) consistent with simulation-based education; and (4) resource governance that converts event outputs into version-controlled teaching assets and periodically reviews them for curricular fit [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoundary conditions: Transferability is most plausible where (a) standards/rubrics are available and trusted; (b) institutions can allocate protected time for coaching and iterative resource development; and (c) there is an organizational mechanism for integrating competition-derived outputs into routine teaching and assessment. Where clinical placement capacity is constrained, scenario-based training may partially compensate, but it should be aligned with local scope-of-practice expectations and quality assurance procedures.\u003c/p\u003e \u003cp\u003eStrengths\u003c/p\u003e \u003cp\u003eStrengths of this study include (1) the use of a multi-source documentary corpus spanning policy, competition, and institutional artefacts; (2) explicit evidence-chain tracing that supports internal validity for a single-case design; and (3) a mechanism-focused explanation that makes the model actionable for educators and program leaders beyond the case institution.\u003c/p\u003e \u003cp\u003eLimitations and future research\u003c/p\u003e \u003cp\u003eThis study is limited by its single-case, document-based design and does not include primary data from learners or faculty (e.g., interviews, observations, or outcome measures). Future studies could employ mixed methods to examine learner outcomes, assessment reliability, and the cost\u0026ndash;benefit profile of competition-driven teaching. Comparative multi-site research would further clarify which mechanisms are context-dependent and which are broadly generalizable.\u003c/p\u003e \u003cp\u003eSkills competitions can function as a systemic reform apparatus in vocational rehabilitation education, linking standards, curriculum\u0026ndash;assessment alignment, faculty development, scenario-based learning, and the standardization and diffusion of teaching resources. The proposed closed-loop model offers a practical framework for converting event-based initiatives into sustained quality-enhancement routines.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Competitions as Reform Apparatuses: From Activity Logic to Mechanism Logic\u003c/h2\u003e \u003cp\u003eOur findings suggest that the educational value of skills competitions lies less in one-off achievements than in institutional embedding. Competitions become reform mechanisms only when task decomposition, curriculum mapping, assessment reform, faculty development, and resource transformation are linked into a closed loop. In this sense, competitions operate as high-challenge task systems that stimulate coordinated improvement across teaching, learning, and governance. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e5.2 Distinctive Features of RTT Competitions: Complex Task Chains and Assessment Consistency\u003c/h2\u003e \u003cp\u003eRehabilitation competitions emphasize complex task chains and scenario-based judgment, which increases the need for clear scoring anchors and judge training. To reduce subjectivity and regional disparities, future work should strengthen: (a) competency element definitions; (b) exemplar repositories and anchor performances; (c) judge calibration and training; and (d) digital assessment tools that capture process data. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e5.3 Practical Implications for Program Governance\u003c/h2\u003e \u003cp\u003eFor policymakers and program leaders, three implications stand out. First, align standards across occupational competency models, curriculum standards, and competition standards. Second, institutionalize coach training within teacher development systems and connect it to teaching-research routines. Third, build resource transformation pipelines so that competition outcomes become reusable curriculum resources, benefiting regular cohorts and facilitating regional sharing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e5.4 Theoretical Implications\u003c/h2\u003e \u003cp\u003eThis study contributes to the literature by operationalizing competition\u0026ndash;education integration as a closed-loop system rather than a set of event-based activities. By specifying four mechanisms and linking them to institutional artifacts, we provide a replicable analytic framework for future comparative studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis paper proposes and substantiates a Competition\u0026ndash;Teaching\u0026ndash;Coach Training\u0026ndash;Instructional Feedback closed-loop model for higher vocational RTT programs. Skills competitions can drive curriculum iteration and quality enhancement through four mechanisms: standards alignment via task decomposition, faculty growth via coach training and teaching-research routines, competency cultivation via scenario-based training, and diffusion via resource transformation.\u003c/p\u003e\n\u003cp\u003eBy articulating concrete mechanisms and boundary conditions, this study provides a transferable framework for vocational health programs seeking to turn episodic competition initiatives into sustained curriculum, assessment, and faculty-development improvements.\u003c/p\u003e\n\u003cp\u003eLimitations include reliance on document-based evidence and a single-case design, which constrains generalizability. Future research could extend to multi-institution comparative studies incorporating interviews, questionnaires, and student outcome data (e.g., performance assessments, internship evaluations, employment indicators). Further attention is warranted to how educational technologies (VR/AI, digital rubrics, learning analytics) reshape competition formats, assessment consistency, and teaching innovation in rehabilitation education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRTT, Rehabilitation Therapy Technology; SP, standardized patient; OSCE, Objective Structured Clinical Examination; VET, vocational education and training; LLM, large language model.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study relied exclusively on document-based materials and did not involve human participants, interventions, or identifiable personal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analysed during the current study. Key non-public institutional documents can be made available from the corresponding author upon reasonable request, subject to institutional permissions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSY and YZ declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Suzhou Vocational Health College (Grant No. SZWZY202419), project titled \u0026ldquo;A Study on the Reliability and Validity of Portable 3D Spinal Scanning Devices in Measuring Adolescent Idiopathic Scoliosis.\u0026rdquo; The funder had no role in the design, analysis, interpretation, or writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSY: Conceptualization, Methodology, Data curation, Formal analysis, Writing\u0026mdash;original draft. YZ: Supervision, Resources, Writing\u0026mdash;review \u0026amp; editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSY is a lecturer at Suzhou Vocational Health College. YZ is a physical therapist at Suzhou Municipal Hospital and affiliated with Nanjing Medical University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., \u0026amp; Vos, T. (2021). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006\u0026ndash;2017. https://doi.org/10.1016/S0140-6736(20)32340-0\u003c/li\u003e\n\u003cli\u003eTian, T., Zhu, L., Fu, Q., Tan, S., Cao, Y., Zhang, D., Wang, M., Zheng, T., Gao, L., Volontovich, D., Wang, Y., Zhang, J., Jiang, Z., Qiu, H., Wang, F., \u0026amp; Zhao, Y. (2025). Needs for rehabilitation in China: Estimates based on the Global Burden of Disease Study 1990\u0026ndash;2019. Chinese Medical Journal, 138(1), 49\u0026ndash;59. https://doi.org/10.1097/CM9.0000000000003245\u003c/li\u003e\n\u003cli\u003eSun, L., et al. (2022). Education and development of rehabilitation therapy in China under the background of aging. Frontiers in Public Health, 10, 1000048. https://doi.org/10.3389/fpubh.2022.1000048\u003c/li\u003e\n\u003cli\u003eOECD. (2021). Teachers and leaders in vocational education and training. OECD Publishing. https://doi.org/10.1787/59d4fbb1-en\u003c/li\u003e\n\u003cli\u003eMcGrath, S., \u0026amp; Yamada, S. (2023). Skills for development and vocational education and training: Current and emergent trends. International Journal of Educational Development, 102, 102853. https://doi.org/10.1016/j.ijedudev.2023.102853\u003c/li\u003e\n\u003cli\u003eWeijzen, S. M. G., Onck, C., Wals, A. E., Tassone, V. C., \u0026amp; Kuijer-Siebelink, W. (2024). Vocational education for a sustainable future: Unveiling the collaborative learning narratives to make space for learning. Journal of Vocational Education \u0026amp; Training, 76(2), 331\u0026ndash;353. https://doi.org/10.1080/13636820.2023.2270468\u003c/li\u003e\n\u003cli\u003eMa, J. (2023). Standardized patient simulation for more effective undergraduate nursing education: A systematic review and meta-analysis. Clinical Simulation in Nursing, 74, 19\u0026ndash;37. https://doi.org/10.1016/j.ecns.2022.10.002\u003c/li\u003e\n\u003cli\u003eDawood, E., Alshutwi, S. S., Alshareif, S., \u0026amp; Shereda, H. A. (2024). Evaluation of the effectiveness of standardized patient simulation as a teaching method in psychiatric and mental health nursing. Nursing Reports, 14(2), 1424\u0026ndash;1438. https://doi.org/10.3390/nursrep14020107\u003c/li\u003e\n\u003cli\u003eMcGuire, M. (2025). Impact of competition-based learning on student engagement and performance. International Journal of Construction Education and Research. Advance online publication. https://doi.org/10.1080/15578771.2025.2512348\u003c/li\u003e\n\u003cli\u003eZhou, N., Tigelaar, D. E. H., \u0026amp; Admiraal, W. (2023). Understanding vocational teachers\u0026rsquo; professional development in work placement: Learning goals, activities, and outcomes. Studies in Continuing Education, 1\u0026ndash;19. https://doi.org/10.1080/0158037X.2021.1960496\u003c/li\u003e\n\u003cli\u003eZhou, N., Tigelaar, D. E. H., \u0026amp; Admiraal, W. (2022). Vocational teachers\u0026apos; professional learning: A systematic literature review of the past decade. Teaching and Teacher Education, 119, 103856. https://doi.org/10.1016/j.tate.2022.103856\u003c/li\u003e\n\u003cli\u003eWorldSkills Global Research Council. (2024). WorldSkills as a catalyst for system-level change. WorldSkills. https://api.worldskills.org/resources/download/24040\u003c/li\u003e\n\u003cli\u003eYin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE.\u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2021). Thematic analysis: A practical guide. SAGE.\u003c/li\u003e\n\u003cli\u003eDewan, P., Khalil, S., \u0026amp; Gupta, P. (2024). Objective structured clinical examination for teaching and assessment: Evidence-based critique. Clinical Epidemiology and Global Health, 25, 101477. https://doi.org/10.1016/j.cegh.2023.101477\u003c/li\u003e\n\u003cli\u003eGarcia-Ros, R., Ruescas-Nicolau, M.-A., Cez\u0026oacute;n-Serrano, N., Flor-Rufino, C., San Martin-Valenzuela, C., \u0026amp; S\u0026aacute;nchez-S\u0026aacute;nchez, M. L. (2024). Improving assessment of procedural skills in health sciences education: A validation study of a rubrics system in neurophysiotherapy. BMC Psychology, 12(1), 147. https://doi.org/10.1186/s40359-024-01643-7\u003c/li\u003e\n\u003cli\u003eElabd, K., Abdul-Kadir, H., Alkhenizan, A., \u0026amp; Alkhalifa, M. K. (2023). A comparison of the checklist scoring systems, global rating systems, and borderline regression method for an objective structured clinical examination for a small cohort in a Saudi medical school. Cureus, 15(6), e39968. https://doi.org/10.7759/cureus.39968\u003c/li\u003e\n\u003cli\u003eGuerrero, J. G., Alqarni, A. S., Turiano Estadilla, L., Benjamin, L. S., \u0026amp; Innocent Rani, V. (2024). Raters and examinees training for objective structured clinical examination: Comparing the effectiveness of three instructional methodologies. BMC Nursing, 23(1), 500. https://doi.org/10.1186/s12912-024-02183-6\u003c/li\u003e\n\u003cli\u003ePeng, Q., Luo, J., Wang, C., Chen, L., \u0026amp; Tan, S. (2025). Impact of station number and duration time per station on the reliability of Objective Structured Clinical Examination (OSCE) scores: A systematic review and meta-analysis. BMC Medical Education, 25(1), 84. https://doi.org/10.1186/s12909-025-06691-0\u003c/li\u003e\n\u003cli\u003eNjenga, M. (2023). Continuing professional development of vocational teachers in Kenya: Motivations, practices and teacher profiles. International Journal of Educational Research Open, 5, 100282. https://doi.org/10.1016/j.ijedro.2023.100282\u003c/li\u003e\n\u003cli\u003eGaldames-Calder\u0026oacute;n, M. G., Stavnsk\u0026aelig;r Pedersen, A., \u0026amp; Rodriguez-Gomez, D. (2024). Systematic review: Revisiting principles of vocational education competitions. Education Sciences, 14(9), 1008. https://doi.org/10.3390/educsci14091008\u003c/li\u003e\n\u003cli\u003eMa, C., \u0026amp; Chen, B.-C. (2025). The impact of competitive and collaborative environments on vocational students\u0026rsquo; competitive attitudes, task motivation, and adaptability: A multilevel structural equation modeling analysis. Behavioral Sciences, 15(4), 433. https://doi.org/10.3390/bs15040433\u003c/li\u003e\n\u003cli\u003eGoller, D., \u0026amp; Wolter, S. C. (2025). Reaching for gold! The impact of a positive reputation shock on career choice. European Economic Review, 175, 105017. https://doi.org/10.1016/j.euroecorev.2025.105017\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 3. Four mechanisms and evidence-chain indicators (for document-based studies).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvidence indicators (examples)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eM1: Competition\u0026ndash;Curriculum\u0026ndash;Assessment alignment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eTask decomposition; competency mapping; modular curriculum; process assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eCurriculum maps; updated syllabi; rubrics; process assessment records\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eM2: Coach\u0026ndash;Teacher\u0026ndash;Teaching-Research growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eCoach training; peer cross-training; simulated judging; reflective routines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTraining syllabi; calibration notes; meeting minutes; teaching-research artifacts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eM3: Scenario-based training for competency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eSP-based simulation; multi-role teamwork; reasoning articulation under time pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eScenario scripts; SP forms; teamwork rubrics; reflective logs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eM4: Resource transformation \u0026amp; diffusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eCase library; task packages; hosting and regional training dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTeaching feedback cases; resource packages; training notices; collaboration records\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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":"Vocational skills competitions, Higher vocational education, Rehabilitation Therapy Technology, Competition-driven teaching, Competency-based education","lastPublishedDoi":"10.21203/rs.3.rs-8616709/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8616709/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVocational skills competitions are widely promoted as levers for competition-driven teaching, learning, and curriculum reform in health professions education, yet evidence remains limited on how competitions systematically reshape rehabilitation education in higher vocational colleges.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a document-based qualitative case study of a Rehabilitation Therapy Technology (RTT) program in China. We built a multi-source document dataset including national and regional policy texts, competition rules and scoring rubrics, training plans, post-competition reflections, coach/teacher training materials, and teaching feedback cases. Data were analyzed using reflexive thematic analysis with triangulation and an evidence-chain approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour mechanisms explained how competitions contributed to program development: (1) competition\u0026ndash;curriculum\u0026ndash;assessment alignment through task decomposition and competency mapping; (2) coach\u0026ndash;teacher capacity building via structured coach training and routine competition\u0026ndash;teaching co-development; (3) scenario-based training that strengthened students\u0026rsquo; clinical reasoning, communication, and teamwork; and (4) resource transformation and diffusion, whereby competition outputs were converted into reusable teaching cases and task packages and disseminated through hosting and regional training.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSkills competitions can operate as a systemic reform apparatus linking standards, curriculum iteration, faculty development, quality evaluation, and regional collaboration. We propose a Competition\u0026ndash;Teaching\u0026ndash;Coach Training\u0026ndash;Instructional Feedback closed-loop model and outline actionable implications for governance and quality enhancement in vocational rehabilitation education.\u003c/p\u003e","manuscriptTitle":"From skills competitions to curriculum reform: a document-based qualitative case study of competition-driven teaching in a Chinese vocational rehabilitation therapy technology program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 17:08:50","doi":"10.21203/rs.3.rs-8616709/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2026-04-21T05:46:03+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T09:32:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T02:20:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T02:19:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-16T08:05:45+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":"27786a6d-4b11-4309-a514-36902f406b8f","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T17:08:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 17:08:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8616709","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8616709","identity":"rs-8616709","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}