2.1 Participants
The study population comprised 104 undergraduates (Chinese) in their senior year studying clinical medicine at Guangxi Medical University, including 42 males and 62 females aged 25-27 years. The sample size was effective [23]. All the participants including teachers and students were all signed the Informed Consent, which required keeping confidential about course materials. All the students were divided into two parallel groups (52 students per group) by random sampling with a random number generator. The group exposed to the MF+CBL model was named the experimental group, while the group exposed to the LBL model was named the control group. There was no significant difference between the two groups in gender (P=0.842), age (P=0.253) or academic record (P=0.347) (Appendix 1).
2.2 Design
2.2.1 General curriculum arrangement
The textbook used was Pediatrics (Wang WP, 2018, People’s Medical Publishing House, Ninth Edition), based on which the teachers developed PowerPoints as supplements. Pneumonia, asthma, hyaline membrane disease and meconium aspiration syndrome were the 4 chapters chosen for this study, highlighting pathogenesis, diagnosis and treatment. Each chapter was covered in 6 class hours over 2 weeks, for a total of 24 class hours over 8 weeks.
2.2.2 Experimental group (MF+CBL model) design
Based on the task-oriented model, the whole experimental group was divided into four sub-groups according to the four chosen chapters. Each sub-group was responsible for making a micro-film with the help of the teacher, who performed the advanced work of taping case videos of children’s symptoms, such as pneumonia, fever, cough, wheezing, cyanosis and dyspnoea. The whole 8-week MF+CBL process was divided into 2 periods.
Period 1 was characterized by teacher-oriented CBL focus group discussion [24], while period 2 featured student-oriented micro-film presentations, followed by expert comments and conclusions (Figure 1). In period 1, the teacher served as a leader to explain the experimental curriculum and requirements, clarified key knowledge points, demonstrated clinical observation and reasoning in wards, and assisted groups with information analysis in the focus group discussion. With respect to the micro-film making, students were required to present a case story containing both clinical factors, such as pathogenesis, diagnosis, and treatment, and related social medicine factors, such as poverty and humanism, sexual discrimination, and doctor-patient relationships. Students were encouraged to discuss these factors in a focus group under CBL structured questioning guidelines provided by the teacher [25].
In Period 2, students played a central role in the micro-film presentation. The teachers shifted to serving as organizers, arranging the class discussions and expert comments. The experts invited included clinicians, doctor-patient relation coordinators, social health management professors, members of the media and film industry.
The photographic equipment consisted of the iPhone X, 2017, Apple Inc., and the video editing software was Videoleap Pro, 2017 Lightricks Ltd, downloaded from the App Store.
2.2.3 Control group (LBL model) design
The whole teaching process was divided into 4 periods corresponding to the chosen chapters, which were covered in teacher-centred lectures with the help of PowerPoints and the necessary pictures and videos typically used, but no media such as micro-films were used. The teacher’s predominant role remained unchanged from beginning to end (Figure 1).
Crucial potential confounding variables were controlled. In the 8-week teaching experiment, the experimental group (MF+CBL) and control group (LBL) used the same basic resources, including classroom sites and basic teaching materials (textbooks, PowerPoints, pictures, audio/video assistance, extra reading materials, etc.). In addition, all the teachers involved were at a similar level according to a comprehensive teaching evaluation and were trained in advance to avoid the introduction of subjective factors.
2.3 Evaluation method
To realize a comprehensive evaluation, both process assessment and outcome assessment were applied in this research. A student self-assessment questionnaire and a satisfaction survey were used for process assessment (Appendix 2); in addition, the final closed-book examination scores were used for outcome assessment.
The student self-assessment questionnaire subjectively evaluated knowledge application, competency, and scenario coping skills by exploring students’ self-evaluation of their fundamental knowledge, clinical thinking, critical thinking, learning creativity, situation coping, and comprehensive capacity. The satisfaction survey mainly evaluated interests (attraction) by exploring students’ opinions about the teaching materials, methods and self-efficacy [26]. The final closed-book examination objectively evaluated the students’ command of fundamental knowledge and clinical comprehensive capacity by the last course of the 8-week experiment. In advance of the 8-week experiment, all the student participants were informed about the final closed-book examination, and there was no time for review. The final closed-book examination was designed and scored by all the teachers involved in the 8-week teaching experiment. The teachers signed confidentiality agreements, and the test papers were scored anonymously.
2.4 Statistical analysis
All statistical analyses were performed with SPSS software (version 24.0), including the validity and reliability tests of all the measures. The measurement data were expressed in the form of`x±s. Significance was assessed via an independent samples t-test. Categorical data were analysed by the chi-square test to compare teaching effects between the two groups. P<0.05 was considered statistically significant.