The effectiveness of the combined mind mapping and problem-based learning method in the clinical practical teaching of ectopic pregnancy

The effectiveness of the combined mind mapping and problem-based learning method in the clinical practical teaching of ectopic pregnancy | 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 Article The effectiveness of the combined mind mapping and problem-based learning method in the clinical practical teaching of ectopic pregnancy Weimin Xie, Zhangyi Wang, Rong Tang, Xiaohang Liu, Chunyan Xie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6188914/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The aim of this study is to explore the effectiveness of combining mind mapping and problem-based learning (MBL) in clinical teaching of ectopic pregnanancy. Fifth-year students were randomly assigned into either the MBL group or the traditional group. All participants received theory tests before and after the course. After the end of the course, both groups of students were required to complete a comprehensive anonymous survey, focusing on the evaluation of teaching methods.There were no significant differences in pre-course basic knowledge and case analysis scores between the 2 groups (P > 0.05). The post-course basic knowledge and case analysis scores in the MBL group were significantly higher than that in the traditional group. The scores for learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course in the MBL group were significantly higher than that in the traditional group (P <0.05 for all). The students learning ectopic pregnancy with the MBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods. Health sciences/Medical research/Outcomes research Health sciences/Medical research/Study design Ectopic pregnancy problem-based learning mind mapping clinical teaching traditional teaching method Figures Figure 1 Introduction Ectopic pregnancy is a relatively common disorder affecting approximately 1% to 2% of all pregnancies 1,2 , and ectopic pregnancy ruptures are the leading cause of maternal mortality within the first trimester of pregnancy with a rate of 9%-14% and an incidence of 5%-10% of all pregnancy-related deaths 3 . Ectopic pregnancy is a complex and acute condition which can be easily misdiagnosed as acute abdominal diseases, such as abortion, corpus luteum rupture, and acute appendicitis. Students often have difficulties understanding basic knowledge concepts and lack enthusiasm. Therefore, reforming the teaching method of ectopic pregnancy, cultivating students' logical thinking and stimulating students’ enthusiasm for learning, turning theory into practice, and leading students to obtain better learning results in a limited time has been a challenge for teachers. Traditional teaching methods deliver basic and clinical science information primarily in a lecture format. As a traditional teaching method, lecture-based learning (LBL) adopts an "indoctrination" teaching method; students passively accepting knowledge rely on repetition and memorization, and evidence suggests that LBL is easy to implement but insufficient for the acquisition of knowledge and can lead to the students’ negligence 4,5 . Problem-based learning (PBL) is a problem-centred, open and exploratory learning method that is currently one of the mainstream teaching methods in international medical education 6 . It allows students to actively participate, interact with peers in small groups to define learning goals, engage in self-study, discuss and apply new knowledge, and eventually integrate a variety of material during the learning process 6,7 . As Tony Bazin originally proposed, mind mapping is a multisensory tool that uses visuospatial orientation to integrate information 8 . It uses vocabulary, lines, symbols and images to form divergent and nodal structural forms. It further transforms tedious text information into hierarchical maps to improve learners’ information storage, extraction, and work and learning efficiency 9-13 . The added dimensions of pictures and colours visualize a long list of mundane information and results and benefit students with diverse learning styles. Mind mapping can teach students to integrate information across disciplines, understand the relationship between basic science and clinical science, and advance medical education 8, 13 . Given the positive role of PBL in guiding students’ learning and the prominent role of mind mapping in concept integration, we hypothesize that a combined mind mapping and PBL (MBL) teaching method can better promote effective, high-quality student learning. In this study, we combined mind mapping with the PBL teaching method for clinical teaching of ectopic pregnancy to evaluate the effectiveness and acceptability of the MBL teaching method. Materials and Methods This was a prospective, randomized, controlled study. We recruited fifth-year undergraduate medical students in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from October 2023 to May 2024. An independent worker prepared a randomization table using SAS (SAS Institute, Cary, NC, USA) software, and study participants were assigned using the simple randomization method. Based on the results, the students were assigned to two groups: the MBL and traditional groups. Neither the students nor the teachers knew the group information before the class started. The ethics committee of the hospitals approved the study. Written informed consent was obtained from all participants. The methods of this investigation were in accordance with the approved guidelines and the principles expressed in the Declaration of Helsinki. The schedule for the MBL group was as follows. Before the course, the teachers drew a mind map using mind mapping software (MindMaster, Shenzhen, China), which consisted of 7 modules: definition, aetiology, classification, time of rupture, clinical findings, diagnosis, and treatment (Fig. 1 ). A final version of the mind map was then constructed and printed. The students were provided with the printed mind map and taught the contents of the mind map. The teachers put forward representative and enlightening questions according to the characteristics of EP. Then, under the instructor's guidance, the students carried on small-group discussions. During these discussions, the students were encouraged to raise relevant questions and seek answers on the Internet and library databases. In the third step, a student representative from each group made a presentation reviewing the main points from the lesson, shared their group’s responses to the questions posed, and asked about any unsolved questions. Finally, the teacher summarized the course content and reviewed the challenging issues raised during the discussion. The schedule for the traditional group was as follows. The teachers carried out traditional classroom teaching according to the teaching syllabus. The students learned the same teaching content as those covered in the MBL group. The teacher thoroughly explained the theoretical knowledge instead of discussing the cases in a group. All participants received theory tests before and after the course. The tests were presented as 20 single-choice questions with 1 point for each and composed of basic theoretical questions (worth 10 points) and clinical case analyses (worth 10 points). After the end of the course, both groups of students were required to complete a comprehensive anonymous survey focusing on the evaluation of teaching methods. The anonymous survey comprised 9 questions, including questions about learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course. The anonymous survey was assessed using a five-point scale, where a score of 1 denoted the lowest level of agreement and a score of 5 indicated the highest (Supplementary Table 1). Statistical analysis was performed using SPSS version 18 (IBM, Armonk, NY, USA). Continuous data are reported as mean and SD when normally distributed and median and interquartile range (IQR) when not normally distributed. Normally distributed continuous data were analyzed using the Student t-test. The Mann-Whitney U tests analyzed continuous data that was not normally distributed. The categorical data are reported as counts and percentages and were analyzed with χ2 and Fisher exact tests. All tests were two-sided, and p < 0.05 was considered significant. Results From October 2023 to May 2024, a total of 96 students (47 men and 49 women), aged between 21 and 23 years (mean:28.6 years), were included and randomly assigned to the MBL group (n = 48) and the traditional group (n = 48). The basic student characteristics can be seen in Table 1 . The average age of students was 22.8 ± 0.7 years old in the MBL group and 23.0 ± 0.7 years old in the traditional group; the difference between the two groups was not statistically significant ( P > 0.05). 24 (50%) females were in the MBL group, and 25 (52%) females were in the traditional group; there was no significant difference between the two groups in terms of gender. Table 1 Comparison of general data between the MBL group and the traditional group Item MBL group (N = 48) Traditional group (N = 48) P value Age 22.8 ± 0.7 23.0 ± 0.7 0.143 Gender Male 24 (50%) 23 (48%) Female 24 (50%) 25 (52%) 0.838 The pre-and post-course test scores are shown in Table 2 . The mean pre-course basic knowledge and case analysis scores in the MBL versus traditional groups were 29.1 ± 4.6 and 29.3 ± 4.4 versus 27.5 ± 2.8, 27.5 ± 2.8, respectively, while the post-course basic knowledge and case analysis scores in the MBL versus traditional groups were 39.1 ± 5.0 and 39.1 ± 5.0 versus 37.8 ± 3.5 and 34.9 ± 2.9, respectively. There were no significant differences in pre-course basic knowledge and case analysis scores between the two groups (P > 0.05). The post-course basic knowledge and case analysis scores in both groups were improved compared to pre-course scores (P < 0.05). The post-course basic knowledge and case analysis scores in the MBL group were significantly higher than that in the traditional group (P < 0.05). Table 2 The comparison of the pre- and post-class test scores of the MBL group vs. the traditional group Items MBL group (N = 48) Traditional group (N = 48) P value Total pre-class score 56.5 ± 4.1 55.8 ± 2.8 0.327 Pre-class basic knowledge score 29.1 ± 4.6 29.3 ± 4.4 0.857 Pre-class case analysis score 27.5 ± 2.8 26.6 ± 3.3 0.163 Total post-class score 77.0 ± 4.8 71.8 ± 4.3 0.000 Post-class basic knowledge score 39.1 ± 5.0 36.8 ± 4.1 0.016 Post-class case analysis score 37.8 ± 3.5 34.9 ± 2.9 0.000 The results of the anonymous survey are shown in Table 3 . The scores for learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course in the MBL group were significantly higher than that in the traditional group ( P < 0.05 for all). Table 3 Comparison of questionnaire survey results between the MBL group and the traditional group Items MBL group (N = 48) Traditional group (N = 48) P value Learning motivation 3.7 ± 0.7 3.2 ± 0.7 0.001 Understanding 3.7 ± 0.7 2.8 ± 0.6 0.000 Student-teacher interaction 3.5 ± 0.5 3.1 ± 0.7 0.004 Communication skills 3.8 ± 0.6 2.9 ± 0.9 0.000 Clinical thinking skills 3.6 ± 0.7 3.0 ± 0.9 0.002 Self-learning skills 3.8 ± 0.7 2.7 ± 0.8 0.000 Teamwork skills 3.8 ± 0.7 2.7 ± 0.6 0.000 Knowledge absorption 3.8 ± 0.7 3.0 ± 0.8 0.000 Satisfaction with the course 4.2 ± 0.5 3.1 ± 0.7 0.000 Discussion In the United States, the estimated prevalence of ectopic pregnancy is 1–2%, but this may be an underestimate because this condition is often treated in the office setting where it is not tracked 2 . Ectopic pregnancy is a potentially life-threatening condition and should be considered in any pregnant patient with lower abdominal pain or vaginal bleeding 14 . The nature, location, constancy, and severity of pain in ectopic pregnancy vary among sufferers. Patients with suspected or confirmed ectopic pregnancy who exhibit clinical findings of ruptured ectopic pregnancy should be emergently treated with surgical intervention. Therefore, this course presents significant challenges for medical students and may lead to confusion about prompt and accurate diagnosis. Traditional teaching methods focus on teachers while students passively receive knowledge. The limitation of this model is that teachers only focus on their understanding of the subject matter, failing to fulfil their role of guiding students to cultivate clinical thinking. Furthermore, many medical students lack initiative and creativity, ultimately making it difficult to apply the acquired knowledge to clinical practice 15 , 16 . PBL is a collaborative process that involves problem-solving through case analysis and clinical reasoning, requiring students to have high learning initiative. However, students with lower self-directed learning abilities may need help to adapt to this teaching method, resulting in difficulties in mastering fundamental knowledge 17 . Mind mapping is a simple and efficient visual-spatial method/tool of combining drawings with words to build memory links between a topic keyword and image, colour, or another link, helping to build a complete knowledge system. This approach will improve students’ comprehensive analysis abilities, resulting in a more scientifically rigorous and effective learning process 18 . Considering their respective advantages, our study applied a teaching method integrating PBL and mind mapping in teaching ectopic pregnancy, allowing them to complement and reinforce each other. To investigate the effectiveness and acceptability of the MBL teaching method in teaching ectopic pregnancy, we compared it with the traditional teaching method. Our study showed no significant difference in basic characteristics and pre-course basic knowledge and case analysis scores between the two groups. However, the MBL group scored higher than the traditional group in the post-course basic knowledge and case analysis scores, demonstrating the effectiveness of the MBL teaching method. The results also indicated that students in the MBL group had formed a comprehensive and organized understanding of ectopic pregnancy, further enhancing their clinical thinking skills. Through anonymous survey scores, it was found that the MBL teaching method had significant advantages in learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, and satisfaction. These findings suggested that students in the MBL group tended to adopt a more balanced approach to learning and practice and obtain a higher satisfaction rate with the course, thereby becoming more proactive learners. This study showed that the MBL teaching method is promising and indicates better short-term effects than the traditional teaching method in gynecologic education. This study had some limitations. First, We assumed that PBL and mind mapping were mutually complementary and could achieve the best effect when combined. However, no control groups used PBL or mind mapping alone in this study, and we could not determine whether the combined method was superior to PBL or mind mapping alone. Second, some analysis biases were unavoidable due to the lack of blinding in our study. Third, there is no subjective method to evaluate the effects of teaching methods. Lastly, our results were based on one ectopic pregnancy course with a small sample size. Long-term follow-up data were not available to produce more grounded assessments. Therefore, more well-designed, randomized controlled trials with large samples are needed to confirm the effect of the MBL teaching method. In conclusion, our study showed that the students learning ectopic pregnancy with the MBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the MBL teaching method might be a promising new mode for gynecologic education. Declarations Competing interests The authors declare no competing interests. Funding This study was supported by the Medical and Health Industry Joint Foundation of Natural Science Foundation of Hunan Province in 2025 (Grant No: 2025JJ80598, 2025JJ80594); the Hunan Nursing Association's 2024 Scientific Research Project Youth Project (CN) [grant numbers: HNKYP202413] Author Contribution CYX conceived the idea and reviewed and edited the manuscript. WMX and ZYW wrote the manuscript. RT and XHL conducted research, selection, data extraction, and statistical analysis. All authors reviewed the manuscript. Acknowledgements Not applicable. Data Availability The datasets obtained and/or analyzed during the current study are available from the corresponding author on reasonable request. References Naimi, A. A. et al. Ectopic pregnancy: a single-center experience over ten years. Reprod. Biol. Endocrinol. 19 (1), 79 (2022). Hendriks, E., Rosenberg, R. & Prine, L. Ectopic Pregnancy: Diagnosis and Management. Am. Fam Physician . 101 (10), 599–606 (2020). Houser, M., Kandalaft, N. & Khati, N. J. Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls. Emerg. Radiol. 29 (1), 161–172 (2022). Zhang, F. Y., Zhao, L., Zeng, Y. L., Xu, K. & Wen, X. A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education. Nurse Educ. Today . 79 , 86–91 (2019). Yang, W. J. & Su, L. A., Liping Ding Application of problem based learning (PBL) and case based learning (CBL) in the teaching of international classification of diseases encoding. Sci. Rep. 13(1),15220 (2023). Wang, Q., Li, H. & Pang, W. From PBL tutoring to PBL coaching in undergraduate medical education: an interpretative phenomenological analysis study. Med. Educ. Online . 21 , 31973 (2016). Arruzza, E., Chau, M. & Kilgour, A. Problem-based learning in medical radiation science education: A scoping review. Radiography 29 (3), 564–572 (2023). D’Antoni, A. V., Zipp, G. P., Olson, V. G. & Cahill, T. F. Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students? BMC. Med. Edu c. 10,61 (2010). Turkestani, F. A. et al. Mind mapping to enhance critical thinking skills in respiratory therapy education. J. Educ. Health Promot . 5 (13), 198 (2024). Wu, H. Z. & Wu, Q. T. Impact of mind mapping on the critical thinking ability of clinical nursing students and teaching application. J. Int. Med. Res. 48 (3),300060519893225 (2020). Yang, H. et al. The use of mind mapping in health education in extended care for children with caries. J. Int. Med. Res. 48 (5), 030006051989805 (2020). Kotcherlakota, S., Zimmerman, L. & Berger, A. M. Developing scholarly thinking using mind maps in graduate nursing education. Nurse Educ. 38 (6), 252–255 (2013). Farrand, P., Hussain, F. & Hennessy, E. The efficacy of the mind map study technique. Med. Educ. 36 (5), 426–431 (2002). Houser, M., Kandalaft, N. & Khati, N. J. Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls. Emerg. Radiol. 29 (1), 161–172 (2022). Oderinu, O. H., Adegbulugbe, I. C., Orenuga, O. O. & Butali, A. Comparison of students’perception of problem-based learning and traditional teaching method in a Nigerian dental school. Eur. J. Dent. Educ. 24 (2), 207–212 (2020). Cantillon, P. Teaching large groups. Br. Med. J. 7386 ,437 (2003). Hung, C. H. & Lin, C. Y. Using concept mapping to evaluate knowledge structure in problem-based learning. BMC Med. Educ. 15 ,212 (2015). Ying, G. et al. Using Mind Maps to Improve Medical Student Performance in a Pharmacology Course at Kunming Medical University. J. Coll. Physicians Surg. Pak . 27 (7), 404–408 (2017). Additional Declarations No competing interests reported. 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Ectopic pregnancy is a complex and acute condition which can be easily misdiagnosed as acute abdominal diseases, such as abortion, corpus luteum rupture, and acute appendicitis. Students often have difficulties understanding basic knowledge concepts and lack enthusiasm. Therefore, reforming the teaching method of ectopic pregnancy, cultivating students' logical thinking and stimulating students’ enthusiasm for learning, turning theory into practice, and leading students to obtain better learning results in a limited time has been a challenge for teachers.\u003c/p\u003e\n\u003cp\u003eTraditional teaching methods deliver basic and clinical science information primarily in a lecture format. As a traditional teaching method, lecture-based learning (LBL) adopts an \"indoctrination\" teaching method; students passively accepting knowledge rely on repetition and memorization, and evidence suggests that LBL is easy to implement but insufficient for the acquisition of knowledge and can lead to the students’ negligence\u003csup\u003e4,5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eProblem-based learning (PBL) is a problem-centred, open and exploratory learning method that is currently one of the mainstream teaching methods in international medical education\u003csup\u003e6\u003c/sup\u003e. It allows students to actively participate, interact with peers in small groups to define learning goals, engage in self-study, discuss and apply new knowledge, and eventually integrate a variety of material during the learning process\u003csup\u003e6,7\u003c/sup\u003e. As Tony Bazin originally proposed, mind mapping is a multisensory tool that uses visuospatial orientation to integrate information\u003csup\u003e8\u003c/sup\u003e. It uses vocabulary, lines, symbols and images to form divergent and nodal structural forms. It further transforms tedious text information into hierarchical maps to improve learners’ information storage, extraction, and work and learning efficiency\u003csup\u003e9-13\u003c/sup\u003e. The added dimensions of pictures and colours visualize a long list of mundane information and results and benefit students with diverse learning styles. Mind mapping can teach students to integrate information across disciplines, understand the relationship between basic science and clinical science, and advance medical education\u003csup\u003e8, 13\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eGiven the positive role of PBL in guiding students’ learning and the prominent role of mind mapping in concept integration, we hypothesize that a combined mind mapping and PBL (MBL) teaching method can better promote effective, high-quality student learning. In this study, we combined mind mapping with the PBL teaching method for clinical teaching of ectopic pregnancy to evaluate the effectiveness and acceptability of the MBL teaching method.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a prospective, randomized, controlled study. We recruited fifth-year undergraduate medical students in the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital from October 2023 to May 2024. An independent worker prepared a randomization table using SAS (SAS Institute, Cary, NC, USA) software, and study participants were assigned using the simple randomization method. Based on the results, the students were assigned to two groups: the MBL and traditional groups. Neither the students nor the teachers knew the group information before the class started. The ethics committee of the hospitals approved the study. Written informed consent was obtained from all participants. The methods of this investigation were in accordance with the approved guidelines and the principles expressed in the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eThe schedule for the MBL group was as follows. Before the course, the teachers drew a mind map using mind mapping software (MindMaster, Shenzhen, China), which consisted of 7 modules: definition, aetiology, classification, time of rupture, clinical findings, diagnosis, and treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A final version of the mind map was then constructed and printed. The students were provided with the printed mind map and taught the contents of the mind map. The teachers put forward representative and enlightening questions according to the characteristics of EP. Then, under the instructor's guidance, the students carried on small-group discussions. During these discussions, the students were encouraged to raise relevant questions and seek answers on the Internet and library databases. In the third step, a student representative from each group made a presentation reviewing the main points from the lesson, shared their group\u0026rsquo;s responses to the questions posed, and asked about any unsolved questions. Finally, the teacher summarized the course content and reviewed the challenging issues raised during the discussion.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe schedule for the traditional group was as follows. The teachers carried out traditional classroom teaching according to the teaching syllabus. The students learned the same teaching content as those covered in the MBL group. The teacher thoroughly explained the theoretical knowledge instead of discussing the cases in a group.\u003c/p\u003e \u003cp\u003eAll participants received theory tests before and after the course. The tests were presented as 20 single-choice questions with 1 point for each and composed of basic theoretical questions (worth 10 points) and clinical case analyses (worth 10 points). After the end of the course, both groups of students were required to complete a comprehensive anonymous survey focusing on the evaluation of teaching methods. The anonymous survey comprised 9 questions, including questions about learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course. The anonymous survey was assessed using a five-point scale, where a score of 1 denoted the lowest level of agreement and a score of 5 indicated the highest (Supplementary Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SPSS version 18 (IBM, Armonk, NY, USA). Continuous data are reported as mean and SD when normally distributed and median and interquartile range (IQR) when not normally distributed. Normally distributed continuous data were analyzed using the Student t-test. The Mann-Whitney U tests analyzed continuous data that was not normally distributed. The categorical data are reported as counts and percentages and were analyzed with χ2 and Fisher exact tests. All tests were two-sided, and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom October 2023 to May 2024, a total of 96 students (47 men and 49 women), aged between 21 and 23 years (mean:28.6 years), were included and randomly assigned to the MBL group (n\u0026thinsp;=\u0026thinsp;48) and the traditional group (n\u0026thinsp;=\u0026thinsp;48). The basic student characteristics can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of students was 22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years old in the MBL group and 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years old in the traditional group; the difference between the two groups was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). 24 (50%) females were in the MBL group, and 25 (52%) females were in the traditional group; there was no significant difference between the two groups in terms of gender.\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\u003eComparison of general data between the MBL group and the traditional group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMBL group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.838\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\u003eThe pre-and post-course test scores are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean pre-course basic knowledge and case analysis scores in the MBL versus traditional groups were 29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 and 29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 versus 27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8, 27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8, respectively, while the post-course basic knowledge and case analysis scores in the MBL versus traditional groups were 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 and 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 versus 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 and 34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9, respectively. There were no significant differences in pre-course basic knowledge and case analysis scores between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The post-course basic knowledge and case analysis scores in both groups were improved compared to pre-course scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The post-course basic knowledge and case analysis scores in the MBL group were significantly higher than that in the traditional group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparison of the pre- and post-class test scores of the MBL group vs. the traditional group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMBL group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal pre-class score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e56.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-class basic knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-class case analysis score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal post-class score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-class basic knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-class case analysis score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\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\u003eThe results of the anonymous survey are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The scores for learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course in the MBL group were significantly higher than that in the traditional group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of questionnaire survey results between the MBL group and the traditional group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMBL group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional group (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent-teacher interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical thinking skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-learning skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge absorption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction with the course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the United States, the estimated prevalence of ectopic pregnancy is 1\u0026ndash;2%, but this may be an underestimate because this condition is often treated in the office setting where it is not tracked\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Ectopic pregnancy is a potentially life-threatening condition and should be considered in any pregnant patient with lower abdominal pain or vaginal bleeding\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The nature, location, constancy, and severity of pain in ectopic pregnancy vary among sufferers. Patients with suspected or confirmed ectopic pregnancy who exhibit clinical findings of ruptured ectopic pregnancy should be emergently treated with surgical intervention. Therefore, this course presents significant challenges for medical students and may lead to confusion about prompt and accurate diagnosis. Traditional teaching methods focus on teachers while students passively receive knowledge. The limitation of this model is that teachers only focus on their understanding of the subject matter, failing to fulfil their role of guiding students to cultivate clinical thinking. Furthermore, many medical students lack initiative and creativity, ultimately making it difficult to apply the acquired knowledge to clinical practice\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePBL is a collaborative process that involves problem-solving through case analysis and clinical reasoning, requiring students to have high learning initiative. However, students with lower self-directed learning abilities may need help to adapt to this teaching method, resulting in difficulties in mastering fundamental knowledge\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Mind mapping is a simple and efficient visual-spatial method/tool of combining drawings with words to build memory links between a topic keyword and image, colour, or another link, helping to build a complete knowledge system. This approach will improve students\u0026rsquo; comprehensive analysis abilities, resulting in a more scientifically rigorous and effective learning process\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Considering their respective advantages, our study applied a teaching method integrating PBL and mind mapping in teaching ectopic pregnancy, allowing them to complement and reinforce each other.\u003c/p\u003e \u003cp\u003eTo investigate the effectiveness and acceptability of the MBL teaching method in teaching ectopic pregnancy, we compared it with the traditional teaching method. Our study showed no significant difference in basic characteristics and pre-course basic knowledge and case analysis scores between the two groups. However, the MBL group scored higher than the traditional group in the post-course basic knowledge and case analysis scores, demonstrating the effectiveness of the MBL teaching method. The results also indicated that students in the MBL group had formed a comprehensive and organized understanding of ectopic pregnancy, further enhancing their clinical thinking skills. Through anonymous survey scores, it was found that the MBL teaching method had significant advantages in learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, and satisfaction. These findings suggested that students in the MBL group tended to adopt a more balanced approach to learning and practice and obtain a higher satisfaction rate with the course, thereby becoming more proactive learners. This study showed that the MBL teaching method is promising and indicates better short-term effects than the traditional teaching method in gynecologic education.\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, We assumed that PBL and mind mapping were mutually complementary and could achieve the best effect when combined. However, no control groups used PBL or mind mapping alone in this study, and we could not determine whether the combined method was superior to PBL or mind mapping alone. Second, some analysis biases were unavoidable due to the lack of blinding in our study. Third, there is no subjective method to evaluate the effects of teaching methods. Lastly, our results were based on one ectopic pregnancy course with a small sample size. Long-term follow-up data were not available to produce more grounded assessments. Therefore, more well-designed, randomized controlled trials with large samples are needed to confirm the effect of the MBL teaching method.\u003c/p\u003e \u003cp\u003eIn conclusion, our study showed that the students learning ectopic pregnancy with the MBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods. These results suggested that the MBL teaching method might be a promising new mode for gynecologic education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the Medical and Health Industry Joint Foundation of Natural Science Foundation of Hunan Province in 2025 (Grant No: 2025JJ80598, 2025JJ80594); the Hunan Nursing Association's 2024 Scientific Research Project Youth Project (CN) [grant numbers: HNKYP202413]\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCYX conceived the idea and reviewed and edited the manuscript. WMX and ZYW wrote the manuscript. RT and XHL conducted research, selection, data extraction, and statistical analysis. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets obtained and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNaimi, A. A. et al. Ectopic pregnancy: a single-center experience over ten years. \u003cem\u003eReprod. Biol. Endocrinol.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e (1), 79 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHendriks, E., Rosenberg, R. \u0026amp; Prine, L. Ectopic Pregnancy: Diagnosis and Management. \u003cem\u003eAm. Fam Physician\u003c/em\u003e. \u003cb\u003e101\u003c/b\u003e (10), 599\u0026ndash;606 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHouser, M., Kandalaft, N. \u0026amp; Khati, N. J. 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Comparison of students\u0026rsquo;perception of problem-based learning and traditional teaching method in a Nigerian dental school. \u003cem\u003eEur. J. Dent. Educ.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (2), 207\u0026ndash;212 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCantillon, P. Teaching large groups. \u003cem\u003eBr. Med. J.\u003c/em\u003e \u003cb\u003e7386\u003c/b\u003e,437 (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung, C. H. \u0026amp; Lin, C. Y. Using concept mapping to evaluate knowledge structure in problem-based learning. \u003cem\u003eBMC Med. Educ.\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e,212 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYing, G. et al. Using Mind Maps to Improve Medical Student Performance in a Pharmacology Course at Kunming Medical University. \u003cem\u003eJ. Coll. Physicians Surg. Pak\u003c/em\u003e. \u003cb\u003e27\u003c/b\u003e (7), 404\u0026ndash;408 (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ectopic pregnancy, problem-based learning, mind mapping, clinical teaching, traditional teaching method","lastPublishedDoi":"10.21203/rs.3.rs-6188914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6188914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"The aim of this study is to explore the effectiveness of combining mind mapping and problem-based learning (MBL) in clinical teaching of ectopic pregnanancy. Fifth-year students were randomly assigned into either the MBL group or the traditional group. All participants received theory tests before and after the course. After the end of the course, both groups of students were required to complete a comprehensive anonymous survey, focusing on the evaluation of teaching methods.There were no significant differences in pre-course basic knowledge and case analysis scores between the 2 groups (P \u003e 0.05). The post-course basic knowledge and case analysis scores in the MBL group were significantly higher than that in the traditional group. The scores for learning motivation, knowledge and understanding, student-teacher interaction, communication skills, clinical practical skills, self-learning skills, teamwork skills, knowledge absorption, as well as satisfaction with the course in the MBL group were significantly higher than that in the traditional group (P \u003c0.05 for all). The students learning ectopic pregnancy with the MBL teaching method exhibited better acquisition of basic knowledge and higher competence in case analysis compared with those learning ectopic pregnancy with the traditional teaching methods.","manuscriptTitle":"The effectiveness of the combined mind mapping and problem-based learning method in the clinical practical teaching of ectopic pregnancy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 09:55:24","doi":"10.21203/rs.3.rs-6188914/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2ffc051-1d87-4623-b5b6-3d809271a785","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47190713,"name":"Health sciences/Medical research/Outcomes research"},{"id":47190714,"name":"Health sciences/Medical research/Study design"}],"tags":[],"updatedAt":"2025-10-03T05:54:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-21 09:55:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6188914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6188914","identity":"rs-6188914","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}