Integrating Medical History into Organ-System Based Curriculum : A Retrospective Study

Integrating Medical History into Organ-System Based Curriculum : A Retrospective Study | 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 Integrating Medical History into Organ-System Based Curriculum : A Retrospective Study Xiaoyun Chen, Mao Fang, Zhenxing Li, Yanfang Xing, Jialin Yang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6994936/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Aim This study aimed to explore the integration of medical history into clinical lecture-based learning, evaluating its impact on the teaching quality of the organ-system-based curriculum (OSBC) as an integration tool, and to investigate a cost-effective approach to implementing interdisciplinary teaching. Background OSBC symbolizes the current trajectory of medical education reform. The implementation of OSBC in China encounters several challenges, including a dearth of effective integration strategies, the inadequacy of traditional lecture-based learning for integrated curricula, insufficient cultivation of students' critical and innovative thinking, and escalating educational expenses. Methods A retrospective study was conducted involving students from 2021 to 2022. Medical history was integrated into clinical lecture-based learning at functional nodes without increasing faculty workload or teaching hours. Students who received the new teaching method were divided into the experimental group, while the other students, who did not receive the method, were in the control group. Formative and summative assessments were utilized to compare the performance of the two groups in terms of in-class and final exam results, the excellent rate of innovation and critical thinking, and student satisfaction. Results Compared with the control group, the experimental group demonstrated significantly higher rates of excellence in final assessments (78.3% vs. 37.3%, P < 0.0001), innovation scores (78.3% vs. 25.4%, P < 0.0001), critical thinking scores (55% vs.16.9%, P < 0.0001).Similarly, the satisfaction of students in the experimental group was higher than that of the control group(96.7% vs. 71.2%, P < 0.0001). In the in-class assessment on primary immune thrombocytopenia, the experimental group demonstrated significantly higher accuracy in questions related to pathogenesis (85% vs. 40.7%, P < 0.0001), laboratory examination (85% vs. 42.4%, P < 0.0001), and therapeutic principles (93.3% vs. 67.8%, P < 0.0001). Conclusion Integrating the history of medicine into clinical lectures at key points of integration and enhancement improves the quality of OSBC through a multidisciplinary approach.It may enhance the linkage between foundational and clinical knowledge,and cultivate critical thinking and innovative abilities in students of this course. This innovative adaptation of LBL within OSBC suggests potential as a low-cost, locally feasible model for integrated curricula reform in China, though it still needs to be further validated in national research. Integrated Teaching Organ-System-Based Curriculum Medical History Teaching Method Lecture-Based Learning Critical Thinking Innovation Figures Figure 1 Background "System-based and competency-oriented" has been identified as the direction of the third-generation medical education reform in the 21st century [ 1 ] . Originating in Western countries, the Organ-System-Based Curriculum (OSBC) integrates basic and clinical sciences around organ systems to address the disconnect between theoretical knowledge and clinical reasoning, representing a new model aligned with modern integrated medical education reforms [ 2 – 6 ] . Most medical schools have adopted Problem-Based Learning (PBL), a student-centered small-group discussion approach, in place of traditional Lecture-Based Learning (LBL) as the primary teaching method in OSBC [ 7 – 8 ] . PBL promotes critical thinking and innovation by encouraging self-directed learning, thereby improving students' ability to solve clinical problems. Long-term implementation in Western medical schools has shown that the OSBC combined with PBL overcomes the limitations of traditional teaching and better cultivates core clinical competencies [ 9 – 10 ] . This model has gradually been introduced in non-Western countries, including China, with some success; however, its associated challenges and limitations have been largely overlooked. One major challenge in OSBC reform is the lack of effective integration strategies to enhance the cohesion of the curriculum. A decade-long U.S. study revealed that OSBC's restructured content lacked contextual and conceptual scaffolding compared to traditional curricula, resulting in difficulties integrating knowledge across topics and reduced student confidence in building foundational understanding [ 11 ] . Similar problems are seen in China, where the rearrangement of basic and clinical content by organ systems remains superficial and fragmented, impeding students’ comprehension of medical concepts [ 12 ] . Without meaningful interdisciplinary integration, the curriculum struggles to provide conceptual coherence. Furthermore, national survey data revealed that the curriculum insufficiently incorporates new medical technologies and methods, limiting its ability to stimulate innovative thinking among students [ 13 ] . Despite the emphasis on competence-based education, PBL implementation in OSBC is restricted, and traditional LBL is inadequate in promoting integration and innovation. While PBL fosters competency development, concerns have arisen over students’ inadequate grasp of foundational knowledge. Some studies suggest that PBL-trained students underperform in basic science exams, limiting PBL’s scalability [ 12 , 14 , 15 ] . Additionally, limited teaching resources, high costs, and cultural mismatches have hindered OSBC implementation in non-Western countries [ 16 – 25 ] . In China, many students struggle to adapt to PBL and face significant academic stress [ 15 ] . Due to constraints in faculty and scheduling, most countries now implement a hybrid model of LBL and PBL, but PBL hours remain limited [ 21 – 23 ] . LBL, a teacher-centered lecture format, lowers the cognitive load for knowledge acquisition but fails to inspire critical thinking. Moreover, LBL’s single-discipline delivery cannot adequately bridge basic and clinical knowledge. Therefore, innovating within the LBL framework to support integrated education—while retaining its practical advantages—has become an urgent need. Guangzhou Medical University has implemented OSBC in its clinical medicine program since 2015.The curriculum is divided into three phases: general education, specialty courses, and clinical practice. During the specialty phase, basic and clinical sciences are integrated into system-based modules, such as the hematology and immunology module, taught by interdisciplinary teams of basic and clinical faculty. LBL, PBL, and self-directed learning are the primary instructional methods. Due to limited faculty resources, PBL accounts for only 21% of total teaching time, and LBL remains dominant. Although the course sequence has been restructured around organ systems, lectures from basic and clinical disciplines are still delivered independently, and true integration has not been realized. Consequently, LBL fails to contribute to knowledge integration or the development of innovation skills. Course evaluation is based on closed-book theoretical exams, innovation scores, and critical thinking assessments. Prior assessments showed unsatisfactory student performance in theoretical exams and weak foundational knowledge. Furthermore, Chinese students’ limited experience with self-directed learning and critical thinking has resulted in low innovation and critical thinking scores in PBL assessments. Interviews revealed that some students find the separation of content from original disciplines disorienting and report difficulty adapting to PBL. Thus, a pressing challenge is how to cost-effectively reform LBL to enhance curricular integration and foster innovation. Medical history became an independent discipline in medical education since the 19th century.In recent years, there has been growing interest in its pedagogical value. First, medical history provides conceptual tools that aid in learning complex diseases and syndromes with unfamiliar terminology [ 24 ] . Historical facts can also highlight new research directions and introduce novel professional concepts [ 24 ] . Second, the narrative structure of medical history—whether chronological or thematic—can connect basic and clinical knowledge through disease exploration [ 25 ] . Additionally, understanding the evolution of medical innovation fosters a critical mindset [ 24 , 26 – 28 ] . Therefore, integrating medical history into LBL lectures may help students grasp medical concepts, organize knowledge frameworks, and cultivate innovation from a historical perspective. We propose that medical history is a potential tool for curricular integration. At present, medical history is taught either as a standalone course or embedded within other subjects, but its interdisciplinary implementation lacks standardization [ 25 , 26 , 29 ] . While independent history of medicine courses are common, their scheduling burden makes them rare in Chinese medical schools. As of 2023, more than half of Korean medical schools offer medical history education, mostly through lectures. However, such unidirectional teaching presents motivational challenges for students [ 25 ] . Queen's University in Canada pioneered an embedded approach, integrating medical history into foundational science courses by teaching the history of each subject alongside its content [ 30 ] . This approach, however, requires strong interdepartmental coordination and protection of allocated teaching hours. Some scholars in North America have proposed brief integration of medical history with clinical content, which appears promising [ 31 ] . Nonetheless, no studies to date have explored the integration of medical history into OSBC clinical modules, nor have specific implementation strategies been described. This retrospective study is the first to explore a low-cost, interdisciplinary implementation of medical history in OSBC. Without increasing teaching time or staffing, we embedded disease-specific medical history into LBL lectures at strategic integration and enrichment points within clinical modules. We then evaluated the impact of this approach on curriculum quality, critical thinking, and innovation among medical students. Materials and Methods Study Design This retrospective study was conducted among undergraduate clinical medicine students at Guangzhou Medical University who participated in an organ system-based integrated curriculum between 2021 and 2022. Students who, for any reason, did not complete the Hematology and Immunology module or its evaluation were excluded. Students who received the traditional single-discipline LBL were designated as the control group, while those who received the new teaching method—LBL incorporating medical history into the clinical modules—were assigned to the experimental group. The effectiveness of the two teaching approaches was compared using both online and offline closed-book examinations, innovation and critical thinking scoring rubrics, and student satisfaction surveys to evaluate whether integrating medical history into clinical lectures improved the teaching quality of the organ system-based curriculum. No standalone medical history course was added; rather, a cross-disciplinary teaching model was adopted. Teaching was delivered by the original Hematology and Immunology teaching team, consisting of both basic and clinical faculty members, without increasing faculty load or teaching hours. Characteristics of the Study Population A total of 119 students who completed the Hematology and Immunology module were included in the study.Among them, 59 students who received the traditional single-discipline LBL formed the control group, while 60 students who participated in the interdisciplinary LBL with integrated medical history formed the experimental group. The experimental group included 31 male and 29 female students, aged 19 to 21 years, with a median age of 20(20,21) years. The control group included 37 male and 22 female students, aged 20 to 21 years, with a median age of 20 (20,20) years. No statistically significant differences were found in the baseline characteristics between the two groups ( P > 0.05), indicating comparability. See Table 1 . Table 1 Baseline Characteristics Control group (n = 59) Experimental group (n = 60) χ 2 /Z P Male:n(%) 37(62.71%) 31(51.67%) 1.482 0.223 Age:[M(P25,P75),year] 20(20,20) 20(20,21) -0.487 0.626 Implementation Plan Development of a Historical Medical Database Categorized by Diseases within the Organ System The database was constructed following these steps: A.Collection Medical historical data were collected based on diseases covered in the Hematology and Immunology module. Sources included PubMed, medical textbooks, and clinical practice guidelines. B.Selection The integration of medical history into the clinical lectures of the Hematology and Immunology module was based on two types of instructional nodes.Primary nodes include introduction points, bridging points, turning points, and expansion points, which serve to integrate knowledge by illustrating the origin of concepts and constructing a knowledge framework through historical context. Introduction points refer to initial case reports or the historical emergence of medical problems. Bridging points refer to laboratory discoveries related to the formation of medical concepts, disease mechanisms, and treatment foundations. Turning points represent milestone events that advanced disease diagnosis and treatment. Expansion points highlight unresolved or controversial issues. Secondary nodes, or enhancement points, include historically innovative or critical perspectives in disease research, as well as influential historical figures. These nodes aim to foster students' understanding of critical and innovative thinking through exemplary role models from history. C.Database Construction After selection, historical materials meeting the criteria for these nodes were discussed by the teaching team and finalized by the team leader before being entered into the database. A comprehensive medical history database related to Hematology and Immunology diseases was then built and made accessible both online and offline. D.Database Validation After completion of the module, the teaching team reviewed teaching evaluations, feedback from course supervisors, student performance, and satisfaction surveys to revise the database by adding, removing, or modifying materials as needed. Implementation of Node-Based Integration of Medical History into the Teaching of the Integrated Curriculum The Hematology and Immunology module is one of the professional subject modules in Guangzhou Medical University’s integrated curriculum, delivered through a hybrid teaching model that combines LBL, PBL, and self-directed learning. LBL still accounts for 76.5% of the teaching hours, while PBL makes up only 21%. This study specifically reformed the LBL component of disease-based teaching within the module. The teaching team conducted collective lesson planning and extracted historical materials from the custom-built database relevant to system-specific diseases. These were embedded into the lectures at both primary and secondary node positions. New teaching objectives were added to foster students’ critical and innovative thinking. Teaching design utilized timeline-based PowerPoint (PPT) presentations as a key instructional tool. These PPTs followed either a chronological or thematic sequence, using historical events corresponding to the two node types as connection points to organize and integrate basic and clinical knowledge. An example of such a timeline PPT for the Primary Immune Thrombocytopenia (pITP) topic is shown in Fig. 1 . Outcome Measures The outcome measures included results from both formative and summative assessments.Formative assessments included in-class quizzes, PBL evaluations, and student satisfaction surveys.Summative assessment was conducted using a final closed-book examination.The in-class quiz was administered during the pITP lecture of the Hematology and Immunology module. It consisted of four multiple-choice questions evaluating students’ understanding of pITP’s pathogenesis, clinical manifestations, laboratory findings, and treatment principles. The accuracy rate for each question was used to assess students’ mastery of corresponding basic knowledge. An overall improvement across all four question types in the experimental group was used as an indirect indicator of the level of knowledge integration in that chapter.The PBL evaluation was conducted during the PBL sessions linked to the professional lectures within the organ system module. A 10-point grading scale (see Table 2 ) was used. A score of ≥ 7 was considered “excellent.” The excellent rate between the experimental and control groups was compared.The final examination and satisfaction survey were conducted after completion of the organ system module. The final test used clinical case-based questions to assess students’ ability to apply knowledge comprehensively. A score of ≥ 80 was considered “excellent,” and the excellent rates were compared between groups.Student satisfaction was categorized as “very satisfied,” “satisfied,” or “neutral.”The satisfaction questionnaire (see Supplementary File 1) was designed specifically for this study and reviewed by medical education experts.The survey was administered anonymously. The calculation methods were as follows: Indicator 1: Accuracy Rate = (Number of students who selected the correct answer) / (Total number of students assessed in the group) × 100% Indicator 2: Excellence Rate = (Number of students who achieved an excellent score) / (Total number of students assessed in the group) × 100% Indicator 3: Satisfaction Rate = (Number of students who were very satisfied + satisfied) / (Total number of students) × 100% Table 2 Scoring Criteria for Innovative and Critical Thinking Ability Ability Type Level Scoring Criteria Score Creative Thinking Ability 1: Very Poor Rarely proposes new ideas and questions 1–3 2: Poor Limited ideas, answers based on online materials and textbooks 4–5 3: Average Repeats information from online sources and textbooks, but can propose some new ideas or questions 6 4: Good Actively proposes new ideas and questions, answers with an understanding of the material 7–8 5: Very Good Frequently proposes new ideas and questions, eager to learn, innovative spirit 9–10 Critical Thinking Ability 1: Very Poor Does not question or challenge others 1–3 2: Poor Occasionally questions or challenges 4–5 3: Average Sometimes willing to challenge 6 4: Good Frequently asks questions, demonstrating deep thinking 7–8 5: Very Good Frequently asks questions that promote deeper thinking, actively engages in rational debates 9–10 Statistical Analysis SPSS 29.0 statistical software was used to analyze the data. Age, scores, and rating values were treated as continuous variables and were described using mean or median/interquartile range, with comparisons conducted using the t-test or Mann-Whitney U test. Categorical variables such as gender, accuracy rate, excellence rate, and satisfaction rate were expressed as frequency and percentage (n, %) and analyzed using the chi-square (χ²) or Fisher test. A p-value < 0.05 was considered statistically significant. Results After implementation of the new and traditional teaching methods, the average final examination scores for the experimental and control groups were 82.53 ± 4.681 and 76.80 ± 7.717, respectively. The excellence rate in the experimental group was significantly higher than that of the control group (78.3% vs. 37.3%, χ² test, P < 0.05), suggesting better academic performance among students in the experimental group (see Table 3 ). The in-class assessment for the pITP lecture revealed that, with the exception of the "clinical manifestations" category, all other questions had P-values less than 0.05.This indicates that students in the experimental group had significantly higher accuracy rates in questions assessing pITP pathogenesis, laboratory examination, and therapeutic principles compared to the control group (Pathogenesis: 85% vs. 40.7%; Laboratory examination: 85% vs. 42.4%; Therapeutic principles: 93.3% vs. 67.8%; all P < 0.05, see Table 4 ). The average scores for critical thinking abilities in the experimental and control groups were 7.77 ± 1.69 and 4.64 ± 1.48, respectively. The average scores for innovative abilities in the experimental group and control group were 7.85 ± 1.39 and 5.83 ± 1.29, respectively. The Mann-Whitney U test for critical thinking ability scores and innovative ability scores showed P < 0.0001* for both.Chi-square test results indicated that the excellence rates for both categories were significantly higher in the experimental group (Innovative thinking: 78.3% vs. 25.4%; Critical thinking: 55.0% vs. 16.9%; all P < 0.05, see Table 5 ). Regarding students' satisfaction, the experimental group showed a significantly higher satisfaction rate compared to the control group (96.7% vs. 71.2%), with the difference being statistically significant (χ² test, P < 0.05, see Table 6 ). Table 3 Comparison of Excellence Rates in Final Assessments under Different Teaching Methods Control group(n = 59) Experimental group(n = 60) χ 2 P Final Assessment Excellence Rate,n(%) 22(37.3%) 47(78.3%) 20.571 < 0.0001 * Note: * indicates that the P value is statistically significant. Table 4 Comparison of Accuracy Rates in In-class Test for the pITP Lecture Control group (n = 59) Experimental group(n = 60) χ 2 /Fisher P In-class Test Accuracy Rates Clinical Manifestation 54(91.5%) 57(95.0%) 0.573 0.449 n(%) Pathogenesis 24(40.7%) 51(85.0%) 25.077 < 0.0001 * Laboratory Examination 25(42.4%) 51(85.0%) 23.423 < 0.0001 * Therapeutic Principle 40(67.8%) 56(93.3%) 12.442 < 0.0004 * Note: * indicates that the P value is statistically significant. Table 5 Comparison of Students' Innovative and Critical Thinking Ability under Different Teaching Methods Control group (n = 59) Experimental group(n = 60) χ 2 P Excellent rates n(%) Innovation Ability Score 15(25.4%) 47(78.3%) 33.370 < 0.0001 * Critical Thinking Score 10(16.9%) 33(55.0%) 18.664 < 0.0001 * Note: * indicates that the P value is statistically significant. Table 6 Comparison of Student Satisfaction with Different Teaching Methods Very satisfied Satisfied General Satisfaction(%) Experimental Group (n = 60) 43 16 1 98.3% Control Group (n = 59) 10 31 18 69.5% χ 2 /Fisher 18.443 P < 0.0001 * Note: * indicates that the P value is statistically significant. Discussion In the organ-system-based integrated curriculum, the disintegration of basic disciplines may lead to superficial understanding of key concepts and mechanisms. Additionally, the simple juxtaposition of basic and clinical knowledge often lacks effective linkage and coherence. In this study, medical history was utilized as an integrative tool, leveraging its temporal and thematic characteristics to bridge basic and clinical content, thereby constructing a coherent disease knowledge framework. Through the implementation of two teaching approaches, we compared the experimental and control groups’ in-class assessments and final exam performances, and also evaluated student satisfaction. The in-class assessments focused on students’ understanding of basic knowledge such as concepts, pathogenesis, laboratory examinations, clinical manifestations, and therapeutic principles, while the final exam assessed students’ ability to apply knowledge comprehensively. The study results demonstrated a significantly higher excellence rate in the final exam among the experimental group, indicating that interdisciplinary LBL integrated with medical history can enhance students' mastery, comprehension, and application of knowledge. In the pITP module’s in-class assessments, the experimental group outperformed the control group in understanding pathogenesis, laboratory results, and therapeutic principles, suggesting the new teaching approach better supports the consolidation of foundational knowledge. Since clinical manifestations are not a major learning difficulty, our results did not show a notable advantage of the new method in that area. Moreover, students exposed to the new teaching model reported higher satisfaction levels. These findings suggest that embedding medical history in clinical medical lectures improved the teaching quality of the hematology and immunology module within the integrated curriculum. The organ-system curriculum is currently a primary model for medical integration reform, yet effective tools for achieving true integration remain limited and understudied. Most medical schools rely on reordering course content and adopting methods like PBL to promote integration. This study investigated whether embedding medical history into clinical lectures could support integration within the organ-system framework. In the pITP module, we demonstrated the use of a historical timeline in LBL to connect the development of disease mechanisms, laboratory diagnostics, and treatment evolution, thus integrating basic and clinical aspects of the disease. As no international tool exists to directly evaluate the degree of curriculum integration, we inferred enhanced integration from the simultaneous improvement of student performance in pathogenesis, diagnostics, and treatment items. Developing students' critical thinking and creativity is a core goal of integrated teaching, particularly through PBL. However, limitations such as restricted instructional hours and student adaptability issues in China affect the efficacy of PBL [ 15 ][ 18 ] . Medical history can foster critical and innovative thinking by exposing students to objective patterns and role models in medical development. Under a hybrid teaching model, LBL serves as a preparatory phase, easing the transition to PBL and reducing the associated learning curve, thereby improving the integration of old and new methods. Our results showed significantly higher excellence rates in critical and innovative thinking scores among the experimental group, indicating that even without increased PBL-associated costs, reforms to traditional LBL can still enhance medical students’ cognitive competencies. A key challenge remains in how to integrate medical history into teaching without increasing instructional load or faculty burden. A recent cross-sectional study proposed a model that embeds disease history into surgical pathology lectures without altering existing curricula [ 35 ] . Encouragingly, this approach was well-received by students. Consistent with that study, our findings support the integration of medical history into clinical LBL sessions within the hematology and immunology module, yielding higher student satisfaction compared to traditional LBL. While integrated teaching reform originated in Western countries and is now globally promoted, even developed nations such as the U.S. face rising education costs after a decade of reform [ 16 ] . A recent review also highlighted resource limitations as a major barrier to PBL implementation in developing countries [ 23 ] . Therefore, localized reforms must balance effectiveness with feasibility. Our study proposed a structured approach for integrating medical history into organ-system teaching. We adopted a node-based, interdisciplinary strategy to avoid adding new courses or instructional hours. The teaching team-led by clinical faculty with support from basic science instructors-required no additional staff, thereby reducing institutional costs. The main contributions of this study are as follows : To our knowledge, this is the first study internationally to demonstrate the advantages of using medical history as an integrative tool in LBL reform within organ-system curricula.We established a novel mode of historical integration under the integrated curriculum, applying a node-based fusion and historical timeline approach.We explored a method for constructing disease history databases and observed that non-historian faculty teams could complete this implementation in our study setting.Our preliminary findings suggest this LBL approach may represent a cost-effective option worthy of further investigation in Chinese medical education contexts. The experience gained through this study could contribute to ongoing discussions about LBL reform and localized adaptation of integrated curricula in non-Western setting. Limitations Due to the small-class structure and single-module focus (hematology and immunology), the generalizability of our findings is limited. Future studies with larger, multi-module samples are needed to confirm these results. While the small-class setting at Guangzhou Medical University allowed for detailed implementation and observation, it inherently restricted our sample size. Furthermore, confining the study to the hematology and immunology module—though representative of our integrated curriculum—may not fully capture the challenges and outcomes of history integration across other disciplines (e.g., cardiology or neurology). Future multi-center studies with larger cohorts and broader disciplinary coverage are needed to validate the scalability of this approach. The absence of disease-classified medical history textbooks necessitated in-house material compilation by our teaching team. Although we have strictly referenced monographs and historical documents, the educational authority and comprehensiveness of these materials still need to be further verified. Collaborative efforts with medical historians could enhance the scholarly rigor of such resources. Moreover, the potential for instructor bias in material selection warrants scrutiny in future iterations. Our evaluation of integration efficacy relied on indirect proxies (e.g., student feedback, thematic analysis of discussions) due to the lack of validated tools for measuring the degree of integration of Organ-System Based Curriculum .Developing standardized metrics could strengthen future studies. The feasibility of this model has been preliminary validated within medical schools operating under China’s unique educational framework, where the integration of humanities remains at an early developmental stage. However, its generalizability to other countries—particularly those with differing historical narratives or curricular structures—has yet to be established. Cross-cultural adaptation would require careful consideration of local pedagogical traditions. Conclusion This study marks the first attempt to explore the educational value of medical history from a disease-based perspective. It provides preliminary evidence for the feasibility and effectiveness of incorporating medical history into clinical lectures within integrated curricula, meriting further investigation. By adopting a node-based, interdisciplinary approach, we enhanced the overall integration of course content and teaching objectives, improving the adaptability of integrated teaching in the Chinese educational setting. Future efforts should aim to expand the research scope, involve medical history experts in in-depth discussions, engage more clinical and basic science faculty in resource development, identify standard evaluation tools for integration, and increase student and long-term course evaluations. These actions will further refine our teaching model and offer new perspectives for integrated education reform in non-Western countries. Abbreviations Full title Abbreviation Organ-system based Curriculum OSBC Lecture-based Learning LBL Problem-based Learning PBL Primary Immune Thrombocytopenia pITP PowerPoint PPT Thrombopoietin TPO Recombinant Human Thrombopoietin rhTPO Thrombopoietin Receptor Agonists TPO-RA Intravenous human gamma globulin IVIG Declarations Acknowledgments The authors would like to thank the students who responded to the survey and Professor Cui Junfeng, an expert in the history of medicine at Zhejiang Normal University, for guiding the research. Authors' Contributions Chen Xiaoyun is the lead author, responsible for research design, implementation, and manuscript writing. Fang Mao, Li Zhenxing, Xing Yanfang, and Yang Jialin were responsible for the student survey, organizing the results, and data analysis. Zhang Jianyu proofread and supervised the manuscript. Li Xue contributed to research design, implementation, and manuscript revision, and was responsible for the initial research idea. All authors have read and approved the final manuscript. Funding Research project on undergraduate teaching reform of clinical teaching bases of general higher medical colleges in Guangdong Province(20233276).Guangzhou Education Science Planning(202214114). Clinical Trial Number ： Not applicable. Consent for publication ： Not applicable. Data and Materials Availability All data generated or analyzed during the current study can be obtained from the corresponding author, Chen Xiaoyun. Statement This study was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, in accordance with the Declaration of Helsinki. All research methods followed relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, approval number [2025] No. 028. As this is a retrospective study, the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University waived the requirement for written informed consent from participants. All authors declare no conflicts of interest. References Tomorrow's Doctor[EB/OL]. [2008- 07- 20]. http://www.gmc-uk.org/education/undergraduate/undergraduate_policy/tomorrows_ doctors.asp. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, García PJ, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Profesionales de la salud para el nuevo siglo: transformando la educación para fortalecer los sistemas de salud en un mundo interdependiente [Health professionals for a new century: transforming education to strengthen health systems in an interdependent world]. Rev Peru Med Exp Salud Publica. 2011 Jun;28(2):337-41. Brown G, Manogue M. AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers. Med Teach. 2001 May;23(3):231-244. Papa F J, Harasym P H. Medical curriculum reformin North America, 1765 to the present: a cognitivescience perspective [ J] .Acad Med, 1999, 74 (2) :154-164. Peters AS, Greenberger-Rosovsky R, Crowder C, Block SD, Moore GT. Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial. Acad Med. 2000;75(5):470-479. Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, Lee R, Remen RN; Education Working Group, Consortium of Academic Health Centers for Integrative Medicine. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004 Jun;79(6):521-31. Koens F, Custers E J F M, Ten Cate O T J. Clinical and basic science teachers, opinions about the required depth of biomedical knowledge for medical students[ J] . Med Teach, 2006, 28( 3) : 234-238. Moore GT, Block SD, Style CB, Mitchell R. The influence of the New Pathway curriculum on Harvard medical students [J]. Acad Med, 1994, 69(12): 983- 989. MBBS. A 5- year undergraduate programme. [EB/OL]. [2008- 07- 20].http://www.smd - edu.qmul.ac.uk/student_info/Undergrad/mbbs/index.php. Neufeld VR, Woodward CA, MacLeod SM. The McMaster M.D. program: a case study of renewal in medical education. Acad Med. 1989 Aug;64(8):423-32. Sulaiman N, Hamdy H. Problem-based learning: where are we now? Guide supplement 36.3--Practical Application. Med Teach. 2013;35(2):160-2. Schauber SK, Hecht M, Nouns ZM, Kuhlmey A, Dettmer S. The role of environmental and individual characteristics in the development of student achievement: a comparison between a traditional and a problem-based-learning curriculum. Adv Health Sci Educ heory Pract. 2015 Oct;20(4):1033-52. Hidaka BH, Asghar A, Aktipis CA, Nesse RM, Wolpaw TM, Skursky NK, Bennett KJ, Beyrouty MW, Schwartz MD. The status of evolutionary medicine education in North American medical schools. BMC Med Educ. 2015 Mar 8;15:38. Muller JH, Jain S, Loeser H, Irby DM. Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Med Educ. 2008 Aug;42(8):778-85. Huang L, Cai Q, Cheng L, et al. Analysis of curricular reform practices at Chinese medical schools. Teach Learn Med. 2014;26(4):412-419. Dahle LO, Brynhildsen J, BehrbohmFallsberg M, Rundquist I, Hammar M. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden. Med Teach. 2002 May;24(3):280-5. Pfeifer CM. A progressive three-phase innovation to medical education in the United States. Med Educ Online. 2018 Dec;23(1): 1427988. Li T, Song R, Zhong W, Liao W, Hu J, Liu X, Wang F. Use of problem-based learning in orthopaedics education: a systematic review and meta-analysis of randomized controlled trials. BMC Med Educ. 2024 Mar 8;24(1):253. Bârsu C. History of Medicine between tradition and modernity. Clujul Med. 2017;90(2):243-245. Park JY, Park S. How to Teach History of Medicine at Medical School: Period, Structure, and Teaching Methods. Uisahak. 2023 Aug;32(2):595-621. Challenges experienced by Korean medical students and tutors during problem-based learning: a cultural perspective. Interdiscip linary J Problem-Based Learn. 2016;10(1). Shehnaz SI. A Five Year Longitudinal Study of the Educational Environment in a Newly Integrated Medical Curriculum. Sultan Qaboos Univ Med J. 2019;19(4):e335-e344. Zhu L, Sun GC, Guan YF. [Role of systematic integration teaching reform at the basic medicine teaching stage in Chinese medical education system]. Sheng Li Xue Bao. 2020 Dec 25;72(6):699-706. Obi CO, Onosogbe M, Ehimen AG, Olamide O, Toluwalase TV, Esther O, Joshua DO, Aborode AT. Comparison of the integrated organ/systems-based curriculum with the traditional subjects-based medical curriculum: Short communication. Ann Med Surg (Lond)..2021 Nov 25;73:103116. Solano J, Zuniga Gutierrez M, Pinel-Guzmán E, Henriquez G. Barriers and Solutions to Successful Problem-Based Learning Delivery in Developing Countries - A Literature Review. Cureus. 2023 Aug 9;15(8):e43187. Chan SCC, Gondhalekar AR, Choa G, Rashid MA. Adoption of Problem-Based Learning in Medical Schools in Non-Western Countries: A Systematic Review[J]. Teach Learn Med. 2024 Apr-May;36(2):111-122. Caramiciu J, Arcella D, Desai MS. History of Medicine in US Medical School Curricula. J Anesth Hist. 2015 Oct;1(4):111-4. Ahmad A, Kant S, Gupta SK. History of medicine in undergraduate medical curriculum in India. Natl Med J India. 2019 Nov-Dec;32(6):360-364. Kent L, Ward PJ. Investigating the Presence of the History of Medicine in North American Medical Education: Can One of the Medical Humanities Concisely Integrate with Biomedical and Clinical Content with Reference to Clinical Competencies? Med Sci Educ. 2020 Sep 17;30(4):1531-1539. Siri A, Gazzaniga V, Licata M, Ciliberti R. The teaching of the History of Medicine in Italy: a path in progress. Acta Biomed. 2021 Jul 1;92(3):e2021245. Iorio S, Gazzaniga V, Lippi D. History of medicine in medical education: new Italian pathways. J Med Libr Assoc. 2023 Apr 21;111(1-2):618-624. Lee KW. 150 Years of Medical History Education in Japan: History and Challenges. Uisahak. 2023 Aug;32(2):661-696. Lee ST, Yeh BI. Education of History of Medicine for 80 Years: History and Current Status in Republic of Korea. Uisahak. 2023 Apr;32(1):147-174. Stahnisch FW. Making Medical History Relevant to Medical Students: The First Fifty Years of the Calgary History of Medicine Program and History of Medicine Days Conferences. J Hist Med Allied Sci. 2023 Mar 23;78(1):83-100. Teo J, Cox A, Ngu T, Doan H, Sinha S. Infiltrating the Curriculum: Integrating Medical History with Existing Surgical Pathology Tutorials. MedEdPublish (2016). 2020 Mar 12;9:44. Rogers NP, Boes CJ. Leonard Rowntree, Louis Wilson, Fielding Garrison, and the origins of teaching medical history at the Mayo Clinic. Proc (Bayl Univ Med Cent). 2024 Feb 28;37(3):493-500. Bauer ME, Akbar S, Bauler TJ, et al. Exploration of the integration of microbiology and immunology emerging topics into undergraduate medical education. Med Educ Online. 2024;29(1):2336331. Dolmans DHJM, Loyens SMM, Marcq H, Gijbels D. Deep and surface learning in problem-based learning: a review of the literature. Adv Health Sci Educ Theory Pract. 2016;21(5):1087-1112. Nouns Z, Schauber S, Witt C, Kingreen H, Schüttpelz-Brauns K. Development of knowledge in basic sciences: a comparison of two medical curricula. Med Educ. 2012;46(12):1206-1214. Chen Yan-bin,Liu shui,et al.Thoughts on the Construction of Second Roud Organ-system Based Curriculum(OSBC) Textbook for Clinical Medicine Planned by the 13 th Five-year Plan of the National Health Commission 2 Medical EducationResearch and Practice Jun.2019 Vol.27 No.3. Additional Declarations No competing interests reported. Supplementary Files Satisfactionsurvey1.0.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers invited by journal 25 Sep, 2025 Editor invited by journal 03 Sep, 2025 Editor assigned by journal 23 Jul, 2025 Submission checks completed at journal 23 Jul, 2025 First submitted to journal 23 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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. 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1","display":"","copyAsset":false,"role":"figure","size":252902,"visible":true,"origin":"","legend":"\u003cp\u003eTimeline PPT for pITP\u003c/p\u003e\n\u003cp\u003eNote:rhTPO: Recombinant Human Thrombopoietin;TPO:Thrombopoietin;IVIG:Intravenous human gamma globulin\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6994936/v1/ef407b9f4987059b2f7c69a0.png"},{"id":93006036,"identity":"b99dfe7b-2c0b-4453-8c25-99d3da39b674","added_by":"auto","created_at":"2025-10-08 06:44:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1158780,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6994936/v1/b4f6ba05-9eee-491c-bdd9-16b037184532.pdf"},{"id":93003752,"identity":"268a7480-3c88-4b86-8968-8469889e6f82","added_by":"auto","created_at":"2025-10-08 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Originating in Western countries, the Organ-System-Based Curriculum (OSBC) integrates basic and clinical sciences around organ systems to address the disconnect between theoretical knowledge and clinical reasoning, representing a new model aligned with modern integrated medical education reforms \u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Most medical schools have adopted Problem-Based Learning (PBL), a student-centered small-group discussion approach, in place of traditional Lecture-Based Learning (LBL) as the primary teaching method in OSBC \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. PBL promotes critical thinking and innovation by encouraging self-directed learning, thereby improving students' ability to solve clinical problems. Long-term implementation in Western medical schools has shown that the OSBC combined with PBL overcomes the limitations of traditional teaching and better cultivates core clinical competencies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. This model has gradually been introduced in non-Western countries, including China, with some success; however, its associated challenges and limitations have been largely overlooked.\u003c/p\u003e\u003cp\u003eOne major challenge in OSBC reform is the lack of effective integration strategies to enhance the cohesion of the curriculum. A decade-long U.S. study revealed that OSBC's restructured content lacked contextual and conceptual scaffolding compared to traditional curricula, resulting in difficulties integrating knowledge across topics and reduced student confidence in building foundational understanding \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Similar problems are seen in China, where the rearrangement of basic and clinical content by organ systems remains superficial and fragmented, impeding students\u0026rsquo; comprehension of medical concepts \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Without meaningful interdisciplinary integration, the curriculum struggles to provide conceptual coherence. Furthermore, national survey data revealed that the curriculum insufficiently incorporates new medical technologies and methods, limiting its ability to stimulate innovative thinking among students \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite the emphasis on competence-based education, PBL implementation in OSBC is restricted, and traditional LBL is inadequate in promoting integration and innovation. While PBL fosters competency development, concerns have arisen over students\u0026rsquo; inadequate grasp of foundational knowledge. Some studies suggest that PBL-trained students underperform in basic science exams, limiting PBL\u0026rsquo;s scalability \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Additionally, limited teaching resources, high costs, and cultural mismatches have hindered OSBC implementation in non-Western countries \u003csup\u003e[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In China, many students struggle to adapt to PBL and face significant academic stress \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Due to constraints in faculty and scheduling, most countries now implement a hybrid model of LBL and PBL, but PBL hours remain limited \u003csup\u003e[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. LBL, a teacher-centered lecture format, lowers the cognitive load for knowledge acquisition but fails to inspire critical thinking. Moreover, LBL\u0026rsquo;s single-discipline delivery cannot adequately bridge basic and clinical knowledge. Therefore, innovating within the LBL framework to support integrated education\u0026mdash;while retaining its practical advantages\u0026mdash;has become an urgent need.\u003c/p\u003e\u003cp\u003eGuangzhou Medical University has implemented OSBC in its clinical medicine program since 2015.The curriculum is divided into three phases: general education, specialty courses, and clinical practice. During the specialty phase, basic and clinical sciences are integrated into system-based modules, such as the hematology and immunology module, taught by interdisciplinary teams of basic and clinical faculty. LBL, PBL, and self-directed learning are the primary instructional methods. Due to limited faculty resources, PBL accounts for only 21% of total teaching time, and LBL remains dominant. Although the course sequence has been restructured around organ systems, lectures from basic and clinical disciplines are still delivered independently, and true integration has not been realized. Consequently, LBL fails to contribute to knowledge integration or the development of innovation skills. Course evaluation is based on closed-book theoretical exams, innovation scores, and critical thinking assessments. Prior assessments showed unsatisfactory student performance in theoretical exams and weak foundational knowledge. Furthermore, Chinese students\u0026rsquo; limited experience with self-directed learning and critical thinking has resulted in low innovation and critical thinking scores in PBL assessments. Interviews revealed that some students find the separation of content from original disciplines disorienting and report difficulty adapting to PBL. Thus, a pressing challenge is how to cost-effectively reform LBL to enhance curricular integration and foster innovation.\u003c/p\u003e\u003cp\u003eMedical history became an independent discipline in medical education since the 19th century.In recent years, there has been growing interest in its pedagogical value. First, medical history provides conceptual tools that aid in learning complex diseases and syndromes with unfamiliar terminology \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Historical facts can also highlight new research directions and introduce novel professional concepts \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Second, the narrative structure of medical history\u0026mdash;whether chronological or thematic\u0026mdash;can connect basic and clinical knowledge through disease exploration \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Additionally, understanding the evolution of medical innovation fosters a critical mindset \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Therefore, integrating medical history into LBL lectures may help students grasp medical concepts, organize knowledge frameworks, and cultivate innovation from a historical perspective. We propose that medical history is a potential tool for curricular integration.\u003c/p\u003e\u003cp\u003eAt present, medical history is taught either as a standalone course or embedded within other subjects, but its interdisciplinary implementation lacks standardization \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. While independent history of medicine courses are common, their scheduling burden makes them rare in Chinese medical schools. As of 2023, more than half of Korean medical schools offer medical history education, mostly through lectures. However, such unidirectional teaching presents motivational challenges for students \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Queen's University in Canada pioneered an embedded approach, integrating medical history into foundational science courses by teaching the history of each subject alongside its content \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. This approach, however, requires strong interdepartmental coordination and protection of allocated teaching hours. Some scholars in North America have proposed brief integration of medical history with clinical content, which appears promising \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Nonetheless, no studies to date have explored the integration of medical history into OSBC clinical modules, nor have specific implementation strategies been described.\u003c/p\u003e\u003cp\u003eThis retrospective study is the first to explore a low-cost, interdisciplinary implementation of medical history in OSBC. Without increasing teaching time or staffing, we embedded disease-specific medical history into LBL lectures at strategic integration and enrichment points within clinical modules. We then evaluated the impact of this approach on curriculum quality, critical thinking, and innovation among medical students.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This retrospective study was conducted among undergraduate clinical medicine students at Guangzhou Medical University who participated in an organ system-based integrated curriculum between 2021 and 2022. Students who, for any reason, did not complete the Hematology and Immunology module or its evaluation were excluded. Students who received the traditional single-discipline LBL were designated as the control group, while those who received the new teaching method\u0026mdash;LBL incorporating medical history into the clinical modules\u0026mdash;were assigned to the experimental group. The effectiveness of the two teaching approaches was compared using both online and offline closed-book examinations, innovation and critical thinking scoring rubrics, and student satisfaction surveys to evaluate whether integrating medical history into clinical lectures improved the teaching quality of the organ system-based curriculum. No standalone medical history course was added; rather, a cross-disciplinary teaching model was adopted. Teaching was delivered by the original Hematology and Immunology teaching team, consisting of both basic and clinical faculty members, without increasing faculty load or teaching hours.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCharacteristics of the Study Population\u003c/b\u003e\u003c/p\u003e\u003cp\u003e A total of 119 students who completed the Hematology and Immunology module were included in the study.Among them, 59 students who received the traditional single-discipline LBL formed the control group, while 60 students who participated in the interdisciplinary LBL with integrated medical history formed the experimental group. The experimental group included 31 male and 29 female students, aged 19 to 21 years, with a median age of 20(20,21) years. The control group included 37 male and 22 female students, aged 20 to 21 years, with a median age of 20 (20,20) years. No statistically significant differences were found in the baseline characteristics between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating comparability. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale:n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37(62.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(51.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge:[M(P25,P75),year]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(20,20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(20,21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.626\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplementation Plan\u003c/b\u003e\u003c/p\u003e\u003c/tfoot\u003e\u003cp\u003e\u003cb\u003eDevelopment of a Historical Medical Database Categorized by Diseases within the Organ System\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe database was constructed following these steps:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eA.Collection\u003c/strong\u003e\u003cp\u003eMedical historical data were collected based on diseases covered in the Hematology and Immunology module. Sources included PubMed, medical textbooks, and clinical practice guidelines.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eB.Selection\u003c/strong\u003e\u003cp\u003eThe integration of medical history into the clinical lectures of the Hematology and Immunology module was based on two types of instructional nodes.Primary nodes include introduction points, bridging points, turning points, and expansion points, which serve to integrate knowledge by illustrating the origin of concepts and constructing a knowledge framework through historical context. \u003cem\u003eIntroduction points\u003c/em\u003e refer to initial case reports or the historical emergence of medical problems.\u003cem\u003eBridging points\u003c/em\u003e refer to laboratory discoveries related to the formation of medical concepts, disease mechanisms, and treatment foundations.\u003cem\u003eTurning points\u003c/em\u003e represent milestone events that advanced disease diagnosis and treatment.\u003cem\u003eExpansion points\u003c/em\u003e highlight unresolved or controversial issues. Secondary nodes, or enhancement points, include historically innovative or critical perspectives in disease research, as well as influential historical figures. These nodes aim to foster students' understanding of critical and innovative thinking through exemplary role models from history.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eC.Database Construction\u003c/strong\u003e\u003cp\u003eAfter selection, historical materials meeting the criteria for these nodes were discussed by the teaching team and finalized by the team leader before being entered into the database. A comprehensive medical history database related to Hematology and Immunology diseases was then built and made accessible both online and offline.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eD.Database Validation\u003c/strong\u003e\u003cp\u003eAfter completion of the module, the teaching team reviewed teaching evaluations, feedback from course supervisors, student performance, and satisfaction surveys to revise the database by adding, removing, or modifying materials as needed.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplementation of Node-Based Integration of Medical History into the Teaching of the Integrated Curriculum\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Hematology and Immunology module is one of the professional subject modules in Guangzhou Medical University\u0026rsquo;s integrated curriculum, delivered through a hybrid teaching model that combines LBL, PBL, and self-directed learning. LBL still accounts for 76.5% of the teaching hours, while PBL makes up only 21%. This study specifically reformed the LBL component of disease-based teaching within the module.\u003c/p\u003e\u003cp\u003eThe teaching team conducted collective lesson planning and extracted historical materials from the custom-built database relevant to system-specific diseases. These were embedded into the lectures at both primary and secondary node positions. New teaching objectives were added to foster students\u0026rsquo; critical and innovative thinking.\u003c/p\u003e\u003cp\u003eTeaching design utilized timeline-based PowerPoint (PPT) presentations as a key instructional tool. These PPTs followed either a chronological or thematic sequence, using historical events corresponding to the two node types as connection points to organize and integrate basic and clinical knowledge. An example of such a timeline PPT for the Primary Immune Thrombocytopenia (pITP) topic is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome Measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe outcome measures included results from both formative and summative assessments.Formative assessments included in-class quizzes, PBL evaluations, and student satisfaction surveys.Summative assessment was conducted using a final closed-book examination.The in-class quiz was administered during the pITP lecture of the Hematology and Immunology module. It consisted of four multiple-choice questions evaluating students\u0026rsquo; understanding of pITP\u0026rsquo;s pathogenesis, clinical manifestations, laboratory findings, and treatment principles. The accuracy rate for each question was used to assess students\u0026rsquo; mastery of corresponding basic knowledge. An overall improvement across all four question types in the experimental group was used as an indirect indicator of the level of knowledge integration in that chapter.The PBL evaluation was conducted during the PBL sessions linked to the professional lectures within the organ system module. A 10-point grading scale (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was used. A score of \u0026ge;\u0026thinsp;7 was considered \u0026ldquo;excellent.\u0026rdquo; The excellent rate between the experimental and control groups was compared.The final examination and satisfaction survey were conducted after completion of the organ system module. The final test used clinical case-based questions to assess students\u0026rsquo; ability to apply knowledge comprehensively. A score of \u0026ge;\u0026thinsp;80 was considered \u0026ldquo;excellent,\u0026rdquo; and the excellent rates were compared between groups.Student satisfaction was categorized as \u0026ldquo;very satisfied,\u0026rdquo; \u0026ldquo;satisfied,\u0026rdquo; or \u0026ldquo;neutral.\u0026rdquo;The satisfaction questionnaire (see Supplementary File 1) was designed specifically for this study and reviewed by medical education experts.The survey was administered anonymously.\u003c/p\u003e\u003cp\u003eThe calculation methods were as follows:\u003c/p\u003e\u003cp\u003eIndicator 1: Accuracy Rate = (Number of students who selected the correct answer) / (Total number of students assessed in the group) \u0026times; 100%\u003c/p\u003e\u003cp\u003eIndicator 2: Excellence Rate = (Number of students who achieved an excellent score) / (Total number of students assessed in the group) \u0026times; 100%\u003c/p\u003e\u003cp\u003eIndicator 3: Satisfaction Rate = (Number of students who were very satisfied\u0026thinsp;+\u0026thinsp;satisfied) / (Total number of students) \u0026times; 100%\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\u003eScoring Criteria for Innovative and Critical Thinking Ability\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\u003eAbility Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScoring Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eCreative Thinking Ability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1: Very Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRarely proposes new ideas and questions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2: Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLimited ideas, answers based on online materials and textbooks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3: Average\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRepeats information from online sources and textbooks, but can propose some new ideas or questions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4: Good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eActively proposes new ideas and questions, answers with an understanding of the material\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5: Very Good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequently proposes new ideas and questions, eager to learn, innovative spirit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eCritical Thinking Ability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1: Very Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDoes not question or challenge others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2: Poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOccasionally questions or challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3: Average\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSometimes willing to challenge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4: Good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequently asks questions, demonstrating deep thinking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5: Very Good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequently asks questions that promote deeper thinking, actively engages in rational debates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSPSS 29.0 statistical software was used to analyze the data. Age, scores, and rating values were treated as continuous variables and were described using mean or median/interquartile range, with comparisons conducted using the t-test or Mann-Whitney U test. Categorical variables such as gender, accuracy rate, excellence rate, and satisfaction rate were expressed as frequency and percentage (n, %) and analyzed using the chi-square (χ\u0026sup2;) or Fisher test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAfter implementation of the new and traditional teaching methods, the average final examination scores for the experimental and control groups were 82.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.681 and 76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.717, respectively. The excellence rate in the experimental group was significantly higher than that of the control group (78.3% vs. 37.3%, χ\u0026sup2; test, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting better academic performance among students in the experimental group (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe in-class assessment for the pITP lecture revealed that, with the exception of the \"clinical manifestations\" category, all other questions had P-values less than 0.05.This indicates that students in the experimental group had significantly higher accuracy rates in questions assessing pITP pathogenesis, laboratory examination, and therapeutic principles compared to the control group (Pathogenesis: 85% vs. 40.7%; Laboratory examination: 85% vs. 42.4%; Therapeutic principles: 93.3% vs. 67.8%; all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe average scores for critical thinking abilities in the experimental and control groups were 7.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69 and 4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48, respectively. The average scores for innovative abilities in the experimental group and control group were 7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39 and 5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29, respectively. The Mann-Whitney U test for critical thinking ability scores and innovative ability scores showed P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001* for both.Chi-square test results indicated that the excellence rates for both categories were significantly higher in the experimental group (Innovative thinking: 78.3% vs. 25.4%; Critical thinking: 55.0% vs. 16.9%; all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding students' satisfaction, the experimental group showed a significantly higher satisfaction rate compared to the control group (96.7% vs. 71.2%), with the difference being statistically significant (χ\u0026sup2; test, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, see Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Excellence Rates in Final Assessments under Different Teaching Methods\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFinal Assessment Excellence Rate,n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(37.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47(78.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: * indicates that the P value is statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Accuracy Rates in In-class Test for the pITP Lecture\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/Fisher\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn-class Test Accuracy Rates\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical Manifestation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54(91.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57(95.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.573\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePathogenesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24(40.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51(85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaboratory Examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25(42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51(85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23.423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTherapeutic Principle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40(67.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56(93.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: * indicates that the P value is statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Students' Innovative and Critical Thinking Ability under Different Teaching Methods\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExperimental group(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExcellent rates n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInnovation Ability Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47(78.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33.370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCritical Thinking Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(16.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33(55.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.664\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: * indicates that the P value is statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Student Satisfaction with Different Teaching Methods\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery satisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSatisfaction(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperimental Group\u003c/b\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e98.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eControl Group\u003c/b\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e69.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/Fisher\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.443\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: * indicates that the P value is statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the organ-system-based integrated curriculum, the disintegration of basic disciplines may lead to superficial understanding of key concepts and mechanisms. Additionally, the simple juxtaposition of basic and clinical knowledge often lacks effective linkage and coherence. In this study, medical history was utilized as an integrative tool, leveraging its temporal and thematic characteristics to bridge basic and clinical content, thereby constructing a coherent disease knowledge framework. Through the implementation of two teaching approaches, we compared the experimental and control groups\u0026rsquo; in-class assessments and final exam performances, and also evaluated student satisfaction. The in-class assessments focused on students\u0026rsquo; understanding of basic knowledge such as concepts, pathogenesis, laboratory examinations, clinical manifestations, and therapeutic principles, while the final exam assessed students\u0026rsquo; ability to apply knowledge comprehensively.\u003c/p\u003e\u003cp\u003eThe study results demonstrated a significantly higher excellence rate in the final exam among the experimental group, indicating that interdisciplinary LBL integrated with medical history can enhance students' mastery, comprehension, and application of knowledge. In the pITP module\u0026rsquo;s in-class assessments, the experimental group outperformed the control group in understanding pathogenesis, laboratory results, and therapeutic principles, suggesting the new teaching approach better supports the consolidation of foundational knowledge. Since clinical manifestations are not a major learning difficulty, our results did not show a notable advantage of the new method in that area. Moreover, students exposed to the new teaching model reported higher satisfaction levels. These findings suggest that embedding medical history in clinical medical lectures improved the teaching quality of the hematology and immunology module within the integrated curriculum.\u003c/p\u003e\u003cp\u003eThe organ-system curriculum is currently a primary model for medical integration reform, yet effective tools for achieving true integration remain limited and understudied. Most medical schools rely on reordering course content and adopting methods like PBL to promote integration. This study investigated whether embedding medical history into clinical lectures could support integration within the organ-system framework. In the pITP module, we demonstrated the use of a historical timeline in LBL to connect the development of disease mechanisms, laboratory diagnostics, and treatment evolution, thus integrating basic and clinical aspects of the disease. As no international tool exists to directly evaluate the degree of curriculum integration, we inferred enhanced integration from the simultaneous improvement of student performance in pathogenesis, diagnostics, and treatment items.\u003c/p\u003e\u003cp\u003eDeveloping students' critical thinking and creativity is a core goal of integrated teaching, particularly through PBL. However, limitations such as restricted instructional hours and student adaptability issues in China affect the efficacy of PBL \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e][\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Medical history can foster critical and innovative thinking by exposing students to objective patterns and role models in medical development. Under a hybrid teaching model, LBL serves as a preparatory phase, easing the transition to PBL and reducing the associated learning curve, thereby improving the integration of old and new methods. Our results showed significantly higher excellence rates in critical and innovative thinking scores among the experimental group, indicating that even without increased PBL-associated costs, reforms to traditional LBL can still enhance medical students\u0026rsquo; cognitive competencies.\u003c/p\u003e\u003cp\u003eA key challenge remains in how to integrate medical history into teaching without increasing instructional load or faculty burden. A recent cross-sectional study proposed a model that embeds disease history into surgical pathology lectures without altering existing curricula\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Encouragingly, this approach was well-received by students. Consistent with that study, our findings support the integration of medical history into clinical LBL sessions within the hematology and immunology module, yielding higher student satisfaction compared to traditional LBL.\u003c/p\u003e\u003cp\u003eWhile integrated teaching reform originated in Western countries and is now globally promoted, even developed nations such as the U.S. face rising education costs after a decade of reform \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. A recent review also highlighted resource limitations as a major barrier to PBL implementation in developing countries\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Therefore, localized reforms must balance effectiveness with feasibility. Our study proposed a structured approach for integrating medical history into organ-system teaching. We adopted a node-based, interdisciplinary strategy to avoid adding new courses or instructional hours. The teaching team-led by clinical faculty with support from basic science instructors-required no additional staff, thereby reducing institutional costs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe main contributions of this study are as follows\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eTo our knowledge, this is the first study internationally to demonstrate the advantages of using medical history as an integrative tool in LBL reform within organ-system curricula.We established a novel mode of historical integration under the integrated curriculum, applying a node-based fusion and historical timeline approach.We explored a method for constructing disease history databases and observed that non-historian faculty teams could complete this implementation in our study setting.Our preliminary findings suggest this LBL approach may represent a cost-effective option worthy of further investigation in Chinese medical education contexts. The experience gained through this study could contribute to ongoing discussions about LBL reform and localized adaptation of integrated curricula in non-Western setting.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDue to the small-class structure and single-module focus (hematology and immunology), the generalizability of our findings is limited. Future studies with larger, multi-module samples are needed to confirm these results.\u003c/p\u003e\u003cp\u003eWhile the small-class setting at Guangzhou Medical University allowed for detailed implementation and observation, it inherently restricted our sample size. Furthermore, confining the study to the hematology and immunology module\u0026mdash;though representative of our integrated curriculum\u0026mdash;may not fully capture the challenges and outcomes of history integration across other disciplines (e.g., cardiology or neurology). Future multi-center studies with larger cohorts and broader disciplinary coverage are needed to validate the scalability of this approach.\u003c/p\u003e\u003cp\u003eThe absence of disease-classified medical history textbooks necessitated in-house material compilation by our teaching team. Although we have strictly referenced monographs and historical documents, the educational authority and comprehensiveness of these materials still need to be further verified. Collaborative efforts with medical historians could enhance the scholarly rigor of such resources. Moreover, the potential for instructor bias in material selection warrants scrutiny in future iterations.\u003c/p\u003e\u003cp\u003eOur evaluation of integration efficacy relied on indirect proxies (e.g., student feedback, thematic analysis of discussions) due to the lack of validated tools for measuring the degree of integration of Organ-System Based Curriculum .Developing standardized metrics could strengthen future studies.\u003c/p\u003e\u003cp\u003eThe feasibility of this model has been preliminary validated within medical schools operating under China\u0026rsquo;s unique educational framework, where the integration of humanities remains at an early developmental stage. However, its generalizability to other countries\u0026mdash;particularly those with differing historical narratives or curricular structures\u0026mdash;has yet to be established. Cross-cultural adaptation would require careful consideration of local pedagogical traditions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study marks the first attempt to explore the educational value of medical history from a disease-based perspective. It provides preliminary evidence for the feasibility and effectiveness of incorporating medical history into clinical lectures within integrated curricula, meriting further investigation. By adopting a node-based, interdisciplinary approach, we enhanced the overall integration of course content and teaching objectives, improving the adaptability of integrated teaching in the Chinese educational setting. Future efforts should aim to expand the research scope, involve medical history experts in in-depth discussions, engage more clinical and basic science faculty in resource development, identify standard evaluation tools for integration, and increase student and long-term course evaluations. These actions will further refine our teaching model and offer new perspectives for integrated education reform in non-Western countries.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eFull title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eAbbreviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eOrgan-system based Curriculum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eOSBC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eLecture-based Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eLBL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eProblem-based Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003ePBL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003ePrimary Immune Thrombocytopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003epITP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003ePowerPoint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003ePPT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eThrombopoietin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eTPO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eRecombinant Human Thrombopoietin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003erhTPO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eThrombopoietin Receptor Agonists\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eTPO-RA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 61.6052%;\"\u003e\n \u003cp\u003eIntravenous human gamma globulin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.3948%;\"\u003e\n \u003cp\u003eIVIG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors would like to thank the students who responded to the survey and Professor Cui Junfeng, an expert in the history of medicine at Zhejiang Normal University, for guiding the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Chen Xiaoyun is the lead author, responsible for research design, implementation, and manuscript writing. Fang Mao, Li Zhenxing, Xing Yanfang, and Yang Jialin were responsible for the student survey, organizing the results, and data analysis. Zhang Jianyu proofread and supervised the manuscript. Li Xue contributed to research design, implementation, and manuscript revision, and was responsible for the initial research idea. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Research project on undergraduate teaching reform of clinical teaching bases of general higher medical colleges in Guangdong Province(20233276).Guangzhou Education Science Planning(202214114).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and Materials Availability\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;All data generated or analyzed during the current study can be obtained from the corresponding author, Chen Xiaoyun.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, in accordance with the Declaration of Helsinki. All research methods followed relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, approval number [2025] No. 028. As this is a retrospective study, the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University waived the requirement for written informed consent from participants. All authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTomorrow\u0026apos;s Doctor[EB/OL]. [2008- 07- 20]. http://www.gmc-uk.org/education/undergraduate/undergraduate_policy/tomorrows_ doctors.asp. \u003c/li\u003e\n\u003cli\u003eFrenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garc\u0026iacute;a PJ, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Profesionales de la salud para el nuevo siglo: transformando la educaci\u0026oacute;n para fortalecer los sistemas de salud en un mundo interdependiente [Health professionals for a new century: transforming education to strengthen health systems in an interdependent world]. Rev Peru Med Exp Salud Publica. 2011 Jun;28(2):337-41. \u003c/li\u003e\n\u003cli\u003eBrown G, Manogue M. AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers. Med Teach. 2001 May;23(3):231-244.\u003c/li\u003e\n\u003cli\u003ePapa F J, Harasym P H. Medical curriculum reformin North America, 1765 to the present: a cognitivescience perspective [ J] .Acad Med, 1999, 74 (2) :154-164.\u003c/li\u003e\n\u003cli\u003ePeters AS, Greenberger-Rosovsky R, Crowder C, Block SD, Moore GT. Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial. Acad Med. 2000;75(5):470-479. \u003c/li\u003e\n\u003cli\u003eKligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, Lee R, Remen RN; Education Working Group, Consortium of Academic Health Centers for Integrative Medicine. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004 Jun;79(6):521-31. \u003c/li\u003e\n\u003cli\u003eKoens F, Custers E J F M, Ten Cate O T J. Clinical and basic science teachers, opinions about the required depth of biomedical knowledge for medical students[ J] . Med Teach, 2006, 28( 3) : 234-238.\u003c/li\u003e\n\u003cli\u003eMoore GT, Block SD, Style CB, Mitchell R. The influence of the New Pathway curriculum on Harvard medical students [J]. Acad Med, 1994, 69(12): 983- 989.\u003c/li\u003e\n\u003cli\u003eMBBS. A 5- year undergraduate programme. [EB/OL]. [2008- 07- 20].http://www.smd - edu.qmul.ac.uk/student_info/Undergrad/mbbs/index.php.\u003c/li\u003e\n\u003cli\u003eNeufeld VR, Woodward CA, MacLeod SM. The McMaster M.D. program: a case study of renewal in medical education. Acad Med. 1989 Aug;64(8):423-32.\u003c/li\u003e\n\u003cli\u003eSulaiman N, Hamdy H. Problem-based learning: where are we now? Guide supplement 36.3--Practical Application. Med Teach. 2013;35(2):160-2.\u003c/li\u003e\n\u003cli\u003eSchauber SK, Hecht M, Nouns ZM, Kuhlmey A, Dettmer S. The role of environmental and individual characteristics in the development of student achievement: a comparison between a traditional and a problem-based-learning curriculum. Adv Health Sci Educ heory Pract. 2015 Oct;20(4):1033-52. \u003c/li\u003e\n\u003cli\u003eHidaka BH, Asghar A, Aktipis CA, Nesse RM, Wolpaw TM, Skursky NK, Bennett KJ, Beyrouty MW, Schwartz MD. The status of evolutionary medicine education in North American medical schools. BMC Med Educ. 2015 Mar 8;15:38. \u003c/li\u003e\n\u003cli\u003eMuller JH, Jain S, Loeser H, Irby DM. Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Med Educ. 2008 Aug;42(8):778-85. \u003c/li\u003e\n\u003cli\u003eHuang L, Cai Q, Cheng L, et al. Analysis of curricular reform practices at Chinese medical schools. Teach Learn Med. 2014;26(4):412-419.\u003c/li\u003e\n\u003cli\u003eDahle LO, Brynhildsen J, BehrbohmFallsberg M, Rundquist I, Hammar M. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Link\u0026ouml;ping, Sweden. Med Teach. 2002 May;24(3):280-5. \u003c/li\u003e\n\u003cli\u003ePfeifer CM. A progressive three-phase innovation to medical education in the United States. Med Educ Online. 2018 Dec;23(1): 1427988. \u003c/li\u003e\n\u003cli\u003eLi T, Song R, Zhong W, Liao W, Hu J, Liu X, Wang F. Use of problem-based learning in orthopaedics education: a systematic review and meta-analysis of randomized controlled trials. BMC Med Educ. 2024 Mar 8;24(1):253.\u003c/li\u003e\n\u003cli\u003eB\u0026acirc;rsu C. History of Medicine between tradition and modernity. Clujul Med. 2017;90(2):243-245. \u003c/li\u003e\n\u003cli\u003ePark JY, Park S. How to Teach History of Medicine at Medical School: Period, Structure, and Teaching Methods. Uisahak. 2023 Aug;32(2):595-621.\u003c/li\u003e\n\u003cli\u003eChallenges experienced by Korean medical students and tutors during problem-based learning: a cultural perspective. Interdiscip linary J Problem-Based Learn. 2016;10(1). \u003c/li\u003e\n\u003cli\u003eShehnaz SI. A Five Year Longitudinal Study of the Educational Environment in a Newly Integrated Medical Curriculum. Sultan Qaboos Univ Med J. 2019;19(4):e335-e344. \u003c/li\u003e\n\u003cli\u003eZhu L, Sun GC, Guan YF. [Role of systematic integration teaching reform at the basic medicine teaching stage in Chinese medical education system]. Sheng Li Xue Bao. 2020 Dec 25;72(6):699-706. \u003c/li\u003e\n\u003cli\u003eObi CO, Onosogbe M, Ehimen AG, Olamide O, Toluwalase TV, Esther O, Joshua DO, Aborode AT. Comparison of the integrated organ/systems-based curriculum with the traditional subjects-based medical curriculum: Short communication. Ann Med Surg (Lond)..2021 Nov 25;73:103116. \u003c/li\u003e\n\u003cli\u003eSolano J, Zuniga Gutierrez M, Pinel-Guzm\u0026aacute;n E, Henriquez G. Barriers and Solutions to Successful Problem-Based Learning Delivery in Developing Countries - A Literature Review. Cureus. 2023 Aug 9;15(8):e43187.\u003c/li\u003e\n\u003cli\u003eChan SCC, Gondhalekar AR, Choa G, Rashid MA. Adoption of Problem-Based Learning in Medical Schools in Non-Western Countries: A Systematic Review[J]. Teach Learn Med. 2024 Apr-May;36(2):111-122. \u003c/li\u003e\n\u003cli\u003eCaramiciu J, Arcella D, Desai MS. History of Medicine in US Medical School Curricula. J Anesth Hist. 2015 Oct;1(4):111-4. \u003c/li\u003e\n\u003cli\u003eAhmad A, Kant S, Gupta SK. History of medicine in undergraduate medical curriculum in India. Natl Med J India. 2019 Nov-Dec;32(6):360-364. \u003c/li\u003e\n\u003cli\u003eKent L, Ward PJ. Investigating the Presence of the History of Medicine in North American Medical Education: Can One of the Medical Humanities Concisely Integrate with Biomedical and Clinical Content with Reference to Clinical Competencies? Med Sci Educ. 2020 Sep 17;30(4):1531-1539. \u003c/li\u003e\n\u003cli\u003eSiri A, Gazzaniga V, Licata M, Ciliberti R. The teaching of the History of Medicine in Italy: a path in progress. Acta Biomed. 2021 Jul 1;92(3):e2021245. \u003c/li\u003e\n\u003cli\u003eIorio S, Gazzaniga V, Lippi D. History of medicine in medical education: new Italian pathways. J Med Libr Assoc. 2023 Apr 21;111(1-2):618-624. \u003c/li\u003e\n\u003cli\u003eLee KW. 150 Years of Medical History Education in Japan: History and Challenges. Uisahak. 2023 Aug;32(2):661-696. \u003c/li\u003e\n\u003cli\u003eLee ST, Yeh BI. Education of History of Medicine for 80 Years: History and Current Status in Republic of Korea. Uisahak. 2023 Apr;32(1):147-174. \u003c/li\u003e\n\u003cli\u003eStahnisch FW. Making Medical History Relevant to Medical Students: The First Fifty Years of the Calgary History of Medicine Program and History of Medicine Days Conferences. J Hist Med Allied Sci. 2023 Mar 23;78(1):83-100. \u003c/li\u003e\n\u003cli\u003eTeo J, Cox A, Ngu T, Doan H, Sinha S. Infiltrating the Curriculum: Integrating Medical History with Existing Surgical Pathology Tutorials. MedEdPublish (2016). 2020 Mar 12;9:44. \u003c/li\u003e\n\u003cli\u003eRogers NP, Boes CJ. Leonard Rowntree, Louis Wilson, Fielding Garrison, and the origins of teaching medical history at the Mayo Clinic. Proc (Bayl Univ Med Cent). 2024 Feb 28;37(3):493-500. \u003c/li\u003e\n\u003cli\u003eBauer ME, Akbar S, Bauler TJ, et al. Exploration of the integration of microbiology and immunology emerging topics into undergraduate medical education. Med Educ Online. 2024;29(1):2336331.\u003c/li\u003e\n\u003cli\u003eDolmans DHJM, Loyens SMM, Marcq H, Gijbels D. Deep and surface learning in problem-based learning: a review of the literature. Adv Health Sci Educ Theory Pract. 2016;21(5):1087-1112. \u003c/li\u003e\n\u003cli\u003eNouns Z, Schauber S, Witt C, Kingreen H, Sch\u0026uuml;ttpelz-Brauns K. Development of knowledge in basic sciences: a comparison of two medical curricula. Med Educ. 2012;46(12):1206-1214. \u003c/li\u003e\n\u003cli\u003eChen Yan-bin,Liu shui,et al.Thoughts on the Construction of Second Roud Organ-system Based Curriculum(OSBC) Textbook for Clinical Medicine Planned by the 13\u003csup\u003eth\u003c/sup\u003e Five-year Plan of the National Health Commission 2 Medical EducationResearch and Practice Jun.2019 Vol.27 No.3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Integrated Teaching, Organ-System-Based Curriculum, Medical History, Teaching Method, Lecture-Based Learning, Critical Thinking, Innovation","lastPublishedDoi":"10.21203/rs.3.rs-6994936/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6994936/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study aimed to explore the integration of medical history into clinical lecture-based learning, evaluating its impact on the teaching quality of the organ-system-based curriculum (OSBC) as an integration tool, and to investigate a cost-effective approach to implementing interdisciplinary teaching.\u003c/p\u003e\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOSBC symbolizes the current trajectory of medical education reform. The implementation of OSBC in China encounters several challenges, including a dearth of effective integration strategies, the inadequacy of traditional lecture-based learning for integrated curricula, insufficient cultivation of students' critical and innovative thinking, and escalating educational expenses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective study was conducted involving students from 2021 to 2022. Medical history was integrated into clinical lecture-based learning at functional nodes without increasing faculty workload or teaching hours. Students who received the new teaching method were divided into the experimental group, while the other students, who did not receive the method, were in the control group. Formative and summative assessments were utilized to compare the performance of the two groups in terms of in-class and final exam results, the excellent rate of innovation and critical thinking, and student satisfaction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCompared with the control group, the experimental group demonstrated significantly higher rates of excellence in final assessments (78.3% vs. 37.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), innovation scores (78.3% vs. 25.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), critical thinking scores (55% vs.16.9%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).Similarly, the satisfaction of students in the experimental group was higher than that of the control group(96.7% vs. 71.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In the in-class assessment on primary immune thrombocytopenia, the experimental group demonstrated significantly higher accuracy in questions related to pathogenesis (85% vs. 40.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), laboratory examination (85% vs. 42.4%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and therapeutic principles (93.3% vs. 67.8%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIntegrating the history of medicine into clinical lectures at key points of integration and enhancement improves the quality of OSBC through a multidisciplinary approach.It may enhance the linkage between foundational and clinical knowledge,and cultivate critical thinking and innovative abilities in students of this course. This innovative adaptation of LBL within OSBC suggests potential as a low-cost, locally feasible model for integrated curricula reform in China, though it still needs to be further validated in national research.\u003c/p\u003e","manuscriptTitle":"Integrating Medical History into Organ-System Based Curriculum : A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 06:04:22","doi":"10.21203/rs.3.rs-6994936/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-09T11:18:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103011032785613558003339533542860783750","date":"2025-10-04T10:03:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T12:29:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-03T04:24:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T11:44:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-23T11:37:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-07-23T11:34:17+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":"75448bf2-3d2f-4442-bb0e-d2a2810fd4b0","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T06:04:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 06:04:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6994936","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6994936","identity":"rs-6994936","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}