Ophthalmology is a clinical subject with professional features. In China, paediatric ophthalmology is a subspecialty in ophthalmology and is a third-level subject. Ophthalmology education is a branch unit of sensory system teaching for five-year paediatric undergraduates at the College of Pediatrics of Chongqing Medical University. The traditional instructional approach focuses on LBL as the teaching centre, emphasizing the delivery of the syllabus and concepts11. Students passively accept the knowledge, leading to the reduction in learning initiative and enthusiasm. At present, traditional teaching methods cannot meet the needs of medical education students. New teaching methods are constantly being tested and improved by educators.
CBL has been used in the medical field since at least 1912, when it was used by Dr. James Lorrain Smith while teaching pathology at the University of Edinburgh12. The goal of CBL is to prepare students for clinical practice through the use of authentic clinical cases. Unlike the traditional method, the CBL model links theory to practice through the application of knowledge to clinical cases using inquiry-based learning methods9. CBL requires advanced preparation by students and provides a more structural strategy for learning. It is based on concrete cases and characterized by effective and interactive teaching9. By discussing a clinical case related to the topic being taught, students evaluate their own understanding of the concept using a high order of cognition. This process encourages active learning and produces a more productive outcome13.
The BOPPPS model, originating from North America, is a brand-new teaching model. The teaching process with a six-phase framework, including the bridge-in, objective, preassessment, participatory learning, post assessment and summary phases, emphasizes the participation of students through feedback during the teaching process14. In addition, this model accelerates the teaching cycle as a whole, including goals, behaviours, learning activities, and evaluation15. In recent years, the BOPPPS model, which pays more attention to the role of students’ initiatives in the teaching process and fully mobilizes their initiatives in the learning process, has been widely considered in China16. A large amount of the literature has shown the advantages of the BOPPPS model in various fields in health care and medicine17, such as clinical medicine18, dentistry6, and histopathology19.
In the current study, we applied the BOPPPS-CBL model to the ophthalmology teaching of five-year paediatric undergraduates. Compared with the traditional LBL teaching method, the BOPPPS-CBL model has several advantages originating from the above two teaching strategies. First, it is based on analyses of typical cases in ophthalmology. At the “bridge-in” stage, students can see the data and information for the cases, stimulating interest in learning. The “objective” stage makes students clearly understand the main content of this course in a framework. Our results showed that the students in the BOPPPS-CBL group knew more about the standard of work expected and had more motivation to learn.
Second, the BOPPPS approach changed the traditional relationships between teaching and learning. Teaching in the classroom is student-centred, with more emphasis on teacher-student interactions. In “participatory learning”, students purposefully acquire knowledge and link theory with practice based on the analysis of actual cases. The results of our survey showed that the BOPPPS-CBL model is more effective in developing students’ problem solving and analytical skills than the LBL model.
Finally, the final examination scores of the BOPPPS-CBL group were significantly higher than those of the LBL group, especially for case analysis. The score was not only an important and direct reference for evaluating the knowledge acquisition of the students but also an important parameter for measuring educational quality20. The results showed that the BOPPPS-CBL model led to better performance on the final test, but there were no significant differences in pressure between the two groups. In other words, the new teaching strategy did not increase the burden on students. Interestingly, more students in the LBL group thought the preclass workload was too high. A lack of real cases and boring theoretical information makes students feel more burdened. The bridge-in of real cases improved the students' interest in learning, and the students in the BOPPPS-CBL group did not feel that the preclass workload was too high. By independently reviewing cases, discussing diagnoses and treatment suggestions, and offering advice to peers, the students consolidated their basic knowledge and benefitted from the model20. Therefore, the BOPPPS-CBL model is a very effective and acceptable method for ophthalmology education. The students’ perception scores indicated that the BOPPPS-CBL model was more beneficial to the development of problem-solving skills, analytical skills and motivation of learning.
Limitations
This study has several limitations. First, the sample size was small. Research with additional samples is needed to validate the effect of this combined method. Second, the model was limited to a single unit of ophthalmology. The results may not be generalizable to students in other specialties. Third, the current study assessed only the final examination scores and lacked preclass and postclass tests to evaluate the learning effects. This may cause bias on learning performance. This study did not compare the differences between the CBL and BOPPPS models separately.