Hybrid BOPPPS model in radiology education: a case study of pediatric undergraduates | BMC Medical Education

Table of Contents

Population/participants

The research is a comparative study. The participants comprised 418 undergraduate students in the five-year program at Pediatric College of Chongqing Medical University from September 1st, 2021 to December 30th, 2022. All undergraduates studied Radiology in their seventh semester. 213 undergraduates in Grade 2018 were included in the traditional LBL group, and 205 undergraduates in Grade 2019 were included in the hybrid BOPPPS group. There were 96 males and 117 females in the LBL group, with a mean age of 21.5 years (range: 21-23 years old), The BOPPPS group consisted of 99 males and 106 females, with an average age of 21.8 years (range: 21–23 years old). Students’ admission scores range from 592–675, with mean points of 634.3 for the LBL group and 630.5 for the BOPPPS group. There were no significant differences in age, gender, and admission scores between these two groups (all p > 0.05), prompt for comparability of data.

Ethical approval

This study was performed in accordance with the Helsinki Declaration. This research comes from education reform project (the Education and Teaching Research Projects of Pediatric College of Chongqing Medical University NO. EY202020) and are exempt from Ethics Committee of the Children’s Hospital of Chongqing Medical University. The informed consent was obtained from all participants in the BOPPPS group, distributed by the teaching assistant at the outset, prior to the commencement of the course. Conversely, participants in the control group (LBL group), who adhered to the conventional model, were not provided with information regarding the study.

Design

The educational material was Medical Imaging textbook (Xu K, Gong QY, Han P. 8th Ed. People’s Medical Publishing House). The teaching administration allotted 16 lessons for the classroom teaching, 13 lessons for the on-line teaching, and 11 for practice teaching, with a total of 40 lessons and each one lasting for 40 min. There were two teaching assistants and one instructor in each lesson. Figure 1 is the flow chart of online-offline hybrid curriculum design.

Pre-class

Pre-class materials included coursewares (PowerPoint), videos, and preview materials (usually several questions about anatomy and pathology correlated with lessons, which are very important basic knowledge), as well as pre-learning assessment. The duration of each video is approximately 10 to 30 min, including typical radiological images of diseases and brief explanation of imaging features by teachers. Those videos were watched on the university’s online education platform and will be documented as a learning node. Teaching assistants would upload pre-learning assessment materials for students online one month prior to the start of the curriculum, and provide preview questions one week before each class. Before this curriculum started, teaching assistants collected and graded assessment, then sent the result to the instructors to facilitate their preparation for the class.

In class

For the LBL group, the instructor explained the theoretical knowledge using PowerPoint, accompanied by the necessary pictures or videos. The students listened and took notes. Finally, the instructor assigned homework to the students, which must be completed online. If the students had any questions, the instructor or teaching assistants answered them in the classroom or on the online platform after class.

For the BOPPPS group, the lessons were designed following the six steps of BOPPPS model based on the teaching content. Flow of diagram based on BOPPPS in classroom-teaching is shown on Fig. 2.

1.

Bridge-in (B): Taking trauma in the central nervous system as an illustrative instance, the introductory component, known as “bridge-in” (B), could incorporate a concise video delineating the consistent occurrence of pediatric victims of traffic accidents undergoing CT examination. Such incidents, ordinary in our daily lives, become astonishing when portrayed. The key objective of designing this bridge-in section is to facilitate medical students in comprehending the primary subject matter of the course within a structured framework, as well as quickly awakening their profound zeal for learning.
2.

Objective (O): According to the course syllabus of the Pediatric College of Chongqing Medical University, the objective (O) section clearly focuses on the typical imaging findings and differential diagnosis. Learning objectives include cognitive goals (professional theory), skill goals (practical ability), and ideological goals (humanistic literacy). They were designed and presented according to Bloom’s Taxonomy Matrix [7]. The learning objectives, with appropriate level of difficulty, are specific, measurable, and challenging, helping students overcome their fear of difficulty and engage in focused learning.
3.

Pre-assessment (P): Create three single-choice questions by the teachers as pre-assessment (P), distribute them via the teaching assistant software during the class, and gather the responses to assess students’ prior knowledge and better tailor upcoming lectures.
4.

Participatory learning (P): The fourth step, participatory learning (P), presents the greatest challenge for a teacher’s instructional skills and comprises the primary content of the teaching. It aligns with learning objectives and incorporates a variety of teaching methods like flipped class, discovery learning and case-based learning (CBL) to engage students in active participation during lessons. In addition to teacher-student interaction, peer-assisted learning [8] is strongly encouraged through student engagement in team work, fostering interaction and collaboration among peers.
5.

Post-assessment (P): The test results should be able to offer feedback on the learning impact in the classroom, identify issues, rectify deviations, enhance teachers’ self-reflection on their teaching methods, and assist teachers in improving their teaching design further. As a result, a thorough and varied evaluation method is necessary for the post-assessment (P). In line with this, we have included 3 single-choice questions for all students to answer using educational software. They typically involve analyzing images related to the diseases in this course, in order to evaluate students’ ability in imaging diagnosis. These questions could be designed to assess the effectiveness of the lesson by referencing the content covered in the pre-assessment or introducing new material.
6.

Summary (S): A concise summary (S) can assist in comprehending and internalizing the main points of the lesson, and can also act as a foundation for additional learning. Mind maps, keywords or rhymes are the methods we prefer to utilize.

In addition to traditional classroom instruction, there are practice sessions offered for radiological image interpretation, led by two experienced teaching assistants from our department. The primary instructional approaches utilized include flipped classroom [9], problem-based learning (PBL) [10], and CBL [11].

After class

Following each class, the homework assignments were posted online. The teacher was accessible through a discussion forum to offer guidance and clarification on any questions or doubts that the students may have had. The promotion of active peer-to-peer interaction and collaboration was also emphasized. Besides, students were encouraged to take advantage of the available teaching resources such as the case presentation video library ( and an online simulation platform ( which were independently created by our teaching and research office, for their self-learning and revision.

Upon finishing the course, students are required to fill out an online questionnaire evaluating the effectiveness of the teacher’s teaching methods. The questionnaire distribution was managed by a teaching assistant who monitored the overall completion status (e.g., overall response rate) without access to individual respondent identities. This approach enabled the assistant to send general reminders to encourage questionnaire completion while maintaining participant anonymity, thereby ensuring a 100% response rate. The questionnaire mainly includes course enthusiasm, self-learning ability, language proficiency, diagnostic reasoning and image interpretation ability, teacher-student interaction, study pressure, teaching satisfaction, and overall teaching effectiveness (Additional file 1). This survey adopted a five-point Likert-type scale, and 1–5 points means completely disagreement-completely agreement.

Teaching evaluation

Teaching evaluation is a fundamental component of the teaching system that provides feedback on instruction, assists in the continual improvement of teaching practices, and ensures constructive alignment between learning objectives, teaching instructions, and assessments. This process not only fosters a cyclical improvement in teaching but also promotes life-long learning for the teacher. The evaluation process involved both assessing students and evaluating teachers. The student assessment was divided into two components. 40% of the assessment was allocated to formative evaluations, which were based on performance and scores obtained from image interpretation exercises during practice classes. The scoring for formative assessments encompasses several key components: performance scores from practical sessions (20% of the overall scores), online activity scores (10%), and mid-term examination scores (10%). Notably, the performance scores from the practical sessions represent the average scores obtained across 11 such classes. Detailed evaluation criteria and rating scales for these assessments are provided in Table 1. The remaining 60% was determined by summative evaluations based on the final exam scores. The primary endpoint of this study was the comprehensive grades, which combined formative assessment scores and final exam scores.

Table 1 Evaluation criteria and rating scales for the practical sessions

On the other hand, the teacher assessment primarily relied on the analysis of questionnaires and test papers completed by the students.

Statistical analysis

All statistical analyses were carried out using SPSS 22.0 (SPSS, Inc., Chicago, IL). Categorical data were analyzed by the chi-square test. Continuous data were first tested for normality with the Kolmogorov-Smirnov test, mean ± standard deviation (M ± SD) was described for the normally distributed data, and an unpaired t test was used for comparisons. Non-normally distributed data were represented by median (25%, 75% quantiles), and the Mann-Whitney U test was used for analysis [12]. Bonferroni correction was applied for multiple comparisons in the questionnaires with an adjusted significance threshold of α = 0.00625 (0.05/8). Statistical significance was defined as p < 0.05, except in multiple comparisons where the adjusted α was applied.

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