Comparative effectiveness of various teaching modes, including PBL, CBL, and CTTM in paediatric medical education with combined online and offline approaches

Abstract

Objective

To explore the differences in the effectiveness of various teaching methods combining online and offline modes in paediatric medical education.

Methods

Fourth-year medical paediatric students at our university in 2020 were randomly divided into three groups: a control group, experimental group 1, and experimental group 2, with 30 students in each group. The control group received traditional teaching, experimental group 1 received a combination of online and offline teaching using two methods simultaneously, and experimental group 2, in addition to the methods used in experimental group 1, engaged in real-case teaching in the ward. The teaching outcomes were evaluated through theoretical exams, clinical skills assessments, and questionnaires.

Results

Experimental groups 1 and 2 were superior to the control group concerning theoretical examination and overall scores (P < 0.05). Experimental group 2 was superior to experimental group 1 and the control group in clinical skills examination scores (P < 0.05). The satisfaction rate for the questionnaire was highest in experimental group 2 (P < 0.05).

Conclusion

The combined use of various teaching methods with online and offline modes is more effective than using traditional teaching methods only in paediatric education. It enhances the overall competence of paediatric students, especially in terms of improving clinical skills, and is well-received by both students and teachers.

Introduction

Paediatric medicine, being an interdisciplinary subject, faces unique challenges. This is because the primary patient population, that is, children, often struggle to express their symptoms clearly. Thus, paediatricians not only need solid theoretical knowledge but also keen observation skills, rich clinical operational skills, and effective communication techniques. Becoming a qualified paediatric clinical physician requires not only the student’s dedication but also the teaching skills of clinical instructors. Currently, the most common and traditional teaching method in China is lecture-based learning (LBL), also known as the lecture-style teaching method. This method, with the teacher as the main entity, involves large class lectures in which students passively receive information. This teaching approach, often referred to as “cramming,” is outdated [1, 2], monotonous, and has several drawbacks, resulting in low student engagement. As such, there is an urgent need to explore and implement various teaching formats to optimise and improve teaching methods in paediatric education.

The problem-based learning (PBL) teaching method was first proposed in the 1970s. Using this method, teachers, through the selection of cases, devise and analyse questions to allow students to master more disease knowledge, which is very different from the traditional lecture-based medical education model [3]. The focus of case-based learning (CBL) teaching is primarily to take trainees as the main body, cases as the lead, thus to cultivate students’ ability to analyse the main problems of cases [4]. Studies have shown [5, 6] that PBL combined with CBL can improve academic motivation strategies and independent learning ability compared with traditional LBL, and then improve students’ overall examination results, in addition to improving their communication skills and professional attitudes.

The case three-dimensional teaching method (CTTM) is a new teaching approach that organically combines case teaching with stereoscopic teaching and fully uses network multimedia technology to expand teaching [7]. This method uses artificial intelligence, computer network, and multimedia technologies, as well as technology for the three-dimensional reconstruction of medical images, alongside multimedia, video, and boutique network curriculum teaching methods to carefully design teaching plans, courseware, and clinical cases to stereoscopically deliver teaching content [8]. The CTTM simulates the details of cases through a variety of teaching methods and promotes students’ thinking and understanding; this, in turn, can promote combining theoretical knowledge and practice, increase the complexity of learning, and help students to flexibly use theoretical knowledge.

Different teaching methods have their own characteristics, and the combined use of teaching methods can comprehensively improve teaching outcomes. Although the effectiveness of the above three methods has been confirmed, the teaching effect of their combined use is not yet clear. We propose that the combined use of PBL, CBL, and CTTM can improve communication skills and professional abilities, as well as deepen students’ understanding of knowledge and help them to successfully apply what they have learned. This study combined PBL, CBL, and CTTM in the application of online and offline teaching models for paediatric students in a bid to explore a more suitable and optimised new teaching model, improve students’ mastery of professional knowledge, improve clinical practice ability, and to help promote more outstanding paediatricians.

Methods

Participants

To facilitate conducting the trial, fourth-year students majoring in paediatrics at our university from August to December 2023 were selected as the study participants. The survey questionnaire for this study comprised 5 items. The sample size for this study was established as needing to be between 50 and 75. Considering that this study included three groups and the possibility of incomplete questionnaires, the study’s sample size was set to 90, with 30 participants in each group. Ninety students were randomly selected as study participants, and all participating students provided their informed consent for inclusion.

Inclusion criteria: Fourth-year paediatric students in our university with clear thinking and good compliance. Exclusion Criteria: Students who received other forms of teaching during their course(off campus tutoring, etc.).

The SPSS 25.0 software was used to generate a random number table, and the participants were divided into three groups: the control group, experimental group 1, and experimental group 2, with 30 participants in each group. To reduce ethical concerns, we only selected 12 h of content from the course of Pediatrics for this study. At the end of the semester, the lecturer would re-teach these 12 h of classes to the students in the control group and in experimental group 1 using the method that had been applied to experimental group 2. The participant screening process is shown in Fig. 1.

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Intervention process

Control group

The control group received 12 h of teaching related to the fifth chapter of the ninth edition of Pediatrics [9]. The teaching method used was LBL. The instructor utilised multimedia to thoroughly explain the aetiology, pathogenesis, clinical manifestations, auxiliary examinations, diagnosis, treatment, and prevention of diseases. Students were expected to acquire solid theoretical knowledge during these sessions. After class time, students were allowed to arrange their own study or review outside of class.

Experimental group 1

Experimental group 1 underwent two phases of teaching. In the first phase, a Ding Talk group (Ding Talk is a communication platform developed by the Alibaba Group, which allows collaborative work online) was established before starting the theoretical class. The online Ding Talk group was used to present questions related to content to be learned soon (the PBL teaching method). According to the diseases presented in the paediatrics syllabus and cases with complete auxiliary examination data, the lecturer set 5–6 PBL problems, based on each medical case record, which covered aspects such as anatomical characteristics, aetiological analysis, clinical manifestation characteristics, diagnosis and differential diagnosis, and treatment options, and sent the teaching materials to the students in advance. The students then carried out self-study and independent thinking by consulting the tool book and the latest literature and having discussions in the Ding Talk group. The teachers in the group gave certain guidance and explain on the students’ questions and answers. For example, in preparation for delivering teaching on neonatal jaundice, the instructor asked the following questions: What is neonatal jaundice? Why does neonatal jaundice occur in the neonatal period? Since most newborns develop jaundice, why would they need treatment? Is it a disease? Students answer these questions [2]. By using the PBL method, teachers can understand and difficulties that students experience and deliver targeted explanations, thereby improving not only the efficiency of their teaching but also supporting students to think independently. Online discussion is a convenient way for students to communicate and share information. In the second phase of experimental group 1, the teaching method was the same as for the control group, utilising LBL teaching methods.

Experimental group 2

Experimental group 2 underwent three phases. The first two phases followed the methods used for experimental group 1. After completing the first two phases, the third phase involved students entering the ward for CBL. Students were asked to complete interviews with children as a group and discuss patients’ conditions combined with PBL teaching methods.They completed the discussion and summary of difficult problems, and compared the actual cases with theoretical knowledge. The teacher raised a question in the Ding Talk group.Some of the questions included the following: Are there differences between real jaundice cases and the related theory? How should a medical history be taken? What are the clinical manifestations of jaundice? What are the key points of a physical examination? These questions aimed to stimulate students’ critical thinking, encourage on-the-spot answers, foster learning interest, and inspire the formulation of new questions. Additionally, the CTTM was used to provide students with a comprehensive understanding of each disease using images, animations, videos, and other methods. This approach aimed to present clinical cases in a three-dimensional and multi-dimensional manner.

The steps used in the different teaching modes are shown in Table 1.

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Evaluation of teaching effectiveness

Teaching effectiveness evaluation should be conducted by an independent assessment team that does not participate in teaching. This helps to avoid bias caused by the subjective will of teaching effectiveness evaluators. After completing the preliminary course, the effectiveness was assessed through stage assessments, including theoretical exams (50 points), clinical skills assessments (50 points), and an anonymous student questionnaire survey. The theoretical exam used unified questions, conducted at a unified time, with standardised question types and difficulty levels. It included multiple-choice questions, multiple-answer questions, true/false questions, term definitions, and short-answer questions. The answers were standardised, and the same instructor corrected all of the papers (the scorer had no knowledge of any of the participants’ information). The clinical skills assessment involved case analysis, disease judgment, and unified training for invigilators, with a standardised scoring standard; deductions had to be accompanied by written reasons. The survey questionnaire included 5 items, which scored satisfaction levels as follows: “Willing to adopt the teaching”, “Increased interest in learning”, “The efficiency of learning has been improved”, “Disease awareness”, and “Ability to diagnose diseases”. The Cronbach’s alpha coefficient of the questionnaire was 0.804, indicating good reliability.

Statistical methods

All data were analysed using the SPSS 25.0 statistical software and expressed as mean ± standard deviation. Since the variances were homogeneous, one-way analysis of variance was used, and pairwise comparisons between the three groups were performed using the q-test. Count data (percentage, %) were analysed using Pearson’s chi-square test, with P < 0.05 indicating statistical significance.

Results

General information about the three groups

Each group comprised 30 students, and there were no statistically significant differences in age, gender, medical speciality, or academic performance among the three groups (P > 0.05). See Table 2 for details.

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The teaching method in each of the three groups was taught by the same teacher, and there was no significant difference in the teaching method, content, and teacher selection of each teaching method (P > 0.05).

Comparison of theoretical exam and clinical skills assessment results among the three groups

The results of theoretical exams, clinical skills assessments, and the overall scores (the sum of theoretical and clinical skills scores) showed statistical significance among the three groups (P < 0.05). The theoretical exam results revealed that experimental groups 1 and 2 performed better than the control group (44. 9 ± 3.06 vs. 43.4 ± 2.27 VS 39.6 ± 2.48), and the difference was statistically significant. There was no significant difference in the theoretical exam scores between experimental groups 1 and 2. In the clinical skills assessments, experimental group 2 outperformed experimental group 1 and the control group (45.9 ± 2.38 vs. 36.7 ± 3.37 vs. 35.8 ± 3.26), and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the clinical skills scores between experimental group 1 and the control group (P > 0.05). In the overall scores, both experimental groups 1 and 2 outperformed the control group (90.8 ± 4.14 vs. 80.1 ± 4.26 vs. 75.4 ± 4.39), with statistically significant differences in pairwise comparisons (P < 0.05). See Table 3 for details.

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Satisfaction rate and self-evaluation of learning effectiveness in the three teaching modes

The satisfaction of 5 items, “Willing to adopt the teaching”, “Increased interest in learning”, “The efficiency of learning has been improved”, “Disease awareness”, and “Ability to diagnose diseases” was higher in experimental group 2 than in experimental group 1, and higher in experimental group 1 than in the control group. The differences among the three groups indicated a statistical significance (P < 0.05). See Table 4 for details.

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Discussion

This study employed various teaching methods and two modes of teaching (online and offline) and compared them between three groups to evaluate teaching effectiveness. The results demonstrated that the teaching mode comprising LBL + PBL + CBL + CTTM, as used in experimental group 2, achieved the best results. A possible reason is that CBL combined with PBL enhances awareness of independent thinking and improves self-study ability through students’ independent learning [10, 11]. In addition, CBL combined with PBL teaching simulates real clinical scenarios using typical cases through teacher-guided and student-led lecture forms, takes problem-oriented and case-based mode, concretises abstract knowledge, deepens students’ understanding of knowledge points, and cultivates students’ ability to discover and solve problems and develop lifelong learning awareness. Furthermore, CBL combined with PBL teaching combines theory with practice to improve students’ case analysis abilities, while facilitating the cultivation of teamwork awareness [12]. In the traditional case-teaching method, CTTM introduces modern teaching approaches such as micro-teaching, video teaching, and simulation teaching, which focus on teaching and students are more likely to accept knowledge points.Helping students to carry out clinical practice simulations through a variety of teaching methods can develop and support students’ subjective initiative and exercise their ability to analyse problems and improve language expression [13, 14]. Through the teaching mode of LBL + PBL + CBL + CTTM, systematic theoretical teaching can be balanced, clinical skills enhanced through practical case teaching, and various teaching methods (illustration, animation, and video) integrated to create enjoyable learning, the ultimate goal of which is to achieve theory and practice integration. Experimental group 2 thus outperformed the two other groups and was highly praised by students in theoretical examinations, clinical skills assessments, and questionnaires.

Research showed that hybrid pedagogy combining PBL and LBL integrates the advantages of conventional and novel teaching methods, significantly improves teaching efficacy, and is easily accepted by students [15]. In this study, experimental group 1, using the online PBL method for free discussion, improved students’ understanding of theoretical knowledge and their ability to independently think about problems. However, due to the lack of real case teaching content in experimental group 1, there was no advantage in clinical skills assessments compared to the control group, and no statistically significant difference was observed. It may be that LBL mainly uses the traditional method of classroom teaching, supplemented by multimedia and textbooks. Although LBL can systematically impart theoretical knowledge, when this method is used, students are always in a passive learning state, may lack learning interest and initiative, and tend to not be receptive to the cultivation of self-study abilities [16]. LBL may also lead to a deficiency that in practical clinical operations, due to the lack of learning and application of cases, students’ clinical thinking and ability to deal with practical problems are also insufficient [17].

The questionnaire survey showed that students in experimental group 2 were most satisfied with the teaching mode they received. The survey indicated a general belief among the participants that this teaching mode could improve learning efficiency, increase memory, broaden their horizons, and enhance practical ability; concurrently, participant responses indicated that this method sparked their learning interest. Furthermore, PBL combined with the CBL teaching model can significantly improve clinical skills scores and theoretical knowledge and is thus worthy of promotion [5]. Research showed that the application of digital technology in case teaching has improved the overall satisfaction and teaching [18]. The results of this study are consistent with the above-noted research. As we anticipated, the combination of multiple teaching modes can leverage their respective advantages and improve teaching effectiveness.

Using a single traditional teaching mode, as was applied for the control group, seems to no longer be popular among students. Most students found it boring, uninteresting, and inefficient in terms of learning. The results of the questionnaire survey and theoretical exams suggest that most students in the control group could recognise the diseases they had learned about and had preliminary judgment abilities. This could be attributed to students’ diligence, rote memorisation, and other individual factors. Through diversified teaching, we not only attach importance to the teaching of theory, but also strengthen the cultivation of clinical abilities, and the model of teacher-student collaboration has highlighted obvious advantages in the teaching of paediatric medical students in universities [19].

Although the innovative teaching mode used in this study has its advantages, some students mentioned concerns, such as the consumption of time outside of class, increased study time, and the complexity of the methods. Additionally, teachers must guide students into the ward, prepare real cases, and create slides, images, and videos, which require more time and effort from teachers. These concerns pose limitations to the development of this teaching mode [20].

This study also has some limitations. First, the sample size was small, which may give rise to a lack of representativeness in the results. Second, only students from our university were selected. The teaching quality, and learning resources of students in different schools are different, which will affect the effect of the teaching model. In addition, single-centre research cannot be easily popularised or applied elsewhere. Third, this study did not implement participant blinding, and their subjective opinions may give rise to bias in the results. Fourth, this study did create a PBL + CBL group and did not isolate the effectiveness of CBL vs. CTTM, which weakened the integrity and reliability of the results. Therefore, in the future, it is hoped that students from other institutions will be included in similar studies, the sample size expanded to enrich the student variety, more groups be created to confirm the impact of individual teaching methods on teaching effectiveness, and screening conducted for more influential teaching methods. It is anticipated that the teaching model of this study will apply to students in other specialities and other disciplines.

Conclusion

After considering the positives and negatives, the advantages of this teaching mode are considered to outweigh the disadvantages. This teaching model has demonstrated advantages in paediatric medical education and may also have reference value for teaching in other fields. Accordingly, this teaching mode is worth promoting.

Data availability

All data generated or analyzed during this study are included in this published article.

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