Abstract
Background
The aim of this study was to evaluate the effectiveness of team-, case-, lecture-, and evidence-based learning (TCLEBL) methods in cultivating students’ clinical and research abilities, as compared to traditional lecture-based learning (LBL) approaches.
Methods
Forty-one medical postgraduates were divided into two groups, a TCLEBL group and an LBL group. Teaching effectiveness was evaluated through student- and teacher-feedback questionnaires, scores from theoretical examinations and written literature reviews, and student learning burdens.
Results
Compared to the LBL approach, both teachers and students were more satisfied with the TCLEBL model (p < 0.001 for both teachers and students). The TCLEBL group performed significantly higher on the theory test compared to the LBL group (p = 0.009). There were significant differences between the LBL and TCLEBL groups, respectively, in terms of literature review and citations (12.683 ± 2.207 vs. 16.302 ± 1.095, p < 0.001), argument and perspective (12.55 ± 1.572 vs. 16.333 ± 1.354, p < 0.001), comprehensiveness of content (13.3 ± 2.268 vs. 16.683 ± 1.344, p < 0.001), and scientific rigor and accuracy (10.317 ± 1.167 vs. 12.746 ± 0.706, p < 0.001). There was no significant difference in the total extracurricular time expended between the two groups (323.75 ± 30.987 min vs. 322.619 ± 24.679 min, respectively for LBL vs. TCLEBL groups, p = 0.898).
Conclusions
TCLEBL is an effective teaching method that cultivates students’ clinical and research abilities.
Similar content being viewed by others
Background
The quality of medical postgraduate training plays a defining role in sha** the future of healthcare [1]. Traditional, lecture-focused models emphasize the theoretical aspects of knowledge acquisition but fail to cultivate self-directed learning in trainees [2]. Meanwhile, clinical instruction stresses skill mastery but rarely explores complex cases, potentially limiting development of trainees’ critical thinking and problem-solving abilities [3].
As the next generation of healthcare professionals, postgraduates should possess certain research competencies. It is crucial to prioritize the cultivation of an inquisitive mindset. This can be achieved through engaging activities such as formulating research questions, creating study protocols, and staying updated with the latest evidence by critically evaluating high-quality clinical trials. Trainees must also acquire essential research methodologies and skills, including literature searching and critical appraisal. These abilities will enable them to promptly address any challenges they may encounter in their future practice [4,5,6,7,8,9]. Educational systems that are adaptable and diverse have the potential to unlock the full capabilities of postgraduates in advancing healthcare innovation and delivery. Merely relying on didactic lectures is inadequate for fostering self-directed learning and cultivating well-rounded, expert clinicians and scientists in the future. It is important to incorporate interactive and experiential learning approaches that encourage critical thinking, problem-solving, and creativity. By embracing a variety of teaching methods and providing opportunities for hands-on experiences, postgraduates can truly thrive and contribute to the advancement of healthcare.
Team-based learning (TBL) is gaining popularity in medical postgraduate education. TBL emphasizes collaborative learning within groups rather than individual study. By promoting team spirit and problem-solving skills through coordinated thinking, TBL can effectively enhance the quality and efficiency of learning compared to traditional didactic approaches. TBL places greater emphasis on the learning process itself rather than solely focusing on outcomes. This approach allows for active engagement, critical thinking, and effective communication among team members, leading to a deeper understanding of the subject matter. Ultimately, TBL has the potential to contribute to the overall improvement of learning outcomes in medical postgraduate education [10, 11].
Case-based learning (CBL) is an effective approach that enhances clinical analytics and problem-solving skills by using authentic or hypothetical cases to stimulate self-driven learning. This method encourages active engagement and critical thinking rather than passive study, aiding in the internalization of skills. Educators play a crucial role in this process by pre-selecting representative clinical vignettes that guide trainees in understanding key diagnoses and making informed judgments. Small groups of students then delve deeper into the cases through multi-perspective and self-reflective thinking, facilitated by the teacher. This approach allows for a comprehensive exploration of the cases and ensures a well-rounded learning experience for the trainees [12,13,14,15,16].
Evidence-based learning is a major focus in current medical education reform. This approach emphasizes using reliable evidence as the foundation for study, which is crucial for enhancing the research capabilities of postgraduates. In the past, certain content in medical education may have been influenced more by subjective opinions. However, evidence-based learning models aim to ensure that judgments and decisions are grounded in sound evidence, aligning closely with clinical practice and research pursuits. By incorporating evidence-based learning into postgraduate education, trainees are encouraged to critically evaluate research findings, stay updated on the latest evidence, and apply evidence-based approaches in their future practice. This helps to cultivate a strong research caliber and ensures that postgraduates are well-equipped to contribute to the advancement of medical knowledge and patient care [17,18,19].
While traditional didactic instruction may have certain limitations, completely abolishing didactics would be misguided. Didactic instruction plays a vital role in providing a structured and systematic delivery of medical knowledge frameworks. Through lectures, instructors can analyze prototypical cases and present principles that help trainees quickly grasp important concepts and their practical applications. This form of instruction serves as an effective conduit for disseminating foundational knowledge and providing a solid framework for further learning and clinical practice. It should be regarded as a complementary approach alongside other interactive and experiential learning methods, rather than being disregarded entirely [20].
The team-, case-, lecture-, and evidence-based learning (TCLEBL) instructional method, by integrating the strengths of various approaches, aims to provide a comprehensive, well-rounded teaching experience in medical postgraduate education [21]. However, there is currently a lack of research and reports on the application of this amalgamated methodology specifically in medical postgraduate education. It is important to unify different pedagogies to optimize use of their respective merits and maximize learning outcomes. However, the implementation and impact of this approach need to be documented and analyzed. Therefore, the objective of this study is to evaluate the effectiveness of the TCLEBL method in cultivating students’ clinical and research abilities, in comparison to traditional lecture-centered teaching approaches.
Methods
Research subjects
This research adhered to the Helsinki Declaration and was approved by the Ethics Committee of the Second ** review. Nurs Health Sci. 2022;24(1):83–92." href="/article/10.1186/s12909-024-05650-5#ref-CR26" id="ref-link-section-d192998454e1473">26]. Lastly, TCLEBL combines traditional teacher-led instruction, in which teachers provide guidance to help students grasp key knowledge points, and research methods, consolidating learning outcomes [27].
Additionally, according to the post-course feedback questionnaires, teachers were generally satisfied with TCLEBL. There were several reasons for teacher satisfaction with the TCLEBL teaching method. Firstly, teachers observed that students were actively engaged in learning under TCLEBL and demonstrated high levels of participation and positivity. Secondly, students were able to understand and apply relevant knowledge in case studies, propose reasonable solutions, and demonstrate learning outcomes. Students were able to effectively collaborate, communicate and coordinate within groups to jointly solve case problems. Thirdly, students provided positive evaluations of TCLEBL and offered constructive suggestions and feedback, which teachers found satisfactory and useful to make further improvements.
Furthermore, to more accurately assess the long-term learning outcomes of the postgraduate students, we conducted a theoretical exam two months after the completion of the course and required the submission of a review paper on the disease. In the theoretical exam, students from the TCLEBL group achieved higher scores. This may be attributed to the emphasis of the TCLEBL teaching method on active student learning and participation, enabling them to develop a deeper understanding of the subject matter through group discussions and case analyses in the classroom. This profound understanding helped students better apply and express their acquired knowledge in the theoretical exam, resulting in better grades.
Regarding the review paper on the disease, students from the TCLEBL group achieved higher scores in terms of literature review and citations, arguments and viewpoints, content completeness, scientific rigor, and accuracy. This indicates that the TCLEBL teaching method has significantly contributed to the development of the students’ literature review skills. Through extensive pre-course literature reading and research, students in the TCLEBL group gained a comprehensive understanding of the relevant knowledge related to the disease, enabling them to provide more substantial references and support in their review papers. Furthermore, the TCLEBL teaching method emphasizes the cultivation of students’ arguments and viewpoints. Through group collaboration and discussions, students are encouraged to think deeply and analyze problems, enabling them to express clearer and more compelling arguments and viewpoints in their review papers. Their papers demonstrate greater completeness, covering various aspects of knowledge, and exhibit scientific rigor and accuracy. Review writing plays a crucial role in clinical research. It is an academic writing form that involves comprehensive review, summary, and evaluation of relevant literature on specific topics or areas. In clinical research, reviews are used to systematically integrate and analyze existing research findings, reveal the current state and progress of knowledge, and propose directions and recommendations for future research. The lack of clinical research training for medical graduate students has been a pain point in medical education in China [9, 28, 29]. The TCLEBL teaching method effectively cultivated the students’ skills in literature review through practices that emphasized literature reading, independent research, group collaboration, and academic writing.
Finally, our study found a significant increase in pre-course preparation time for the TCLEBL group. This increase was primarily due to extensive literature reading and evidence searching required by students before the course. This is consistent with the phenomenon of increased extracurricular workload observed in some other new teaching models [30,31,32,33]. However, we also observed a significant decrease in post-course review time and review paper writing time for the TCLEBL group. It is noteworthy that despite these changes, the total time spent by students in both groups did not show a significant difference.
However, we must acknowledge some limitations in our study that need to be considered when interpreting the results. Firstly, there may be selection bias as our samples were from a specific school and discipline. Secondly, research results may be impacted by subjective factors in participants. Students’ academic performance and paper quality could be influenced by individual differences, learning motivations, styles, even though controlling for these factors was attempted in the study design. Additionally, our evaluation employed specific assessment methods of theory exams and literature reviews. These may not fully reflect learning outcomes in other areas such as clinical practical skills.
In summary, TCLEBL is an effective teaching method that has achieved significant improvements over traditional teaching models in multiple areas. By conducting learning and collaboration in small groups, TCLEBL promotes classroom interactivity and improves learning efficiency, knowledge acquisition, independent learning ability, and teamwork skills. In addition, TCLEBL focuses on cultivating students’ clinical thinking and research abilities. Using typical cases and extensive literature reviews, students can better understand and apply medical theoretical knowledge to improve clinical practice ability and research competency.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Sierocinski E, Mathias L, Freyer Martins Pereira J, Chenot JF. Postgraduate medical training in Germany: a narrative review. GMS J Med Educ. 2022;39(5):Doc49.
Cho HJ, Zhao K, Lee CR, Runshe D, Krousgrill C. Active learning through flipped classroom in mechanical engineering: improving students’ perception of learning and performance. Int J STEM Educ. 2021;8(1):46.
Khan AA, Rakinic J, Kim RH, Mellinger JD, Ganai S. National trends in General surgery Resident exposure to Complex Oncology-relevant cases. J Surg Educ. 2019 Mar-Apr;76(2):378–86.
Alam M, Dirr MA, Anvery N, Christensen RE, Arndt KA, Brodell RT, Carr DR, Cartee TV, Dover JS, Eisen DB, Goldberg LH, Lawrence N, Lee M, Maher IA, Nehal KS, Sobanko JF, Walocko F, Xu YG. Performing research and publishing in the peer-reviewed medical literature should be a requirement for completion of post-graduate residency and fellowship training. Arch Dermatol Res. 2023;315(5):1405–8.
Li Y, Li J, Li B, Cao Y, Liu M, Zhang L, Zeng Z. Factors associated with the research efficiency of clinical specialties in a research-oriented hospital in China. PLoS ONE. 2021;16(4):e0250577.
Ratte A, Drees S, Schmidt-Ott T. The importance of scientific competencies in German medical curricula - the student perspective. BMC Med Educ. 2018;18(1):146.
Xu Z, Qiu J, Yang B, Huang P, Cai L, Chen L, Hou M, Ji M, Wu G. Evaluation of factors influencing the guide to read biomedical English literature course for Chinese new medical postgraduates-a multiple regression analysis. BMC Med Educ. 2019;19(1):295.
Cruser dA, Brown SK, Ingram JR, Podawiltz AL, Dubin BD, Colston JS, Bulik RJ. Learning outcomes from a biomedical research course for second year osteopathic medical students. Osteopath Med Prim Care. 2010;4:4.
Du Y, Luo W. A strong culture of clinical research is essential for the training of medical postgraduates in China. Postgrad Med J. 2023;99(1168):77–8.
Joshi T, Budhathoki P, Adhikari A, Poudel A, Raut S, Shrestha DB. Team-based learning among Health Care professionals: a systematic review. Cureus. 2022;14(1):e21252.
Anselmann V, Brouwer J, Mulder RH. The relationships between perceived individual and team characteristics, individual and team learning activities with effectiveness in nursing teams. Front Psychol. 2023;14:1163494.
Dai A, Wu LQ, Jacobs RC, Raghuram A, Dhar SU. Implementation of a Medical School Elective Course Incorporating Case-based learning: a pilot study. Med Sci Educ. 2020;30(1):339–44.
Dong H, Guo C, Zhou L, Zhao J, Wu X, Zhang X, Zhang X. Effectiveness of case-based learning in Chinese dental education: a systematic review and meta-analysis. BMJ Open. 2022;12(2):e048497.
Berkoben M, Roberts JK. The treatment of metabolic acidosis: an interactive case-based learning activity. MedEdPORTAL. 2019;15:10835.
Novack JP. Designing cases for case-based Immunology Tea Ching in large medical school classes. Front Immunol. 2020;11:995.
Wu F, Wang T, Yin D, Xu X, ** C, Mu N, Tan Q. Application of case-based learning in psychology teaching: a meta-analysis. BMC Med Educ. 2023;23(1):609.
Wilson A, Howitt S, Holloway A, Williams AM, Higgins D. Factors affecting paramedicine students’ learning about evidence-based practice: a phenomenographic study. BMC Med Educ. 2021;21(1):45.
Kumah EA, McSherry R, Bettany-Saltikov J, van Schaik P, Hamilton S, Hogg J, Whittaker V. Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: a comprehensive systematic review of UG student. Campbell Syst Rev. 2022;18(2):e1233.
Chiu YL, Lee YC, Tsai CC. Internet-specific epistemic beliefs in Medicine and Intention to use evidence-based Online Medical databases among Health Care Professionals: cross-sectional survey. J Med Internet Res. 2021;23(3):e20030.
Instructional methods used by US and Canadian medical schools. Association of American Medical Colleges. 2018. https://www.aamc.org/data-reports/curriculum-reports/interactive-data/instructional-methods-used-us-and-canadian-medical-schools. Accessed 21 Nov 2019.
Jiang W, Tian Y, Chen J, Chen B. Team-, case-, lecture- and evidence-based learning. Med Educ. 2017;51(11):1172.
Burgess A, van Diggele C, Roberts C, Mellis C. Team-based learning: design, facilitation and participation. BMC Med Educ. 2020;20(Suppl 2):461.
Alberti S, Motta P, Ferri P, Bonetti L. The effectiveness of team-based learning in nursing education: a systematic review. Nurse Educ Today. 2021;97:104721.
Chytas D, Mitrousias V, Raoulis V, Banios K, Fyllos A, Zibis AH. A review of the outcomes of the implementation of case-based anatomy learning. Cureus. 2021;13(11):e19179.
Winkler MF, Tappenden KA, Spangenburg M, Iyer K. Learn intestinal failure Tele-ECHO Project: an innovative online telementoring and case-based learning clinic. Nutr Clin Pract. 2021;36(4):785–92.
Shorey S, Chua JYX. Nursing students’ insights of learning evidence-based practice skills using interactive online technology: sco** review. Nurs Health Sci. 2022;24(1):83–92.
Zeng HL, Chen DX, Li Q, Wang XY. Effects of seminar teaching method versus lecture-based learning in medical education: a meta-analysis of randomized controlled trials. Med Teach. 2020;42(12):1343–9.
Zhang J, Huang H, Shen X. Cultivating and investing in clinical research in China. Lancet. 2015;386(10002):1506–8.
Hu Y, Huang Y, Ding J, Liu Y, Fan D, Li T, Shou C, Fan J, Wang W, Dong Z, Qin X, Fang W, Ke Y. Status of clinical research in China. Lancet. 2011;377(9760):124–5.
Betihavas V, Bridgman H, Kornhaber R, Cross M. The evidence for ‘flip** out’: a systematic review of the flipped classroom in nursing education. Nurse Educ Today. 2016;38:15–21.
Evans L, Vanden Bosch ML, Harrington S, Schoofs N, Coviak C. Flip** the Classroom in Health Care Higher Education: A Systematic Review. Nurse Educ. 2019 Mar/Apr;44(2):74–78.
Hew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018;18(1):38.
Tang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, Zhou L, Zou Y, Liang D. Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online. 2017;22(1):1395679.
Acknowledgements
Not applicable.
Funding
This work was supported by Exploration and Application of Double Helix Teaching Mode in Clinical Medicine Education under the background of New Medical Construction HNJG-2022-0023 Key Research Project of Teaching Reform in Colleges and Universities of Hunan Province.
Author information
Authors and Affiliations
Contributions
CD designed the study. SZ and QW acquired the data. TH and CD analysed and interpreted the data. TH drafted the manuscript. CD revised the final version of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was performed in accordance with the Helsinki Declaration and was approved by the Second **angya Hospital Ethics Committee. The informed consent obtained from study participants was written.
Consent for publication
Not applicable.
Conflicts of interest
None of the authors has financial or other conflicts of interest concerning this study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Huang, T., Zhou, S., Wei, Q. et al. Team-, case-, lecture- and evidence-based learning in medical postgraduates training. BMC Med Educ 24, 675 (2024). https://doi.org/10.1186/s12909-024-05650-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12909-024-05650-5