Application of PBL in combination with the SP teaching method in the clinical teaching of orthopedics and traumatology | BMC Medical Education

This study was conducted at three residential physician standardization training bases affiliated with the China Academy of Chinese Medical Sciences: Wangjing Hospital, Xiyuan Hospital, and Guang’anmen Hospital. A total of 59 students who participated in standardization training between October 2020 and September 2022 were selected as research subjects. All the students were graduate students in the clinical orientation of traditional Chinese medicine from Beijing University of Chinese Medicine and the China Academy of Chinese Medical Sciences. The students were randomly divided into two groups: the control group (29 students: 16 males, 13 females, aged 23.34 ± 0.94 years) and the study group (30 students: 18 males, 12 females, aged 23.03 ± 1.16 years). There was no statistically significant difference in the baseline characteristics between the two groups (P > 0.05).

Both groups were instructed on seven representative common and frequently occurring diseases in traditional Chinese medicine orthopedics, including cervical spondylosis (neck pain syndrome), lumbar disc herniation (low back pain syndrome), adhesive capsulitis of the shoulder joint (frozen shoulder syndrome), femoral head necrosis (bone necrosis syndrome), distal radius fracture (fracture syndrome), knee osteoarthritis (knee pain syndrome), and ankle sprain (muscle strain syndrome). The course includes the holistic view of TCM and orthopedic skills. Each disease was taught for 3 h, totaling 21 h of instruction.

All orthopedic chief physicians involved in the teaching underwent a two-day standardized training prior to the commencement of the courses. The training content included the following aspects:1.PBL + SP teaching method: The training covered how to design guiding questions, organize group discussions, and conduct clinical reasoning through SP-simulated cases. 2.Uniform implementation of the teaching syllabus: Every teacher was required to strictly explain the disease-related knowledge points in accordance with the requirements of the syllabus to ensure consistency in teaching content. 3.SP interaction norms: Teachers were required to follow a unified script to demonstrate the process of inquiry and physical examination with the SPs, so as to avoid the influence of individual teaching styles on the teaching process. The teaching director randomly attends 20% of the courses to ensure that the teachers implement the syllabus.

After the training, all teachers were assessed through mock teaching sessions to ensure that their teaching abilities met the consistent standards.All the teaching faculty members possess several years of clinical experience in orthopedics and the experience of instructing resident physicians. Moreover, they hold the position of chief orthopedic physicians in tertiary first-class hospitals. This qualification requirement ensures a high-level benchmark for the teachers in terms of both professional knowledge and teaching capabilities. The teaching was conducted in the form of online courses, which could reduce the bias caused by differences in teaching quality.

The control group employed the traditional LBL method combined with SP. Course notices and syllabi were released one week prior to the course, and students were not explicitly required to preview the material beforehand. Lectures were conducted by experienced chief physicians in orthopedics, and one trained nonmedical volunteer served as the SP. The classroom instruction began with the teacher presenting knowledge points and slides, followed by the SP simulating clinical consultations, physical examinations, and diagnostic processes related to orthopedic diseases, with interspersed questions and answers throughout the session. After class, the students completed an electronic questionnaire to evaluate teaching effectiveness. Owing to the COVID-19 pandemic, these teaching sessions were conducted online via Tencent Meeting software, with the teacher enabling their camera to demonstrate the SP simulation.

The study group utilized the PBL method combined with SP. Course notices were released one week in advance, along with syllabi and 6–9 thought-provoking questions closely related to the teaching focus. Students were required to preview and discuss the material in groups, encouraging them to self-study the etiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatment plans for the orthopedic diseases outlined in the syllabus. Students were also encouraged to review the physiological, pathological, and anatomical knowledge involved and stay updated on the latest research progress in these diseases. The teachers and SPs were the same as those in the control group. During the lectures, the teacher presented key points with slides, demonstrated clinical diagnostic processes through the SP, guided students to discuss and present their thoughts on the preclass questions and issues identified during self-study, and finally provided answers, feedback, and supplementary information. After class, the students completed an electronic questionnaire to evaluate teaching effectiveness. Students were free to choose the form of preclass group self-study and discussion. Owing to the pandemic, the study group’s teaching sessions were also conducted online via Tencent Meeting software, with the teacher demonstrating the SP simulation process via video.

Outcome measures

Both the study and control groups were evaluated via self-designed electronic questionnaires and final exams to assess teaching effectiveness. The questionnaire was divided into four modules: preclass preview, classroom performance, postclass review, and SP evaluation. Each module contains 3–4 questions, including multiple-choice questions, multiple-response questions, and rating questions. The aims of this study were to compare students’ self-study initiative, team collaboration ability, classroom learning efficiency, learning interest, and ability to handle clinical problems under different teaching methods, investigate teaching satisfaction, and evaluate the effectiveness of introducing SPs into orthopedic clinical classes. Students completed the questionnaire on the basis of their actual situations for the preclass preview, postclass review, and SP evaluation modules, whereas the classroom performance module was assessed on the basis of random 1-minute sign-in rates during the course and student self-evaluations. The final exam was conducted after the completion of all the courses and included both written and practical assessments. The written exam, accounting for 60% of the total score, was a closed-book test using the same paper for both groups. The practical exam, accounting for 40% of the total score, involved SP simulation for diagnostic physical examinations and was graded by the same examiner.

Data analysis

The results of the electronic questionnaires were imported into Microsoft Office Excel software for data organization and analyzed statistically via SPSS 25.0 software. The quantitative data are presented as the means ± standard deviations, and comparisons between the two groups were performed via independent sample t tests. The graded data are presented as percentages, and comparisons between the two groups were performed via the rank-sum test. A P value < 0.05 was considered statistically significant.