A Practical Study on Enhancing Medical Interviewing Skills and Humanistic Care in Undergraduate Medical Students through CBL Combined with Role-Playing and Reflective Writing

A Practical Study on Enhancing Medical Interviewing Skills and Humanistic Care in Undergraduate Medical Students through CBL Combined with Role-Playing and Reflective Writing | 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 A Practical Study on Enhancing Medical Interviewing Skills and Humanistic Care in Undergraduate Medical Students through CBL Combined with Role-Playing and Reflective Writing Ningjun Zhu, Mengli Li, Zhen Wang, Yanmei Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8145501/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective To explore the effectiveness of combining Case-Based Learning (CBL), role-playing scenarios, and reflective writing in enhancing medical undergraduates' medical interviewing skills and humanistic care literacy. Methods Sixty medical undergraduates were randomly divided into two groups, with 30 students in each group. The intervention group received a teaching model combining CBL, role-playing scenario simulation, and reflective writing, while the control group received traditional teaching methods. The effects were evaluated using pre-and post-course communication skills assessments and questionnaires. Results After the intervention, both groups showed improvements in medical interviewing skills and humanistic care literacy. In the intervention group, medical interviewing scores increased from (75.07 ± 5.53) to (82.13 ± 6.70) (t = 0.741, P < 0.001), and humanistic care scores increased from (108.33 ± 9.64) to (117.60 ± 8.24) (t = 0.824, P < 0.001). In the control group, medical interviewing scores increased from (74.27 ± 5.00) to (78.03 ± 5.55) (t = 0.862, P < 0.001), and humanistic care scores increased from (108.93 ± 10.08) to (112.40 ± 10.29) (t = 0.955, P < 0.001). Furthermore, the post-intervention scores of the intervention group were significantly higher than those of the control group in both medical interviewing skills [(82.13 ± 6.70) vs. (78.03 ± 5.55), t = -2.580, P = 0.012] and humanistic care literacy [(117.60 ± 8.24) vs. (112.40 ± 10.29), t = -2.16, P = 0.035]. The teaching satisfaction survey also showed significantly higher scores in the intervention group (89.6 ± 3.69) compared to the control group (84 ± 5.15) (t = -4.843, P < 0.001). Conclusion The combination of CBL, role-playing scenario simulation, and reflective writing can effectively enhance students' medical interviewing skills and humanistic care levels. Case-Based Learning Role-Playing Reflective Writing Medical Interviewing Skills Humanistic Care 1 Introduction Medical undergraduates, as the future reserve force of healthcare, currently face a less-than-harmonious physician-patient relationship. It is essential for them not only to acquire proficient medical skills but also to excel in communication and strengthen training in humanistic care, which also constitutes an important component of ideological and political education in the curriculum [1]. As a critical component of physical diagnostics, the medical interview serves as a bridge connecting basic medical sciences with clinical medicine. Proficiency in interviewing skills and humanistic care literacy are core objectives of clinical medical education [2]. Traditional medical teaching models, primarily based on theoretical lectures and case analysis, offer students limited opportunities for interaction with real patients, making it difficult to translate theoretical knowledge into clinical communication skills and empathy. Case-Based Learning (CBL) combined with role-playing simulates real clinical scenarios, enhancing students' active learning and problem-solving abilities [3,4]. When integrated with reflective writing, this approach promotes in-depth self-assessment of students' own performance, further strengthening their interviewing techniques and awareness of humanistic care [5]. 2 Subjects and Methods 2.1 Subjects Sixty undergraduate students from the Class of 2022 Clinical Medicine program at the Second Clinical Medical College of Anhui Medical University were selected as study subjects. All participants were required to study the "Medical Interview" chapter from Part II of the 10th edition of Physical Diagnostics, published by People's Medical Publishing House in 2024, according to the teaching syllabus. The students were randomly divided into two groups, with 30 students in each group. The same instructor, who held a teaching qualification certificate and had extensive teaching experience, conducted the classes for both groups. There were no significant differences between the two groups in terms of age, gender, or baseline academic performance (mean annual comprehensive scores), indicating comparability. 2.2 Methods Intervention Group Received instruction integrating CBL, role-playing scenario simulation, and reflective writing.. One week before the class, the instructor provided students with a case introduction and clinical data of a patient with "chest pain." Students were required to preview the relevant content of the "Medical Interview" chapter in the textbook. The students were divided into six groups, with five students in each group, and roles were pre-assigned, including doctor, nurse, patient, and family members. During the formal classroom session, the "patients" and "family members" performed scenario simulations based on predefined physiological, psychological, and social background information. The "doctors" and "nurses" were required to complete the entire process from patient reception and relationship establishment to comprehensive medical interviewing. The scenario simulation was recorded in its entirety. After the simulation, all students participated in a discussion on interview logic, communication methods, and responses to patient emotions. The instructor concluded with summarizing comments. After the course, each student was required to write a reflective report of no less than 500 words, structured to include factual descriptions, feeling analysis, in-depth reflection, and action plans. Control Group The traditional lecture-based teaching method was adopted. One week before the class, students were informed to preview the relevant content of the "Medical Interview" chapter in the textbook. During the formal class, PowerPoint-based lectures on the "Medical Interview" chapter were delivered according to the teaching syllabus and lesson plan. No scenario simulation or reflective writing was conducted. 2.3 Evaluation Tools Pre-tests and post-tests were conducted for all students before and after the teaching intervention, including assessments of medical interviewing skills and humanistic care. A teaching satisfaction survey was administered after the course. Medical interviewing skills were assessed using a paper-based scoring form, while humanistic care and teaching satisfaction were evaluated using self-administered questionnaires created via Questionnaire Star, which students accessed by scanning QR codes. All questions in the questionnaires were set as mandatory to ensure completeness. To prevent duplicate responses, the backend settings restricted submissions to one response per IP address and device, with a minimum response time of 5 minutes to avoid random or rapid answering. Student queries were addressed in real time during the response process. Questionnaires with response patterns showing obvious regularity or logical inconsistencies in data were deemed invalid. Medical Interviewing Skills Assessment: Two experienced teachers participated in the assessment. One teacher played the role of the "patient," and all students conducted medical interviews with this teacher before and after the course. The other teacher scored the students' interviewing skills using the SEGUE Framework [ 6 ], with pre-tests and post-tests administered as SEGUE Framework 1 and SEGUE Framework 2, respectively. The framework includes five dimensions: Set the Stage (S, preparation), Elicit Information (E, information gathering), Give Information (G, information giving), Understand the Patient's Perspective (U, understanding the patient), and End the Encounter (E, concluding the interview). The framework consists of 25 items, each scored 4 points, with a total score of 100. Both teachers were blinded to the group assignments of the students. Humanistic Care Assessment: The self-administered Jefferson Scale of Empathy [ 7 ] was used, with pre-tests and post-tests administered as Jefferson Scale of Empathy 1 and Jefferson Scale of Empathy 2, respectively. The scale consists of 20 items rated on a 7-point Likert scale (1–7 corresponding to strongly disagree, disagree, slightly disagree, uncertain, slightly agree, agree, and strongly agree), with a total score of 140. Ten items in the scale were reverse-scored. For forward-scored items, the score was the selected number; for reverse-scored items, the converted score was 8 minus the original score. Higher scores indicated higher self-reported levels of empathy. Teaching Satisfaction Assessment: A self-administered questionnaire was developed based on the teaching content and modified from a previously published scale[ 8 ]. The newly designed teaching evaluation scale consists of 20 items covering learning motivation, knowledge and skills, application and transfer, teaching process, core interventions, overall evaluation, and willingness to recommend. It employs a 5-point Likert scale(1 = strongly disagree, 2 = disagree, 3 = uncertain, 4 = agree, 5 = strongly agree), with a total possible score of 100. Higher scores indicate greater satisfaction with the teaching. 2.4 Statistical Analysis Data processing was performed using SPSS 30.0 software. Measurement data were tested for normality. Normally distributed data were expressed as mean ± standard deviation, while non-normally distributed data were expressed as median (interquartile range). Comparisons between two groups were conducted using independent samples t-tests or Mann-Whitney U tests. Categorical data were expressed as frequencies and analyzed using χ² tests. A P-value < 0.05 was considered statistically significant. 3 Results 3.1 Comparison of Baseline Characteristics Prior to the intervention, no statistically significant differences were observed between the two groups in terms of age (intervention group: 21 [21, 21] vs. control group: 21 [21, 21], P = 0.958), gender (males in intervention group: 14 [46.7%] vs. males in control group: 17 [56.7%], P = 0.438), baseline academic performance (intervention group: 81.48 ± 7.40 vs. control group: 82.53 ± 6.51, P = 0.560), SEGUE Framework 1 scores (intervention group: 75.07 ± 5.53 vs. control group: 74.27 ± 5.00, P = 0.559), or Jefferson Scale of Empathy 1 scores (intervention group: 108.33 ± 9.64 vs. control group: 108.93 ± 10.08, P = 0.815). All p-values were > 0.05, indicating the groups were comparable at baseline. Table 1 . Table 1 Comparison of Baseline Characteristics Control Group(n = 30) Intervention Group(n = 30) Total(n = 60) x2/t/z P gender(male) 17(56.7%) 14(46.7%) 31(51.7%) 0.601 0.438 age(year) a 21(21,21) 21(21, 21) 21(21,21) -0.053 0.958 baseline academic performance 82.53 ± 6.51 81.48 ± 7.40 82.01 ± 6.94 0.587 0.560 SEGUE Framework 1 74.27 ± 5.00 75.07 ± 5.53 74.67 ± 5.24 -0.588 0.559 Jefferson Scale of Empathy1 108.93 ± 10.08 108.33 ± 9.64 108.63 ± 9.78 0.236 0.815 a: The age data did not follow a normal distribution, and the ages of students in the same grade were highly concentrated, resulting in the median and quartiles being identical. 3.2 Comparison Before and After Teaching Both groups showed improvement in medical interviewing skills and humanistic care literacy after their respective teaching interventions. In the intervention group, the SEGUE Framework score increased from 75.07 ± 5.53 before teaching to 82.13 ± 6.70 after teaching (t = 0.741, P < 0.001); the Jefferson Scale of Empathy score increased from 108.33 ± 9.64 to 117.60 ± 8.24 (t = 0.824, P < 0.001). In the control group, the SEGUE Framework score increased from 74.27 ± 5.00 to 78.03 ± 5.55 (t = 0.862, P < 0.001); the Jefferson Scale of Empathy score increased from 108.93 ± 10.08 to 112.40 ± 10.29 (t = 0.955, P < 0.001). Table 2 . Table 2 Comparison Before and After Teaching SEGUE Framework Jefferson Scale of Empathy Control Group(n = 30) Intervention Group(n = 30) Control Group(n = 30) Intervention Group(n = 30) Pre-intervention 74.27 ± 5.00 75.07 ± 5.53 108.93 ± 10.08 108.33 ± 9.64 Post-intervention 78.03 ± 5.55 82.13 ± 6.70 112.40 ± 10.29 117.60 ± 8.24 t 0.862 0.741 0.955 0.824 P <0.001 <0.001 <0.001 <0.001 3.3 Comparison of the Effects of Different Teaching Models After receiving different teaching interventions, the students in the intervention group achieved a significantly higher SEGUE Framework 2 score (82.13 ± 6.70) compared to the control group (78.03 ± 5.55) (t = -2.580, P = 0.012). Similarly, the intervention group's score on the Jefferson Scale of Empathy 2 (117.60 ± 8.24) was significantly higher than that of the control group (112.40 ± 10.29) (t = -2.16, p = 0.035). Furthermore, the teaching satisfaction score in the intervention group (89.6 ± 3.69) was significantly higher than that in the control group (84 ± 5.15) (t = -4.843, p < 0.001). Table 3 . Table 3 Comparison of the Effects of Different Teaching Models Control Group(n = 30) Intervention Group(n = 30) Total(n = 60) t P SEGUE Framework2 78.03 ± 5.55 82.13 ± 6.70 80.08 ± 6.44 -2.580 0.012 Jefferson Scale of Empathy2 112.40 ± 10.29 117.60 ± 8.24 115.00 ± 9.61 -2.16 0.035 Teaching Satisfaction Survey 84 ± 5.15 89.6 ± 3.69 86.8 ± 5.26 -4.843 < 0.001 4 Discussion 4.1 Practical Value of CBL Combined with Role-Playing Scenario Simulation CBL combined with role-playing scenario simulation provides students with a "safe-to-fail" learning environment by creating high-fidelity clinical settings.[ 9 ]. In traditional teaching, although students acquire theoretical knowledge, they lack opportunities to interact with real patients, leading to a disconnect between "knowing" and "doing." By playing different roles such as doctors, patients, and family members, students not only practice the complete medical interview process from the perspective of healthcare professionals but also personally experience the suffering, anxiety, and expectations of patients, as well as the concerns and doubts of family members, through "perspective-taking." This deep role immersion goes beyond mere skill training, directly triggering students' emotional responses and empathy mechanisms, enabling them to deeply understand the necessity and practical pathways of humanistic care in practice. Meanwhile, the immediate interaction and unpredictability in role-playing effectively train students' abilities in on-the-spot adaptation, emotional management, and communication coordination[ 10 ]. This "learning by doing" model aligns with constructivist learning theory, emphasizing the active construction of knowledge systems and skill structures in authentic tasks, thereby helping students translate abstract communication principles into operable and internalizable communication behaviors. 4.2 Cognitive Reinforcement Role of Reflective Writing Reflective writing, as a key component of the teaching closed loop, prompts students to systematically review and deeply reflect on the simulation process[ 11 ]. When writing reflective reports, students need to transition from "factual descriptions" to "feeling analysis," "in-depth reflection," and "action planning." This process promotes the development of metacognitive abilities, enabling them to identify their own shortcomings in interview logic, empathetic expression, non-verbal communication, and other aspects, and to formulate improvement strategies. Reflective writing helps students learn from experience and develop a professional habit of continuous self-improvement. It is worth noting that when reflective writing is alienated into an institutionalized task that is mandatory and closely tied to high-stakes assessment, its authenticity may be compromised, and it may increase student burden or even trigger resistance. As Launer warned, reflective writing risks becoming a "monster that needs to be fed"[ 12 ]. However, the design of reflective writing in this study differs fundamentally from the aforementioned scenario: firstly, it is explicitly defined as a formative assessment tool, with its core purpose being to promote learning and development rather than for grading or evaluation; secondly, the writing task is closely embedded after the authentic and profound learning experience created by CBL and role-playing, providing students with ample material and intrinsic motivation for reflection, avoiding the hollow sense of "reflection for reflection's sake." Therefore, within the framework of this study, reflective writing successfully fulfilled its core supportive and developmental function, serving as a key bridge connecting practical experience and ability internalization, rather than a formalistic administrative burden. 4.3 Internalization Mechanism of Humanistic Care Literacy This study specifically focused on the enhancement of humanistic care literacy. The results of the Jefferson Scale of Empathy indicated significant improvement in the intervention group students' understanding of patient perspectives and emotional responses. This may stem from the role immersion as "patients" and "family members" in the scenario simulation, allowing students to personally experience the emotional needs and psychological states of patients, thereby enhancing their emotional resonance ability. Reflective writing further rationalizes and structures this emotional experience, prompting students to transform "empathy" from an external requirement into an internal quality. 4.4 Teaching Satisfaction and Promotion Potential The teaching satisfaction survey results indicated that students in the intervention group rated the practicality of teaching content, classroom engagement, and overall learning experience more highly. This demonstrates student recognition of this highly interactive and timely feedback teaching approach. CBL scenario simulation combined with reflective writing not only enhanced students' professional competencies but also strengthened their learning motivation and sense of agency, aligning with the "student-centered" modern educational philosophy. This model possesses strong operational feasibility and promotion value, making it applicable across various courses including diagnostics, doctor-patient communication, and pre-clinical internship training. 4.5 Research Limitations and Prospects This study has several limitations. The relatively small sample size and recruitment from a single institution may affect the generalizability of the findings. Furthermore, the long-term effectiveness of the teaching outcomes requires further validation through follow-up studies. Future research should expand the sample size, conduct multi-center studies, and explore the integration of digital tools (e.g., VR simulation, AI feedback systems) into the teaching process [ 13 ] to further enhance instructional precision and interactivity. 5 Conclusion This study systematically explored the role of organically combining CBL, role-playing scenario simulation, and reflective writing in cultivating medical interviewing skills and humanistic care literacy among medical undergraduates. The results showed that the intervention group significantly outperformed the control group in SEGUE Framework scores, Jefferson Scale of Empathy scores, and teaching satisfaction, indicating that this teaching model has significant advantages in enhancing students' clinical communication skills and humanistic literacy. CBL-based role-playing scenarios combined with reflective writing is an effective teaching method that can significantly improve medical undergraduates' medical interviewing skills and humanistic care levels, warranting promotion and application in clinical medical education. Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (Approval No: YX2024-115). All participants provided written informed consent, and the study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Consent for publication: Not applicable. Funding The study was supported by the 2022 Scientific Research Fund of Anhui Medical University (Grant No. 2022xkj195). Data Availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Note: Clinical trial number: not applicable. Author Contribution Ningjun Zhu was responsible for drafting the main manuscript text, conducting data analysis, and delivering student instruction; Mengli Li and Zhen Wang participated in the research process and were responsible for the assessment of interviewing skills; Yanmei Zhang was responsible for the research design and manuscript review；All authors reviewed the manuscript. References Xiao X, Han LQ, Liu JH, Dong HB. Discussion on ideological and political education in medical school curricula. China Educational Technol Equip. 2019;24108–10. 10.3969/j.issn.1671-489X.2019.24.108 . Xu XM. Practice and exploration of humanistic quality cultivation for clinical medicine interns under the background of comprehensive health. Zhejiang Clin Med J. 2023;25(6):946–8. Yan Y, Zhang Y, Jia S, Huang Y, Liu X, Liu Y, Zhu H, Wen H. Using case-based learning supported by role-playing situational teaching method in endocrine physiology education. Adv Physiol Educ. 2024;48(3):498–504. Epub 2024 May 2. PMID: 38695082. Abdel-Wahed N, Badahdah A, Qutob AF, Bahanan L, Bukhary SMN. The effectiveness of integrating role play into case-based learning in dental education: enhancing critical thinking and teamwork skills. BMC Med Educ. 2024;24(1):1531. 10.1186/s12909-024-06550-4 . PMID: 39725972; PMCID: PMC11670448. Franco RS, Franco CAGDS, Severo M, Ferreira MA, Karnieli-Miller O. Reflective writing in the teaching of communication skills for medical students-A systematic review. Patient Educ Couns. 2022;105(7):1842–51. 10.1016/j.pec.2022.01.003 . Li LJ, Xia XW, Guan NH, Wei QL. Application of SEGUE framework scenario-based case teaching method in cultivating medical students' doctor-patient communication skills. China Continuing Med Educ. 2024;16(13):82–6. 10.3969/j.issn.1674-9308.2024.13.017 . Chen ZH, Han ZQ, Dong YQ, Tian LR, Ye GC, Mi BB. Reliability and validity of the Chinese version of Jefferson Scale of Empathy in assessing empathy levels among medical students. Med Educ Res Pract. 2022;30(6):723–726789. 10.13555/j.cnki.c.m.e.2022.06.011 . Deng J, Yang L, Yang QZ, Su BX, Dong HL, Lei W. Application of teaching satisfaction questionnaire in surgical teaching quality evaluation and design of a new questionnaire. China High Med Educ. 2019;942–3. 10.3969/j.issn.1002-1701.2019.09.020 . Thistlethwaite JE, Davies D, Ekeocha S, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide 23. Med Teach. 2012;34(6):e421–44. 10.3109/0142159X.2012.680939 . Song GY, Li WR, Gu Y, et al. Cultivating empathy and shared decision-making skills through role-playing in orthodontic case-based teaching. Chin J Med Educ. 2025;45(11):833–7. 10.3760/cma.j.cn115259-20240620-00632 . Lim JY, Ong SYK, Ng CYH et al. A systematic scoping review of reflective writing in medical education. BMC Med Educ. 2023;23(1):12. Published 2023 Jan 9. 10.1186/s12909-022-03924-4 Launer J. John Launer: Reflective writing and feeding the monster. BMJ. 2023;383:2717. 10.1136/bmj.p2717 . Published 2023 Nov 22. Xu H, Jiao Y. Research and prospects of artificial intelligence in new clinical reasoning teaching models. Chin J Med Educ Res. 2025;24(10):1372–8. 10.3760/cma.j.cn116021-20250310-02066 . Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eMedical undergraduates, as the future reserve force of healthcare, currently face a less-than-harmonious physician-patient relationship. It is essential for them not only to acquire proficient medical skills but also to excel in communication and strengthen training in humanistic care, which also constitutes an important component of ideological and political education in the curriculum [1]. As a critical component of physical diagnostics, the medical interview serves as a bridge connecting basic medical sciences with clinical medicine. Proficiency in interviewing skills and humanistic care literacy are core objectives of clinical medical education [2]. Traditional medical teaching models, primarily based on theoretical lectures and case analysis, offer students limited opportunities for interaction with real patients, making it difficult to translate theoretical knowledge into clinical communication skills and empathy. Case-Based Learning (CBL) combined with role-playing simulates real clinical scenarios, enhancing students\u0026apos; active learning and problem-solving abilities [3,4]. When integrated with reflective writing, this approach promotes in-depth self-assessment of students\u0026apos; own performance, further strengthening their interviewing techniques and awareness of humanistic care [5].\u003c/p\u003e"},{"header":"2 Subjects and Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Subjects\u003c/h2\u003e \u003cp\u003eSixty undergraduate students from the Class of 2022 Clinical Medicine program at the Second Clinical Medical College of Anhui Medical University were selected as study subjects. All participants were required to study the \"Medical Interview\" chapter from Part II of the 10th edition of Physical Diagnostics, published by People's Medical Publishing House in 2024, according to the teaching syllabus. The students were randomly divided into two groups, with 30 students in each group. The same instructor, who held a teaching qualification certificate and had extensive teaching experience, conducted the classes for both groups. There were no significant differences between the two groups in terms of age, gender, or baseline academic performance (mean annual comprehensive scores), indicating comparability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Methods\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eIntervention Group\u003c/strong\u003e \u003cp\u003eReceived instruction integrating CBL, role-playing scenario simulation, and reflective writing.. One week before the class, the instructor provided students with a case introduction and clinical data of a patient with \"chest pain.\" Students were required to preview the relevant content of the \"Medical Interview\" chapter in the textbook. The students were divided into six groups, with five students in each group, and roles were pre-assigned, including doctor, nurse, patient, and family members. During the formal classroom session, the \"patients\" and \"family members\" performed scenario simulations based on predefined physiological, psychological, and social background information. The \"doctors\" and \"nurses\" were required to complete the entire process from patient reception and relationship establishment to comprehensive medical interviewing. The scenario simulation was recorded in its entirety. After the simulation, all students participated in a discussion on interview logic, communication methods, and responses to patient emotions. The instructor concluded with summarizing comments. After the course, each student was required to write a reflective report of no less than 500 words, structured to include factual descriptions, feeling analysis, in-depth reflection, and action plans.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControl Group\u003c/strong\u003e \u003cp\u003eThe traditional lecture-based teaching method was adopted. One week before the class, students were informed to preview the relevant content of the \"Medical Interview\" chapter in the textbook. During the formal class, PowerPoint-based lectures on the \"Medical Interview\" chapter were delivered according to the teaching syllabus and lesson plan. No scenario simulation or reflective writing was conducted.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Evaluation Tools\u003c/h2\u003e \u003cp\u003ePre-tests and post-tests were conducted for all students before and after the teaching intervention, including assessments of medical interviewing skills and humanistic care. A teaching satisfaction survey was administered after the course. Medical interviewing skills were assessed using a paper-based scoring form, while humanistic care and teaching satisfaction were evaluated using self-administered questionnaires created via Questionnaire Star, which students accessed by scanning QR codes. All questions in the questionnaires were set as mandatory to ensure completeness. To prevent duplicate responses, the backend settings restricted submissions to one response per IP address and device, with a minimum response time of 5 minutes to avoid random or rapid answering. Student queries were addressed in real time during the response process. Questionnaires with response patterns showing obvious regularity or logical inconsistencies in data were deemed invalid.\u003c/p\u003e \u003cp\u003eMedical Interviewing Skills Assessment: Two experienced teachers participated in the assessment. One teacher played the role of the \"patient,\" and all students conducted medical interviews with this teacher before and after the course. The other teacher scored the students' interviewing skills using the SEGUE Framework [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], with pre-tests and post-tests administered as SEGUE Framework 1 and SEGUE Framework 2, respectively. The framework includes five dimensions: Set the Stage (S, preparation), Elicit Information (E, information gathering), Give Information (G, information giving), Understand the Patient's Perspective (U, understanding the patient), and End the Encounter (E, concluding the interview). The framework consists of 25 items, each scored 4 points, with a total score of 100. Both teachers were blinded to the group assignments of the students.\u003c/p\u003e \u003cp\u003eHumanistic Care Assessment: The self-administered Jefferson Scale of Empathy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] was used, with pre-tests and post-tests administered as Jefferson Scale of Empathy 1 and Jefferson Scale of Empathy 2, respectively. The scale consists of 20 items rated on a 7-point Likert scale (1\u0026ndash;7 corresponding to strongly disagree, disagree, slightly disagree, uncertain, slightly agree, agree, and strongly agree), with a total score of 140. Ten items in the scale were reverse-scored. For forward-scored items, the score was the selected number; for reverse-scored items, the converted score was 8 minus the original score. Higher scores indicated higher self-reported levels of empathy.\u003c/p\u003e \u003cp\u003eTeaching Satisfaction Assessment: A self-administered questionnaire was developed based on the teaching content and modified from a previously published scale[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The newly designed teaching evaluation scale consists of 20 items covering learning motivation, knowledge and skills, application and transfer, teaching process, core interventions, overall evaluation, and willingness to recommend. It employs a 5-point Likert scale(1\u0026thinsp;=\u0026thinsp;strongly disagree, 2\u0026thinsp;=\u0026thinsp;disagree, 3\u0026thinsp;=\u0026thinsp;uncertain, 4\u0026thinsp;=\u0026thinsp;agree, 5\u0026thinsp;=\u0026thinsp;strongly agree), with a total possible score of 100. Higher scores indicate greater satisfaction with the teaching.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData processing was performed using SPSS 30.0 software. Measurement data were tested for normality. Normally distributed data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while non-normally distributed data were expressed as median (interquartile range). Comparisons between two groups were conducted using independent samples t-tests or Mann-Whitney U tests. Categorical data were expressed as frequencies and analyzed using χ\u0026sup2; tests. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of Baseline Characteristics\u003c/h2\u003e \u003cp\u003ePrior to the intervention, no statistically significant differences were observed between the two groups in terms of age (intervention group: 21 [21, 21] vs. control group: 21 [21, 21], P\u0026thinsp;=\u0026thinsp;0.958), gender (males in intervention group: 14 [46.7%] vs. males in control group: 17 [56.7%], P\u0026thinsp;=\u0026thinsp;0.438), baseline academic performance (intervention group: 81.48\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40 vs. control group: 82.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51, P\u0026thinsp;=\u0026thinsp;0.560), SEGUE Framework 1 scores (intervention group: 75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53 vs. control group: 74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00, P\u0026thinsp;=\u0026thinsp;0.559), or Jefferson Scale of Empathy 1 scores (intervention group: 108.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64 vs. control group: 108.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08, P\u0026thinsp;=\u0026thinsp;0.815). All p-values were \u0026gt;\u0026thinsp;0.05, indicating the groups were comparable at baseline. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex2/t/z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender(male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(51.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage(year)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(21,21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(21, 21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(21,21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebaseline academic performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.48\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSEGUE Framework 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJefferson Scale of Empathy1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ea: The age data did not follow a normal distribution, and the ages of students in the same grade were highly concentrated, resulting in the median and quartiles being identical.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison Before and After Teaching\u003c/h2\u003e \u003cp\u003eBoth groups showed improvement in medical interviewing skills and humanistic care literacy after their respective teaching interventions. In the intervention group, the SEGUE Framework score increased from 75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53 before teaching to 82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70 after teaching (t\u0026thinsp;=\u0026thinsp;0.741, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); the Jefferson Scale of Empathy score increased from 108.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64 to 117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24 (t\u0026thinsp;=\u0026thinsp;0.824, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the control group, the SEGUE Framework score increased from 74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00 to 78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55 (t\u0026thinsp;=\u0026thinsp;0.862, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); the Jefferson Scale of Empathy score increased from 108.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08 to 112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29 (t\u0026thinsp;=\u0026thinsp;0.955, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\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\u003eComparison Before and After Teaching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSEGUE Framework\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eJefferson Scale of Empathy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of the Effects of Different Teaching Models\u003c/h2\u003e \u003cp\u003eAfter receiving different teaching interventions, the students in the intervention group achieved a significantly higher SEGUE Framework 2 score (82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70) compared to the control group (78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55) (t = -2.580, P\u0026thinsp;=\u0026thinsp;0.012). Similarly, the intervention group's score on the Jefferson Scale of Empathy 2 (117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24) was significantly higher than that of the control group (112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29) (t = -2.16, p\u0026thinsp;=\u0026thinsp;0.035). Furthermore, the teaching satisfaction score in the intervention group (89.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69) was significantly higher than that in the control group (84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15) (t = -4.843, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the Effects of Different Teaching Models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"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=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention Group(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSEGUE Framework2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e80.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJefferson Scale of Empathy2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e115.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching Satisfaction Survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e89.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e86.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-4.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Practical Value of CBL Combined with Role-Playing Scenario Simulation\u003c/h2\u003e \u003cp\u003eCBL combined with role-playing scenario simulation provides students with a \"safe-to-fail\" learning environment by creating high-fidelity clinical settings.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In traditional teaching, although students acquire theoretical knowledge, they lack opportunities to interact with real patients, leading to a disconnect between \"knowing\" and \"doing.\" By playing different roles such as doctors, patients, and family members, students not only practice the complete medical interview process from the perspective of healthcare professionals but also personally experience the suffering, anxiety, and expectations of patients, as well as the concerns and doubts of family members, through \"perspective-taking.\" This deep role immersion goes beyond mere skill training, directly triggering students' emotional responses and empathy mechanisms, enabling them to deeply understand the necessity and practical pathways of humanistic care in practice. Meanwhile, the immediate interaction and unpredictability in role-playing effectively train students' abilities in on-the-spot adaptation, emotional management, and communication coordination[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This \"learning by doing\" model aligns with constructivist learning theory, emphasizing the active construction of knowledge systems and skill structures in authentic tasks, thereby helping students translate abstract communication principles into operable and internalizable communication behaviors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Cognitive Reinforcement Role of Reflective Writing\u003c/h2\u003e \u003cp\u003eReflective writing, as a key component of the teaching closed loop, prompts students to systematically review and deeply reflect on the simulation process[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. When writing reflective reports, students need to transition from \"factual descriptions\" to \"feeling analysis,\" \"in-depth reflection,\" and \"action planning.\" This process promotes the development of metacognitive abilities, enabling them to identify their own shortcomings in interview logic, empathetic expression, non-verbal communication, and other aspects, and to formulate improvement strategies. Reflective writing helps students learn from experience and develop a professional habit of continuous self-improvement. It is worth noting that when reflective writing is alienated into an institutionalized task that is mandatory and closely tied to high-stakes assessment, its authenticity may be compromised, and it may increase student burden or even trigger resistance. As Launer warned, reflective writing risks becoming a \"monster that needs to be fed\"[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the design of reflective writing in this study differs fundamentally from the aforementioned scenario: firstly, it is explicitly defined as a formative assessment tool, with its core purpose being to promote learning and development rather than for grading or evaluation; secondly, the writing task is closely embedded after the authentic and profound learning experience created by CBL and role-playing, providing students with ample material and intrinsic motivation for reflection, avoiding the hollow sense of \"reflection for reflection's sake.\" Therefore, within the framework of this study, reflective writing successfully fulfilled its core supportive and developmental function, serving as a key bridge connecting practical experience and ability internalization, rather than a formalistic administrative burden.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Internalization Mechanism of Humanistic Care Literacy\u003c/h2\u003e \u003cp\u003eThis study specifically focused on the enhancement of humanistic care literacy. The results of the Jefferson Scale of Empathy indicated significant improvement in the intervention group students' understanding of patient perspectives and emotional responses. This may stem from the role immersion as \"patients\" and \"family members\" in the scenario simulation, allowing students to personally experience the emotional needs and psychological states of patients, thereby enhancing their emotional resonance ability. Reflective writing further rationalizes and structures this emotional experience, prompting students to transform \"empathy\" from an external requirement into an internal quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Teaching Satisfaction and Promotion Potential\u003c/h2\u003e \u003cp\u003eThe teaching satisfaction survey results indicated that students in the intervention group rated the practicality of teaching content, classroom engagement, and overall learning experience more highly. This demonstrates student recognition of this highly interactive and timely feedback teaching approach. CBL scenario simulation combined with reflective writing not only enhanced students' professional competencies but also strengthened their learning motivation and sense of agency, aligning with the \"student-centered\" modern educational philosophy. This model possesses strong operational feasibility and promotion value, making it applicable across various courses including diagnostics, doctor-patient communication, and pre-clinical internship training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Research Limitations and Prospects\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The relatively small sample size and recruitment from a single institution may affect the generalizability of the findings. Furthermore, the long-term effectiveness of the teaching outcomes requires further validation through follow-up studies. Future research should expand the sample size, conduct multi-center studies, and explore the integration of digital tools (e.g., VR simulation, AI feedback systems) into the teaching process [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] to further enhance instructional precision and interactivity.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study systematically explored the role of organically combining CBL, role-playing scenario simulation, and reflective writing in cultivating medical interviewing skills and humanistic care literacy among medical undergraduates. The results showed that the intervention group significantly outperformed the control group in SEGUE Framework scores, Jefferson Scale of Empathy scores, and teaching satisfaction, indicating that this teaching model has significant advantages in enhancing students' clinical communication skills and humanistic literacy. CBL-based role-playing scenarios combined with reflective writing is an effective teaching method that can significantly improve medical undergraduates' medical interviewing skills and humanistic care levels, warranting promotion and application in clinical medical education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (Approval No: YX2024-115). All participants provided written informed consent, and the study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by the 2022 Scientific Research Fund of Anhui Medical University (Grant No. 2022xkj195).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNingjun Zhu was responsible for drafting the main manuscript text, conducting data analysis, and delivering student instruction; Mengli Li and Zhen Wang participated in the research process and were responsible for the assessment of interviewing skills; Yanmei Zhang was responsible for the research design and manuscript review；All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eXiao X, Han LQ, Liu JH, Dong HB. 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Chin J Med Educ Res. 2025;24(10):1372\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.cn116021-20250310-02066\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.cn116021-20250310-02066\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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":"Case-Based Learning, Role-Playing, Reflective Writing, Medical Interviewing Skills, Humanistic Care","lastPublishedDoi":"10.21203/rs.3.rs-8145501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8145501/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 effectiveness of combining Case-Based Learning (CBL), role-playing scenarios, and reflective writing in enhancing medical undergraduates' medical interviewing skills and humanistic care literacy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSixty medical undergraduates were randomly divided into two groups, with 30 students in each group. The intervention group received a teaching model combining CBL, role-playing scenario simulation, and reflective writing, while the control group received traditional teaching methods. The effects were evaluated using pre-and post-course communication skills assessments and questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter the intervention, both groups showed improvements in medical interviewing skills and humanistic care literacy. In the intervention group, medical interviewing scores increased from (75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53) to (82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70) (t\u0026thinsp;=\u0026thinsp;0.741, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and humanistic care scores increased from (108.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64) to (117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24) (t\u0026thinsp;=\u0026thinsp;0.824, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the control group, medical interviewing scores increased from (74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00) to (78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55) (t\u0026thinsp;=\u0026thinsp;0.862, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and humanistic care scores increased from (108.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08) to (112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29) (t\u0026thinsp;=\u0026thinsp;0.955, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the post-intervention scores of the intervention group were significantly higher than those of the control group in both medical interviewing skills [(82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70) vs. (78.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55), t = -2.580, P\u0026thinsp;=\u0026thinsp;0.012] and humanistic care literacy [(117.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24) vs. (112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29), t = -2.16, P\u0026thinsp;=\u0026thinsp;0.035]. The teaching satisfaction survey also showed significantly higher scores in the intervention group (89.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69) compared to the control group (84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15) (t = -4.843, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of CBL, role-playing scenario simulation, and reflective writing can effectively enhance students' medical interviewing skills and humanistic care levels.\u003c/p\u003e","manuscriptTitle":"A Practical Study on Enhancing Medical Interviewing Skills and Humanistic Care in Undergraduate Medical Students through CBL Combined with Role-Playing and Reflective Writing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 17:36:06","doi":"10.21203/rs.3.rs-8145501/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-09T03:17:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194736033619131182390941658146864591424","date":"2025-12-26T02:55:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-19T11:07:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-02T09:40:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T02:48:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-02T02:40:52+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":"b34f6946-c209-4417-a416-eb2e3ad0277f","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T17:36:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 17:36:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8145501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8145501","identity":"rs-8145501","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}