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To study the practical value of case-based learning (CBL) combined with the transfer learning, targeted learning, pre-assessment, participatory learning, post-assessment and summarization (BOPPPS) model in the teaching of master’s degree students in oral and maxillofacial surgery. From January to December 2022, 38 second- and third-year master’s degree students in oral and maxillofacial surgery were recruited as research subjects and randomly divided into a traditional LBL (Learn-based Learning) training group (19 people) and a CBL training group combined with the BOPPPS model (19 people). After the training, the theoretical knowledge of the learners was assessed, and the modified Mini-Clinical Evaluation Exercise (Mini-CEX) scale was used to assess the clinical thinking of the learners. At the same time, the learners’ personal teaching efficacy and the teacher’s sense of teaching efficacy (TSTE) were assessed, and the learners’ satisfaction with the learning results was investigated. The basic theoretical knowledge, clinical case analysis and total score of the experimental group were better than those of the control group, and the difference was statistically significant (P < 0.05). The modified Mini-CEX clinical critical thinking score showed that except the case history writing level, there was no statistical difference (P > 0.05), the other 4 items and total score of the experimental group were better than those of the control group, and the difference was statistically significant (P < 0.05). The personal teaching effectiveness, TSTE and total score were higher than those before CBL combined with BOPPPS teaching mode, and the difference was statistically significant (P < 0.05). The sampled master’s degree students in the experimental group believed that the new teaching method could improve students’ clinical critical thinking ability, and the difference in all aspects was statistically significant (P < 0.05). More subjects in the experimental group thought that the new teaching mode increased the learning pressure, but the difference was not statistically significant (P > 0.05). CBL combined with BOPPPS teaching method can improve students’ clinical critical thinking ability and help them adapt to the clinical rhythm. It is an effective measure to ensure the quality of teaching and is worth promoting. It is worth promoting the application of CBL combined with BOPPPS model in the master’s program of oral and maxillofacial surgery, which can not only improve the basic theoretical knowledge and critical thinking ability of master’s students, but also improve the teaching efficiency.
Oral and maxillofacial surgery as a branch of dentistry is characterized by the complexity of diagnosis and treatment, a wide variety of diseases, and the complexity of diagnostic and treatment methods. In recent years, the scale of postgraduate student admission has continued to increase, but the sources of student admission and the situation with personnel training are worrying. At present, postgraduate education is mainly based on self-study supplemented by lectures. The lack of clinical thinking ability has led to the fact that many postgraduate students are unable to be competent in oral and maxillofacial surgery after graduation or to form a set of logical “positional and qualitative” diagnostic ideas. Therefore, it is imperative to introduce innovative practical teaching methods, stimulate students’ interest and enthusiasm in studying oral and maxillofacial surgery, and improve the efficiency of clinical practice. The CBL teaching model can integrate key issues into clinical scenarios, help students form sound clinical thinking when discussing clinical issues1,2, fully mobilize students’ initiative, and effectively solve the problem of insufficient integration of clinical practice into traditional education3,4. BOPPPS is an effective teaching model proposed by the North American Workshop on Teaching Skills (ISW), which has achieved good results in clinical teaching of nursing, pediatrics and other disciplines5,6. CBL combined with BOPPPS teaching model is based on clinical cases and takes students as the core material, fully developing students’ critical thinking, strengthening the combination of teaching and clinical practice, improving the quality of teaching and improving the training of talents in the field of oral and maxillofacial surgery.
To study the feasibility and practicality of the study, 38 second- and third-year master’s degree students (19 in each year) from the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Zhengzhou University were recruited as study subjects from January to December 2022. They were randomly divided into the experimental group and the control group (Figure 1). All participants gave informed consent. There was no significant difference in age, gender and other general data between the two groups (P>0.05). The experimental group used the CBL teaching method combined with BOPPPS, and the control group used the traditional LBL teaching method. The clinical course in both groups was 12 months. The inclusion criteria included: (i) second- and third-year postgraduate students in the Department of Oral and Maxillofacial Surgery of our hospital from January to December 2022 and (ii) willing to participate in the study and sign the informed consent. Exclusion criteria also included (i) students who did not complete the 12-month clinical study and (ii) students who did not complete questionnaires or assessments.
The aim of this study was to compare the CBL teaching model combined with BOPPPS with the traditional LBL teaching method and evaluate its effectiveness in the postgraduate education of maxillofacial surgery. The CBL teaching model combined with BOPPPS is a case-based, problem-oriented and student-centered teaching method. It helps students think and learn independently by introducing them to real cases, and develops students’ clinical critical thinking and problem-solving abilities. The traditional LBL teaching method is a lecture-based, teacher-centered teaching method that focuses on knowledge transfer and memorization and ignores students’ initiative and participation. By comparing the differences between the two teaching models in the assessment of theoretical knowledge, assessment of clinical critical thinking ability, assessment of personal teaching effectiveness and teacher performance, and the questionnaire survey on graduates’ satisfaction with teaching, we can evaluate the advantages and disadvantages of the CBL model combined with the BOPPPS teaching model in the education of graduates in the specialty of Oral and Maxillofacial Surgery and lay the foundation for improving teaching methods.
Second- and third-year master’s students in 2017 were randomly assigned to an experimental group, which included 8 second-year students and 11 third-year students in 2017, and a control group, which included 11 second-year students and 8 third-year students in 2017.
The theoretical score of the experimental group was 82.47±2.57 points, and the basic skills test score was 77.95±4.19 points. The theoretical score of the control group was 82.89±2.02 points, and the basic skills test score was 78.26±4.21 points. There was no significant difference in the theoretical score and basic skills test score between the two groups (P>0.05).
Both groups underwent 12 months of clinical training and were compared on measures of theoretical knowledge, clinical reasoning ability, personal teaching efficacy, teacher effectiveness, and graduate satisfaction with teaching.
Communication: Create a WeChat group and the teacher will post the case content and related questions to the WeChat group 3 days before the start of each course to help graduate students understand what they should pay attention to during their studies.
Objective: To create a new teaching model that focuses on description, applicability and effectiveness, improves learning efficiency and gradually develops students’ clinical critical thinking ability.
Pre-class assessment: With the help of short tests, we can fully assess the students’ knowledge level and adjust teaching strategies in time.
Participatory learning: This is the core of this model. Learning is based on real cases, fully mobilizing the subjective initiative of students and connecting relevant knowledge points.
Summary: Ask students to draw a mind map or knowledge tree to summarize what they have learned.
The instructor followed a traditional teaching model in which the instructor spoke and the students listened, without further interaction, and explained the patient’s condition based on his or her condition.
It includes basic theoretical knowledge (60 points) and analysis of clinical cases (40 points), the total score is 100 points.
Subjects were assigned to self-assess patients in the emergency oral and maxillofacial surgery department and were supervised by two attending physicians. The attending physicians were trained in the use of the scale, did not participate in the training, and were unaware of the group assignments. The modified Mini-CEX scale was used to evaluate the students, and the average score was taken as the student’s final grade7. Each graduate student will be assessed 5 times, and an average score will be calculated. The modified Mini-CEX scale evaluates graduate students on five aspects: clinical decision-making, communication and coordination skills, adaptability, treatment delivery, and case writing. The maximum score for each item is 20 points.
The Personalized Teaching Effectiveness Scale by Ashton and the TSES by Yu et al.8 were used to observe and evaluate the application of CBL in combination with the BOPPPS evidence-based model in oral and maxillofacial surgery teaching. A 6-point Likert scale was used with a total score ranging from 27 to 162. The higher the score, the higher the teacher’s sense of teaching effectiveness.
Two groups of subjects were anonymously surveyed using a self-assessment scale to understand their satisfaction with the teaching method. The Cronbach’s alpha coefficient of the scale was 0.75.
SPSS 22.0 statistical software was used to analyze the relevant data. All data corresponding to normal distribution were expressed as mean ± SD. Paired sample t-test was used for comparison between groups. P < 0.05 indicated that the difference was statistically significant.
The theoretical scores of the text (including basic theoretical knowledge, clinical case analysis and total score) of the experimental group were better than those of the control group, and the difference was statistically significant (P < 0.05), as shown in Table 1.
Each dimension was assessed using the modified Mini-CEX. Except for the level of writing medical history, which showed no statistical difference (P> 0.05), the other four items and the total score of the experimental group were better than those of the control group, and the difference was statistically significant (P< 0.05), as shown in Table 2.
After the implementation of CBL combined with the BOPPPS teaching model, students’ personal learning efficacy, TSTE results and total scores improved compared with the pre-implementation period, and the difference was statistically significant (P < 0.05), as shown in Table 3.
Compared with the traditional teaching model, CBL combined with BOPPPS teaching model makes the learning objectives clearer, highlights key points and difficulties, makes the teaching content easy to understand, and improves students’ subjective initiative in learning, which is conducive to the improvement of students’ clinical thinking. The differences in all aspects were statistically significant (P < 0.05). Most students in the experimental group thought that the new teaching model increased their study load, but the difference was not statistically significant compared with the control group (P > 0.05), as shown in Table 4.
The reasons why the current master’s degree students in oral and maxillofacial surgery are incompetent for clinical work after graduation are analyzed as follows: Firstly, the curriculum of oral and maxillofacial surgery: during their studies, master’s degree students are required to complete standardized residency, defend a thesis, and conduct basic medical research. At the same time, they have to work night shifts and do clinical trivialities, and they are unable to complete all the assignments within the set time. Secondly, the medical environment: as the doctor-patient relationship becomes tense, the clinical work opportunities for master’s degree students are gradually decreasing. Most students do not have independent diagnosis and treatment capabilities, and their overall quality has significantly declined. Therefore, it is extremely important to introduce practical teaching methods to stimulate students’ interest and enthusiasm for learning and improve the effectiveness of clinical internships.
The CBL case teaching method is based on clinical cases9,10. Teachers raise clinical problems, and students solve them through independent learning or discussion. Students exercise their subjective initiative in learning and discussion, and gradually form a full-fledged clinical thinking, which to some extent solves the problem of insufficient integration of clinical practice and traditional teaching. The BOPPPS model links together several originally independent disciplines to form a scientific, complete and logically clear knowledge network, helping students effectively learn and apply the acquired knowledge in clinical practice11,12. CBL combined with the BOPPPS teaching model transforms previously unclear knowledge of maxillofacial surgery into pictures and clinical scenarios13,14, conveying knowledge in a more intuitive and vivid way, which greatly improves the learning efficiency. The results showed that, compared with the control group, the application of CBL15 combined with BOPPPS16 model in maxillofacial surgery teaching was beneficial in developing master’s students’ clinical critical thinking ability, strengthening the combination of teaching and clinical practice, and improving the teaching quality. The results of the experimental group were significantly higher than those of the control group. There are two reasons for this: first, the new teaching model adopted by the experimental group improved students’ subjective initiative in learning; second, the integration of multiple knowledge points further improved their understanding of professional knowledge.
Mini-CEX was developed by the American Academy of Internal Medicine in 1995 based on a simplified version of the traditional CEX scale17. It is not only widely used in overseas medical schools18 but also used as a method to evaluate the learning performance of physicians and nurses in major medical schools and medical schools in China19,20. This study used the modified Mini-CEX scale to evaluate the clinical ability of two groups of master’s degree students. The results showed that except for the level of case history writing, the other four clinical abilities of the experimental group were higher than those of the control group, and the differences were statistically significant. This is because the combined teaching method of CBL pays more attention to the connection between knowledge points, which is more conducive to the cultivation of clinicians’ clinical critical thinking ability. The basic concept of CBL combined with the BOPPPS model is student-centered, which requires students to study materials, actively discuss and summarize, and deepen their understanding through case-based discussion. By integrating theory with practice, professional knowledge, clinical thinking ability and all-round strength are improved.
People with a high sense of teaching efficacy will be more active in their work and will be able to improve their teaching effectiveness better. This study showed that teachers who applied CBL combined with the BOPPPS model in oral surgery teaching had a higher sense of teaching efficacy and personal teaching efficacy than those who did not apply the new teaching method. It is suggested that CBL combined with the BOPPPS model can not only improve students’ clinical practice ability, but also improve teachers’ sense of teaching efficacy. Teachers’ teaching goals become clearer and their enthusiasm for teaching is higher. Teachers and students communicate more often and can share and review teaching content in a timely manner, which allows teachers to receive feedback from students, which helps improve teaching skills and teaching effectiveness.
Limitations: The sample size of this study was small and the study time was short. The sample size needs to be increased and the follow-up time needs to be extended. If a multi-center study is designed, we can better understand the learning ability of postgraduate students. This study also demonstrated the potential benefits of combining CBL with the BOPPPS model in oral and maxillofacial surgery teaching. In small-sample studies, multi-center projects with larger sample sizes are gradually introduced to achieve better research results, thereby contributing to the development of oral and maxillofacial surgery teaching.
CBL, combined with the BOPPPS teaching model, focuses on cultivating students’ independent thinking ability and improving their clinical diagnosis and treatment decision-making ability, so that students can better solve oral and maxillofacial problems with the thinking of doctors and quickly adapt to the rhythm and change of clinical practice. This is an effective way to ensure the quality of teaching. We draw on the best practices at home and abroad and base it on the actual situation of our specialty. This will not only help students better clarify their ideas and train their clinical logical thinking ability, but also help improve the efficiency of teaching and thus improve the quality of teaching. It is worthy of clinical promotion and application.
The authors provide, without reservation, the raw data that support the conclusions of this article. The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
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Post time: Mar-17-2025