Application of standardized patients simulation teaching supported medical history collection thinking training in TCM internal medicine teaching

Application of standardized patients simulation teaching supported medical history collection thinking training in TCM internal medicine teaching | 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 Application of standardized patients simulation teaching supported medical history collection thinking training in TCM internal medicine teaching Huiping Ou, Hui Lin, Hui Xu, Linglan Mo, Duo Yuan, Ge Fang, Xiaoxiao Xiao, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8979230/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 Objective To explore the impact of medical history collection thinking training supported by SP simulation teaching on the teaching of Traditional Chinese Medicine (TCM) internal medicine. Methods Two classes of acupuncture and massage therapy majors were randomly selected as the experimental group (n = 40) and the control group (n = 40). During the practical teaching process of internal medicine in TCM, the experimental group employed a medical history collection thinking training method supported by SP simulation teaching, while the control group received case-based teaching. Both groups underwent assessments on medical history collection skills for lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine; The final practical skills exam; The first simulated exam, the second simulated exam, and the formal exam of the first stage medical history collection exam for the competence of TCM practitioners. Additionally, the experimental group's teaching effectiveness was evaluated through methods such as questionnaire surveys. Results Compared with the control group, the scores of the experimental group students in collecting medical history of lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine were significantly increased (all P < 0.05). The experimental group scored better than the control group in the final practical skills exam, the first simulated exam, the second simulated exam, and the formal exam of the first stage medical history collection exam for the competence of TCM practitioners (all P < 0.05). Conclusion The teaching method of medical history collection thinking training and inquiry skills supported by SP simulation teaching can improve students' ability to collect medical history and clinical thinking in TCM, and enhance their level of diagnosis in TCM. Traditional Chinese Medicine internal medicine Medical history collection Standardized patients Simulated teaching Clinical thinking Figures Figure 1 Figure 2 Introduction Internal medicine of Traditional Chinese Medicine (TCM) is the core course of Chinese medicine, acupuncture and moxibustion and massage, and its teaching quality directly affects the training level of Chinese medicine talents. The cultivation of clinical thinking ability is the core goal of medical education[ 1 ], and "dialectical thinking and dialectical treatment" is the core of TCM education[ 2 ]. Especially in the teaching of TCM internal medicine that emphasizes holistic concepts and dialectical treatment, how to effectively train students to collect medical history, analyze pathogenesis, and form systematic clinical dialectical diagnosis and treatment ideas in the teaching process has always been a key challenge.The traditional teaching mode of TCM internal medicine often focuses on teacher centered lectures and typical case demonstrations, emphasizing the imparting of theoretical knowledge during the teaching process and neglecting the cultivation of students' clinical thinking ability [ 3 ], practical skills, and doctor-patient communication ability[ 4 ]. Although students can master theoretical knowledge, they generally lack opportunities to interact with real patients and construct clinical thinking in dynamic consultations.This disconnect between "theory" and "practice" reduces students' enthusiasm and initiative in learning, resulting in students often feeling confused and unsure of how to analyze complex and changing clinical situations[ 5 ]. They do not know how to conduct analysis, incomplete consultations, and rigid thinking in dialectical diagnosis, which affects the quality of talent cultivation. With the widespread use of Simulation based teaching (SBT) in medical education [ 6 , 7 ], Simulation Based Medical Education (SBME) provides students with a safe, standardized, high fidelity, and reproducible medical simulation environment to acquire and hone various clinical related skills without causing any harm to patients[ 8 , 9 ]. Simulated teaching can make up for the lack of early clinical practice and communication skills between doctors and patients, and is an effective method for systematically training TCM clinical thinking. It has become an urgent need for modern TCM education reform. Standardized Patient (SP) is a simulation teaching tool that has undergone systematic training and can accurately simulate the clinical manifestations of real patients. It has been proven to effectively improve students' consultation skills, communication abilities, and clinical confidence, and has been widely used in Western medicine education worldwide[ 10 ]. In 1992, Student Standardized Patients (SSPs) were introduced into the field of medical education [ 11 , 12 ]. Using students as SPs can more accurately and stably simulate clinical symptoms, signs, and psychology, providing students with reproducible, standardized, and highly clinical simulated patients[ 13 ]. Medical history collection, as an important part of diagnosis, is not only the main way to obtain medical history data, but also a key step in cultivating clinical thinking ability [ 14 ]. However, TCM diagnosis and treatment have unique characteristics. Its medical history collection not only focuses on symptoms, but also emphasizes exploring the pathogenesis through the combination of "observation, hearing, questioning, and palpation". Its deep exploration of symptoms (such as cold and heat, sweating, diet, bowel movements, emotions, etc.) and identification of pulse and tongue images put forward higher requirements for the "standardization" and "authenticity" of simulation training. Introducing SP into the teaching of TCM internal medicine not only creates a safe and risk-free practice environment, but also provides specialized reinforcement training for the core thinking of disease differentiation and syndrome differentiation, such as "treating the same disease differently" and "treating different diseases with the same treatment". It is a key bridge to bridge the gap between theory and practice. Although SP has been widely used in Western medicine education, its application value in TCM education, especially in TCM thinking training, has not been fully explored[ 2 ]. At present, most relevant research is still in the stage of experience summary, lacking an objective evaluation of how SP medical history collection thinking training specifically affects students' TCM clinical thinking process (such as medical history collection, disease diagnosis, differential diagnosis, TCM disease differentiation and syndrome differentiation ability). Therefore, the aim of this study is to design and implement a training program for TCM medical history collection and disease differentiation and syndrome differentiation thinking based on SP simulation teaching support, accompanied by a pre class medical history collection assurance process. The teacher constructs a case library of TCM internal diseases, trains students on SP and medical history collection, releases group tasks, supervises and guides to ensure quality, students independently complete the group medical history collection activity task. Students learn independently through online platforms and learning materials, using disease case libraries to deduce relevant content for medical history collection. The process of collecting medical history on their own may not be absolutely objective, true, accurate, and detailed, but under the guidance of teachers, problems are discovered and solved through discussions during and after class. Through comparative research, scientifically evaluate its application effect in the teaching of TCM internal medicine, and focus on exploring the role of this model in improving students' clinical thinking ability, medical history collection ability, disease differentiation and syndrome differentiation ability, and medical humanities literacy, in order to provide evidence-based basis for innovating TCM teaching models and improving the quality of talent cultivation. Method The 2022 and 2023 junior college acupuncture and moxibustion and massage major classes studied in Hunan College of TCM from September 2021 to July 2024 were selected as the research objects. The students in the 2022 and 2023 classes were randomly selected and the students in the class voluntarily participated in the study. The early core courses of the students in the two classes were the same, with the students in the 2022 class as the experimental group (n = 40) and the students in the 2023 class as the control group (n = 40). The teaching of TCM Internal Medicine in the experimental group and control group will be arranged in the third semester according to a unified syllabus, with a teaching duration of 72 class period each, including 20 practical class period. To evaluate the teaching effectiveness of medical history collection thinking training supported by SP simulation teaching, this study used a combination of controlled experiments and questionnaire surveys. Both groups are taught by equally experienced teachers. During the practical teaching process, the experimental group adopted the SSP simulation teaching method to support the training of medical history collection thinking for medical history collection, while the control group adopted the case-based teaching method, which integrates real typical clinical cases into the practical classroom process, and students in each group engage in case discussions and independent medical history collection exercises. Meanwhile, the control group was evaluated for teaching effectiveness through a questionnaire survey. Flowchart of the research process (Fig. 1 ). By comparing the medical history collection scores of two groups of students in TCM, including lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases, as well as the final practical skills exam and the first stage medical history collection exam for TCM practitioners' job competency, a questionnaire survey was conducted to evaluate the impact of SSP simulation teaching supported medical history collection thinking training methods on students' clinical thinking ability and diagnostic level in TCM. Experimental group intervention methods The training of medical history collection thinking supported by SP situational teaching in TCM internal medicine teaching consists of the following three stages (Fig. 2 ): Preparation for pre-class medical history collection assurance Teachers build a case library of TCM internal medicine diseases. The disease case library is the script of SP. According to the requirements of the teaching syllabus and curriculum standards of TCM Internal Medicine, and with reference to the qualification examination syllabus for TCM Practicing Assistant Physicians, common and typical cases of TCM Internal Medicine in clinical practice are selected. A clinical teaching teacher with medium-grade professional title or above and years of teaching experience is responsible for compiling a case library of TCM Internal Medicine. Each disease case consists of chief complaint, current medical history, past medical history, personal history, menstrual history, marriage and childbearing history, family history, TCM observation, smelling, and palpation, key physical examination, and auxiliary examination. It mainly describes the current medical history of the disease, including the characteristics, development and evolution of the main symptoms, accompanying symptoms, and diagnosis and treatment process. The case library of TCM internal medicine diseases is jointly discussed and revised by the associate professor teams of various majors in the teaching and research department of TCM internal medicine. The patient's medical history, laboratory test results, and imaging examination data are in line with clinical practice, ensuring authenticity and credibility. The instructor provides SP training to the students. SSP training includes: (1) Training on basic theoretical knowledge of SSP, including the concept of SSP, required qualities, responsibilities and significance, responsibility, content, and basic principles to be followed. (2) SSP training as a simulated patient role: One week before the practical training class, typical medical record scripts involved in the teaching will be distributed. The teacher will select 2 students from each group as SSP to receive simulated patient role training based on the needs of the medical record roles. Adopting individual training methods, SSP understands and familiarizes with medical records and medical scenario scripts under the guidance and explanation of teachers, identifies key points, and remembers the medical history, symptoms, physical signs, and imitation points in the medical records and medical scenario scripts. Some symptoms and physical signs need to be expressed by SSP through facial expressions, expressions, language, emotions, and physical reactions. Tongue diagnosis, pulse diagnosis, vital signs, auxiliary examination results, and positive signs that cannot be simulated by SSP can be supplemented through oral, visual, or written forms similar to laboratory tests. Ensure that SSP can proficiently, completely, and accurately retell medical history, perform accurately and accurately, be faithful to medical records, and not exaggerate, imply, or induce. Require SSP to strictly keep the medical records confidential before class. (3) Training for SSP as an Evaluator: As an evaluator, SSP evaluates medical students' humanistic care and language communication skills in real-time, assesses whether medical history collection is comprehensive and organized, and evaluates whether physical examinations are complete and correct. Teachers provide training on medical history collection for students. The training mainly covers the basic process and skills of medical history collection. Medical humanistic care and doctor-patient communication skills must be integrated into the process of medical history collection. The basic process of medical history collection includes: (1) Inquiry of current medical history (inquiry about the cause and urgency of onset based on the chief complaint, inquiry about the main symptom, inquiry about the differential diagnosis of related diseases and syndromes, inquiry about the diagnosis and treatment process (past medication use and auxiliary examinations), and inquiry about the general situation since the onset of the disease. (2) Relevant medical history inquiry (past medical history, personal history, menstrual history, marriage and childbearing history, family history). (3) TCM observation, smelling, and palpation. (4) Physical examination. (5) TCM prescription medication ideas and key points for regulation and care. (6) Writing Standards for TCM Outpatient Medical Records. The training of medical students as evaluators by the instructor. As evaluators, medical students evaluate whether SSP is familiar with the script (medical records), whether they can proficiently, completely, and accurately retell the medical history, whether they can express symptoms and signs through language, expressions, and physical reactions, whether their language can be colloquial, avoid medical terminology, simulate patients accurately, without exaggeration, implication, or induction. Teachers use a learning platform called "Xuexitong" to group students, publish group tasks, assignments, and course guidance. Xuexitong is not only a platform that provides students with online self-learning resources, but also a tool for teachers to organize teaching activities and manage learning. Teachers provide advice or guidance as needed. In-class medical history collection activity Carry out practical teaching. This classroom teaching lasted for 80 minutes. The process of the medical history collection thinking training activity supported by SP simulation teaching is as follows: (1) Assign roles. The students in the experimental group were divided into 6 large groups, which were further divided into 2 small groups, for a total of 12 groups. Each group member is randomly assigned different roles, such as doctor, doctor's assistant, student simulated patient, and patient's family. (2) Students engage in medical history collection activities. Each group of students will collect medical history for 15 minutes in the TCM internal medicine training classroom through internal division of labor and team collaboration. Each large group is assigned a different case of illness, and simulated medical history collection exercises are conducted between groups. Doctors inquire about SSP medical history, conduct relevant physical examinations, and perform laboratory tests based on the training content of medical history collection. Physicians and physician assistants record patients' medical history, including patients and their families presenting and describing symptoms and signs of the disease. After the medical history collection is completed, the physician and physician assistant conduct a collective consultation, comprehensively analyze the condition, formulate a diagnosis and treatment plan, including disease differentiation and syndrome differentiation, establish treatment methods, prescribe medication, and explain medical orders. The outpatient medical record writing is completed within 10 minutes. The teacher provides guidance on student feedback throughout the medical history collection activity. (3) Students engage in discussions and evaluations. The completed outpatient medical records of each group will be projected onto the screen through the Xuexitong, and doctors will share the diagnosis and treatment of each group's medical records in class for a total of 30 minutes. Next, SSP and medical students will conduct real-time self correction and evaluation of the medical history collection process; SSP provides timely comments and feedback to medical students, medical students to SSP, and among medical students. Teachers will conduct group discussions on customized questions related to medical history collection, and guide students to find and apply appropriate basic theoretical knowledge of TCM and Western medicine to analyze clinical problems, for a total of 15 minutes. (4) Students give presentations. Using the Xuexitong app on their mobile phones, one student was randomly selected. Under the supervision of the teacher, the student used the pre class medical history collection mind map to summarize the content of medical history collection and check their mastery of the medical history collection process for a total of 5 minutes. (5) Teachers conduct evaluations. The teacher provides an overall evaluation of the quality and rationality of the medical history collection process, with a focus on whether the medical history collection process is complete and orderly; Is the collection of medical history comprehensive and focused; Whether TCM observation, smelling, palpation, Western medicine examination, disease differentiation and diagnosis, and prescription and medication are accurate and reasonable; Evaluate whether the medical record writing is standardized, and evaluate the use of humanistic care, doctor-patient communication skills, etc. during the reception process. Provide guidance on areas that need improvement, totaling 5 minutes. After-class feedback and reflection Complete homework after class. In the discussion section of Xuexitong, the teacher organized a medical history collection reflection discussion, where students can express their opinions or have private conversations with the teacher. After class, medical students and SSP role transitions randomly and repeatedly practice medical history collection independently, and upload a "medical history collection" video. Questionnaire survey After the teaching is completed, an anonymous and confidential questionnaire survey will be conducted. The questionnaire is compiled based on existing literature and is mainly divided into six parts: (1) demographic information (Items 1–2), collect the gender and age of the experimental group; (2) clinical professional competence in TCM (Projects 3–7); (3) TCM thinking and comprehensive ability (Projects 8–11); (4) learning ability (projects 12–14); (5) humanistic literacy and communication and collaboration skills (Projects 15–17); (6) satisfaction with teaching methods (Item 18) (Supplementary Table 1). Conduct pre testing before the investigation to verify the clarity and rationality of the project, and optimize based on feedback results. Finally, 18 projects were determined to adopt a hybrid structure. Among them, 16 Likert three-point scales (1 = agree 2 = disagree 3 uncertain) were used for attitude measurement, and the other 2 items were demographic information (Items 1–2). Table 1 Application effect of medical history collection thinking training supported by SP simulation teaching in the teaching of TCM Internal Medicine: summary of questionnaire 1 What is your gender? A: Male B: Female 2 How old are you? A: 18 B: 19 C: 20 C: 21 C: 22 C: 23 From Question 3 to 18: A: Agree; B: Disagree; C: Uncertain 3 Does it help to improve the ability to comprehensively obtain medical history? 4 Does it help to deepen the diagnostic ability of TCM internal medicine diseases? 5 Does it help to improve the ability of TCM internal medicine disease differentiation and diagnosis? 6 Does it help to promote the ability of TCM to differentiate diseases and syndromes? 7 Does it help to improve the four diagnostic abilities of TCM? 8 Does it help to improve clinical comprehensive ability? 9 Does it help train clinical thinking in TCM? 10 Does it help to increase the ability to apply what has been learned? 11 Does it help to integrate and connect learned knowledge? 12 Does it help to enhance learning interest༟ 13 Does it help to improve learning motivation and initiative༟ 14 Does it help improve self-directed learning ability༟ 15 Does it help to enhance medical humanities literacy and improve humanistic care capabilities༟ 16 Does it help improve doctor-patient communication skills༟ 17 Does it help cultivate team collaboration awareness༟ 18 Do you wish to continue using this teaching method༟ Control group intervention methods The control group of students employed case-based teaching. The teacher releases the same learning materials and requirements as the experimental group before class, but without SSP and medical history collection training and role-playing tasks. Therefore, there were no students playing SSP in the classroom practice, no medical students conduct medical history collection for SP, and no immediate structured and multi-dimensional feedback. During the teaching process, students are divided into groups to independently practice medical history collection and case discussions based on different typical clinical cases. Teachers will ask questions based on clinical issues in medical records to facilitate students' thinking and discussion. After class, the same homework and medical history collection were discussed and exchanged, without randomly repeating the practice of medical history collection for medical students or SSP role transitions, without the need to upload a "medical history collection" video (Fig. 2 ). Assessment and evaluation methods Assessment of Medical History Collection Ability All students participated in the assessment of medical history collection skills for lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine, as well as the final practical skills exam and the medical history collection exam in the first tier competency assessment of TCM practitioners. The medical history collection section was scored on a 20 point scale. The diseases for medical history collection and assessment are all aligned with the outline of the TCM Practitioner Assistant Physician Qualification Examination, which is a teaching content of TCM Internal Medicine. The difficulty of the questions is equal, and each student is randomly tested for one item, which is randomly assigned by drawing lots. By conducting statistical analysis on the scores of the medical history collection skills assessment, final practical skills examination, and the first tier competency assessment for TCM practitioners in the course of TCM Internal Medicine for two groups of students, the differences in scores between the experimental group and the control group were compared. Survey and evaluation methods After the teaching is completed, an anonymous questionnaire survey will be conducted to understand the satisfaction of the experimental group students with the use of the teaching method. The investigation includes: whether the medical history collection skills have been mastered through learning, whether the communication and exchange abilities between doctors and patients, self-learning ability, clinical thinking ability, application ability, and medical humanities literacy have been improved. Ethics This study has been approved by the Ethics Review Committee of Hunan Traditional Chinese Medicinal College (Approval No. : YXLL202109001) and implemented in accordance with the Helsinki Declaration. All participants provided written informed consent forms. In order to reduce bias in evaluating students' medical history, teachers and examiners are not aware of whether students have participated in the study. The potential benefits, possible discomfort or risks have been fully explained to the participants, and their informed consent has been obtained prior to the study. Statistical analysis methods SPSS 26.0 software was used for statistical analysis of the data. The measurement data is represented by (mean ± SD), which conforms to normal distribution and homogeneity of variance. The comparison between groups is conducted using t-test; Non parametric tests, including Mann-Whitney U rank sum test, are used for non conformities and/or homogeneity of variance. Count data is represented as N (%), and inter group comparison is performed using X 2 test. A difference of P < 0.05 is considered statistically significant. Results Baseline Characteristics of students The basic characteristics of the two groups of students are that the experimental group consists of students aged 19 to 22 years old, with an average of 20.30 ± 0.12 years old. There are 28 females (70.0%) and 12 males (30.0%). The age range of the control group students was 19–22 years old, with an average of 20.30 ± 0.11 years old. There were 29 females (72.5%) and 11 males (27.5%). There was no statistically significant difference in age ( z = 2.16, p = 0.829) and Sex (χ2 = 0.061, p = 0.805) between the two groups of students (Table 2 ). Table 2 Baseline Characteristics of the students. Characteristic students, No (%) Experimental (n = 40) Control (n = 40) Age, mean ± SD, y 20.30 ± 0.12 20.30 ± 0.11 Sex Male 12 (30) 11 (27.5) Female 28 (70) 29 (72.5) Comparison of medical history collection scores between two groups of students in different disease and syndrome systems The results of medical history collection for each disease system of two groups of students (Table 3 ). The medical history collection scores of each disease system in the experimental group were higher than those in the control group, with pulmonary diseases accounting for 15.25 ± 0.40 vs 10.35 ± 0.33, p = 0.000; Heart disease syndrome 14.88 ± 0.38 vs 10.17 ± 0.38, p = 0.000; Brain disease syndrome 15.30 ± 0.34 vs 10.52 ± 0.37, p = 0.000; Spleen and stomach disease syndrome 14.55 ± 0.39 vs 10.49 ± 0.37, p = 0.000; Liver and gallbladder disease syndrome 14.50 ± 0.40 vs 10.56 ± 0.38, p = 0.000; Kidney disease syndrome 15.32 ± 0.35 vs 10.65 ± 0.37, p = 0.000; Qi-blood-body fluid disease syndrome 14.82 ± 0.44 vs 10.54 ± 0.35, p = 0.000; Limb meridian disease syndrome 15.09 ± 0.40 vs 9.91 ± 0.36, p = 0.000; The difference is statistically significant. Table 3 Medical history collection skills scores for two groups of disease syndrome systems Variables Experimental (n = 40) Control (n = 40) z p Maximum score Minimum score Average score mean ± SD Maximum score Minimum score Average score mean ± SD Pulmonary disease syndrome 18.5 5 15.25 ± 0.40 14.0 6.5 10.35 ± 0.33 -6.762 0.000 Heart disease syndrome 18.0 6 14.88 ± 0.38 14.5 5 10.17 ± 0.38 -6.589 0.000 Brain system disease syndrome 18.0 7 15.30 ± 0.34 15.5 6 10.52 ± 0.37 -6.680 0.000 Spleen and stomach disease syndrome 17.5 6 14.55 ± 0.39 15.0 5 10.49 ± 0.37 -5.943 0.000 Liver and gallbladder disease syndrome 18.0 5 14.50 ± 0.40 16.0 5.5 10.56 ± 0.38 -5.860 0.000 Kidney disease syndrome 18.5 7 15.32 ± 0.35 14.5 5 10.65 ± 0.37 -6.765 0.000 Qi-blood-body fluid disease syndrome 19.0 6 14.82 ± 0.44 15.5 5.5 10.54 ± 0.35 -6.024 0.000 Limb meridian disease syndrome 18.5 8 15.09 ± 0.40 14.0 5 9.91 ± 0.36 -6.620 0.000 Comparison of final practical skills exam scores between two groups of students The results of the final practical skills exam for two groups of students (Table 4 ). The final practical skills exam scores of the experimental group were higher than those of the control group (95.05 ± 0.29 vs 82.17 ± 0.58, p = 0.000), The difference is statistically significant. Table 4 Final Practical Skills Exam Scores of Two Groups of Students Groups Count Maximum score Minimum score Average score mean ± SD Experimental 40 100 92 95.05 ± 0.29 Control 40 88 78 82.17 ± 0.58 z −7.803 p 0.000 Comparison of Medical History Collection Exam Scores in the First Stage of TCM Practitioner Competence between Two Groups of Students The results of the medical history collection exam for the first stage of competence in the position of TCM practitioner (Table 5 ). The score of the first stage disease history collection exam for the competence of TCM practitioners in the experimental group was higher than that in the control group, with a score of 15.35 ± 0.33 vs 10.41 ± 0.36 in the first simulated exam, p = 0.000; The second mock exam score was 16.90 ± 0.31 vs 10.96 ± 0.39, p = 0.000; The official exam score is 17.41 ± 0.29 vs 15.42 ± 0.28, p = 0.000; The difference is statistically significant. Table 5 Results of the first stage medical history collection examination for the competence of TCM practitioners in two groups of students Variables Experimental (n = 40) Control (n = 40) z p Maximum score Minimum score Average score mean ± SD Maximum score Minimum score Average score mean ± SD The first mock exam 19.0 9.2 15.35 ± 0.33 15.0 6.0 10.41 ± 0.36 -6.799 0.000 Second mock exam 20.0 12.2 16.90 ± 0.31 18.5 5.0 10.96 ± 0.39 -7.062 0.000 Official Exam 19.9 14.0 17.41 ± 0.29 18.4 12.0 15.42 ± 0.28 -4.255 0.000 Evaluation of the effectiveness of medical history collection thinking training supported by SP simulation teaching The survey results show that 98.31% of students have mastered the skills of medical history collection through the SP medical history collection thinking training teaching method. 94.92% to 100% of students believe that learning through this system can improve the communication and exchange ability between doctors and patients, the four diagnostic abilities of TCM, the diagnosis and differential diagnosis ability of internal medicine diseases in TCM, as well as the clinical thinking, application ability, medical humanities literacy, and humanistic care ability of TCM. More than 90% of students hope to continue using this teaching method (Table 6 ). Table 6 Evaluation of Students' Medical History Collection Thinking Training Supported by SP Simulation Teaching Content students, No (%) Agree Disagree Uncertain Helps improve the ability to comprehensively obtain medical history 38(95.0) 2(5.0) 0 Helps deepen the diagnostic ability of TCM internal medicine diseases 40(100) 0 0 Helps to improve the ability of TCM internal medicine disease differentiation and diagnosis 39(97.5) 0 1(2.5) Helps promote the ability of TCM to differentiate diseases and syndromes 40(100) 0 0 Helps to improve the four diagnostic abilities of TCM 40(100) 0 0 Helps to improve clinical comprehensive ability 39(97.5) 0 1(2.5) Helps train clinical thinking in TCM 39(97.5) 0 1(2.5) Helps to enhance learning interest 38(95.0) 1(2.5) 1(2.5) Helps to improve learning motivation and initiative 40(100) 0 0 Helps improve self-directed learning ability 40(92.5) 0 3(7.5) Helps to increase the ability to apply what has been learned 40(100) 0 0 Helps to enhance medical humanities literacy and improve humanistic care capabilities 40(100) 0 0 Helps improve doctor-patient communication skills 40(100) 0 0 Helps to integrate and connect learned knowledge 39(97.5) 0 1(2.5) Helps cultivate team collaboration awareness 39(97.5) 0 1(2.5) Do you wish to continue using this teaching method 39(97.5) 0 1(2.5) Discussion This study found that the medical history collection thinking training teaching method supported by SP simulation teaching can improve students' abilities in medical history collection, TCM syndrome differentiation thinking, clinical communication skills, and self-confidence. A questionnaire survey showed that this method was well received by students. The Current Challenges in Teaching TCM Internal Medicine As a core course of TCM education, the teaching objective of TCM Internal Medicine aims to cultivate students to establish a systematic TCM clinical thinking mode of disease differentiation and syndrome differentiation. Modern medical education emphasizes student-centered approach and focuses on cultivating students' clinical thinking and practical abilities[ 15 ]. Currently, there is a common problem in the teaching of TCM internal medicine that emphasizes theory over practice. The characteristic of TCM's clinical thinking is "syndrome differentiation and treatment" [ 16 ], emphasizing "external diagnosis and internal treatment" and "four diagnostic methods combined with reference". However, the traditional teaching model mainly relies on classroom lectures, where students passively receive knowledge [ 17 ]and lack opportunities for active thinking and clinical practice. Classroom teaching mainly focuses on teachers teaching theories and analyzing typical medical cases, with limited opportunities for students to interact with real patients, resulting in a serious disconnect between theory and practice. This "talk on paper" teaching method is difficult to train students in the ability to interact with patients, dynamically collect medical history, and form disease differentiation and syndrome differentiation ideas in real time through "external guidance and internal guidance" and "four diagnostic methods". Students often master fragmented knowledge points, but are unable to effectively integrate and apply them in complex clinical scenarios, resulting in the dilemma of "knowing but not acting", which restricts the cultivation of their clinical confidence and job competence. In addition, the existing teaching of TCM internal medicine lacks sufficient emphasis on the cultivation of medical history collection skills. Comprehensive and systematic medical history collection is the foundation of clinical diagnosis [ 14 , 18 ] and an important manifestation of clinical thinking ability. However, in current teaching, medical history collection is often seen as a simple task of collecting diagnostic data, lacking systematic thinking training and method guidance. This often leads to students being unable to collect medical history comprehensively and accurately during clinical internships and future work, which affects the accuracy of diagnosis and treatment outcomes. How to break through this bottleneck and create an efficient and safe clinical thinking training environment is the focus of current reform in TCM education. Therefore, reforming the teaching mode of TCM internal medicine and strengthening the training of medical history collection thinking have become urgent needs to improve the quality of TCM talent cultivation. SP Simulation Teaching: Building a Bridge between Theory and Practice Scenario simulation teaching method allows students to consolidate medical knowledge and acquire clinical skills through simulating real medical scenarios in practice[ 19 , 20 ]. The results of this study are highly consistent with the broad consensus in the global medical education field regarding the value of simulated teaching, and further highlight its unique significance in the specific context of TCM. The core advantage of simulated teaching lies in its ability to provide opportunities for deliberate practice, allowing learners to repeatedly practice, make mistakes, and learn from immediate feedback in a "risk-free" environment[ 21 , 22 ]. This is a key link in internalizing clinical skills and building clinical confidence. This study further deepens this consensus and reveals the unique advantages of SP in the specific context of TCM history collection. The integration of SP teaching mode provides innovative solutions to solve the above difficulties. SSP refers to a simulator who, through systematic and standardized training, can accurately and consistently simulate the clinical manifestations and emotional responses of specific diseases[ 8 ]. In the context of TCM, the core value of SSP lies in its ability to highly replicate the complex scenarios of TCM consultations. Unlike Western medical consultations that focus on localization and qualitative diagnosis, the collection of medical history in TCM is not simply a list of information, but a dynamic and exploratory clinical thinking process. It requires medical students to be able to use TCM theory to guide and systematically question patients based on their initial complaints, in order to uncover hidden key information with dialectical value (such as patients' subjective feelings of "cold and heat", "sweating", "taste", "emotion", "bowel movements" and physical signs (such as tongue and pulse), etc.). Although traditional teacher oral teaching can impart knowledge, it cannot vividly convey these subtle and complex information, making it difficult to simulate this dynamic and interactive thinking process. The SSP used in this study, after careful design and training, can stably, accurately, and repetitively simulate the demeanor, tone, chief complaint details, and response content that specific syndromes should have, creating a high fidelity simulation environment that enables students to truly practice the art of "medical history collection" in a controlled, safe, and tolerant environment, training their ability to quickly capture key pathological points from chaotic information, and providing students with a risk-free, almost real "clinical" experience. This is the fundamental reason for the significant improvement in the "logicality" and "accuracy" of medical history collection. The cultivation of clinical reasoning ability is the core of medical education[ 23 – 26 ]. Modern medical education emphasizes student-centered approach and focuses on cultivating students' clinical thinking and practical abilities[ 15 ]. SSP uses highly standardized deduction to transform abstract TCM syndromes (such as "liver depression and spleen deficiency", "yin deficiency and fire excess") into concrete and perceptible clinical manifestations, enabling students to connect theoretical knowledge in textbooks with the symptoms, signs, and behaviors of "real" patients, thus deeply understanding the concept of "syndrome" and mastering the methods of "differentiation". The results of this study indicate that the experimental group students have significantly better completeness, accuracy, and logicality in medical history collection than the control group, which is a direct reflection of the effectiveness of SSP teaching. It effectively trains students to capture key pathological information from scattered symptoms and closely links it with the "thinking process" of TCM theory and thinking of "treating external symptoms with internal symptoms" and "integrating the four diagnostic methods". This coincides with the concept that simulated teaching can help students develop "clinical reasoning" [ 27 ]. This immersive learning experience that combines theory with practice greatly stimulates students' interest and intrinsic motivation in learning. At the same time, it transforms students from passive knowledge receivers to active clinical explorers, internalizing TCM theory into clinical skills in practice. This is directly reflected in the extremely high satisfaction level of the questionnaire survey. The feedback from students that they have "deepened their understanding of theoretical knowledge" and "improved their ability to distinguish diseases and syndromes" is a direct proof of the effective training of medical and clinical thinking. SP simulation teaching: multi-dimensional improvement of teaching effectiveness The contribution of SP goes far beyond training in medical history collection techniques. Its deeper value lies in promoting the early construction and solidification of students' clinical reasoning patterns. This study comprehensively evaluated the effectiveness of SP teaching from two dimensions: objective skill assessment and subjective perception. In terms of objective skills, the excellent performance of the experimental group in the medical history collection of the "First Step Assessment of TCM Practitioner Job Competence" proves that SSP training can be directly transformed into higher clinical competence by integrating more advanced simulation techniques and high fidelity script design. This improvement is not only reflected in students' simple listing of symptoms, but also in their sorting of logical relationships between symptoms and capturing of core pathological information, achieving the completeness, logicality, and accuracy of medical history collection, which is precisely the core of TCM dialectical thinking. In terms of subjective feelings, the high satisfaction and recognition of the questionnaire survey are strong evidence of the success of SP teaching. Student feedback indicates that this model greatly stimulates learning interest and initiative, deepens understanding of abstract TCM theories (such as syndrome concepts), and significantly enhances clinical practice ability and confidence in disease differentiation and syndrome differentiation. This positive learning experience aligns with Edward Deci and Richard Ryan's "Self Determination Theory (SDT) [ 28 – 31 ]", where SP teaching effectively promotes students' intrinsic learning motivation by providing satisfaction with autonomy (active medical history collection), competence (successful completion of medical history collection and feedback), and relevance (interaction with the "patient"). The core role of SP simulation teaching: building feedback loop and metacognitive ability The success of SP teaching goes beyond simple simulations of clinical scenarios, and its essence lies in constructing a complete learning loop that includes "practice→feedback→reflection→re-practice". The real-time structured feedback of SSP in simulated teaching is another key mechanism driving students' ability improvement. Bokken et al. emphasized that providing effective clinical and communication skills feedback to students through SP can enable students in simulated teaching to demonstrate better skills [ 32 ]. Philosopher and educator John Dewey placed reflection at the core of education[ 33 ]; In addition, Schön's[ 34 , 35 ] practical epistemology of "Reflection-in-Action" states that practitioners can pause or control some daily obstacles in the experimental context of the virtual world to engage in rigorous reflective actions. Feedback is an important component of the teaching process [ 36 , 37 ], and timely feedback plays a crucial role in promoting the development of students' clinical reasoning abilities. Throughout the simulation teaching process, students can continuously receive timely feedback from SP, reflect on it, adjust their medical history collection strategies in a timely manner, improve the strategies in the medical history collection process, and enhance clinical thinking. In the design of this study, after each medical history collection, SSP provides immediate, structured, and multi-dimensional feedback that not only evaluates students' communication and empathy abilities from the patient's perspective, but also points out omissions in the process of medical history collection from the perspective of TCM, such as not asking about sweating, ignoring emotional triggers. This direct, specific, and contextualized feedback from the "patient" is more impactful and memorable than third-party comments from teachers, allowing students to immediately recognize their own thinking blind spots, such as missing inquiries about specific "Ten Questions Song" items, which is a key mechanism driving students' ability improvement. This practice based feedback mechanism aims to cultivate students' metacognition ability– the ability to monitor and regulate their own thinking processes [ 38 , 39 ], which is a core trait of mature clinical physicians. Through repeated SSP training and feedback during the practical process, students are able to reflect on and internalize a more comprehensive, systematic, and rigorous framework for collecting TCM medical history and dialectical thinking in a timely manner, thereby avoiding the omission of key dialectical elements in subsequent practice and future real clinical situations, ultimately achieving self optimization and spiral learning effects. Limitations and further improvements Although this study has achieved positive results, there are still certain limitations. Firstly, the research was conducted within a single institution with a relatively limited sample size. In the future, multi center, large sample studies will be needed to validate the generalizability of the results. Secondly, the success of SP simulation teaching highly depends on the quality of medical case scripts and the level of SP training. The development of medical case scripts, student standard patient training, and quality control require continuous funding and manpower investment, which may be a practical challenge for widespread promotion. Finally, this study mainly evaluated the teaching effectiveness in the short and medium term, and the impact of SP training on students' long-term clinical ability maintenance and development, which still requires long-term follow-up research. Looking ahead to the future, there is still great potential to explore the application of TCM teaching models supported by SP simulation teaching in TCM education. The next step of research can focus on: 1) Develop an SP medical case library covering different levels of difficulty from single syndrome to complex compound syndrome, and construct a progressive TCM thinking training curriculum system; 2) Explore the integration of artificial intelligence (AI) and augmented reality (AR) technology into SP for simulating objective signs with more TCM characteristics such as tongue and pulse, further enhancing the authenticity of the simulation; 3) Further integrate SP with Objective Structured Clinical Examination (OSCE) to establish a more scientific and objective evaluation standard for TCM clinical thinking ability. Conclusion In summary, the medical history collection thinking training supported by SP simulation teaching is an efficient and reliable teaching method for TCM internal medicine, and an effective innovation to address the challenges of traditional teaching. It can not only significantly improve the completeness, accuracy, and logicality of students' medical history collection, but also enhance their TCM dialectical thinking ability, clinical communication skills, and confidence, and gain high recognition from students. More importantly, it creates a bridge between theory and practice for students by providing high fidelity simulation environments and structured feedback, effectively promoting the construction of their TCM clinical thinking patterns and the development of their metacognitive abilities. Despite the challenges in terms of cost and promotion, its enormous potential in cultivating high-quality and capable clinical talents in TCM that meet the requirements of the new era makes it an important direction for promoting the modernization reform of TCM education. Declarations Acknowledgements Not applicable. Authors’ contributions Huiping Ou: Data organization, formal analysis, investigation, and initial draft writing; Hui Lin: Supervision, proofreading, writing review, and editing. Hui Xu and Linglan Mo: conceptualized and designed this study; Duo Yuan, Chuang Fang and Li Liu: Collecting data and analyzing results; Enjin Zeng and Xing Huang: Data management, investigation, methodology. Ge Fang and Xiaoxiao Xiao: Contributed to manuscript revision and methodology. All authors have read and approved the final manuscript. Funding This study was funded by the Hunan Vocational College Education and Teaching Reform Research Project (ZJGB2022010) Data availability The data used and/or analyzed in this study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study has been approved by the Ethics Review Committee of Hunan Traditional Chinese Medicinal College (Approval No. : YXLL202109001), and all participants provided written informed consent forms. Consent for publication Participants were assured in the consent form they signed the publication of the data will not indicate their names or any identification information. Competing interests The authors declare no competing interests. References Zhou F, Sang A, Zhou Q, Wang QQ, Fan Y, Ma S. The impact of an integrated PBL curriculum on clinical thinking in undergraduate medical students prior to clinical practice. BMC Med Educ. 2023;23(1):460. Zeng J, Liang S, Zhang X, Yan R, Chen C, Wen L, Xia T, Li W, Lu B, Nian Q, et al. Assessment of clinical competency among TCM medical students using standardized patients of traditional Chinese medicine: A 5-year prospective randomized study. Integr Med Res. 2022;11(2):100804. 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Promoting Residents' Motivation to Develop Laparoscopic Skills Through Simulation. J Surg Educ. 2025;82(9):103617. Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans JJ. Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Med Educ. 2009;43(3):202–10. Wear D, Zarconi J, Garden R, Jones T. Reflection in/and writing: pedagogy and practice in medical education. Acad Med. 2012;87(5):603–9. Schön DA. The Reflective Practitioner: How Professionals Think in Action. Basic Books; 1983. Comer M. Rethinking reflection-in-action: What did Schon really mean? Nurse Educ Today. 2016;36:4–6. Osborne B, Parange N, Thoirs K. The effectiveness of the use of high fidelity simulators in obstetric ultrasound training: A systematic review. Australas J Ultrasound Med. 2015;18(3):107–11. Alsahafi A, Newell M, Kropmans T. A retrospective feedback analysis of objective structured clinical examination performance of undergraduate medical students. 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Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 17 Mar, 2026 Editor assigned by journal 02 Mar, 2026 Submission checks completed at journal 01 Mar, 2026 First submitted to journal 01 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8979230","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621547423,"identity":"ead36b41-e36d-42c5-be51-a96f4b1e29f9","order_by":0,"name":"Huiping 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10:26:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":713792,"visible":true,"origin":"","legend":"\u003cp\u003eTeaching design of Medical History Collection thinking training\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8979230/v1/514bcbf082294894eb7ff86c.png"},{"id":106875990,"identity":"0acfa92a-8225-412c-a0c8-643457ca6914","added_by":"auto","created_at":"2026-04-14 10:27:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2200217,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8979230/v1/846c8e81-a994-42cb-8778-b22374bba941.pdf"},{"id":106875771,"identity":"7385eab5-bbb1-4c37-be6f-f48e8b358da2","added_by":"auto","created_at":"2026-04-14 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The cultivation of clinical thinking ability is the core goal of medical education[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and \"dialectical thinking and dialectical treatment\" is the core of TCM education[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Especially in the teaching of TCM internal medicine that emphasizes holistic concepts and dialectical treatment, how to effectively train students to collect medical history, analyze pathogenesis, and form systematic clinical dialectical diagnosis and treatment ideas in the teaching process has always been a key challenge.The traditional teaching mode of TCM internal medicine often focuses on teacher centered lectures and typical case demonstrations, emphasizing the imparting of theoretical knowledge during the teaching process and neglecting the cultivation of students' clinical thinking ability [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], practical skills, and doctor-patient communication ability[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although students can master theoretical knowledge, they generally lack opportunities to interact with real patients and construct clinical thinking in dynamic consultations.This disconnect between \"theory\" and \"practice\" reduces students' enthusiasm and initiative in learning, resulting in students often feeling confused and unsure of how to analyze complex and changing clinical situations[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. They do not know how to conduct analysis, incomplete consultations, and rigid thinking in dialectical diagnosis, which affects the quality of talent cultivation. With the widespread use of Simulation based teaching (SBT) in medical education [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Simulation Based Medical Education (SBME) provides students with a safe, standardized, high fidelity, and reproducible medical simulation environment to acquire and hone various clinical related skills without causing any harm to patients[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Simulated teaching can make up for the lack of early clinical practice and communication skills between doctors and patients, and is an effective method for systematically training TCM clinical thinking. It has become an urgent need for modern TCM education reform.\u003c/p\u003e \u003cp\u003eStandardized Patient (SP) is a simulation teaching tool that has undergone systematic training and can accurately simulate the clinical manifestations of real patients. It has been proven to effectively improve students' consultation skills, communication abilities, and clinical confidence, and has been widely used in Western medicine education worldwide[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In 1992, Student Standardized Patients (SSPs) were introduced into the field of medical education [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Using students as SPs can more accurately and stably simulate clinical symptoms, signs, and psychology, providing students with reproducible, standardized, and highly clinical simulated patients[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Medical history collection, as an important part of diagnosis, is not only the main way to obtain medical history data, but also a key step in cultivating clinical thinking ability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, TCM diagnosis and treatment have unique characteristics. Its medical history collection not only focuses on symptoms, but also emphasizes exploring the pathogenesis through the combination of \"observation, hearing, questioning, and palpation\". Its deep exploration of symptoms (such as cold and heat, sweating, diet, bowel movements, emotions, etc.) and identification of pulse and tongue images put forward higher requirements for the \"standardization\" and \"authenticity\" of simulation training. Introducing SP into the teaching of TCM internal medicine not only creates a safe and risk-free practice environment, but also provides specialized reinforcement training for the core thinking of disease differentiation and syndrome differentiation, such as \"treating the same disease differently\" and \"treating different diseases with the same treatment\". It is a key bridge to bridge the gap between theory and practice.\u003c/p\u003e \u003cp\u003eAlthough SP has been widely used in Western medicine education, its application value in TCM education, especially in TCM thinking training, has not been fully explored[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. At present, most relevant research is still in the stage of experience summary, lacking an objective evaluation of how SP medical history collection thinking training specifically affects students' TCM clinical thinking process (such as medical history collection, disease diagnosis, differential diagnosis, TCM disease differentiation and syndrome differentiation ability). Therefore, the aim of this study is to design and implement a training program for TCM medical history collection and disease differentiation and syndrome differentiation thinking based on SP simulation teaching support, accompanied by a pre class medical history collection assurance process. The teacher constructs a case library of TCM internal diseases, trains students on SP and medical history collection, releases group tasks, supervises and guides to ensure quality, students independently complete the group medical history collection activity task. Students learn independently through online platforms and learning materials, using disease case libraries to deduce relevant content for medical history collection. The process of collecting medical history on their own may not be absolutely objective, true, accurate, and detailed, but under the guidance of teachers, problems are discovered and solved through discussions during and after class. Through comparative research, scientifically evaluate its application effect in the teaching of TCM internal medicine, and focus on exploring the role of this model in improving students' clinical thinking ability, medical history collection ability, disease differentiation and syndrome differentiation ability, and medical humanities literacy, in order to provide evidence-based basis for innovating TCM teaching models and improving the quality of talent cultivation.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe 2022 and 2023 junior college acupuncture and moxibustion and massage major classes studied in Hunan College of TCM from September 2021 to July 2024 were selected as the research objects. The students in the 2022 and 2023 classes were randomly selected and the students in the class voluntarily participated in the study. The early core courses of the students in the two classes were the same, with the students in the 2022 class as the experimental group (n\u0026thinsp;=\u0026thinsp;40) and the students in the 2023 class as the control group (n\u0026thinsp;=\u0026thinsp;40).\u003c/p\u003e \u003cp\u003eThe teaching of TCM Internal Medicine in the experimental group and control group will be arranged in the third semester according to a unified syllabus, with a teaching duration of 72 class period each, including 20 practical class period. To evaluate the teaching effectiveness of medical history collection thinking training supported by SP simulation teaching, this study used a combination of controlled experiments and questionnaire surveys. Both groups are taught by equally experienced teachers. During the practical teaching process, the experimental group adopted the SSP simulation teaching method to support the training of medical history collection thinking for medical history collection, while the control group adopted the case-based teaching method, which integrates real typical clinical cases into the practical classroom process, and students in each group engage in case discussions and independent medical history collection exercises. Meanwhile, the control group was evaluated for teaching effectiveness through a questionnaire survey. Flowchart of the research process (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). By comparing the medical history collection scores of two groups of students in TCM, including lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases, as well as the final practical skills exam and the first stage medical history collection exam for TCM practitioners' job competency, a questionnaire survey was conducted to evaluate the impact of SSP simulation teaching supported medical history collection thinking training methods on students' clinical thinking ability and diagnostic level in TCM.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eExperimental group intervention methods\u003c/h2\u003e \u003cp\u003eThe training of medical history collection thinking supported by SP situational teaching in TCM internal medicine teaching consists of the following three stages (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e):\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePreparation for pre-class medical history collection assurance\u003c/p\u003e \u003cp\u003eTeachers build a case library of TCM internal medicine diseases. The disease case library is the script of SP. According to the requirements of the teaching syllabus and curriculum standards of TCM Internal Medicine, and with reference to the qualification examination syllabus for TCM Practicing Assistant Physicians, common and typical cases of TCM Internal Medicine in clinical practice are selected. A clinical teaching teacher with medium-grade professional title or above and years of teaching experience is responsible for compiling a case library of TCM Internal Medicine. Each disease case consists of chief complaint, current medical history, past medical history, personal history, menstrual history, marriage and childbearing history, family history, TCM observation, smelling, and palpation, key physical examination, and auxiliary examination. It mainly describes the current medical history of the disease, including the characteristics, development and evolution of the main symptoms, accompanying symptoms, and diagnosis and treatment process. The case library of TCM internal medicine diseases is jointly discussed and revised by the associate professor teams of various majors in the teaching and research department of TCM internal medicine. The patient's medical history, laboratory test results, and imaging examination data are in line with clinical practice, ensuring authenticity and credibility.\u003c/p\u003e \u003cp\u003eThe instructor provides SP training to the students. SSP training includes:\u003c/p\u003e \u003cp\u003e(1) Training on basic theoretical knowledge of SSP, including the concept of SSP, required qualities, responsibilities and significance, responsibility, content, and basic principles to be followed.\u003c/p\u003e \u003cp\u003e(2) SSP training as a simulated patient role: One week before the practical training class, typical medical record scripts involved in the teaching will be distributed. The teacher will select 2 students from each group as SSP to receive simulated patient role training based on the needs of the medical record roles. Adopting individual training methods, SSP understands and familiarizes with medical records and medical scenario scripts under the guidance and explanation of teachers, identifies key points, and remembers the medical history, symptoms, physical signs, and imitation points in the medical records and medical scenario scripts. Some symptoms and physical signs need to be expressed by SSP through facial expressions, expressions, language, emotions, and physical reactions. Tongue diagnosis, pulse diagnosis, vital signs, auxiliary examination results, and positive signs that cannot be simulated by SSP can be supplemented through oral, visual, or written forms similar to laboratory tests. Ensure that SSP can proficiently, completely, and accurately retell medical history, perform accurately and accurately, be faithful to medical records, and not exaggerate, imply, or induce. Require SSP to strictly keep the medical records confidential before class.\u003c/p\u003e \u003cp\u003e(3) Training for SSP as an Evaluator: As an evaluator, SSP evaluates medical students' humanistic care and language communication skills in real-time, assesses whether medical history collection is comprehensive and organized, and evaluates whether physical examinations are complete and correct.\u003c/p\u003e \u003cp\u003eTeachers provide training on medical history collection for students. The training mainly covers the basic process and skills of medical history collection. Medical humanistic care and doctor-patient communication skills must be integrated into the process of medical history collection. The basic process of medical history collection includes:\u003c/p\u003e \u003cp\u003e(1) Inquiry of current medical history (inquiry about the cause and urgency of onset based on the chief complaint, inquiry about the main symptom, inquiry about the differential diagnosis of related diseases and syndromes, inquiry about the diagnosis and treatment process (past medication use and auxiliary examinations), and inquiry about the general situation since the onset of the disease.\u003c/p\u003e \u003cp\u003e(2) Relevant medical history inquiry (past medical history, personal history, menstrual history, marriage and childbearing history, family history).\u003c/p\u003e \u003cp\u003e(3) TCM observation, smelling, and palpation.\u003c/p\u003e \u003cp\u003e(4) Physical examination.\u003c/p\u003e \u003cp\u003e(5) TCM prescription medication ideas and key points for regulation and care.\u003c/p\u003e \u003cp\u003e(6) Writing Standards for TCM Outpatient Medical Records.\u003c/p\u003e \u003cp\u003eThe training of medical students as evaluators by the instructor. As evaluators, medical students evaluate whether SSP is familiar with the script (medical records), whether they can proficiently, completely, and accurately retell the medical history, whether they can express symptoms and signs through language, expressions, and physical reactions, whether their language can be colloquial, avoid medical terminology, simulate patients accurately, without exaggeration, implication, or induction.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eTeachers use a learning platform called \"Xuexitong\" to group students, publish group tasks, assignments, and course guidance. Xuexitong is not only a platform that provides students with online self-learning resources, but also a tool for teachers to organize teaching activities and manage learning. Teachers provide advice or guidance as needed.\u003c/p\u003e \u003cp\u003eIn-class medical history collection activity\u003c/p\u003e \u003cp\u003eCarry out practical teaching. This classroom teaching lasted for 80 minutes. The process of the medical history collection thinking training activity supported by SP simulation teaching is as follows:\u003c/p\u003e \u003cp\u003e(1) Assign roles. The students in the experimental group were divided into 6 large groups, which were further divided into 2 small groups, for a total of 12 groups. Each group member is randomly assigned different roles, such as doctor, doctor's assistant, student simulated patient, and patient's family.\u003c/p\u003e \u003cp\u003e(2) Students engage in medical history collection activities. Each group of students will collect medical history for 15 minutes in the TCM internal medicine training classroom through internal division of labor and team collaboration. Each large group is assigned a different case of illness, and simulated medical history collection exercises are conducted between groups. Doctors inquire about SSP medical history, conduct relevant physical examinations, and perform laboratory tests based on the training content of medical history collection. Physicians and physician assistants record patients' medical history, including patients and their families presenting and describing symptoms and signs of the disease. After the medical history collection is completed, the physician and physician assistant conduct a collective consultation, comprehensively analyze the condition, formulate a diagnosis and treatment plan, including disease differentiation and syndrome differentiation, establish treatment methods, prescribe medication, and explain medical orders. The outpatient medical record writing is completed within 10 minutes. The teacher provides guidance on student feedback throughout the medical history collection activity.\u003c/p\u003e \u003cp\u003e(3) Students engage in discussions and evaluations. The completed outpatient medical records of each group will be projected onto the screen through the Xuexitong, and doctors will share the diagnosis and treatment of each group's medical records in class for a total of 30 minutes. Next, SSP and medical students will conduct real-time self correction and evaluation of the medical history collection process; SSP provides timely comments and feedback to medical students, medical students to SSP, and among medical students. Teachers will conduct group discussions on customized questions related to medical history collection, and guide students to find and apply appropriate basic theoretical knowledge of TCM and Western medicine to analyze clinical problems, for a total of 15 minutes.\u003c/p\u003e \u003cp\u003e(4) Students give presentations. Using the Xuexitong app on their mobile phones, one student was randomly selected. Under the supervision of the teacher, the student used the pre class medical history collection mind map to summarize the content of medical history collection and check their mastery of the medical history collection process for a total of 5 minutes.\u003c/p\u003e \u003cp\u003e(5) Teachers conduct evaluations. The teacher provides an overall evaluation of the quality and rationality of the medical history collection process, with a focus on whether the medical history collection process is complete and orderly; Is the collection of medical history comprehensive and focused; Whether TCM observation, smelling, palpation, Western medicine examination, disease differentiation and diagnosis, and prescription and medication are accurate and reasonable; Evaluate whether the medical record writing is standardized, and evaluate the use of humanistic care, doctor-patient communication skills, etc. during the reception process. Provide guidance on areas that need improvement, totaling 5 minutes.\u003c/p\u003e \u003cp\u003eAfter-class feedback and reflection\u003c/p\u003e \u003cp\u003eComplete homework after class. In the discussion section of Xuexitong, the teacher organized a medical history collection reflection discussion, where students can express their opinions or have private conversations with the teacher. After class, medical students and SSP role transitions randomly and repeatedly practice medical history collection independently, and upload a \"medical history collection\" video.\u003c/p\u003e \u003cp\u003eQuestionnaire survey\u003c/p\u003e \u003cp\u003eAfter the teaching is completed, an anonymous and confidential questionnaire survey will be conducted. The questionnaire is compiled based on existing literature and is mainly divided into six parts: (1) demographic information (Items 1\u0026ndash;2), collect the gender and age of the experimental group; (2) clinical professional competence in TCM (Projects 3\u0026ndash;7); (3) TCM thinking and comprehensive ability (Projects 8\u0026ndash;11); (4) learning ability (projects 12\u0026ndash;14); (5) humanistic literacy and communication and collaboration skills (Projects 15\u0026ndash;17); (6) satisfaction with teaching methods (Item 18) (Supplementary Table\u0026nbsp;1). Conduct pre testing before the investigation to verify the clarity and rationality of the project, and optimize based on feedback results. Finally, 18 projects were determined to adopt a hybrid structure. Among them, 16 Likert three-point scales (1\u0026thinsp;=\u0026thinsp;agree 2\u0026thinsp;=\u0026thinsp;disagree 3 uncertain) were used for attitude measurement, and the other 2 items were demographic information (Items 1\u0026ndash;2).\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\u003eApplication effect of medical history collection thinking training supported by SP simulation teaching in the teaching of TCM Internal Medicine: summary of questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat is your gender?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eA: Male\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eB: Female\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow old are you?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA: 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB: 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC: 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eC: 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eC: 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eC: 23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eFrom Question 3 to 18: A: Agree; B: Disagree; C: Uncertain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to improve the ability to comprehensively obtain medical history?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to deepen the diagnostic ability of TCM internal medicine diseases?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to improve the ability of TCM internal medicine disease differentiation and diagnosis?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to promote the ability of TCM to differentiate diseases and syndromes?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to improve the four diagnostic abilities of TCM?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to improve clinical comprehensive ability?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help train clinical thinking in TCM?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to increase the ability to apply what has been learned?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to integrate and connect learned knowledge?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to enhance learning interest༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to improve learning motivation and initiative༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help improve self-directed learning ability༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help to enhance medical humanities literacy and improve humanistic care capabilities༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help improve doctor-patient communication skills༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDoes it help cultivate team collaboration awareness༟\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDo you wish to continue using this teaching method༟\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\u003eControl group intervention methods\u003c/p\u003e\u003cp\u003eThe control group of students employed case-based teaching. The teacher releases the same learning materials and requirements as the experimental group before class, but without SSP and medical history collection training and role-playing tasks. Therefore, there were no students playing SSP in the classroom practice, no medical students conduct medical history collection for SP, and no immediate structured and multi-dimensional feedback. During the teaching process, students are divided into groups to independently practice medical history collection and case discussions based on different typical clinical cases. Teachers will ask questions based on clinical issues in medical records to facilitate students' thinking and discussion. After class, the same homework and medical history collection were discussed and exchanged, without randomly repeating the practice of medical history collection for medical students or SSP role transitions, without the need to upload a \"medical history collection\" video (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment and evaluation methods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Medical History Collection Ability\u003c/h2\u003e \u003cp\u003eAll students participated in the assessment of medical history collection skills for lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine, as well as the final practical skills exam and the medical history collection exam in the first tier competency assessment of TCM practitioners. The medical history collection section was scored on a 20 point scale. The diseases for medical history collection and assessment are all aligned with the outline of the TCM Practitioner Assistant Physician Qualification Examination, which is a teaching content of TCM Internal Medicine. The difficulty of the questions is equal, and each student is randomly tested for one item, which is randomly assigned by drawing lots. By conducting statistical analysis on the scores of the medical history collection skills assessment, final practical skills examination, and the first tier competency assessment for TCM practitioners in the course of TCM Internal Medicine for two groups of students, the differences in scores between the experimental group and the control group were compared.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey and evaluation methods\u003c/h3\u003e\n\u003cp\u003eAfter the teaching is completed, an anonymous questionnaire survey will be conducted to understand the satisfaction of the experimental group students with the use of the teaching method. The investigation includes: whether the medical history collection skills have been mastered through learning, whether the communication and exchange abilities between doctors and patients, self-learning ability, clinical thinking ability, application ability, and medical humanities literacy have been improved.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e This study has been approved by the Ethics Review Committee of Hunan Traditional Chinese Medicinal College (Approval No. : YXLL202109001) and implemented in accordance with the Helsinki Declaration. All participants provided written informed consent forms. In order to reduce bias in evaluating students' medical history, teachers and examiners are not aware of whether students have participated in the study. The potential benefits, possible discomfort or risks have been fully explained to the participants, and their informed consent has been obtained prior to the study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis methods\u003c/h2\u003e \u003cp\u003eSPSS 26.0 software was used for statistical analysis of the data. The measurement data is represented by (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), which conforms to normal distribution and homogeneity of variance. The comparison between groups is conducted using t-test; Non parametric tests, including Mann-Whitney \u003cem\u003eU\u003c/em\u003e rank sum test, are used for non conformities and/or homogeneity of variance. Count data is represented as N (%), and inter group comparison is performed using \u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test. A difference of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics of students\u003c/h2\u003e \u003cp\u003eThe basic characteristics of the two groups of students are that the experimental group consists of students aged 19 to 22 years old, with an average of 20.30 ± 0.12 years old. There are 28 females (70.0%) and 12 males (30.0%). The age range of the control group students was 19–22 years old, with an average of 20.30 ± 0.11 years old. There were 29 females (72.5%) and 11 males (27.5%). There was no statistically significant difference in age (\u003cem\u003ez\u003c/em\u003e = 2.16, \u003cem\u003ep\u003c/em\u003e = 0.829) and Sex (χ2 = 0.061, \u003cem\u003ep\u003c/em\u003e = 0.805) between the two groups of students (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of the students.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\"\u003e \u003cp\u003estudents, No (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eExperimental (n = 40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eControl (n = 40)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAge, mean ± SD, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20.30 ± 0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20.30 ± 0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e11 (27.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e28 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e29 (72.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of medical history collection scores between two groups of students in different disease and syndrome systems\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe results of medical history collection for each disease system of two groups of students (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The medical history collection scores of each disease system in the experimental group were higher than those in the control group, with pulmonary diseases accounting for 15.25 ± 0.40 \u003cem\u003evs\u003c/em\u003e 10.35 ± 0.33, \u003cem\u003ep\u003c/em\u003e = 0.000; Heart disease syndrome 14.88 ± 0.38 \u003cem\u003evs\u003c/em\u003e 10.17 ± 0.38, \u003cem\u003ep\u003c/em\u003e = 0.000; Brain disease syndrome 15.30 ± 0.34 \u003cem\u003evs\u003c/em\u003e 10.52 ± 0.37, \u003cem\u003ep\u003c/em\u003e = 0.000; Spleen and stomach disease syndrome 14.55 ± 0.39 \u003cem\u003evs\u003c/em\u003e 10.49 ± 0.37, \u003cem\u003ep\u003c/em\u003e = 0.000; Liver and gallbladder disease syndrome 14.50 ± 0.40 \u003cem\u003evs\u003c/em\u003e 10.56 ± 0.38, \u003cem\u003ep\u003c/em\u003e = 0.000; Kidney disease syndrome 15.32 ± 0.35 \u003cem\u003evs\u003c/em\u003e 10.65 ± 0.37, \u003cem\u003ep\u003c/em\u003e = 0.000; Qi-blood-body fluid disease syndrome 14.82 ± 0.44 \u003cem\u003evs\u003c/em\u003e 10.54 ± 0.35, \u003cem\u003ep\u003c/em\u003e = 0.000; Limb meridian disease syndrome 15.09 ± 0.40 \u003cem\u003evs\u003c/em\u003e 9.91 ± 0.36, \u003cem\u003ep\u003c/em\u003e = 0.000; The difference is statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedical history collection skills scores for two groups of disease syndrome systems\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003eExperimental (n = 40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003eControl (n = 40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAverage score\u003c/p\u003e \u003cp\u003e mean ± SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAverage score mean ± SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePulmonary disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.25 ± 0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.35 ± 0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHeart disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.88 ± 0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.17 ± 0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBrain system disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.30 ± 0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.52 ± 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpleen and stomach disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.55 ± 0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.49 ± 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-5.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLiver and gallbladder disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.50 ± 0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.56 ± 0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-5.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eKidney disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.32 ± 0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.65 ± 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eQi-blood-body fluid disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.82 ± 0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.54 ± 0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLimb meridian disease syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.09 ± 0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9.91 ± 0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of final practical skills exam scores between two groups of students\u003c/h2\u003e \u003cp\u003eThe results of the final practical skills exam for two groups of students (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The final practical skills exam scores of the experimental group were higher than those of the control group (95.05 ± 0.29 \u003cem\u003evs\u003c/em\u003e 82.17 ± 0.58, \u003cem\u003ep =\u003c/em\u003e 0.000), The difference is statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal Practical Skills Exam Scores of Two Groups of Students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAverage score\u003c/p\u003e \u003cp\u003e mean ± SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e95.05 ± 0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e82.17 ± 0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e−7.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of Medical History Collection Exam Scores in the First Stage of TCM Practitioner Competence between Two Groups of Students\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe results of the medical history collection exam for the first stage of competence in the position of TCM practitioner (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). The score of the first stage disease history collection exam for the competence of TCM practitioners in the experimental group was higher than that in the control group, with a score of 15.35 ± 0.33 \u003cem\u003evs\u003c/em\u003e 10.41 ± 0.36 in the first simulated exam, \u003cem\u003ep\u003c/em\u003e = 0.000; The second mock exam score was 16.90 ± 0.31 \u003cem\u003evs\u003c/em\u003e 10.96 ± 0.39, \u003cem\u003ep\u003c/em\u003e = 0.000; The official exam score is 17.41 ± 0.29 \u003cem\u003evs\u003c/em\u003e 15.42 ± 0.28, \u003cem\u003ep\u003c/em\u003e = 0.000; The difference is statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the first stage medical history collection examination for the competence of TCM practitioners in two groups of students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003eExperimental (n = 40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003eControl (n = 40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAverage score\u003c/p\u003e \u003cp\u003e mean ± SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAverage score mean ± SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe first mock exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.35 ± 0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.41 ± 0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-6.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecond mock exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e16.90 ± 0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10.96 ± 0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-7.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOfficial Exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e17.41 ± 0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e15.42 ± 0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e-4.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of the effectiveness of medical history collection thinking training supported by SP simulation teaching\u003c/h2\u003e \u003cp\u003eThe survey results show that 98.31% of students have mastered the skills of medical history collection through the SP medical history collection thinking training teaching method. 94.92% to 100% of students believe that learning through this system can improve the communication and exchange ability between doctors and patients, the four diagnostic abilities of TCM, the diagnosis and differential diagnosis ability of internal medicine diseases in TCM, as well as the clinical thinking, application ability, medical humanities literacy, and humanistic care ability of TCM. More than 90% of students hope to continue using this teaching method (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab6\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of Students' Medical History Collection Thinking Training Supported by SP Simulation Teaching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" rowspan=\"2\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\"\u003e \u003cp\u003estudents, No (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps improve the ability to comprehensively obtain medical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e38(95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps deepen the diagnostic ability of TCM internal medicine diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to improve the ability of TCM internal medicine disease differentiation and diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps promote the ability of TCM to differentiate diseases and syndromes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to improve the four diagnostic abilities of TCM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to improve clinical comprehensive ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps train clinical thinking in TCM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to enhance learning interest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e38(95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to improve learning motivation and initiative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps improve self-directed learning ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to increase the ability to apply what has been learned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to enhance medical humanities literacy and improve humanistic care capabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps improve doctor-patient communication skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e40(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps to integrate and connect learned knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHelps cultivate team collaboration awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDo you wish to continue using this teaching method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e39(97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":"\u003cp\u003eThis study found that the medical history collection thinking training teaching method supported by SP simulation teaching can improve students' abilities in medical history collection, TCM syndrome differentiation thinking, clinical communication skills, and self-confidence. A questionnaire survey showed that this method was well received by students.\u003c/p\u003e\u003ch2\u003eThe Current Challenges in Teaching TCM Internal Medicine\u003c/h2\u003e\u003cp\u003eAs a core course of TCM education, the teaching objective of TCM Internal Medicine aims to cultivate students to establish a systematic TCM clinical thinking mode of disease differentiation and syndrome differentiation. Modern medical education emphasizes student-centered approach and focuses on cultivating students' clinical thinking and practical abilities[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Currently, there is a common problem in the teaching of TCM internal medicine that emphasizes theory over practice. The characteristic of TCM's clinical thinking is \"syndrome differentiation and treatment\" [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], emphasizing \"external diagnosis and internal treatment\" and \"four diagnostic methods combined with reference\". However, the traditional teaching model mainly relies on classroom lectures, where students passively receive knowledge [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]and lack opportunities for active thinking and clinical practice. Classroom teaching mainly focuses on teachers teaching theories and analyzing typical medical cases, with limited opportunities for students to interact with real patients, resulting in a serious disconnect between theory and practice. This \"talk on paper\" teaching method is difficult to train students in the ability to interact with patients, dynamically collect medical history, and form disease differentiation and syndrome differentiation ideas in real time through \"external guidance and internal guidance\" and \"four diagnostic methods\". Students often master fragmented knowledge points, but are unable to effectively integrate and apply them in complex clinical scenarios, resulting in the dilemma of \"knowing but not acting\", which restricts the cultivation of their clinical confidence and job competence. In addition, the existing teaching of TCM internal medicine lacks sufficient emphasis on the cultivation of medical history collection skills. Comprehensive and systematic medical history collection is the foundation of clinical diagnosis [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e] and an important manifestation of clinical thinking ability. However, in current teaching, medical history collection is often seen as a simple task of collecting diagnostic data, lacking systematic thinking training and method guidance. This often leads to students being unable to collect medical history comprehensively and accurately during clinical internships and future work, which affects the accuracy of diagnosis and treatment outcomes. How to break through this bottleneck and create an efficient and safe clinical thinking training environment is the focus of current reform in TCM education. Therefore, reforming the teaching mode of TCM internal medicine and strengthening the training of medical history collection thinking have become urgent needs to improve the quality of TCM talent cultivation.\u003c/p\u003e\u003ch2\u003eSP Simulation Teaching: Building a Bridge between Theory and Practice\u003c/h2\u003e\u003cp\u003eScenario simulation teaching method allows students to consolidate medical knowledge and acquire clinical skills through simulating real medical scenarios in practice[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. The results of this study are highly consistent with the broad consensus in the global medical education field regarding the value of simulated teaching, and further highlight its unique significance in the specific context of TCM. The core advantage of simulated teaching lies in its ability to provide opportunities for deliberate practice, allowing learners to repeatedly practice, make mistakes, and learn from immediate feedback in a \"risk-free\" environment[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This is a key link in internalizing clinical skills and building clinical confidence. This study further deepens this consensus and reveals the unique advantages of SP in the specific context of TCM history collection. The integration of SP teaching mode provides innovative solutions to solve the above difficulties. SSP refers to a simulator who, through systematic and standardized training, can accurately and consistently simulate the clinical manifestations and emotional responses of specific diseases[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the context of TCM, the core value of SSP lies in its ability to highly replicate the complex scenarios of TCM consultations. Unlike Western medical consultations that focus on localization and qualitative diagnosis, the collection of medical history in TCM is not simply a list of information, but a dynamic and exploratory clinical thinking process. It requires medical students to be able to use TCM theory to guide and systematically question patients based on their initial complaints, in order to uncover hidden key information with dialectical value (such as patients' subjective feelings of \"cold and heat\", \"sweating\", \"taste\", \"emotion\", \"bowel movements\" and physical signs (such as tongue and pulse), etc.). Although traditional teacher oral teaching can impart knowledge, it cannot vividly convey these subtle and complex information, making it difficult to simulate this dynamic and interactive thinking process. The SSP used in this study, after careful design and training, can stably, accurately, and repetitively simulate the demeanor, tone, chief complaint details, and response content that specific syndromes should have, creating a high fidelity simulation environment that enables students to truly practice the art of \"medical history collection\" in a controlled, safe, and tolerant environment, training their ability to quickly capture key pathological points from chaotic information, and providing students with a risk-free, almost real \"clinical\" experience. This is the fundamental reason for the significant improvement in the \"logicality\" and \"accuracy\" of medical history collection.\u003c/p\u003e\u003cp\u003eThe cultivation of clinical reasoning ability is the core of medical education[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Modern medical education emphasizes student-centered approach and focuses on cultivating students' clinical thinking and practical abilities[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. SSP uses highly standardized deduction to transform abstract TCM syndromes (such as \"liver depression and spleen deficiency\", \"yin deficiency and fire excess\") into concrete and perceptible clinical manifestations, enabling students to connect theoretical knowledge in textbooks with the symptoms, signs, and behaviors of \"real\" patients, thus deeply understanding the concept of \"syndrome\" and mastering the methods of \"differentiation\". The results of this study indicate that the experimental group students have significantly better completeness, accuracy, and logicality in medical history collection than the control group, which is a direct reflection of the effectiveness of SSP teaching. It effectively trains students to capture key pathological information from scattered symptoms and closely links it with the \"thinking process\" of TCM theory and thinking of \"treating external symptoms with internal symptoms\" and \"integrating the four diagnostic methods\". This coincides with the concept that simulated teaching can help students develop \"clinical reasoning\" [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. This immersive learning experience that combines theory with practice greatly stimulates students' interest and intrinsic motivation in learning. At the same time, it transforms students from passive knowledge receivers to active clinical explorers, internalizing TCM theory into clinical skills in practice. This is directly reflected in the extremely high satisfaction level of the questionnaire survey. The feedback from students that they have \"deepened their understanding of theoretical knowledge\" and \"improved their ability to distinguish diseases and syndromes\" is a direct proof of the effective training of medical and clinical thinking.\u003c/p\u003e\u003ch2\u003eSP simulation teaching: multi-dimensional improvement of teaching effectiveness\u003c/h2\u003e\u003cp\u003eThe contribution of SP goes far beyond training in medical history collection techniques. Its deeper value lies in promoting the early construction and solidification of students' clinical reasoning patterns. This study comprehensively evaluated the effectiveness of SP teaching from two dimensions: objective skill assessment and subjective perception.\u003c/p\u003e\u003cp\u003eIn terms of objective skills, the excellent performance of the experimental group in the medical history collection of the \"First Step Assessment of TCM Practitioner Job Competence\" proves that SSP training can be directly transformed into higher clinical competence by integrating more advanced simulation techniques and high fidelity script design. This improvement is not only reflected in students' simple listing of symptoms, but also in their sorting of logical relationships between symptoms and capturing of core pathological information, achieving the completeness, logicality, and accuracy of medical history collection, which is precisely the core of TCM dialectical thinking.\u003c/p\u003e\u003cp\u003eIn terms of subjective feelings, the high satisfaction and recognition of the questionnaire survey are strong evidence of the success of SP teaching. Student feedback indicates that this model greatly stimulates learning interest and initiative, deepens understanding of abstract TCM theories (such as syndrome concepts), and significantly enhances clinical practice ability and confidence in disease differentiation and syndrome differentiation. This positive learning experience aligns with Edward Deci and Richard Ryan's \"Self Determination Theory (SDT) [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]\", where SP teaching effectively promotes students' intrinsic learning motivation by providing satisfaction with autonomy (active medical history collection), competence (successful completion of medical history collection and feedback), and relevance (interaction with the \"patient\").\u003c/p\u003e\u003ch2\u003eThe core role of SP simulation teaching: building feedback loop and metacognitive ability\u003c/h2\u003e\u003cp\u003eThe success of SP teaching goes beyond simple simulations of clinical scenarios, and its essence lies in constructing a complete learning loop that includes \"practice→feedback→reflection→re-practice\". The real-time structured feedback of SSP in simulated teaching is another key mechanism driving students' ability improvement. Bokken et al. emphasized that providing effective clinical and communication skills feedback to students through SP can enable students in simulated teaching to demonstrate better skills [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. Philosopher and educator John Dewey placed reflection at the core of education[\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]; In addition, Schön's[\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e] practical epistemology of \"Reflection-in-Action\" states that practitioners can pause or control some daily obstacles in the experimental context of the virtual world to engage in rigorous reflective actions. Feedback is an important component of the teaching process [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e], and timely feedback plays a crucial role in promoting the development of students' clinical reasoning abilities. Throughout the simulation teaching process, students can continuously receive timely feedback from SP, reflect on it, adjust their medical history collection strategies in a timely manner, improve the strategies in the medical history collection process, and enhance clinical thinking. In the design of this study, after each medical history collection, SSP provides immediate, structured, and multi-dimensional feedback that not only evaluates students' communication and empathy abilities from the patient's perspective, but also points out omissions in the process of medical history collection from the perspective of TCM, such as not asking about sweating, ignoring emotional triggers. This direct, specific, and contextualized feedback from the \"patient\" is more impactful and memorable than third-party comments from teachers, allowing students to immediately recognize their own thinking blind spots, such as missing inquiries about specific \"Ten Questions Song\" items, which is a key mechanism driving students' ability improvement. This practice based feedback mechanism aims to cultivate students' metacognition ability– the ability to monitor and regulate their own thinking processes [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e], which is a core trait of mature clinical physicians. Through repeated SSP training and feedback during the practical process, students are able to reflect on and internalize a more comprehensive, systematic, and rigorous framework for collecting TCM medical history and dialectical thinking in a timely manner, thereby avoiding the omission of key dialectical elements in subsequent practice and future real clinical situations, ultimately achieving self optimization and spiral learning effects.\u003c/p\u003e\u003ch2\u003eLimitations and further improvements\u003c/h2\u003e\u003cp\u003eAlthough this study has achieved positive results, there are still certain limitations. Firstly, the research was conducted within a single institution with a relatively limited sample size. In the future, multi center, large sample studies will be needed to validate the generalizability of the results. Secondly, the success of SP simulation teaching highly depends on the quality of medical case scripts and the level of SP training. The development of medical case scripts, student standard patient training, and quality control require continuous funding and manpower investment, which may be a practical challenge for widespread promotion. Finally, this study mainly evaluated the teaching effectiveness in the short and medium term, and the impact of SP training on students' long-term clinical ability maintenance and development, which still requires long-term follow-up research.\u003c/p\u003e\u003cp\u003eLooking ahead to the future, there is still great potential to explore the application of TCM teaching models supported by SP simulation teaching in TCM education. The next step of research can focus on: 1) Develop an SP medical case library covering different levels of difficulty from single syndrome to complex compound syndrome, and construct a progressive TCM thinking training curriculum system; 2) Explore the integration of artificial intelligence (AI) and augmented reality (AR) technology into SP for simulating objective signs with more TCM characteristics such as tongue and pulse, further enhancing the authenticity of the simulation; 3) Further integrate SP with Objective Structured Clinical Examination (OSCE) to establish a more scientific and objective evaluation standard for TCM clinical thinking ability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the medical history collection thinking training supported by SP simulation teaching is an efficient and reliable teaching method for TCM internal medicine, and an effective innovation to address the challenges of traditional teaching. It can not only significantly improve the completeness, accuracy, and logicality of students' medical history collection, but also enhance their TCM dialectical thinking ability, clinical communication skills, and confidence, and gain high recognition from students. More importantly, it creates a bridge between theory and practice for students by providing high fidelity simulation environments and structured feedback, effectively promoting the construction of their TCM clinical thinking patterns and the development of their metacognitive abilities. Despite the challenges in terms of cost and promotion, its enormous potential in cultivating high-quality and capable clinical talents in TCM that meet the requirements of the new era makes it an important direction for promoting the modernization reform of TCM education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuiping Ou: Data organization, formal analysis, investigation, and initial draft writing; Hui\u003csup\u003e \u003c/sup\u003eLin: Supervision, proofreading, writing review, and editing. Hui Xu and Linglan Mo: conceptualized and designed this study; Duo\u003csup\u003e \u003c/sup\u003eYuan, Chuang Fang and Li Liu: Collecting data and analyzing results; Enjin Zeng and Xing Huang: Data management, investigation, methodology. Ge Fang and Xiaoxiao Xiao: Contributed to manuscript revision and methodology. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Hunan Vocational College Education and Teaching Reform Research Project (ZJGB2022010)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed in this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has been approved by the Ethics Review Committee of Hunan Traditional Chinese Medicinal College (Approval No. : YXLL202109001), and all participants provided written informed consent forms. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were assured in the consent form they signed the publication of the data will not indicate their names or any identification information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhou F, Sang A, Zhou Q, Wang QQ, Fan Y, Ma S. 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J Educ Health Promot. 2023;12:283.\u003c/span\u003e\u003c/li\u003e\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":"Traditional Chinese Medicine internal medicine, Medical history collection, Standardized patients, Simulated teaching, Clinical thinking","lastPublishedDoi":"10.21203/rs.3.rs-8979230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8979230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo explore the impact of medical history collection thinking training supported by SP simulation teaching on the teaching of Traditional Chinese Medicine (TCM) internal medicine.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTwo classes of acupuncture and massage therapy majors were randomly selected as the experimental group (n\u0026thinsp;=\u0026thinsp;40) and the control group (n\u0026thinsp;=\u0026thinsp;40). During the practical teaching process of internal medicine in TCM, the experimental group employed a medical history collection thinking training method supported by SP simulation teaching, while the control group received case-based teaching. Both groups underwent assessments on medical history collection skills for lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine; The final practical skills exam; The first simulated exam, the second simulated exam, and the formal exam of the first stage medical history collection exam for the competence of TCM practitioners. Additionally, the experimental group's teaching effectiveness was evaluated through methods such as questionnaire surveys.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCompared with the control group, the scores of the experimental group students in collecting medical history of lung, heart, brain, spleen and stomach, liver and gallbladder, kidney, qi-blood-body fluid, and limb meridian system diseases in TCM internal medicine were significantly increased (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The experimental group scored better than the control group in the final practical skills exam, the first simulated exam, the second simulated exam, and the formal exam of the first stage medical history collection exam for the competence of TCM practitioners (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe teaching method of medical history collection thinking training and inquiry skills supported by SP simulation teaching can improve students' ability to collect medical history and clinical thinking in TCM, and enhance their level of diagnosis in TCM.\u003c/p\u003e","manuscriptTitle":"Application of standardized patients simulation teaching supported medical history collection thinking training in TCM internal medicine teaching","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 10:23:43","doi":"10.21203/rs.3.rs-8979230/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-11T23:15:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81492246170178360507677070498853175227","date":"2026-04-07T13:48:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T12:39:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-17T09:26:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T12:44:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-01T13:55:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-01T13:49:59+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":"cb98742c-0470-48c6-b6dc-3d5dd19ed77b","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T10:23:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 10:23:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8979230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8979230","identity":"rs-8979230","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}