In order to fulfill the ever-changing challenge facing by medical education, this research aimed to establish a sustainable learning mechanism including interests (attraction), knowledge application, competency, and scenario coping skills. During this immersive learning process, students were required to intensively throw themselves into case observation, analytical discussion and summarization, guided by the teacher. The teaching quality was depended on the functional roles of teacher and student in a loop of mutual reinforcement, and evaluated by designed assessments individually and mutually to students and teachers (Fig. 2). Thus, the effect of advanced teaching mode by blending CBL with micro-film technique would be discussed below based on the results of all measurements.
First, MF + CBL model was more attractive to students than LBL model, which could be testified by the statistics of satisfaction survey in three dimensions of course content, teaching method and student’s self-efficacy. Since the course content was the control variable, teaching method and the learning process, as well as student’s feeling of rewarding were more likely influenced the satisfaction level. The reason analysis probably was: first, in micro-film stories, CBL model was updated to live-CBL or e-CBL [26], which was more vivid than test book lines; second, micro-film was an aesthetic fruit based on medical student’s interdisciplinary hard working, and the presentation was a stimulation of their inner potential on teamwork, case-reasoning and scaffolding for case representations [27]; third, CBL model with its structured question technique could better lead students to apply fundamental knowledge to practical clinic situations, narrows the gap between knowledge and usage [28], which may increase the feel of self-efficacy and then motivates the learning initiative and creativity [29].
Second, MF + CBL model was more effective towards knowledge application than LBL model. The objective result of closed book examination revealed a general higher score status in terms of fundamental knowledge and case analysis from experimental group to control group (Table 2). The reason analysis probably was: first, traditional LBL model was characterized by its teacher-center efficiency in a cramming system, where students could only seize fragments of knowledge by rote [30], whereas MF + CBL increase student’s automatic processing in cognition by providing abundant opportunities to experiential practice [31]; second, micro-film told a case story based on the development of illness, which followed the nature law of medical field and knowledge assimilation process; third, MF + CBL model encouraged case study under situational affection, within which students could realize knowledge application by the mutual reinforcing of learning and using.
Third, MF + CBL model could better develop student’s learning capacity than LBL model. Learning capacity could be evaluated by the ability of critical thinking and learning creativity [30]. With the requirement of vast stores of knowledge, mastery of complex clinical situation and incorporate frontier learning, medical education not only focused on the right answer, but on the right way which can be paved by developing critical thinking based on a solid foundation of knowledge. Simultaneously, learning creativity could help students persist to learn by motivate their initiative thinking and inquiry. The reasons that “critical thinking” and “learning creativity” performed higher score in the experimental group might be: first,micro-film was an video expression technique, which allowed information explosion. Students in the experimental group were encouraged to scan the available information, for instance, some important yet subtle clue functioning at enhancing visual cue interpretation [31], some deviant behaviors that covered by dramatic plots helping to trigger critical thinking; second, MF + CBL model was a creative learning method that could be assimilated during the improvement of practical, medical humanities and evidence-based medicine abilities by students. Teaching was not ended at the time of knowledge assimilation, instead, it continued in the construction of student’s learning model. Individual established his learning model by acquisition [30], and further influenced others.
Fourth, MF + CBL model could better promote student’s situation understanding and coping than LBL model. The social issues related to the patient or illness that reflected by MF + CBL model could expand students’ case discussion to the bio-psycho-social system of the patient [32]. Themes of social medical triggers, values affected health service offering, doctor-patient relationship and etc, could be revealed by structure guiding questions from the teacher in MF + CBL focus group. For example, “How to design a family rehabilitation plan for the patient?”, “What’s the risk factors between doctor-patient relationship in pediatrics? How to improve the relationship?”, “In medical field, how to help a children with special needs in a sustainable way?” and etc. Therefore, the learning procedure was also the progress to practicing in scenarios [22]. Therefore, students were required brought not only questions, but also solutions to the case scenario. In addition, during the shooting process, students needed to interview hospital staffs, patients and their families, and media staffs, which deepened the comprehend of clinical practice and dilemma and social stress facing by medical care, resulted in the improvement of situational coping skills.
In fact, MF + CBL model had its limitation as a demanding teaching method for both students and teachers, in terms of student’s willingness of self-study, creative thinking, expression, and teacher’s capacity of handling innovative technique, group discussion leading and conclusion [33]. In addition, initial planning and extracurricular activities were important parts of MF + CBL model, no wonder some students—in the experimental group—expressed their oppose opinion about this innovative trial. We did not deny that honest-to-goodness cramming could lead to a better grade on an exam in current Chinese education system, since the way a student obtained knowledge was not inherent, but acquired dependent on the learning context or environmental influence. Nevertheless, the seemingly superior efficiency of knowledge imparting was outweighed by the disadvantage of lack of critical thinking, which might limit student’s capacity development in the path of mechanical memorization. MF + CBL model was comparatively time-consuming in reaching a fine grade, but useful in developing student’s deep learning approach [30], which changed the destination of learning from scores to strength.