Although neurosurgery is very popular among medical students in other countries, in China, it is still a challenge to recruit high-quality students into neurosurgery [15–18]. How to recruit high-quality students into neurosurgery in China is an important question that needs to be addressed. In this study, we use CBL and PBL integrated methods to implement teaching, which makes it easier for students to master neurosurgery knowledge and thus boosts their interest in neurosurgery compared to the traditional teaching method. Meanwhile, students’ self-confidence was significantly increased, and more students were inclined to choose neurosurgery as a career.
The traditional teaching method is the most efficient and economical way to deliver core knowledge and concepts [3, 14]. It is very suitable for teaching in large, basic medical classes, such as physiology, biochemistry, and tissue embryology, because these courses are focused on students' mastery of knowledge points. However, in the teaching of clinical courses, such as internal medicine, surgery, gynecology, and pediatrics, more attention is given to the cultivation of students' ability to integrate theory with practice and clinical thinking ability. The traditional teaching model is not suitable for the teaching of these courses. However, thus far, there no standard teaching plan for clinical courses has been developed.
Most instructors are constantly exploring new teaching methods for clinical courses. In this study, the results revealed that the scores of students' self-evaluation, theoretical examination, and the students' clinical application ability evaluation tests of those who received the CBL and PBL integrated methods were significantly higher than those students who received the traditional teaching method, suggesting that the CBL and PBL integrated method is more suitable for neurosurgery teaching.
CBL and PBL integrated methods have been demonstrated to be significantly better than the traditional teaching method in the teaching of other clinical courses. Liu et al. adopted CBL-PBL teaching for maxillary sinus floor augmentation, and better results were obtained in terms of academic knowledge acquisition, case analysis ability, and student satisfaction compared to the traditional teaching method . Zhao et al. also demonstrated that in teaching about thyroid disease, CBL and PBL integrated methods significantly improved residents' and medical students' performance and enhanced their clinical skills compared to the traditional teaching method . However, some scholars' research shows that student performance has not been significantly improved with the new teaching method and that students prefer traditional lecture-style teaching [19, 20].
In fact, CBL is considered a derivative of PBL, and the two are often confused [10, 11]. Srinivasan et al. pointed out that, unlike PBL, CBL often requires a certain basic theoretical knowledge of the subject . Obviously, it is inadequate if CBL is used alone for the clinical teaching of undergraduates because they do not have theoretical knowledge of various fields. In addition, CBL pays more attention to the analysis of clinical cases, not just to the mastery of professional knowledge. However, PBL can make up for these shortcomings of CBL. As in this study, when assigning cases, we summarize the knowledge points that students need to master in problems and let students analyze cases based on the type of problem. The students’ clinical skills improved significantly, and it was easier for them to master theoretical knowledge.
Another advantage of CBL is that neurosurgery can be exposed to students early in the form of cases, and early exposure to neurosurgery contributes to medical student recruitment [22, 23]. In this study, students' interests in neurosurgery increased through case teaching, and neurosurgery selection at the end of the semester increased significantly. However, the teaching methods of CBL and PBL integrated methods also have certain shortcomings. This teaching method is only suitable for small class teaching, which not only requires more neurosurgeons to participate in medical teaching but also requires neurosurgeons to have a great interest in teaching. Compared with the traditional teaching method, the PBL and CBL teaching methods require instructors to dedicate more time and energy.
There are several inevitable limitations in this study. First, this is a single-institution, small-sample study, and a multi-institution, large sample size study is needed. Second, this study cannot be completed in a double-blind manner because students may communicate privately. Third, although the teaching procedures of CBL and PBL integrated methods are uniform, the teaching style of each teacher in the traditional teaching model is different. Therefore, the results obtained may be biased. Last, teachers of other majors may also choose some new teaching methods, which may impact students' major selection. This study did not capture these details.