BOPPPS-Based Teaching with Professionalism Integration Improves Multidimensional Outcomes in Undergraduate Geriatric Medicine Clerkships: A Randomized Controlled Study

BOPPPS-Based Teaching with Professionalism Integration Improves Multidimensional Outcomes in Undergraduate Geriatric Medicine Clerkships: A Randomized Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article BOPPPS-Based Teaching with Professionalism Integration Improves Multidimensional Outcomes in Undergraduate Geriatric Medicine Clerkships: A Randomized Controlled Study Nan Wang, Lin Chen, Yongxia Xu, Yan Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8468817/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Geriatric medicine clerkships require instructional approaches that foster not only clinical competence but also self‑directed learning and professional values. Structured, learner‑centered teaching models may support these multidimensional outcomes more effectively than traditional lecture‑based instruction. This study evaluated the educational effects of BOPPPS‑based teaching with professionalism integration in undergraduate geriatric medicine clerkships. Methods: A randomized controlled study was conducted in 2024 involving 80 undergraduate clinical medicine students completing a geriatric medicine clerkship at the First Affiliated Hospital of Anhui Medical University. Students were randomly assigned to an intervention group receiving BOPPPS‑based teaching with integrated professionalism‑focused elements ( n = 40) or a control group receiving traditional teaching ( n = 40). Learning outcomes were assessed using a three‑dimensional framework encompassing knowledge, skills, and values. Knowledge was evaluated using ethics and case‑analysis items derived from the National Medical Licensing Examination. Skills outcomes included structured observation of medical history‑taking behaviors and a validated self‑directed learning ability scale. Values were measured using a professional values questionnaire and a teaching satisfaction survey. Group comparisons were performed using appropriate parametric or non‑parametric statistical tests, with a two‑sided significance level set at P < 0.05. Results: The intervention group demonstrated significantly better performance in the skills domain compared with the control group (P < 0.05). Notable improvements were observed in social support inquiry, economically adaptive clinical decision‑making, and the completeness of cognitive and psychological assessments. Students in the intervention group also achieved significantly higher scores in overall self‑directed learning ability, particularly in information processing, communication, and collaboration (P < 0.05). In the values domain, higher scores were observed for key professional values, including contribution, self‑actualization, and interpersonal relationships, along with greater teaching satisfaction (P 0.05). Conclusion: BOPPPS‑based teaching with professionalism integration was associated with enhanced clinical skills, improved self‑directed learning, and stronger professional values among undergraduate students in geriatric medicine clerkships. This approach represents a feasible strategy for promoting multidimensional learning outcomes in undergraduate medical education. BOPPPS teaching model professionalism integration geriatrics clinical clerkship undergraduate medical education Figures Figure 1 Background With the rapid acceleration of population ageing worldwide, geriatric medicine has become increasingly prominent within contemporary healthcare systems. The health needs of older adults extend beyond age‑related physiological decline to include complex psychological concerns and challenges related to social adaptation[ 1 ]. Meeting these needs requires future physicians to demonstrate not only solid biomedical knowledge and clinical skills, but also patient‑centered care abilities and humanistic competencies to deliver comprehensive geriatric care effectively[ 2 ]. Geriatric medicine clerkships are often the first structured opportunity for undergraduate medical students to participate in the clinical care of older adults. Although students usually enter clerkships after completing core basic and clinical coursework, their real‑world clinical exposure remains limited, and their understanding of professional roles, ethical responsibilities, and professional behaviours is still developing. This stage is therefore pivotal for professional identity formation and the development of professional values[ 3 ]. However, traditional clerkship teaching frequently emphasises knowledge transmission and technical training, with comparatively less structured support for professionalism, ethical reasoning, patient‑centered communication, and other humanistic outcomes. Educational strategies that can strengthen clinical competence while fostering professionalism‑related development remain needed in undergraduate medical education. To address this gap, this study evaluated a teaching intervention that combined the BOPPPS model (Bridge‑in, Objective, Pre‑assessment, Participatory Learning, Post‑assessment, and Summary) with professionalism‑focused teaching elements integrated throughout the clerkship. BOPPPS is a learner‑centered framework that enhances engagement through structured learning activities, active participation, and continuous feedback, thereby supporting a complete teaching–learning cycle. Prior research[ 4 , 5 ] suggests that BOPPPS can improve classroom interaction, learning motivation, and learning outcomes across medical education settings. In parallel, professionalism integration emphasises embedding professional values, ethical awareness, and social responsibility within discipline‑specific teaching rather than delivering them as a separate curricular module[ 6 ]. This approach is particularly relevant in geriatric medicine, where psychosocial complexity and ethical challenges are common in routine care. Accordingly, we systematically embedded professionalism‑focused elements within each phase of the BOPPPS framework in geriatric medicine clerkships. Teaching cases reflected psychosocial features and real‑world challenges in geriatric care, and a three‑dimensional evaluation framework encompassing knowledge, skills, and values was used to assess outcomes. We aimed to examine whether BOPPPS‑based teaching with professionalism integration could improve students’ knowledge‑related performance, clinical skills, and professional values during geriatric medicine clerkships, thereby providing empirical evidence to inform innovation in undergraduate medical education. Methods Ethical approval This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ-2025-11-29). All participants voluntarily agreed to take part in the study and provided written informed consent prior to enrolment. Participants This study was conducted in the Department of Geriatric Endocrinology at the First Affiliated Hospital of Anhui Medical University. A total of 80 undergraduate medical students from the 2020 cohort who were undertaking their first geriatric medicine clerkship were enrolled. The inclusion criteria were as follows: completion of core clinical courses, including internal medicine, surgery, and diagnostics; first exposure to a specialized geriatric medicine clerkship; and voluntary participation with signed informed consent. The exclusion criteria included: prior clerkship experience in geriatrics or other endocrinology subspecialties; interruption of clinical rotation for more than one week due to postgraduate examination preparation or medical leave; and refusal to participate in teaching evaluations or submission of incomplete questionnaires. Eligible students were randomly assigned, using a random number table, to either the intervention group ( n = 40) or the control group ( n = 40). No statistically significant differences were observed between the two groups in baseline characteristics such as age, sex, or previous comprehensive academic performance (P > 0.05). Study design and teaching intervention This study adopted a randomized controlled design. The textbook Geriatric Medicine (People’s Medical Publishing House), edited by Wang Jianye et al., was used as the standard teaching reference for both groups. Teaching in both groups was delivered by the same senior physician from the Department of Geriatrics to ensure consistency in instructional experience, teaching content, and total contact hours. The intervention group received teaching based on the BOPPPS instructional model with professionalism integration. The complete teaching process followed the six core components of the BOPPPS framework—Bridge‑in, Objective, Pre‑assessment, Participatory Learning, Post‑assessment, and Summary—with professionalism -focused elements systematically embedded into each stage. The detailed instructional process is illustrated in Figure 1. The control group was taught using a conventional lecture‑based approach supported by PowerPoint presentations, with instruction primarily focused on disease diagnosis and treatment and led by the instructor. Outcome measures and evaluation A three‑dimensional evaluation framework encompassing knowledge, skills, and values was applied. Knowledge assessment Knowledge outcomes were assessed using theory‑based ethics and case‑analysis questions derived from the National Medical Licensing Examination item bank, with a total score of 100 points. Ethical decision‑making ability focused on issues relevant to geriatric diabetes care, including informed consent and healthcare resource allocation. Examinations were organized uniformly by the teaching department, and grading was conducted independently by a second senior geriatric physician to ensure separation of teaching and assessment. Skills assessment Observed history‑taking behaviors Standardized patients (SPs) were used to assess students’ history‑taking performance. Three core behaviors were evaluated: Inquiry into social support systems (0–2 points): 0 = not assessed; 1 = passive response (only when the patient voluntarily mentioned difficulties); 2 = active and in‑depth inquiry (covering at least two domains, such as financial resources and caregiving arrangements). Economically adaptive medication decision‑making (0–2 points): 0 = not considered; 1 = passive response; 2 = active provision of alternative treatment options (e.g. medications covered by insurance). Assessment and documentation of cognitive and psychological status (0–2 points): 0 = not assessed or recorded; 1 = simple inquiry or brief description; 2 = use of standardized tools (e.g. GDS‑15, MMSE). Self‑directed learning ability Self‑directed learning ability was assessed using a validated structured scale with high reliability (Cronbach’s α = 0.929)[7]. The scale contains 40 items across six domains: self‑motivation, learning beliefs, goal planning, self‑monitoring, information processing, and collaboration. Items 8, 10, 19, and 37 were reverse‑scored; all other items were positively scored. Responses were recorded using a five‑point Likert scale ranging from “strongly disagree” (1) to “strongly agree” (5). Higher scores indicate stronger self‑directed learning ability. Values assessment Professional values Professional values were measured using the Medical Students’ Professional Values Scale developed by Pei Xianhuan et al.[8], which demonstrated excellent internal consistency (Cronbach’s α = 0.986). The scale includes seven dimensions: self-realization, interpersonal relations and security, contribution, economic reward, working environment, prestige, and intellectual stimulation. Each item was rated on a five‑point Likert scale from “very unimportant” (1) to “very important” (5). Teaching satisfaction survey A self‑designed questionnaire was used to assess student satisfaction with the teaching approach, including learning interest, mastery of professional knowledge, improvement in clinical communication skills, development of medical humanistic qualities, and overall satisfaction with the teaching model. Statistical analysis Data were analyzed using SPSS version 21.0. Normality of continuous variables was assessed using the Shapiro–Wilk test. Normally distributed variables are presented as mean ± standard deviation and were compared using Student’s t test. Non‑normally distributed data are expressed as median (interquartile range) [M (P25, P75)] and were analyzed using the Mann–Whitney U test. Categorical variables are presented as frequencies and percentages and were compared using the Pearson χ² test. A two‑sided P value < 0.05 was considered statistically significant. Results Knowledge outcomes No significant differences were observed between the intervention and control groups in the ethics and case‑analysis examination based on the National Medical Licensing Examination question bank (P > 0.05). Detailed results are shown in Table 1. Table 1. Knowledge-domain assessment scores Outcome Intervention ( n =40) Control ( n =40) Test statistic P value Ethics module (40 points), mean ± SD 32.48 ± 3.79 31.78 ± 4.22 t = 0.807 0.423 Case analysis (60 points), mean ± SD 51.23 ± 5.12 50.08 ± 5.89 t = 0.931 0.355 Total score (100 points), mean ± SD 83.70 ± 7.22 81.85 ± 8.12 t = 1.076 0.286 Proportion scoring ≥85, n (%) 22 (55.0) 17 (42.5) χ² = 1.253 0.263 Skills outcomes Observed history ‑ taking behaviors Students in the intervention group more frequently achieved the highest performance level (score=2) for three observed history-taking behaviors: inquiry about social support systems (85.0% vs 42.5%), economically adaptive medication decision-making (77.5% vs 38.8%), and assessment and documentation of cognitive and psychological status using standardized tools (65.0% vs 25.0%). The between-group differences were 42.5%, 38.7%, and 40.0%, respectively, and were statistically significant (all P < 0.05; Table 2). Table 2. Observed history-taking behaviors (highest performance level, score = 2) Outcome (0–2 scale) Highest performance (score=2) Intervention ( n =40), n (%) Control ( n =40), n (%) percentage points χ² P value Inquiry about social support systems Proactive inquiry 34 (85.0) 17 (42.5) +42.5 16.330 <0.001 Economically adaptive medication decision-making Proactive plan 31 (77.5) 15 (38.8) +38.7 13.332 0.001 Assessment and documentation of cognitive and psychological status Use of standardized tools 26 (65.0) 10 (25.0) +40.0 14.923 0.001 Self ‑ directed learning ability Compared with the control group, students in the intervention group had higher scores in self-motivation (P=0.018), information processing (P=0.003), collaboration (P 0.05). Detailed results are presented in Table 3. Table 3. Self-directed learning ability scores（mean ± SD） Outcome Intervention ( n =40) Control ( n =40) t P value Self-motivation 22.68 ± 3.46 20.83 ± 3.42 2.406 0.018 Learning beliefs 21.18 ± 2.37 21.58 ± 3.08 −0.651 0.517 Goal planning 24.17 ± 3.96 23.68 ± 3.78 0.577 0.565 Self-monitoring 28.13 ± 4.58 28.45 ± 3.86 −0.343 0.732 Information processing 15.18 ± 1.98 13.78 ± 2.11 3.050 0.003 Collaboration 33.73 ± 3.53 30.30 ± 3.92 4.108 <0.001 Total score 145.05 ± 9.14 138.60 ± 10.28 3.342 0.001 Values outcomes Professional values Compared with the control group, students in the intervention group had higher scores for self-realization (P=0.004), interpersonal relationships and security (P=0.001), and contribution (P0.05). Detailed findings are presented in Table 4. Table 4. Professional values scale scores[ M （ P25 ， P75 ） ] Outcome Intervention ( n =40) Control ( n =40) Z P value Self-realization 21 (19, 22) 18 (16, 20) 2.87 0.004 Interpersonal relationships and security 36 (33, 39) 32 (29, 35) 3.25 0.001 Contribution 22 (20, 24) 17 (15, 19) 4.52 <0.001 Economic reward 14 (12, 16) 15 (13, 17) −0.42 0.674 Working environment 18 (16, 20) 19 (17, 21) −0.31 0.756 Prestige 13 (11, 15) 12 (10, 14) 0.85 0.395 Intellectual stimulation 16 (14, 18) 15 (13, 17) 1.02 0.308 Teaching satisfaction Compared with the control group, students in the intervention group reported higher satisfaction regarding learning interest (P=0.007), improvement in clinical communication skills (P<0.001), development of medical humanistic qualities (P= 0.001), and the overall teaching model (P=0.002). No between-group difference was observed in perceived mastery of professional knowledge (P=0.958). Results are summarized in Table 5. Table 5. Satisfaction questionnaire results (grouped layout) Outcome Response categories Intervention ( n =40), n (%) Control ( n =40), n (%) χ² P value Learning interest 9.834 0.007 very interested 19 (47.5) 6 (15.0) Basically interested 11 (27.5) 18 (45.0) Not interested 10 (25.0) 16 (40.0) Perceived mastery of professional knowledge 0.086 0.958 Completely mastered 6 (15.0) 6 (15.0) Basically mastered 26 (65.0) 27 (67.5) Not mastered 8 (20.0) 7 (17.5) Improvement in clinical communication skills 31.857 <0.001 Yes 20 (50.0) 5 (12.5) No 5 (12.5) 30 (75.0) Uncertain 15 (37.5) 5 (12.5) Development of medical humanistic qualities 14.967 0.001 Yes 32 (80.0) 15 (37.5) No 3 (7.5) 8 (20.0) Uncertain 5 (12.5) 17 (42.5) Satisfaction with the overall teaching model 11.998 0.002 Satisfied 23 (57.5) 8 (20.0) Basically satisfied 8 (20.0) 17 (42.5) Not satisfied 9 (22.5) 15 (37.5) Discussion This study demonstrated that integrating the BOPPPS instructional model with professionalism integration in geriatric medicine clerkship teaching produced significant educational benefits. These findings provide empirical support for pedagogical innovation in medical education and highlight the distinctive suitability of geriatric medicine as a clinical context for cultivating professionalism alongside clinical competence. The inherent characteristics of geriatric medicine make it particularly well suited for professionalism‑integrated medical education. Compared with other clinical specialties, geriatric practice naturally incorporates teaching elements centered on social support assessment, economically adaptive decision‑making, and evaluation of cognitive and psychological status, all of which reflect essential components of humanistic and patient‑centered care[9]. Leveraging these characteristics, the present study constructed a three‑dimensional evaluation framework encompassing knowledge, skills, and values, thereby addressing the limitations of traditional values education assessments that rely primarily on single‑dimension questionnaires. This framework enabled a more coherent connection between values education theory and observable clinical practice in geriatric medicine[10]. The significant improvements observed in the intervention group in both skill‑related behaviors-such as social support inquiry, economically adaptive medication decisions, and documentation of cognitive and psychological status and value‑related outcomes related to core medical humanitarian principles indicate that abstract ethical concepts and educational goals can be effectively translated into measurable and observable clinical behaviors. By grounding assessment in authentic clinical scenarios, this approach establishes a clear evidence‑based link between instructional objectives and learner performance and offers a practical, operational evaluation tool for medical humanities education. The integration of the BOPPPS teaching model with professionalism‑integrated instructional elements also generated a synergistic educational effect. The superior performance of the intervention group in self‑directed learning ability supports the effectiveness of this teaching approach in enhancing student initiative and learning autonomy. Within the BOPPPS framework, the pre‑assessment stage helps learners clarify their learning needs, participatory learning promotes active engagement and deeper cognitive processing, and post‑assessment reinforces learning outcomes through timely feedback. Notably, professionalism integration did not increase students’ cognitive burden; instead, their close alignment with real‑world clinical issues appeared to enhance learning relevance and interest. This mechanism may help explain why students in the intervention group reported higher satisfaction across four key dimensions in the teaching satisfaction survey. These findings are consistent with those of previous studies[5, 11, 12] examining the effectiveness of BOPPPS‑based blended teaching models in medical education, further supporting the educational value of integrated instructional designs. Despite these encouraging findings, several limitations should be acknowledged. First, the study was conducted with a relatively small sample size from a single institution, which may limit the generalizability of the results. Second, the intervention period was short, and long‑term follow‑up data on the sustainability of educational outcomes were not available. Third, although a multi‑dimensional evaluation framework was adopted, assessment of values‑related outcomes inevitably retains a degree of subjectivity. From an implementation perspective, this integrated teaching model places higher demands on instructors, who must possess not only solid disciplinary expertise but also the capacity to deliver professionalism‑integrated guidance and manage participatory learning effectively. In addition, some students initially demonstrated difficulty adapting to an active, student‑centered learning approach. Future studies should therefore expand sample sources across institutions, extend the observation period, and incorporate longitudinal tracking tools such as professional identity or career commitment scales. Strengthening faculty development programmes, enriching teaching resources, and providing structured, progressive learning guidance may further facilitate student adaptation and optimize teaching effectiveness. In conclusion, integrating the BOPPPS teaching model with professionalism integration within the authentic clinical context of geriatric medicine effectively achieves alignment between knowledge acquisition, skill development, and professional values formation. The three‑dimensional evaluation framework proposed in this study offers a novel and practical approach for assessing the outcomes of medical humanities education and provides a reference for future pedagogical reform in undergraduate medical training. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval No.: PJ-2025-11-29). Written informed consent was obtained from all participants prior to enrolment. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was funded by the 2024 Anhui Medical University Quality Engineering Project (supported by the Anhui Provincial Department of Education; Grant No. 2024xjxm77). Authors ’ contributions Wang Nan conceived and designed the study. Chen Lin, Xu Yongxia and Sun Yan conducted the intervention and collected the data. Chen Lin performed the statistical analysis. Wang Nan drafted the manuscript. Wang Nan and Sun Yan revised the final version of the manuscript. All authors critically revised the manuscript and approved the final version. Acknowledgements We would like to thank the students who participated in this study and the teaching staff of the Department of Geriatric Endocrinology for their support. References Wang X; Miao H; Jin Q. The structural characteristics of the lifestyle among older adults and its impact on the health in China. Front Public Health. 2023; 11:1286530. Watson A; Pearson G;Winter R; Blundell A; Masud T; Gordon AL; Henderson EJ. What are we teaching UK medical students about ageing and geriatric medicine? Results of the third British Geriatrics Society national curriculum and teaching survey. Age Ageing. 2025; 54(8). Masud T; Ogliari G; Lunt E; Blundell A; Gordon AL; Roller-Wirnsberger R; Vassallo M; Mari D; Kotsani M; Singler K; Romero-Ortuno R; Cruz-Jentoft AJ; Stuck AE. A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods. Eur Geriatr Med. 2022; 13(3):513-528. Li S; Wei W; Li X; Ma L; Li Q; Sun X; Chen X. Impacts of blended learning with BOPPPS model on Chinese medical undergraduate students: a comprehensive systematic review and meta-analysis of 44 studies. BMC Med Educ. 2024; 24(1):914. Hu K; Ma RJ; Ma C; Zheng QK; Sun ZG. Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education. BMC Med Educ. 2022; 22(1):447. Guraya SS; Guraya SY; Rashid-Doubell F; Fredericks S; Harkin DW; Bin Mat Nor MZ; Bahri Yusoff MS. Reclaiming the concept of professionalism in the digital context: a principle-based concept analysis. Ann Med. 2024; 56(1):2398202. Wang XD, Tang GQ, Wang SZ, Ma JD, Liu W, Tian H, Gao YS. Development of a self-directed learning ability assessment scale for medical students. Chinese Journal of Health Psychology. 2014;22(7):1034-1037. Pei XH. A study on medical students' professional values from the perspective of ideological and political education [master' s thesis]. Dalian: Dalian Medical University; 2023. Kokorelias KM; Sheikh MH; Naimi M; Ho B; Wong EW; Brooks SG; Gandell D; Berger AS. Enhancing professionalism in post-graduate medical education: the initial implementation and evaluation of a longitudinal curriculum for geriatrics residents in Toronto, Canada. Can Med Educ J. 2025; 16(3):33-45. Venville A; Andrews P. Building great health care teams: enhancing interprofessional work readiness skills, knowledge and values for undergraduate health care students. J Interprof Care. 2020; 34(2):272-275. Wei L; Yu X; Wang Y; Shan N. Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training. BMC Med Educ. 2025; 25(1):655. Chen Y; Xiao Z; Gu X; Lang Q; Chen C; Zhang J. Effect of the EBM-integrated BOPPPS model on clinical competence and EBM confidence in neurology clerkships for three-year junior college medical clerks. Front Public Health. 2025; 13:1676073. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 23 Jan, 2026 Editor invited by journal 02 Jan, 2026 Editor assigned by journal 01 Jan, 2026 Submission checks completed at journal 01 Jan, 2026 First submitted to journal 28 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8468817","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580480905,"identity":"1763a8bd-b546-436a-afb0-b83741009492","order_by":0,"name":"Nan Wang","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nan","middleName":"","lastName":"Wang","suffix":""},{"id":580480906,"identity":"295c18e1-7d35-41ea-8e0a-72587e3b0b16","order_by":1,"name":"Lin Chen","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Chen","suffix":""},{"id":580480907,"identity":"1c4e9036-6355-45fd-983c-695c51a005f8","order_by":2,"name":"Yongxia Xu","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yongxia","middleName":"","lastName":"Xu","suffix":""},{"id":580480908,"identity":"e667891a-c649-4575-8d01-ff4cd7f06bec","order_by":3,"name":"Yan Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYLCCj39s5NjY2w8Qr4NxZkOaMR/PmQTitTDzNhxKnCfhYECccvkZyc8e8+44kN4mwZDA8KNiG2EtBjfSzA3nnrmT2ybdeICx58xtIrRIJJhJvGF7ltsmcyCBmbGNCC3yM9K/SfCwHU5nk0gwIE4Lw40cM0netsMJxGsxOPOmTHLGmTTDNmAgHyTKL/Lt6dskPlTYyMu3tx988KOCGIcJJCDYB4hQDwT8RKobBaNgFIyCEQwAY0U/ErP589IAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-12-29 03:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8468817/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8468817/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101363265,"identity":"39c50a23-6d5d-476d-bb64-767742e5c085","added_by":"auto","created_at":"2026-01-29 00:35:06","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1203516,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the BOPPPS‑based teaching process with professionalism integration for geriatric diabetes management. Professionalism‑focused elements were embedded through community‑based videos, structured reflection on “What matters besides laboratory values?”, standardized patient interviews, and behavioural observation with feedback. The figure maps each BOPPPS phase to aligned learning objectives and assessments across knowledge, clinical skills, and the values domain.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8468817/v1/8d6ad4203bda07fdb87cd9de.jpeg"},{"id":101363271,"identity":"89645751-19a6-4301-903c-4651afe60ee4","added_by":"auto","created_at":"2026-01-29 00:35:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1935834,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8468817/v1/5192c231-8fce-4e21-b5c7-de4060028c5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"BOPPPS-Based Teaching with Professionalism Integration Improves Multidimensional Outcomes in Undergraduate Geriatric Medicine Clerkships: A Randomized Controlled Study","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the rapid acceleration of population ageing worldwide, geriatric medicine has become increasingly prominent within contemporary healthcare systems. The health needs of older adults extend beyond age‑related physiological decline to include complex psychological concerns and challenges related to social adaptation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Meeting these needs requires future physicians to demonstrate not only solid biomedical knowledge and clinical skills, but also patient‑centered care abilities and humanistic competencies to deliver comprehensive geriatric care effectively[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGeriatric medicine clerkships are often the first structured opportunity for undergraduate medical students to participate in the clinical care of older adults. Although students usually enter clerkships after completing core basic and clinical coursework, their real‑world clinical exposure remains limited, and their understanding of professional roles, ethical responsibilities, and professional behaviours is still developing. This stage is therefore pivotal for professional identity formation and the development of professional values[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, traditional clerkship teaching frequently emphasises knowledge transmission and technical training, with comparatively less structured support for professionalism, ethical reasoning, patient‑centered communication, and other humanistic outcomes. Educational strategies that can strengthen clinical competence while fostering professionalism‑related development remain needed in undergraduate medical education.\u003c/p\u003e \u003cp\u003eTo address this gap, this study evaluated a teaching intervention that combined the BOPPPS model (Bridge‑in, Objective, Pre‑assessment, Participatory Learning, Post‑assessment, and Summary) with professionalism‑focused teaching elements integrated throughout the clerkship. BOPPPS is a learner‑centered framework that enhances engagement through structured learning activities, active participation, and continuous feedback, thereby supporting a complete teaching\u0026ndash;learning cycle. Prior research[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] suggests that BOPPPS can improve classroom interaction, learning motivation, and learning outcomes across medical education settings.\u003c/p\u003e \u003cp\u003eIn parallel, professionalism integration emphasises embedding professional values, ethical awareness, and social responsibility within discipline‑specific teaching rather than delivering them as a separate curricular module[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This approach is particularly relevant in geriatric medicine, where psychosocial complexity and ethical challenges are common in routine care.\u003c/p\u003e \u003cp\u003eAccordingly, we systematically embedded professionalism‑focused elements within each phase of the BOPPPS framework in geriatric medicine clerkships. Teaching cases reflected psychosocial features and real‑world challenges in geriatric care, and a three‑dimensional evaluation framework encompassing knowledge, skills, and values was used to assess outcomes. We aimed to examine whether BOPPPS‑based teaching with professionalism integration could improve students\u0026rsquo; knowledge‑related performance, clinical skills, and professional values during geriatric medicine clerkships, thereby providing empirical evidence to inform innovation in undergraduate medical education.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ-2025-11-29). All participants voluntarily agreed to take part in the study and provided written informed consent prior to enrolment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the Department of Geriatric Endocrinology at the First Affiliated Hospital of Anhui Medical University. A total of 80 undergraduate medical students from the 2020 cohort who were undertaking their first geriatric medicine clerkship were enrolled. The inclusion criteria were as follows: completion of core clinical courses, including internal medicine, surgery, and diagnostics; first exposure to a specialized geriatric medicine clerkship; and voluntary participation with signed informed consent. The exclusion criteria included: prior clerkship experience in geriatrics or other endocrinology subspecialties; interruption of clinical rotation for more than one week due to postgraduate examination preparation or medical leave; and refusal to participate in teaching evaluations or submission of incomplete questionnaires.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEligible students were randomly assigned, using a random number table, to either the intervention group (\u003cem\u003en\u003c/em\u003e = 40) or the control group (\u003cem\u003en\u003c/em\u003e = 40). No statistically significant differences were observed between the two groups in baseline characteristics such as age, sex, or previous comprehensive academic performance (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and teaching intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adopted a randomized controlled design. The textbook Geriatric Medicine (People\u0026rsquo;s Medical Publishing House), edited by Wang Jianye et al., was used as the standard teaching reference for both groups. Teaching in both groups was delivered by the same senior physician from the Department of Geriatrics to ensure consistency in instructional experience, teaching content, and total contact hours.\u003c/p\u003e\n\u003cp\u003eThe intervention group received teaching based on the BOPPPS instructional model with professionalism integration. The complete teaching process followed the six core components of the BOPPPS framework\u0026mdash;Bridge‑in, Objective, Pre‑assessment, Participatory Learning, Post‑assessment, and Summary\u0026mdash;with professionalism -focused elements systematically embedded into each stage. The detailed instructional process is illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003eThe control group was taught using a conventional lecture‑based approach supported by PowerPoint presentations, with instruction primarily focused on disease diagnosis and treatment and led by the instructor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures and evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA three‑dimensional evaluation framework encompassing knowledge, skills, and values was applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eKnowledge assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKnowledge outcomes were assessed using theory‑based ethics and case‑analysis questions derived from the National Medical Licensing Examination item bank, with a total score of 100 points. Ethical decision‑making ability focused on issues relevant to geriatric diabetes care, including informed consent and healthcare resource allocation. Examinations were organized uniformly by the teaching department, and grading was conducted independently by a second senior geriatric physician to ensure separation of teaching and assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSkills assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObserved history‑taking behaviors\u003c/p\u003e\n\u003cp\u003eStandardized patients (SPs) were used to assess students\u0026rsquo; history‑taking performance. Three core behaviors were evaluated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInquiry into social support systems (0\u0026ndash;2 points):\u003c/p\u003e\n\u003cp\u003e0 = not assessed;\u003c/p\u003e\n\u003cp\u003e1 = passive response (only when the patient voluntarily mentioned difficulties);\u003c/p\u003e\n\u003cp\u003e2 = active and in‑depth inquiry (covering at least two domains, such as financial resources and caregiving arrangements).\u003c/p\u003e\n\u003cp\u003eEconomically adaptive medication decision‑making (0\u0026ndash;2 points):\u003c/p\u003e\n\u003cp\u003e0 = not considered;\u003c/p\u003e\n\u003cp\u003e1 = passive response;\u003c/p\u003e\n\u003cp\u003e2 = active provision of alternative treatment options (e.g. medications covered by insurance).\u003c/p\u003e\n\u003cp\u003eAssessment and documentation of cognitive and psychological status (0\u0026ndash;2 points):\u003c/p\u003e\n\u003cp\u003e0 = not assessed or recorded;\u003c/p\u003e\n\u003cp\u003e1 = simple inquiry or brief description;\u003c/p\u003e\n\u003cp\u003e2 = use of standardized tools (e.g. GDS‑15, MMSE).\u003c/p\u003e\n\u003cp\u003eSelf‑directed learning ability\u003c/p\u003e\n\u003cp\u003eSelf‑directed learning ability was assessed using a validated structured scale with high reliability (Cronbach\u0026rsquo;s\u0026nbsp;\u0026alpha; = 0.929)[7]. The scale contains 40 items across six domains: self‑motivation, learning beliefs, goal planning, self‑monitoring, information processing, and collaboration. Items 8, 10, 19, and 37 were reverse‑scored; all other items were positively scored. Responses were recorded using a five‑point Likert scale ranging from\u0026nbsp;\u0026ldquo;strongly disagree\u0026rdquo;\u0026nbsp;(1) to\u0026nbsp;\u0026ldquo;strongly agree\u0026rdquo;\u0026nbsp;(5). Higher scores indicate stronger self‑directed learning ability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eValues assessment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProfessional values\u003c/p\u003e\n\u003cp\u003eProfessional values were measured using the Medical Students\u0026rsquo; Professional Values Scale developed by Pei Xianhuan et al.[8], which demonstrated excellent internal consistency (Cronbach\u0026rsquo;s\u0026nbsp;\u0026alpha; = 0.986). The scale includes seven dimensions: self-realization, interpersonal relations and security, contribution, economic reward, working environment, prestige, and intellectual stimulation. Each item was rated on a five‑point Likert scale from\u0026nbsp;\u0026ldquo;very unimportant\u0026rdquo;\u0026nbsp;(1) to\u0026nbsp;\u0026ldquo;very important\u0026rdquo;\u0026nbsp;(5).\u003c/p\u003e\n\u003cp\u003eTeaching satisfaction survey\u003c/p\u003e\n\u003cp\u003eA self‑designed questionnaire was used to assess student satisfaction with the teaching approach, including learning interest, mastery of professional knowledge, improvement in clinical communication skills, development of medical humanistic qualities, and overall satisfaction with the teaching model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 21.0. Normality of continuous variables was assessed using the Shapiro\u0026ndash;Wilk test. Normally distributed variables are presented as mean \u0026plusmn; standard deviation and were compared using Student\u0026rsquo;s t test. Non‑normally distributed data are expressed as median (interquartile range) \u003cem\u003e[M (P25, P75)]\u003c/em\u003e and were analyzed using the Mann\u0026ndash;Whitney U test. Categorical variables are presented as frequencies and percentages and were compared using the Pearson \u0026chi;\u0026sup2; test. A two‑sided P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eKnowledge outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences were observed between the intervention and control groups in the ethics and case‑analysis examination based on the National Medical Licensing Examination question bank (P \u0026gt; 0.05). Detailed results are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Knowledge-domain assessment scores\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 217px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003eIntervention (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTest statistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eEthics module (40 points), mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e32.48\u0026nbsp;\u0026plusmn;\u0026nbsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e31.78\u0026nbsp;\u0026plusmn;\u0026nbsp;4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003et = 0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eCase analysis (60 points), mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e51.23\u0026nbsp;\u0026plusmn;\u0026nbsp;5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e50.08\u0026nbsp;\u0026plusmn;\u0026nbsp;5.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003et = 0.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal score (100 points),\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e83.70\u0026nbsp;\u0026plusmn;\u0026nbsp;7.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e81.85\u0026nbsp;\u0026plusmn;\u0026nbsp;8.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003et = 1.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eProportion scoring \u0026ge;85, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e22 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e17 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u0026nbsp;= 1.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSkills outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eObserved history\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e‑\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003etaking behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents in the intervention group more frequently achieved the highest performance level (score=2) for three observed history-taking behaviors: inquiry about social support systems (85.0% vs 42.5%), economically adaptive medication decision-making (77.5% vs 38.8%), and assessment and documentation of cognitive and psychological status using standardized tools (65.0% vs 25.0%). The between-group differences were 42.5%, 38.7%, and 40.0%, respectively, and were statistically significant (all P \u0026lt; 0.05; Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2. Observed history-taking behaviors (highest performance level, score = 2)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"682\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eOutcome (0\u0026ndash;2 scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eHighest performance (score=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eIntervention (\u003cem\u003en\u003c/em\u003e=40), \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e=40), \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003epercentage points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eInquiry about social support systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eProactive inquiry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e34 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e17 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e+42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e16.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eEconomically adaptive medication decision-making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eProactive plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e31 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e+38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e13.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eAssessment and documentation of cognitive and psychological status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eUse of standardized tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e26 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e+40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e14.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSelf\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e‑\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003edirected learning ability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the control group, students in the intervention group had higher scores in self-motivation (P=0.018), information processing (P=0.003), collaboration (P\u0026lt;0.001), and overall self-directed learning ability (P=0.001). No between-group differences were observed in learning beliefs, goal planning, or self-monitoring (all P\u0026gt; 0.05). Detailed results are presented in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Self-directed learning ability scores（mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD）\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003eIntervention (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eSelf-motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e22.68\u0026nbsp;\u0026plusmn;\u0026nbsp;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e20.83\u0026nbsp;\u0026plusmn;\u0026nbsp;3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eLearning beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e21.18 \u0026plusmn; 2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e21.58 \u0026plusmn; 3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026minus;0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eGoal planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e24.17\u0026nbsp;\u0026plusmn;\u0026nbsp;3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e23.68\u0026nbsp;\u0026plusmn;\u0026nbsp;3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eSelf-monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e28.13 \u0026plusmn; 4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e28.45 \u0026plusmn; 3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026minus;0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eInformation processing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e15.18\u0026nbsp;\u0026plusmn;\u0026nbsp;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e13.78\u0026nbsp;\u0026plusmn;\u0026nbsp;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eCollaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e33.73\u0026nbsp;\u0026plusmn;\u0026nbsp;3.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e30.30\u0026nbsp;\u0026plusmn;\u0026nbsp;3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e145.05\u0026nbsp;\u0026plusmn;\u0026nbsp;9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e138.60\u0026nbsp;\u0026plusmn;\u0026nbsp;10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e3.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eValues outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProfessional values\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the control group, students in the intervention group had higher scores for self-realization (P=0.004), interpersonal relationships and security (P=0.001), and contribution (P\u0026lt;0.001). No between-group differences were observed for economic reward, working environment, prestige, or intellectual stimulation (all P\u0026gt;0.05). Detailed findings are presented in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4. Professional values scale scores[\u003cem\u003eM\u003c/em\u003e\u003cem\u003e（\u003c/em\u003e\u003cem\u003eP25\u003c/em\u003e\u003cem\u003e，\u003c/em\u003e\u003cem\u003eP75\u003c/em\u003e\u003cem\u003e）\u003c/em\u003e]\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eIntervention (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e=40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eSelf-realization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e21 (19, 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (16, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eInterpersonal relationships and security\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e36 (33, 39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e32 (29, 35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eContribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e22 (20, 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (15, 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eEconomic reward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e14 (12, 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (13, 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026minus;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eWorking environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e18 (16, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (17, 21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026minus;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003ePrestige\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e13 (11, 15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (10, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 191px;\"\u003e\n \u003cp\u003eIntellectual stimulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e16 (14, 18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (13, 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTeaching satisfaction\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the control group, students in the intervention group reported higher satisfaction regarding learning interest (P=0.007), improvement in clinical communication skills (P\u0026lt;0.001), development of medical humanistic qualities (P= 0.001), and the overall teaching model (P=0.002). No between-group difference was observed in perceived mastery of professional knowledge (P=0.958). Results are summarized in Table 5.\u003c/p\u003e\n\u003cp\u003eTable 5. Satisfaction questionnaire results (grouped layout)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eResponse categories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eIntervention (\u003cem\u003en\u003c/em\u003e=40), \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eControl (\u003cem\u003en\u003c/em\u003e=40), \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eLearning interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e9.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003every interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e19 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e6 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eBasically interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e11 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e18 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eNot interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e10 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e16 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003ePerceived mastery of professional knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eCompletely mastered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e6 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e6 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eBasically mastered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e26 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e27 (67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eNot mastered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e8 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e7 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eImprovement in clinical communication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e31.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e20 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e30 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e15 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eDevelopment of medical humanistic qualities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e14.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e32 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e15 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e3 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e8 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eUncertain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e17 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eSatisfaction with the overall teaching model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e11.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e23 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e8 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eBasically satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e8 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e17 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e9 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e15 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated that integrating the BOPPPS instructional model with professionalism integration in geriatric medicine clerkship teaching produced significant educational benefits. These findings provide empirical support for pedagogical innovation in medical education and highlight the distinctive suitability of geriatric medicine as a clinical context for cultivating professionalism alongside clinical competence.\u003c/p\u003e\n\u003cp\u003eThe inherent characteristics of geriatric medicine make it particularly well suited for professionalism‑integrated medical education. Compared with other clinical specialties, geriatric practice naturally incorporates teaching elements centered on social support assessment, economically adaptive decision‑making, and evaluation of cognitive and psychological status, all of which reflect essential components of humanistic and patient‑centered care[9]. Leveraging these characteristics, the present study constructed a three‑dimensional evaluation framework encompassing knowledge, skills, and values, thereby addressing the limitations of traditional values education assessments that rely primarily on single‑dimension questionnaires. This framework enabled a more coherent connection between values education theory and observable clinical practice in geriatric medicine[10]. The significant improvements observed in the intervention group in both skill‑related behaviors-such as social support inquiry, economically adaptive medication decisions, and documentation of cognitive and psychological status and value‑related outcomes related to core medical humanitarian principles indicate that abstract ethical concepts and educational goals can be effectively translated into measurable and observable clinical behaviors. By grounding assessment in authentic clinical scenarios, this approach establishes a clear evidence‑based link between instructional objectives and learner performance and offers a practical, operational evaluation tool for medical humanities education.\u003c/p\u003e\n\u003cp\u003eThe integration of the BOPPPS teaching model with professionalism‑integrated instructional elements also generated a synergistic educational effect. The superior performance of the intervention group in self‑directed learning ability supports the effectiveness of this teaching approach in enhancing student initiative and learning autonomy. Within the BOPPPS framework, the pre‑assessment stage helps learners clarify their learning needs, participatory learning promotes active engagement and deeper cognitive processing, and post‑assessment reinforces learning outcomes through timely feedback. Notably, professionalism integration did not increase students\u0026rsquo;\u0026nbsp;cognitive burden; instead, their close alignment with real‑world clinical issues appeared to enhance learning relevance and interest. This mechanism may help explain why students in the intervention group reported higher satisfaction across four key dimensions in the teaching satisfaction survey. These findings are consistent with those of previous studies[5, 11, 12]\u0026nbsp;examining the effectiveness of BOPPPS‑based blended teaching models in medical education, further supporting the educational value of integrated instructional designs.\u003c/p\u003e\n\u003cp\u003eDespite these encouraging findings, several limitations should be acknowledged. First, the study was conducted with a relatively small sample size from a single institution, which may limit the generalizability of the results. Second, the intervention period was short, and long‑term follow‑up data on the sustainability of educational outcomes were not available. Third, although a multi‑dimensional evaluation framework was adopted, assessment of values‑related outcomes inevitably retains a degree of subjectivity. From an implementation perspective, this integrated teaching model places higher demands on instructors, who must possess not only solid disciplinary expertise but also the capacity to deliver professionalism‑integrated guidance and manage participatory learning effectively. In addition, some students initially demonstrated difficulty adapting to an active, student‑centered learning approach. Future studies should therefore expand sample sources across institutions, extend the observation period, and incorporate longitudinal tracking tools such as professional identity or career commitment scales. Strengthening faculty development programmes, enriching teaching resources, and providing structured, progressive learning guidance may further facilitate student adaptation and optimize teaching effectiveness.\u003c/p\u003e\n\u003cp\u003eIn conclusion, integrating the BOPPPS teaching model with professionalism integration within the authentic clinical context of geriatric medicine effectively achieves alignment between knowledge acquisition, skill development, and professional values formation. The three‑dimensional evaluation framework proposed in this study offers a novel and practical approach for assessing the outcomes of medical humanities education and provides a reference for future pedagogical reform in undergraduate medical training.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval No.: PJ-2025-11-29). Written informed consent was obtained from all participants prior to enrolment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the 2024 Anhui Medical University Quality Engineering Project (supported by the Anhui Provincial Department of Education; Grant No. 2024xjxm77).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWang Nan conceived and designed the study. Chen Lin, Xu Yongxia and Sun Yan conducted the intervention and collected the data. Chen Lin performed the statistical analysis. Wang Nan drafted the manuscript. Wang Nan and Sun Yan revised the final version of the manuscript. All authors critically revised the manuscript and approved the final version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the students who participated in this study and the teaching staff of the Department of Geriatric Endocrinology for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWang X; Miao H; Jin Q. The structural characteristics of the lifestyle among older adults and its impact on the health in China. Front Public Health. 2023; 11:1286530.\u003c/li\u003e\n\u003cli\u003eWatson A; Pearson G;Winter R; Blundell A; Masud T; Gordon AL; Henderson EJ. What are we teaching UK medical students about ageing and geriatric medicine? Results of the third British Geriatrics Society national curriculum and teaching survey. Age Ageing. 2025; 54(8).\u003c/li\u003e\n\u003cli\u003eMasud T; Ogliari G; Lunt E; Blundell A; Gordon AL; Roller-Wirnsberger R; Vassallo M; Mari D; Kotsani M; Singler K; Romero-Ortuno R; Cruz-Jentoft AJ; Stuck AE. A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods. Eur Geriatr Med. 2022; 13(3):513-528.\u003c/li\u003e\n\u003cli\u003eLi S; Wei W; Li X; Ma L; Li Q; Sun X; Chen X. Impacts of blended learning with BOPPPS model on Chinese medical undergraduate students: a comprehensive systematic review and meta-analysis of 44 studies. BMC Med Educ. 2024; 24(1):914.\u003c/li\u003e\n\u003cli\u003eHu K; Ma RJ; Ma C; Zheng QK; Sun ZG. Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education. BMC Med Educ. 2022; 22(1):447.\u003c/li\u003e\n\u003cli\u003eGuraya SS; Guraya SY; Rashid-Doubell F; Fredericks S; Harkin DW; Bin Mat Nor MZ; Bahri Yusoff MS. Reclaiming the concept of professionalism in the digital context: a principle-based concept analysis. Ann Med. 2024; 56(1):2398202.\u003c/li\u003e\n\u003cli\u003eWang XD, Tang GQ, Wang SZ, Ma JD, Liu W, Tian H, Gao YS. Development of a self-directed learning ability assessment scale for medical students. Chinese Journal of Health Psychology. 2014;22(7):1034-1037.\u003c/li\u003e\n\u003cli\u003ePei XH. A study on medical students\u0026apos; professional values from the perspective of ideological and political education [master\u0026apos; s thesis]. Dalian: Dalian Medical University; 2023.\u003c/li\u003e\n\u003cli\u003eKokorelias KM; Sheikh MH; Naimi M; Ho B; Wong EW; Brooks SG; Gandell D; Berger AS. Enhancing professionalism in post-graduate medical education: the initial implementation and evaluation of a longitudinal curriculum for geriatrics residents in Toronto, Canada. Can Med Educ J. 2025; 16(3):33-45.\u003c/li\u003e\n\u003cli\u003eVenville A; Andrews P. Building great health care teams: enhancing interprofessional work readiness skills, knowledge and values for undergraduate health care students. J Interprof Care. 2020; 34(2):272-275.\u003c/li\u003e\n\u003cli\u003eWei L; Yu X; Wang Y; Shan N. Application of BOPPPS and Flipped Classroom Joint Teaching Model into Clinical Practice Ability of Obstetrics and Gynecology Residents in Standardized Training. BMC Med Educ. 2025; 25(1):655.\u003c/li\u003e\n\u003cli\u003eChen Y; Xiao Z; Gu X; Lang Q; Chen C; Zhang J. Effect of the EBM-integrated BOPPPS model on clinical competence and EBM confidence in neurology clerkships for three-year junior college medical clerks. Front Public Health. 2025; 13:1676073.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"BOPPPS teaching model, professionalism integration, geriatrics, clinical clerkship, undergraduate medical education","lastPublishedDoi":"10.21203/rs.3.rs-8468817/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8468817/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eGeriatric medicine clerkships require instructional approaches that foster not only clinical competence but also self‑directed learning and professional values. Structured, learner‑centered teaching models may support these multidimensional outcomes more effectively than traditional lecture‑based instruction. This study evaluated the educational effects of BOPPPS‑based teaching with professionalism integration in undergraduate geriatric medicine clerkships.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA randomized controlled study was conducted in 2024 involving 80 undergraduate clinical medicine students completing a geriatric medicine clerkship at the First Affiliated Hospital of Anhui Medical University. Students were randomly assigned to an intervention group receiving BOPPPS‑based teaching with integrated professionalism‑focused elements (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40) or a control group receiving traditional teaching (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40). Learning outcomes were assessed using a three‑dimensional framework encompassing knowledge, skills, and values. Knowledge was evaluated using ethics and case‑analysis items derived from the National Medical Licensing Examination. Skills outcomes included structured observation of medical history‑taking behaviors and a validated self‑directed learning ability scale. Values were measured using a professional values questionnaire and a teaching satisfaction survey. Group comparisons were performed using appropriate parametric or non‑parametric statistical tests, with a two‑sided significance level set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe intervention group demonstrated significantly better performance in the skills domain compared with the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notable improvements were observed in social support inquiry, economically adaptive clinical decision‑making, and the completeness of cognitive and psychological assessments. Students in the intervention group also achieved significantly higher scores in overall self‑directed learning ability, particularly in information processing, communication, and collaboration (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the values domain, higher scores were observed for key professional values, including contribution, self‑actualization, and interpersonal relationships, along with greater teaching satisfaction (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No statistically significant differences were found between groups in the knowledge domain (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eBOPPPS‑based teaching with professionalism integration was associated with enhanced clinical skills, improved self‑directed learning, and stronger professional values among undergraduate students in geriatric medicine clerkships. This approach represents a feasible strategy for promoting multidimensional learning outcomes in undergraduate medical education.\u003c/p\u003e","manuscriptTitle":"BOPPPS-Based Teaching with Professionalism Integration Improves Multidimensional Outcomes in Undergraduate Geriatric Medicine Clerkships: A Randomized Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 00:35:02","doi":"10.21203/rs.3.rs-8468817/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-16T14:47:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40913429172267096520251008684393658539","date":"2026-02-04T00:29:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-23T07:54:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-02T12:53:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-01T21:53:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-01T21:53:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-29T03:32:58+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":"6f1739dc-610f-49db-9e54-3661659008ab","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T00:35:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 00:35:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8468817","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8468817","identity":"rs-8468817","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}