Learning curve in evaluation of graded progressive image-model teaching in echocardiography | BMC Medical Education

Necessity of applying graded progressive image-model teaching in medical education

Echocardiography, as a non-invasive, radiation-free, and real-time imaging modality, plays a vital role in the diagnosis, monitoring, and therapeutic evaluation of cardiovascular diseases [14]. However, due to its technical complexity and the involvement of multidisciplinary knowledge such as cardiac anatomy, hemodynamics, and pathophysiology, it presents a steep learning curve and poses significant challenges for beginners. The current traditional teaching model often separates theory from practice, resulting in limited hands-on opportunities, delayed feedback, and fragmented teaching content, making it difficult to effectively enhance students’ clinical operation skills [15].

Therefore, an efficient teaching method is urgently needed to reduce the learning time while ensuring that students can master echocardiography examination skills effectively to meet the clinical demand for such professionals. In this study, we designed and implemented a teaching method based on a ” graded progressive image-model teaching.” This method incorporates tiered teaching strategies, 3D cardiac models, 4D ultrasound imaging, and mind mapping, providing a structured and layered learning pathway. This comprehensive teaching strategy facilitates students’ understanding of cardiac structure and function while gradually mastering ultrasound operation skills and clinical application capabilities.

Our results showed that the experimental group achieved significantly shorter times in 2D imaging, M-mode imaging, Doppler imaging, and total echocardiography examination time, along with higher theoretical exam scores compared to the control group (Table 1). These findings suggest that the graded progressive image-model teaching method helps students more quickly acquire echocardiography operational skills and deepen their understanding of theoretical knowledge. Moreover, the questionnaire survey results revealed that students in the experimental group scored higher in areas such as active learning ability, clearly identifying personal learning shortcomings, enhanced spatial understanding of cardiac structures, appropriate learning difficulty, more targeted teacher feedback, and high interest in practical operation learning (Table 2). This reflects that the graded progressive image-model teaching method not only improved students’ technical competence but also boosted their learning motivation and satisfaction. Therefore, applying this teaching model in clinical cardiac ultrasound education holds significant value.

Value of graded progressive image-model teaching in echocardiography examination education

Graded progressive teaching follows the principles of moving from the simple to the complex and advancing step by step. It systematizes and stratifies cardiac ultrasound knowledge based on its difficulty, enabling students to build a progressively more complex conceptual framework of skills while mastering fundamental knowledge. This approach reduces the frustration caused by knowledge gaps, enhances learning interest and self-confidence, and facilitates knowledge internalization and skill transfer [16]. Students can focus on relevant content at different stages and flexibly adjust their learning pace according to their individual level of mastery, fostering self-directed learning and self-assessment abilities. Graded progressive teaching is flexible and systematic, significantly enhancing students’ learning experience and practical abilities, making it an effective teaching strategy in modern education. Li [17] et al. proved that graded teaching content in ultrasound education significantly helps beginners memorize and familiarize themselves with operational procedures. Similarly, Wang [18] and others found that graded progressive teaching helped students grasp the key steps and details in the operation process, assisting beginners in quickly achieving proficiency. This finding aligns with the results of the current study. In this study, after three months of training, the experimental group significantly outperformed the control group in both echocardiography practical operations and theoretical scores (p < 0.05).

The image-model teaching method utilizes mind mapping to clarify knowledge structure, while 3D heart model and 4D dynamic cardiac imaging help students develop spatial awareness and functional understanding of cardiac anatomy. This enables a deep integration of theory with practice. The results of this study showed that students in the experimental group outperformed those in the control group in both practical echocardiography skills and theoretical assessments. Questionnaire data also indicated a higher level of satisfaction with this teaching approach.

Furthermore, the graded progressive image-model teaching method contributes to the development of students’ clinical reasoning abilities. By guiding students to construct mind maps based on cardiac ultrasound images, it helps them understand the logical relationships between cardiac anatomy and pathological manifestations, thereby promoting the integration of ultrasound imaging with clinical disease interpretation. The use of 3D heart model and 4D cardiac imaging enhances intuitive understanding of the spatial structure and dynamic processes of the heart, effectively overcoming the abstract and complex nature of cardiac ultrasound learning. This approach addresses key challenges and difficulties in teaching cardiac ultrasound.

Exploration of evaluating echocardiography practical skills based on learning curves

In this study, we employed learning curves to assess the effectiveness of the graded progressive image-model teaching approach in echocardiography education. The core of echocardiography education lies in improving practical operation skills. However, traditional evaluation methods primarily rely on theoretical assessments and single practical operation assessments, which fail to comprehensively reflect students’ learning progress and skill acquisition. Therefore, we innovatively introduced a learning curve evaluation system, using echocardiography examination time as a quantitative indicator to dynamically track the improvement in students’ proficiency.

Firstly, learning curves provide a foundation for stepwise learning, making them highly suitable for graded and personalized teaching, aligning with the principles of the graded progressive teaching method used in this study. Combining these approaches enables both teachers and students to monitor individual learning progress more effectively and tailor personalized learning plans accordingly. Secondly, learning curves visually demonstrate the changing trends in students’ operation times, allowing educators to identify turning points, bottlenecks, and breakthrough moments in the learning process and investigate their causes [19]. Lastly, instructors can adjust teaching content and strategies according to student performance at different stages, enhancing overall instructional effectiveness and establishing an efficient feedback mechanism. Students, in turn, can modify their learning strategies based on their progress to improve learning efficiency.

In this study, we established a CUSUM learning curve based on echocardiography examination time, dividing the learning process into a growth stage and a proficiency stage. With an increasing number of operation cases, the average examination time of students gradually decreased and stabilized, indicating a progressive improvement in operational proficiency (Fig. 2). The turning point in the learning curve for the experimental group occurred at the 40th case, while it occurred at the 46th case in the control group (Fig. 3). This indicates that students in the experimental group reached the proficiency stage more quickly, suggesting that this teaching model has certain advantages in improving learning efficiency and fostering practical abilities.

Therefore, the learning curve, as a supplementary tool for evaluating teaching effectiveness, possesses strong scientific validity and practical value. It not only assists in the development of personalized teaching plans but also facilitates the establishment of a dynamic feedback mechanism during the instructional process, thereby enhancing the precision and efficiency of teaching.

Strengths and limitations

The learning process of echocardiography is complex. This study innovatively applies a graded progressive image-model teaching method, which is highly suitable for echocardiography education. It meets the needs of both cardiac operation training and clinical practice. First, this approach allows students to absorb knowledge progressively, alleviating their fear of new technologies and stimulating their learning motivation and confidence. Secondly, the innovative use of 3D anatomical models and 4D ultrasound imaging in teaching significantly enhances students’ understanding of cardiac spatial structures and hemodynamics. The integration of mind mapping teaching further strengthens the connection between echocardiography education and clinical practice. Finally, this study employs learning curves to evaluate teaching effectiveness, providing an intuitive understanding of students’ progress at different stages of learning, which facilitates a more accurate assessment of teaching outcomes. However, this study also has certain limitations, including a small sample size and being a single-center study. Future research will require a larger sample size and a multicenter approach for further validation.