Based on the Theory of Mastery Learning and Reinforcement theory: The relationship between online student engagement and skills test scores in Clinical Skills Course

Background: The sudden outbreak of the COVID-19 pandemic in 2019 has affected our lives in different ways. The teaching method of colleges and universities has changed from traditional face-to-face learning to online learning. Clinical skills teaching is one of the core contents of clinical medical teaching. The key to ensure that students have a good grasp of learning is to ensure that they have enough time to learn effectively.Based on the mastery learning theory and reinforcement theory, the mixed online and offline teaching mode is carried out, which not only has the flexibility and convenience of online teaching, but also provides students with better offline teacher-student interaction and practical operation practice,which is more suitable for practical courses such as clinical skills courses.Studies have shown that student engagement in face-to-face learning is directly related to academic record. Little research has been done on the relationship between online student engagement and academic performance. Objective: Based on mastery learning theory and reinforcement theory in the teaching of clinical skills courses, and to explore the impact of online student engagement on academic performance and its magnitude in Clinical Skills Course by constructing a structural equation model. Methods: : 259 fourth-year clinical medicine students volunteered for the study. They watched the video of skill operation on the online learning platform and took the chapter test before the class.Then they entered the face-to-face class with teacher demonstration and guidance to practice the operation.Finally, we arrange an online comprehensive theory test and an offline skill operation test.Throughout the course, they can discuss the course content interactivelyon the online platform.Record their video viewing duration, times of chapter learning, times of discussions, chapter test scores, comprehensive test scores and offline skill test scores.Amos was used to construct structural equation model to analyze the data. Results: : The results showed that the model fits well(` c / df =1.565, GFI =0.984, AGFI =0.958, CFI =0.952, RMSEA =0.047);In Clinical Skills Course, applied learning behaviors (such as times of discussions, chapter test scores, comprehensive test scores) had a direct impact on clinical skills test scores, and the standardized path coefficient was 0.3 ( p <0.05). Observational learning behaviors (such as video viewing duration and times of chapter learning) can directly affect applied learning behaviors, with a standardized path coefficient of 0.63 ( p <0.05), and then indirectly affect clinical skills test scores through applied learning behaviors. Conclusion: Based on mastery learning theory and reinforcement theory in the online and offline blended clinical skills course teaching,enhancing observational learning behavior can improve the scores of applied learning behavior, and thus improve the scores of clinical skills examination.