8-year medicine programme in China are designed to train high-quality clinician-scientists. But students of the long-term medical education model are enrolled from high school, which makes it difficult for them to adapt to study due to different learning strategies and high learning standards in the initial stage of basic medicine. In this project, the prerequisite course provide a good opportunity to help students adjust their learning strategies and increase basic medical knowledge to adapt to study in the initial stage of basic medicine.
High-school education in China has been characterized by a style of teacher-centred didactic teaching. Faculty transmit knowledge too much in a too short time, while students are expected to be passive recipients of knowledge, which decreases the time to develop abilities such as critical thinking, problem solving, and clinical decision making[13]. The student-centred approach is an active learning strategy which focuses on the learners' learning, rather than the teacher's teaching [14]. The student-centred approach has the potential to advance student not only learning basic knowledge but also training critical thinking and learning skills [15]. Our prerequisite course activities change a teacher-centred, content driven approach to a student-centred, process-driven approach, which is expected to generate independent, active, and autonomous learners. The results showed that most students found this learning strategy promoted their learning.
Due to rapidly increasing medical knowledge, traditional educational resources cannot meet the needs of teaching. There are more and more online teaching resources with the advancement of IT technology. Massive Open Online Courses (MOOCs) are unlimited web-based courses accessed through computers, smartphones, or other digital devices [16]. There are thousands of MOOCs from hundreds of universities worldwide, including universities of China. These courses are made accessible online, which are beneficial to learn and use for students[17]. These online resources benefit the participants to facilitate their learning. The practice of teaching histology is based on theoretical didactic strategies along with practical training. Students can observe the microstructure of the tissue by digital microscopic images. A virtual microscopy programs were introduced in many universities [18, 19]. We also constructed online microscopy classes and clinical cases bank which ensure knowledge learning and retention. Use of the online resources can be an effective supplement for developing students' competence, confidence and satisfaction.[20]
Several studies show that online course organization and computer-assisted teaching tools are helpful to improve students’ learning. Despite the advances in online technologies, it is not possible to fully replace traditionally teaching pattern. Fully online based learning provides advantages such as flexibility and variety, but comes with disadvantages such as inhibiting face to face communication with other peers [21]. Students can learn basic knowledge by self but need experts for the higher levels thinking skills such as integration or evaluation of knowledge which are better delivered by tutorials. Blended learning is integrated of face to face learning experiences with online experiences affiliating the strengths of traditional and modern learning settings [22, 23]. The real test of blended learning is the effective integration of the two main components [24, 25]. Blended learning was acceptable and of interest to undergraduate students. Students identified that the blend rather than a purely online learning module was beneficial. They expressed a desire for more blended learning in their courses. Our prerequisite course implementation offer a useful teaching reform for medical students that strengthen their competences in terms of knowledge and skills
Histology is a visually oriented, foundational anatomical sciences subject, which is learned in early medical school curricula. There are many difficulties for undergraduate students in learning histology, such as a better grasp of the terminology being used with insufficient time[26]. Biology knowledge learned at high school is not sufficient to support histology learning, which creates a gap between high school and college. The prerequisite course may provide more biology knowledge and learning strategies used as the starting point to build upon in a later course [27]. In this example, prerequisite course provide appropriate learning strategies and resources to enhance student learning in later requisite histology course. Appropriate learning strategies help students to better master relevant histology knowledge. Sufficient basic medicine knowledge lay a good foundation for students to develop clinical analysis ability, which is supported by our findings and other reports [8]. These findings showed our prerequisite course is useful resource to support histology learning.
Histology is a discipline that mainly involves analyzing the normal structure and related functions present in a cell, tissue, or organ. As the basis for the study of pathology, the mastery of histological knowledge affect the learning of pathology. Markus etal reported that histological knowledge is a predictor of medical students' performance in diagnostic pathology [28]. In our course, students' learning strategies acquired in the prerequisite course accelerate their learning of pathology. The basic knowledge learned in our course supports the study of pathology and other clinical courses. In conclusion, our prerequisite course is beneficial for the study of other courses.
The goal of the 8-year programme is to train high-quality clinician-scientists, who have not only rich clinical skills but also multiple scientific research skills[2]. The cultivation of scientific research ability takes a long time, which makes it necessary to start training as early as possible[3]. Our prerequisite course is implemented at the beginning of basic medicine stage. Therefore, we have added the content of cultivating students' scientific research ability. Our prerequisite course provides professional English learning materials to train students in professional English learning, which helps students to read and write scientific research papers. Section observation and morphological analysis are important methods of scientific research, which are conducive to the improvement of students' scientific research ability. The basic knowledge of histology and the observation of section can improve students’ clinical reasoning skills and experimental techniques. Therefore, our course not only provide rich basic knowledge but also cultivate academic research ability for students of 8-year medical programme.
However, some participants in this study were negative about the prerequisite course. Our further analysis found that it was more difficult for those students to adapt to a student-centered teaching approach in a short time. It takes longer time for these students to change their learning strategies. Another limitation of this study was that the number of participants was relatively small, and therefore not provides more information about the prerequisite course. This will need to be explored in future studies.
In conclusion, the prerequisite course is a powerful tool for bridging the gap between high school and college, which helps students not only in adjusting their learning strategies but also increasing basic medical knowledge and improving scientific research ability. Our prerequisite course is useful for curriculum development and resources support to achieve the objectives of 8-year medical programmeme. These findings suggest that our prerequisite course is useful for students of eight-year medical programmeme and should be added in curriculum reform to help students adapt earlier to the initial stage of basic medicine.