Assessment on a blended teaching model for surgical laboratory course among international medical students in response to the COVID-19 pandemic: a case study in a Chinese university

Assessment on a blended teaching model for surgical laboratory course among international medical students in response to the COVID-19 pandemic: a case study in a Chinese university | 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 Assessment on a blended teaching model for surgical laboratory course among international medical students in response to the COVID-19 pandemic: a case study in a Chinese university Xin Wang, Yi Wang, Yuping Liu, Zhe Xie, Jingfeng Li, Xinliang Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1805348/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With the ongoing crisis of the COVID-19 pandemic in China and the increasing online teaching platforms, the blended teaching model for international medical students is necessary. Our study aims at assessing the effectiveness of the combination of online and classroom teaching in surgical laboratory course among international medical students in a Chinese university. Methods This was a cross-sectional study conducted in a Chinese university. All international medical students enrolled in 2016–2019 were included in our study and were all third year undergraduate students majoring in Clinical Medicine for a 5-year program. At the final stage of the surgical laboratory course learning, the scores of OSCE (Objective Structured Clinical Examination) and the performance of usual learning and the skills practice from 2019 to 2022 were used as measures to assess the effectiveness. STATA 14 software was applied to conduct the relevant descriptive and statistical analysis. The statistical significance was set at P < 0.05. Results A total of 29 international medical students from 14 developing countries were included in our study. The mean age of them was 25.5 ± 2.2 years. The mean scores of OSCE was 76.55 ± 21.91, and it was 76.80 ± 22.05 for the usual learning and skill practice among all the international medical students. The mean scores of OSCE was 75.69 ± 21.40 for the international medical students in the blended teaching model, close to that (77.47 ± 23.21) in the traditional teaching model. Besides, the mean scores of usual learning and skill practice for the international medical students in the blended teaching model was 74.40 ± 20.92, lower than that (77.43 ± 23.18) in the traditional teaching model ( P > 0.0.05). Conclusions Our study as a preliminary study confirmed that a blended teaching model was effective like the traditional teaching model, which can reduce the disruption for the international medical students’ study during the COVID-19 pandemic. Online interactions between international medical students and instructors positively contribute to global health education. Better coordination of online and face-to-face blended teaching models is an important direction for global medical education. Global medical education COVID-19 Surgical laboratory course Case study International medical students China Figures Figure 1 Background The COVID-19 pandemic has been still ongoing in China. Currently, China has remained a ‘dynamic zero-COVID-19’ policy in order to control the COVID-19 as far as possible at the minimum cost ( 1 ). The COVID-19 has resulted in huge changes in people’s daily life, including medical education ( 2 , 3 ). Medical universities or schools as a high risk to exposure to the COVID-19 need to be shut down when all level of the governments require students and educators to stay at home ( 4 ). This has disrupted traditional medical education, which are mostly presented in clinical clerkships and face-to-face teaching activities. Online distance medical study has become part of medical education during the COVID-19 pandemic ( 4 , 5 ). China has been the third largest destination country globally to attract international students for higher education ( 6 ). Especially, medicine is the most common program chosen by international students in China ( 7 ). On one hand, a portion of international students have chosen to go back to their home countries the COVID-19 pandemic. Due to international travel restrictions and cost at quarantine hotels during the COVID-19 pandemic set by Chinese government ( 8 ), some international students cannot go back to China for their study. Therefore, online distance medical study is a must for them to keep on studying. One the other hand, those international students who can still stay in China are able to attend the lectures and participate in clinical clerkships in person. Hence, a blended teaching model has become common for global medical education ( 9 ). A blended teaching model is a teaching activity which combines online self-learning/teaching and classroom teaching ( 10 , 11 ). Current studies have confirmed that a blended teaching model is applied to medical education. For example, Wu et al. has developed a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors ( 12 ). Coyle et al. conducted a narrative review to describe the application of blended learning to a sexual health education program ( 13 ). Both of them have provided evidence that a blended teaching model is effective and feasible. Surgical laboratory course is one of the basic surgical courses for medical students to get knowledge and practice. With the ongoing crisis of the COVID-19 pandemic in China and the increasing online teaching platforms, the blended teaching model for international medical students is necessary. The blended teaching model used in teaching surgical laboratory course for international medical students is innovative. It is necessary to assess the effectiveness of the blended teaching model. Therefore, our study aims at assessing the effectiveness of the combination of online teaching and classroom teaching in surgical laboratory course among international medical students in a Chinese university. Methods Setting This cross-sectional study was conducted in Wuhan University (WHU), which is a comprehensive and key national university directly under the administration of the Ministry of Education in China. It is also one of the “211 Project” and “985 Project” universities in China. School of Medicine is one of the schools in WHU and Zhongnan Hospital of Wuhan University is one of three affiliated hospitals where medical students can participate in clinical clerkships. Currently, a total of 1623 international students are studying in WHU. Study participants All international medical students who were enrolled in 2016–2019 were included in our study. These international students were all 2-year undergraduate students majoring in Clinical Medicine for 5 years (2016 class, 2017 class, 2018 class, and 2019 class). Informed consent was obtained from the international students and the results would be published without any potential possibility to share any information about personal data. The blended teaching model for surgical laboratory course Traditional teaching model (face-to-face teaching): International medical students were required to independently complete the assigned reading material, including theoretical knowledge, operational overview, and step-by-step instructions for surgical laboratory course prior to classroom teaching. In the first 20–30 minutes of the class, the instructor summarised the main points of the skills and the application of laboratory equipment and precautions. Then, the students practiced their medical simulation skills after class. Online teaching model: With the full support from online platforms of WHU Luojia, our team has established a Massive Open Online Course (MOOC) for the international medical students. This can provide micro videos, extra reading material relevant to surgical laboratory course, and online assignments and assessments. Besides, we also provided the international medical students with online relevant information about the surgical laboratory course to help them get the most of knowledge. Therefore, those international students enrolled in 2016 and 2017 only attend the traditional teaching model, while those enrolled in 2018 and 2019 attended both the traditional teaching model and online teaching model. Please see Fig. 1 . Assessment measures on the blended teaching model for surgical laboratory course All the international medical students were required to attend the lectures according to undergraduate medical course guidelines set by WHU. The course contents, reading materials, and assessment methods have been keeping the same. At the final stage of the surgical laboratory course learning, the international medical students needed to take part in the Objective Structured Clinical Examination (OSCE). The scores of OSCE accounted for 60% of the final results, while the scores of the performance of usual learning like attendance and the skills practice accounted for 40% of the final results. Therefore, the scores of OSCE and the performance of usual learning and the skills practice from 2019 to 2022 were used as measures to assess the effectiveness of the blended teaching model. Data analysis The data were all entered in Excel file by two independent researchers in order to make sure of the data quality. Numerous data were presented in mean and standard deviation (SD) and independent t test was used to conclude the causal effects. Categorical data were presented in percentages and sums, and Chi-square test was used to conclude the causal effects. STATA 14 software was applied to conduct the relevant statistical analysis. The statistical significance was set at P < 0.05. Results Characteristics of the included international medical students As shown in Table 1 , a total of 29 international medical students from 14 developing countries were included in our study. The mean age of all the international medical students was 25.5 ± 2.2 years. The mean age of the international medical students participating in the traditional teaching model was 26.6 ± 2.1 years, which was higher than that of those international medical students participating in the blended teaching model (24.4 ± 1.7 years). Moreover, more male international medical students were in the blended teaching model, while more female international medical students were in the traditional teaching model. Table 1 Characteristics of the included international medical students Characteristics Blended teaching model Traditional teaching model Total Age (mean ± SD) 24.4 ± 1.7 26.6 ± 2.1 25.5 ± 2.2 Gender (N) Male 11 5 16 Female 4 9 13 Origin of country (N) Nepal - 5 5 Chad 5 1 6 Mongolia - 1 1 Morocco - 1 1 Benin 1 2 3 Indonesia - 1 1 Tajikistan 1 1 2 Somalia 1 2 3 Armenia 1 - 1 Kazakhstan 1 - 1 Gabon 2 - 2 Zambia 1 - 1 Yemen 1 - 1 Cambodia 1 - 1 Total (N) 15 14 29 Differences on scores of OSCE and the performance of usual learning and skills practice between the blended teaching model and the traditional teaching model Table 2 presents that the mean scores of OSCE was 76.55 ± 21.91, while it was 76.80 ± 22.05 for the usual learning and skill practice among all the international medical students. The mean scores of OSCE was 75.69 ± 21.40 for the international medical students in the blended teaching model, which was close to that (77.47 ± 23.21) for the international medical students in the traditional teaching model. The difference is not statistically significant ( P = 0.831). Besides, the mean scores of usual learning and skill practice for the international medical students in the blended teaching model was 74.40 ± 20.92, which was lower than that (77.43 ± 23.18) for the international medical students in the traditional teaching model. The difference is not statistically significant ( P = 0.714). Table 2 Scores of OSCE and the performance of usual learning and the skills practice between the blended teaching model and the traditional teaching model Scores (mean ± SD) Total Blended teaching model Traditional teaching model t test P value OSCE 76.55 ± 21.91 75.69 ± 21.40 77.47 ± 23.21 0.215 0.831 Usual learning and skills practice 76.80 ± 22.05 74.40 ± 20.92 77.43 ± 23.18 0.370 0.714 Discussion Our study used the surgical laboratory course as an example to show the effectiveness of the blended teaching model. According to our findings, the blended teaching model could achieve the goal of the traditional one by comparing the scores. International medical students could study normally before the COVID-19 pandemic. A study conducted by Agustina provided evidence that blended learning models could improve student learning outcomes among nursing students ( 14 ). This also means that a blended teaching model could satisfy the requirements of international medical students suffering the interruption like the COVID-19 pandemic. Besides, unlike the traditional teaching model in which instructor has the domain role, our online and offline blended teaching successfully set international medical students as priority. International medical students had more discretionary time and were more active and motivated to attend the lectures or participate in the clinical clerkships. This blended teaching model also increased the interaction between instructors and international medical students, which can contribute to global medical education. Since our international medical students are all from developing countries, this requires that not only medical universities or schools in China need to achieve the capacity to complement the blended teaching, but also developing countries can support those international medical students back to home countries to be involved in the blended teaching. Eight independent factors which may have an impact on the blended teaching during the COVID-19 pandemic are summarized in a study ( 9 ). They are e-learning environment, e-learning facilitation, e-learning materials, e-learning technical support, instructor’s personal attention, interaction with instructors, interaction with peer students, and laboratory learning environment. To note, the blended teaching model definitely needs the support of information technology, which might be a challenge in some developing countries ( 15 , 16 ). The blended teaching model not only enables global medical education for educators, but also minimises disruptions to students’ daily schedules and keep students’ motivation ( 17 , 18 ). Our study reveals that a blended teaching model incorporating a formative assessment addresses the barriers which prevent international medical students quarantined at home due to the COVID-19 pandemic from synchronising their learning progress with on-campus medical students. Online distance learning, discussion and interaction are provided through a MOOC system. International medical students can choose to participate in learning either synchronously or asynchronously and are able to attend the lectures of surgical laboratory course at different locations and times. Therefore, the blended teaching model may become the new normal even for the post-COVID-19 pandemic ( 11 , 19 ). Improved blended teaching models are currently mostly applied in platforms of universities or schools by various online platforms ( 20 ). Their application to global medical education still needs to be elaborated by cross-regional, multi-centre pedagogical pilot designs and empirical studies. Transition from a traditional face-to-face teaching model into a blended teaching model requires concerted efforts and dedicated technical and pedagogical policy support at all levels. On December 9, 2021, the China Consortium of Universities for Global Health (CCUGH) elected Wuhan University as the fifth presidential institution of the Consortium through an anonymous vote at a web conference. CCUGH aims to establish interdisciplinary collaboration and promote knowledge sharing amongst member universities in China to address global health challenges, including global health education. In the future, CCUGH will focus on promoting the popularisation and standardisation of global health education, which will provide a good platform and policy support for the practice and promotion of the improved blended learning strategy in major medical schools worldwide. By implementing the blended teaching, international medical students are provided with simultaneous, high-quality access to general surgery theory. The fulfilment of the course may require close contact among international medical students. The blended teaching model is an effective way to meet the challenges in the context of the COVID-19 pandemic. In addition, students participating in face-to-face teaching and online interactive learning showed a high level of autonomy in learning and questioning and were highly satisfied with their learning outcomes, and it was effective to reduce the risk of getting COVID-19 ( 21 ). The COVID-19 pandemic has triggered changes in the teaching and assessment of medical education and it would persist for a long period. Strategic innovations that use information technology in conjunction with existing medical teaching methods can address current medical education issues, especially for international medical students. These innovations for continuous improvement and development provide the basis for blended teaching, online learning and formative assessment in global medical education. Our study also has some limitations. This is a single centre study and the sample size is not enough because of the limited number of international medical students in this Chinese university. Therefore, the findings cannot be widely applied. A multi-centre study and more data need to be conducted to achieve the robust results in the future. Also, comparative analysis between different countries is necessary to learn different education models. Conclusions Our study as a preliminary study confirmed that a blended teaching model was effective like the traditional teaching model, which can reduce the disruption for the international medical students’ study during the COVID-19 pandemic. Online interactions between international medical students and instructors positively contribute to global medical education. Better coordination of online and face-to-face blended teaching models is an important direction for global medical education. Abbreviations CCUGH: China Consortium of Universities for Global Health CTBL: Clinical teaching blended learning MOOC: Massive Open Online Course OSCE: Objective Structured Clinical Examination SD: standard deviation WCP : Web-based clinical pedagogy WHU: Wuhan University Declarations Ethics approval and consent to participate Our study was approved by ethic committee from Zhongnan Hospital of Wuhan University. Informed consent was obtained from the international students and the results would be published without any potential possibility to share any information about personal data. Consent for publication Consent for publication was obtained from the international students. Availability of data and materials Data are available from the authors upon reasonable request. Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding It is not applicable. Author contributions X.W. designed and conducted the study, gave comments on the manuscript, and was in charge of the whole study. Y.W. analysed the data and drafted the manuscript. Y.L. collected and analysed the data. Z.X. conducted the study and gave comments on the manuscript. X.L. drafted and revised the manuscript, and analysed the data. J.L. designed and conducted the study, and gave comments on the manuscript. Acknowledgements We would like to thank those international medical students for participating our study and giving their comments and recommendations on surgical laboratory course. References Lu HZ. More effective vaccines and oral antivirals: Keys for the battle against Omicron. Biosci Trends. 2022;16(1):1–3. Kaul V, de Moraes AG, Khateeb D, Greenstein Y, Winter G, Chae J, et al. Medical Education During the COVID-19 Pandemic. Chest. 2021;159(5):1949–60. Fitzgerald DA, Scott KM, Ryan MS. Blended and e-learning in pediatric education: harnessing lessons learned from the COVID-19 pandemic. Eur J Pediatrics. 2022;181(2):447–52. Rajab MH, Gazal AM, Alkattan K. Challenges to Online Medical Education During the COVID-19 Pandemic. Cureus. 2020;12(7). Santos JM, De Jesus LF, Sealmoy RR, Fajardo RRC. Online Distance Learning Amidst the Pandemic COVID-19. Ijeri-International Journal of Educational Research and Innovation. 2021(15):291–304. Gong X, Huybers T. 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Online or Blended Learning: the COVID-19 Pandemic and First-Year Medical Students' Academic Motivation. Med Sci Educ. 2022;32(1):221–8. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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-1805348","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":126476123,"identity":"703f5c7f-2f8a-408d-9c5f-62a01298ffce","order_by":0,"name":"Xin Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIie3RIcsCMRjA8Y0DLZMzTgQ/wwPCRAz3VQRBDVMEo8V0FsV6fgybUVm4MrEeaLh0xQuKSXhf8DazO22C+4c9C/ux8CBks31toE8c46ma7feJAx+QZwX6FoFwL85kdPIalLNJaSOQW+SA7hsDkcNuM4DEaQacHUtSoMo8BbyQrwnbcgYXEAWIMjLwBcou4GDfQA4pgzYIoshYES+XRLweZ79QRRz9C80hXpQyHIAAkMm4+u/3CJXJaLcwkMqS12/kT3gQdtbXld+qubPOOr4bCFLr0KPc1wsl6tgaQbb0ix5uGOc8tNlstl/tAZ46U/MOmP1WAAAAAElFTkSuQmCC","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wang","suffix":""},{"id":126476124,"identity":"31e79e35-0bba-4c52-9f31-ee923187821d","order_by":1,"name":"Yi Wang","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Wang","suffix":""},{"id":126476125,"identity":"0fdd39ee-b0fb-431f-844e-c7ea40f6a03a","order_by":2,"name":"Yuping Liu","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Yuping","middleName":"","lastName":"Liu","suffix":""},{"id":126476126,"identity":"aea0d3d9-21b9-46b8-a792-f37c18cd14f5","order_by":3,"name":"Zhe Xie","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Zhe","middleName":"","lastName":"Xie","suffix":""},{"id":126476127,"identity":"8ea557cb-a5f2-49d7-94f5-276f4bfa12a8","order_by":4,"name":"Jingfeng Li","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Jingfeng","middleName":"","lastName":"Li","suffix":""},{"id":126476128,"identity":"2de7460d-586b-482a-9a14-4a05060f407b","order_by":5,"name":"Xinliang Liu","email":"","orcid":"","institution":"The University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Xinliang","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2022-06-28 21:31:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1805348/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1805348/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24935689,"identity":"6057cb13-c56d-4fd2-8b5f-9b8e23f960c9","added_by":"auto","created_at":"2022-08-08 17:38:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49138,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe blended teaching model for surgical laboratory course for international medical students\u003cspan class=\"ql-cursor\"\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1805348/v1/1760e3386b74aa59248f8424.jpg"},{"id":27151908,"identity":"a2ca12ee-60d0-4c30-b442-7c210fa350f3","added_by":"auto","created_at":"2022-09-29 19:24:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":379133,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1805348/v1/7160ecd1-6809-4f60-ac17-c67cd28432aa.pdf"}],"financialInterests":"","formattedTitle":"Assessment on a blended teaching model for surgical laboratory course among international medical students in response to the COVID-19 pandemic: a case study in a Chinese university","fulltext":[{"header":"Background","content":"\u003cp\u003eThe COVID-19 pandemic has been still ongoing in China. Currently, China has remained a \u0026lsquo;dynamic zero-COVID-19\u0026rsquo; policy in order to control the COVID-19 as far as possible at the minimum cost (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The COVID-19 has resulted in huge changes in people\u0026rsquo;s daily life, including medical education (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Medical universities or schools as a high risk to exposure to the COVID-19 need to be shut down when all level of the governments require students and educators to stay at home (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This has disrupted traditional medical education, which are mostly presented in clinical clerkships and face-to-face teaching activities. Online distance medical study has become part of medical education during the COVID-19 pandemic (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChina has been the third largest destination country globally to attract international students for higher education (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Especially, medicine is the most common program chosen by international students in China (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). On one hand, a portion of international students have chosen to go back to their home countries the COVID-19 pandemic. Due to international travel restrictions and cost at quarantine hotels during the COVID-19 pandemic set by Chinese government (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), some international students cannot go back to China for their study. Therefore, online distance medical study is a must for them to keep on studying. One the other hand, those international students who can still stay in China are able to attend the lectures and participate in clinical clerkships in person. Hence, a blended teaching model has become common for global medical education (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA blended teaching model is a teaching activity which combines online self-learning/teaching and classroom teaching (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Current studies have confirmed that a blended teaching model is applied to medical education. For example, Wu et al. has developed a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Coyle et al. conducted a narrative review to describe the application of blended learning to a sexual health education program (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Both of them have provided evidence that a blended teaching model is effective and feasible.\u003c/p\u003e \u003cp\u003eSurgical laboratory course is one of the basic surgical courses for medical students to get knowledge and practice. With the ongoing crisis of the COVID-19 pandemic in China and the increasing online teaching platforms, the blended teaching model for international medical students is necessary. The blended teaching model used in teaching surgical laboratory course for international medical students is innovative. It is necessary to assess the effectiveness of the blended teaching model. Therefore, our study aims at assessing the effectiveness of the combination of online teaching and classroom teaching in surgical laboratory course among international medical students in a Chinese university.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in Wuhan University (WHU), which is a comprehensive and key national university directly under the administration of the Ministry of Education in China. It is also one of the \u0026ldquo;211 Project\u0026rdquo; and \u0026ldquo;985 Project\u0026rdquo; universities in China. School of Medicine is one of the schools in WHU and Zhongnan Hospital of Wuhan University is one of three affiliated hospitals where medical students can participate in clinical clerkships. Currently, a total of 1623 international students are studying in WHU.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eAll international medical students who were enrolled in 2016\u0026ndash;2019 were included in our study. These international students were all 2-year undergraduate students majoring in Clinical Medicine for 5 years (2016 class, 2017 class, 2018 class, and 2019 class). Informed consent was obtained from the international students and the results would be published without any potential possibility to share any information about personal data.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eThe blended teaching model for\u003c/span\u003e \u003cem\u003esurgical laboratory course\u003c/em\u003e\u003c/p\u003e \u003cp\u003eTraditional teaching model (face-to-face teaching): International medical students were required to independently complete the assigned reading material, including theoretical knowledge, operational overview, and step-by-step instructions for surgical laboratory course prior to classroom teaching. In the first 20\u0026ndash;30 minutes of the class, the instructor summarised the main points of the skills and the application of laboratory equipment and precautions. Then, the students practiced their medical simulation skills after class.\u003c/p\u003e \u003cp\u003eOnline teaching model: With the full support from online platforms of WHU Luojia, our team has established a Massive Open Online Course (MOOC) for the international medical students. This can provide micro videos, extra reading material relevant to surgical laboratory course, and online assignments and assessments. Besides, we also provided the international medical students with online relevant information about the surgical laboratory course to help them get the most of knowledge.\u003c/p\u003e \u003cp\u003eTherefore, those international students enrolled in 2016 and 2017 only attend the traditional teaching model, while those enrolled in 2018 and 2019 attended both the traditional teaching model and online teaching model. Please see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment measures on the blended teaching model for surgical laboratory course\u003c/h2\u003e \u003cp\u003e All the international medical students were required to attend the lectures according to undergraduate medical course guidelines set by WHU. The course contents, reading materials, and assessment methods have been keeping the same. At the final stage of the surgical laboratory course learning, the international medical students needed to take part in the Objective Structured Clinical Examination (OSCE). The scores of OSCE accounted for 60% of the final results, while the scores of the performance of usual learning like attendance and the skills practice accounted for 40% of the final results. Therefore, the scores of OSCE and the performance of usual learning and the skills practice from 2019 to 2022 were used as measures to assess the effectiveness of the blended teaching model.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data were all entered in Excel file by two independent researchers in order to make sure of the data quality. Numerous data were presented in mean and standard deviation (SD) and independent \u003cem\u003et\u003c/em\u003e test was used to conclude the causal effects. Categorical data were presented in percentages and sums, and Chi-square test was used to conclude the causal effects. STATA 14 software was applied to conduct the relevant statistical analysis. The statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of the included international medical students\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 29 international medical students from 14 developing countries were included in our study. The mean age of all the international medical students was 25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 years. The mean age of the international medical students participating in the traditional teaching model was 26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 years, which was higher than that of those international medical students participating in the blended teaching model (24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 years). Moreover, more male international medical students were in the blended teaching model, while more female international medical students were in the traditional teaching model.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the included international medical students\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlended teaching model\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional teaching model\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"14\"\u003e\n \u003cp\u003eOrigin of country (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNepal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMongolia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMorocco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBenin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndonesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTajikistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomalia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArmenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGabon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZambia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYemen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCambodia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eDifferences on scores of OSCE and the performance of usual learning and skills practice between the blended teaching model and the traditional teaching model\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents that the mean scores of OSCE was 76.55\u0026thinsp;\u0026plusmn;\u0026thinsp;21.91, while it was 76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;22.05 for the usual learning and skill practice among all the international medical students. The mean scores of OSCE was 75.69\u0026thinsp;\u0026plusmn;\u0026thinsp;21.40 for the international medical students in the blended teaching model, which was close to that (77.47\u0026thinsp;\u0026plusmn;\u0026thinsp;23.21) for the international medical students in the traditional teaching model. The difference is not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.831). Besides, the mean scores of usual learning and skill practice for the international medical students in the blended teaching model was 74.40\u0026thinsp;\u0026plusmn;\u0026thinsp;20.92, which was lower than that (77.43\u0026thinsp;\u0026plusmn;\u0026thinsp;23.18) for the international medical students in the traditional teaching model. The difference is not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.714).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eScores of OSCE and the performance of usual learning and the skills practice between the blended teaching model and the traditional teaching model\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScores (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlended teaching model\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTraditional teaching model\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e test\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOSCE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.55\u0026thinsp;\u0026plusmn;\u0026thinsp;21.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.69\u0026thinsp;\u0026plusmn;\u0026thinsp;21.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.47\u0026thinsp;\u0026plusmn;\u0026thinsp;23.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsual learning and skills practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;22.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.40\u0026thinsp;\u0026plusmn;\u0026thinsp;20.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.43\u0026thinsp;\u0026plusmn;\u0026thinsp;23.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study used the surgical laboratory course as an example to show the effectiveness of the blended teaching model. According to our findings, the blended teaching model could achieve the goal of the traditional one by comparing the scores. International medical students could study normally before the COVID-19 pandemic. A study conducted by Agustina provided evidence that blended learning models could improve student learning outcomes among nursing students (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This also means that a blended teaching model could satisfy the requirements of international medical students suffering the interruption like the COVID-19 pandemic. Besides, unlike the traditional teaching model in which instructor has the domain role, our online and offline blended teaching successfully set international medical students as priority. International medical students had more discretionary time and were more active and motivated to attend the lectures or participate in the clinical clerkships. This blended teaching model also increased the interaction between instructors and international medical students, which can contribute to global medical education.\u003c/p\u003e \u003cp\u003eSince our international medical students are all from developing countries, this requires that not only medical universities or schools in China need to achieve the capacity to complement the blended teaching, but also developing countries can support those international medical students back to home countries to be involved in the blended teaching. Eight independent factors which may have an impact on the blended teaching during the COVID-19 pandemic are summarized in a study (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). They are e-learning environment, e-learning facilitation, e-learning materials, e-learning technical support, instructor\u0026rsquo;s personal attention, interaction with instructors, interaction with peer students, and laboratory learning environment. To note, the blended teaching model definitely needs the support of information technology, which might be a challenge in some developing countries (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe blended teaching model not only enables global medical education for educators, but also minimises disruptions to students\u0026rsquo; daily schedules and keep students\u0026rsquo; motivation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Our study reveals that a blended teaching model incorporating a formative assessment addresses the barriers which prevent international medical students quarantined at home due to the COVID-19 pandemic from synchronising their learning progress with on-campus medical students. Online distance learning, discussion and interaction are provided through a MOOC system. International medical students can choose to participate in learning either synchronously or asynchronously and are able to attend the lectures of surgical laboratory course at different locations and times. Therefore, the blended teaching model may become the new normal even for the post-COVID-19 pandemic (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproved blended teaching models are currently mostly applied in platforms of universities or schools by various online platforms (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Their application to global medical education still needs to be elaborated by cross-regional, multi-centre pedagogical pilot designs and empirical studies. Transition from a traditional face-to-face teaching model into a blended teaching model requires concerted efforts and dedicated technical and pedagogical policy support at all levels. On December 9, 2021, the China Consortium of Universities for Global Health (CCUGH) elected Wuhan University as the fifth presidential institution of the Consortium through an anonymous vote at a web conference. CCUGH aims to establish interdisciplinary collaboration and promote knowledge sharing amongst member universities in China to address global health challenges, including global health education. In the future, CCUGH will focus on promoting the popularisation and standardisation of global health education, which will provide a good platform and policy support for the practice and promotion of the improved blended learning strategy in major medical schools worldwide.\u003c/p\u003e \u003cp\u003eBy implementing the blended teaching, international medical students are provided with simultaneous, high-quality access to general surgery theory. The fulfilment of the course may require close contact among international medical students. The blended teaching model is an effective way to meet the challenges in the context of the COVID-19 pandemic. In addition, students participating in face-to-face teaching and online interactive learning showed a high level of autonomy in learning and questioning and were highly satisfied with their learning outcomes, and it was effective to reduce the risk of getting COVID-19 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has triggered changes in the teaching and assessment of medical education and it would persist for a long period. Strategic innovations that use information technology in conjunction with existing medical teaching methods can address current medical education issues, especially for international medical students. These innovations for continuous improvement and development provide the basis for blended teaching, online learning and formative assessment in global medical education.\u003c/p\u003e \u003cp\u003eOur study also has some limitations. This is a single centre study and the sample size is not enough because of the limited number of international medical students in this Chinese university. Therefore, the findings cannot be widely applied. A multi-centre study and more data need to be conducted to achieve the robust results in the future. Also, comparative analysis between different countries is necessary to learn different education models.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study as a preliminary study confirmed that a blended teaching model was effective like the traditional teaching model, which can reduce the disruption for the international medical students\u0026rsquo; study during the COVID-19 pandemic. Online interactions between international medical students and instructors positively contribute to global medical education. Better coordination of online and face-to-face blended teaching models is an important direction for global medical education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCCUGH:\u003c/strong\u003e China Consortium of Universities for Global Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCTBL:\u0026nbsp;\u003c/strong\u003eClinical teaching blended learning\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMOOC:\u003c/strong\u003e Massive Open Online Course\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOSCE:\u003c/strong\u003e Objective Structured Clinical Examination\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD:\u003c/strong\u003e standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWCP\u003c/strong\u003e: Web-based clinical pedagogy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHU:\u003c/strong\u003e Wuhan University\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study was approved by ethic committee from Zhongnan Hospital of Wuhan University. Informed consent was obtained from the international students and the results would be published without any potential possibility to share any information about personal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was obtained from the international students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX.W. designed and conducted the study, gave comments on the manuscript, and was in charge of the whole study. Y.W. analysed the data and drafted the manuscript. Y.L. collected and analysed the data. Z.X. conducted the study and gave comments on the manuscript. X.L. drafted and revised the manuscript, and analysed the data. J.L. designed and conducted the study, and gave comments on the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank those international medical students for participating our study and giving their comments and recommendations on surgical laboratory course.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLu HZ. More effective vaccines and oral antivirals: Keys for the battle against Omicron. Biosci Trends. 2022;16(1):1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaul V, de Moraes AG, Khateeb D, Greenstein Y, Winter G, Chae J, et al. Medical Education During the COVID-19 Pandemic. Chest. 2021;159(5):1949\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitzgerald DA, Scott KM, Ryan MS. Blended and e-learning in pediatric education: harnessing lessons learned from the COVID-19 pandemic. Eur J Pediatrics. 2022;181(2):447\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajab MH, Gazal AM, Alkattan K. Challenges to Online Medical Education During the COVID-19 Pandemic. Cureus. 2020;12(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos JM, De Jesus LF, Sealmoy RR, Fajardo RRC. Online Distance Learning Amidst the Pandemic COVID-19. Ijeri-International Journal of Educational Research and Innovation. 2021(15):291\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong X, Huybers T. International student flows into provincial China - the main motivations for higher education students. Higher Education Research \u0026amp; Development.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi W, Liu C, Liu SJ, Zhang X, Shi RG, Jiang HL, et al. Perceptions of education quality and influence of language barrier: graduation survey of international medical students at four universities in China. Bmc Medical Education. 2020;20(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi H, He J, Chen J, Pan S, Feng J, Liu S. The governance of imported 2019-nCov infections: What can be learned from China\u0026rsquo;s experience? Global Health Research and Policy. 2022;7(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSankar JP, Kalaichelvi R, Elumalai KV, Alqahtani MSM. EFFECTIVE, BLENDED LEARNING IN HIGHER EDUCATION DURING COVID-19. Inform Technol Learn Tools. 2022;88(2):214\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Zhou JH, Wang Y, Qi GY, Xia CB, Mo G, et al. Blended learning in basic medical laboratory courses improves medical students' abilities in self-learning, understanding, and problem solving. Adv Physiol Educ. 2020;44(1):9\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMegahed N, Ghoneim E. Blended Learning: The New Normal for Post-COVID-19 Pedagogy. International Journal of Mobile and Blended Learning. 2022;14(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu XV, Chi YC, Selvam UP, Devi MK, Wang W, Chan YS, et al. A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors' Teaching Competencies: Pretest and Posttest Study. Journal of Medical Internet Research. 2020;22(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoyle KK, Chambers BD, Anderson PM, Firpo-Triplett R, Waterman EA. Blended Learning for Sexual Health Education: Evidence Base, Promising Practices, and Potential Challenges. J Sch Health. 2019;89(10):847\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgustina AN, Knowledge E, editors. Blended Learning Models to Improve Student Learning Outcomes During the Covid-19 Pandemic. 4th International Virtual Conference on Nursing (IVCN); 2020 Aug 30; STIKep PPNI Jawa, Bandung, INDIA2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNjambi KV, Mayoka GW. Inequality in accessing learning during pandemic crises in developing countries: Reflections from COVID-19-induced online learning at a Kenyan pharmacy school. Pharm Educ. 2021;21(1):713\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEli-Chukwu NC, Igbokwe IC, Ifebude B, Nmadu D, Iguodala W, Uma U, et al. Challenges confronting e-learning in higher education institutions in Nigeria amid Covid \u0026ndash; 19. Journal of Applied Research in Higher Education.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa L, Lee CS. Evaluating the effectiveness of blended learning using the ARCS model. J Comput Assist Learn. 2021;37(5):1397\u0026ndash;408.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasaran S. Investigating University Students' Acceptance of Blended Learning during COVID-19 Pandemic. International Transaction Journal of Engineering Management \u0026amp; Applied Sciences \u0026amp; Technologies. 2021;12(13).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevi B, Sharma C, Lepcha N. Blended Learning - A Global Solution in the Age of COVID-19. J Pharm Res Int. 2021;33(41B):125\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar A, Krishnamurthi R, Bhatia S, Kaushik K, Ahuja NJ, Nayyar A, et al. Blended Learning Tools and Practices: A Comprehensive Analysis. Ieee Access. 2021;9:85151\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolatov AK, Gabbasova AM, Baikanova RK, Igenbayeva BB, Pavalkis D. Online or Blended Learning: the COVID-19 Pandemic and First-Year Medical Students' Academic Motivation. Med Sci Educ. 2022;32(1):221\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Global medical education, COVID-19, Surgical laboratory course, Case study, International medical students, China","lastPublishedDoi":"10.21203/rs.3.rs-1805348/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1805348/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the ongoing crisis of the COVID-19 pandemic in China and the increasing online teaching platforms, the blended teaching model for international medical students is necessary. Our study aims at assessing the effectiveness of the combination of online and classroom teaching in surgical laboratory course among international medical students in a Chinese university.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study conducted in a Chinese university. All international medical students enrolled in 2016\u0026ndash;2019 were included in our study and were all third year undergraduate students majoring in Clinical Medicine for a 5-year program. At the final stage of the surgical laboratory course learning, the scores of OSCE (Objective Structured Clinical Examination) and the performance of usual learning and the skills practice from 2019 to 2022 were used as measures to assess the effectiveness. STATA 14 software was applied to conduct the relevant descriptive and statistical analysis. The statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 29 international medical students from 14 developing countries were included in our study. The mean age of them was 25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 years. The mean scores of OSCE was 76.55\u0026thinsp;\u0026plusmn;\u0026thinsp;21.91, and it was 76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;22.05 for the usual learning and skill practice among all the international medical students. The mean scores of OSCE was 75.69\u0026thinsp;\u0026plusmn;\u0026thinsp;21.40 for the international medical students in the blended teaching model, close to that (77.47\u0026thinsp;\u0026plusmn;\u0026thinsp;23.21) in the traditional teaching model. Besides, the mean scores of usual learning and skill practice for the international medical students in the blended teaching model was 74.40\u0026thinsp;\u0026plusmn;\u0026thinsp;20.92, lower than that (77.43\u0026thinsp;\u0026plusmn;\u0026thinsp;23.18) in the traditional teaching model (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur study as a preliminary study confirmed that a blended teaching model was effective like the traditional teaching model, which can reduce the disruption for the international medical students\u0026rsquo; study during the COVID-19 pandemic. Online interactions between international medical students and instructors positively contribute to global health education. Better coordination of online and face-to-face blended teaching models is an important direction for global medical education.\u003c/p\u003e","manuscriptTitle":"Assessment on a blended teaching model for surgical laboratory course among international medical students in response to the COVID-19 pandemic: a case study in a Chinese university","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-08 17:38:50","doi":"10.21203/rs.3.rs-1805348/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d27bb7b-e991-476e-a2ed-92efbb65bc54","owner":[],"postedDate":"August 8th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-09-29T19:24:25+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-08 17:38:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1805348","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1805348","identity":"rs-1805348","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}