Integrating Outcome-Based Education (OBE) and Problem-Based Learning (PBL) in psychiatric clinical practice teaching: an empirical study | BMC Medical Education

Study subjects

Overall, a total of 43 fifth-year undergraduate students majoring in psychiatry who completed their internships at the Huai’an Clinical College of Mental Health, Jining Medical University, from September 2022 to June 2024 were included as study subjects. They were divided into two groups based on their own willingness.

The Control Group consisted of 21 students, including 11 males and 10 females, with 5 from Xuzhou Medical University and 16 from Jining Medical University, all aged 22–23 years. The conventional teaching model was adopted.

The Study Group consisted of 22 students, including 12 males and 10 females, with 6 from Xuzhou Medical University and 16 from Jining Medical University, all aged 21–23 years. The OBE-integrated PBL teaching model was applied for clinical practice teaching during the internship.

Baseline data were compared between the two groups, including gender (males: 12/23 vs. 11/21, χ² = 0.020), age (21.91 ± 0.75 vs. 21.81 ± 0.68, t = 0.455), school origin (students from Jining Medical University: 16/22 vs. 15/21, χ² = 0.068), and average course score in the 4th academic year (81.73 ± 8.18 vs. 81.38 ± 7.00, t = 0.149). No statistically significant differences were observed between the groups (all p > 0.05).

The research received approval from the Ethics Committee of Huai’an NO.3 People’s Hospital (Approval Number: 2023002) and was executed in alignment with the principles of the Declaration of Helsinki. All participants provided informed consent.

Research methods

This study employed a controlled design. Both the Control Group (receiving the conventional teaching model) and the Study Group (receiving OBE-integrated PBL teaching model) underwent a total of 480 credit hours of psychiatric clinical practice teaching, which was the standard allocation for fifth-year undergraduates in this discipline. This rotation period comprising 320 credit hours of clinical hands-on practice and 160 credit hours of clinical-theory integration sessions. The key difference lay in the instructional approach, as detailed below:

Control group

The Control Group received conventional lecture-based instruction. The Psychiatry department allocated physicians with extensive teaching experience, who developed teaching plans based on the curriculum for the psychiatric clinical internship. They established clear teaching objectives, systematically delivered clinical practice knowledge in psychiatry, and addressed trainees’ questions. Instructors remained in charge throughout the entire teaching process, while interns primarily participated through post-lecture Q&A sessions and passive listening. The primary mode was large-group instruction with limited interactive components.

Study group

The Study Group had their psychiatric practice teaching by integrating the OBE concept with the PBL teaching method, and the details of the implementation are described below.

Teacher-student training: Both the instructors and the interns and clinical teaching teachers in the study group received systematic training to deeply interpret the core connotations and fundamental meanings of the OBE concept and the PBL teaching method.​

Analysis of learning situation and goal setting: Demographic data, past learning situation, and career development plans (postgraduate entrance examination success or employment in tertiary hospitals one year after graduation) of students were collected through self-designed questionnaires. Electronic files of students were created, a learning scenario analysis was carried out, and customized training objectives were developed based on the results. For the full survey questionnaire, please refer to Supplementary Material 1.​

Group teaching and dynamic adjustment: 4–5 students with similar self-development plans were divided into groups, and each group was assigned a responsible teacher. Teachers and students jointly formulated PBL teaching plans, which focused on English, theoretical learning, clinical practice, scientific research foundation, and other aspects according to the training goals. The responsible instructor led the students in discussing and learning about the specific subjects included in the lesson plan during the internship, and optimized teaching activities in real time according to students’ feedback.​This small-group, case-based format emphasized active participation and collaborative problem-solving.

Diversified assessment system: This study constructed a “process-formative-summative” three-dimensional evaluation system to assess teaching quality and learning effects comprehensively.

Theoretical teaching and evaluation: Process evaluation was conducted via the Rain Classroom platform (an intelligent teaching tool integrating course presentation, real-time interaction and learning data statistics) and PBL qualitative/quantitative evaluation tools, enabling real-time teaching optimization. With a focus on evaluating students’ thorough application of theoretical knowledge, the theoretical assessment used a “dual-track system” that integrated summative theoretical test results with PBL process evaluation scores.

Clinical practice evaluation: Standardized patients (SP) and objective structured clinical examinations (OSCE) were added to clinical practice assessment to conduct summative comprehensive evaluation from the dimensions of knowledge application, professional quality, clinical thinking, and operational skills. Instructors conducted dynamic assessments based on students’ daily diagnosis and treatment practice performance, with process and formative evaluation at the center.

Observation indicators​

In this study, theoretical assessment scores, practical assessment scores, teaching satisfaction, and the achievement rate of career plans were chosen as observation indicators to assess the efficacy of instruction from a variety of angles, such as academic performance, subjective feedback, and long-term development.​

Theoretical assessment scores: Both groups of interns’ thorough command of psychiatric theoretical knowledge was assessed using a standardized closed-book written exam. The test paper, covering core psychiatric theoretical knowledge with a total score of 100, was compiled by a chief psychiatrist who was not involved in this study. Questions were randomly selected from a pre-established question bank in line with the teaching syllabus. Higher scores indicated a more solid grasp of fundamental theories.​

Practical assessment scores: Multi-station clinical practice assessments were conducted using a combination of SP and OSCE with reference to the clinical competence assessment protocol for standardized psychiatric residency training. These assessments focused on clinical skills, clinical reasoning, interpretation of auxiliary examinations, and neurological examination. The primary diseases evaluated were schizophrenia and delusional disorders, mood disorders, and neurotic disorders, containing 10 clinical practice assessment questions distributed in a 5:3:2 ratio. One question was chosen at random by each intern to respond to. The assessment duration was 30 min (Station 1), 20 min (Station 2), 10 min (Station 3), and 10 min (Station 4), totaling 70 min. Each station was initially scored out of 100, and the total score was calculated using weights of 40% (Station 1), 30% (Station 2), 10% (Station 3), and 20% (Station 4).​

Teaching satisfaction: A self-designed questionnaire was used for an anonymous assessment, which was disseminated and gathered centrally following the interns’ assessment. Three aspects were the emphasis of the questionnaire, which was created using the principles of content validity: teaching methods, teaching content, and assessment design. It included 20 Likert 5-point scale items (1 = extremely dissatisfied, 5 = very satisfied), with a total score of 100.​

Achievement rate of career plans one year after graduation: To ascertain whether the career plans created by interns at the beginning of the internship were realized, a follow-up was carried out a year after graduation using reserved contact information (phone calls, WeChat [a widely used social media and messaging application in China], or email). Those who successfully gained admission to postgraduate programs or secured employment in tertiary hospitals were considered to have completed their career goals; others who worked in a secondary hospital or had not yet secured a satisfactory position were not considered to have achieved their career plan.

Per-group achievement rates of career plans were quantified as follows:

Statistical methods​

SPSS 26.0 software was used to statistically evaluate all of the data after it was entered into Excel. Measurement data were expressed as (mean ± standard deviation), and categorical data as percentages. Normally distributed measurement data between the two groups were compared using the independent samples t-test while categorical data were compared using the chi-square test or Fisher’s exact test. A p-value < 0.05 was considered to be statistically significant (α = 0.05).