A Practical Study on Improving the Teaching Quality of Biochemistry and Molecular Biology: A Combined Online and Offline Teaching Model of MW- PBL-FC

doi:10.21203/rs.3.rs-2712639/v1

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Research Article

A Practical Study on Improving the Teaching Quality of Biochemistry and Molecular Biology: A Combined Online and Offline Teaching Model of MW- PBL-FC

https://doi.org/10.21203/rs.3.rs-2712639/v1

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Objective: To investigate the impact of "MOOC + WeChat platform + PBL + flipped classroom" online-and-offline hybrid teaching mode (MW-PBL-FC) on the enhancement of Biochemistry and Molecular Biology (BMB)teaching quality.

Methods: A total of 1545 students studying clinical medicine and preventive medicine in a university during 2019–2021 into groups A and B. The first half of the course refers to introduction to amino acid metabolism,In group A's classroom, the first half of the course was taught using the "MW-PBL-FC" mode, while group B was taught using the lecture-based learning mode (LBL). The second half of the course (molecular biology and clinical biochemistry, or "second half") was taught using the exchange method. "MW-PBL-FC" and "LBL" modes were compared in terms of student satisfaction, learning attitude, and academic performance.

Results: ① The student satisfaction survey revealed that the satisfaction rate and satisfaction score of the MW-PBL-FC group were greater than those of the LBL group (p<0.001), regardless of whether the first or second half of the course was taught; ② Based on the evaluation of learning attitude, the improvement rate and total score of the MW-PBL-FC group were significantly higher than those of the LBL group (p<0.001).. After the first half of teaching, the learning attitudes of both groups improved, but the improvement of the MW-PBL-FC group was more pronounced, with a significant difference between the two groups (p<0.001). There was also a significant difference between the two groups during the second half of teaching (p<0.001);③ The overall average score, basic average score, comprehensive average score, and excellent rate of the MW-PBL-FC group were all higher than those of the LBL group (p<0.001), whereas the failure rate was lower (p<0.001).

Conclusion: The MW-PBL-FC online-and-offline hybrid teaching mode significantly improved BMB teaching quality, Change thelearning attitude.

MW-PBL-FCteaching mode

online-and-offline

Biochemistry and Molecular Biology

teaching quality

To prevent the spread of COVID-19 in early 2020, online teaching was fully implemented in China. In this context, "PowerPoint + Tencent Conference" has been the standard format for online instruction. However, when teaching online for an extended period of time, teachers become easily fatigued, which diminishes their passion for teaching. Moreover, students' eyes become dry and tired, which diminishes their listening efficiency. In addition, it affects teacher's impact on learningperformance and impairs student’s participation (de Oliveira Kubrusly Sobral,et al., 2022). Furthermore, monitoring students is difficult and students tend to suffer from a poor learning attitude and low satisfaction, all of which have a negativeMassive open online courses (MOOC) comprise large-scale online open courses on the internet, providing text, PowerPoint, video, animation, audio, or case studies, etc., so that learners are not limited by time or space(Chan, M. M., etc.,2019;Claflin, S. B., etc.,2020;Roller-Wirnsberger, R., et al.,2019;Castle, M.,et al.,2016). In addition, they administer online quizzes, peer assessments, and forum discussionsto provide a flexible, effective, and cost-effective learning environment(Adamski, M., etc.,2022; Duncan, A., etc.,2022;Du, M.,etc.,2022;Luk, T. T.,etc.,2019). Accordingly, they have a wide range of applications. However, MOOCs are also plagued by several disadvantages, such as a wide variation in platform quality, underestimation of student base for unified model teaching, inadequate assessment of students' goals and needs, inability to provide face-to-face instruction, insufficient understanding of MOOC content and structure by students, lack of digital skills by students, inability to learn by doing, and insufficient student engagement(de Oliveira Kubrusly Sobral, J. B.,et al. 2022;Goshtasbpour, F., et al.,2022;Schettino, G., et al.,2022; Huang, Z., et al.,2022).

In order to compensate for the shortcomings of MOOC, blended learning, which organically combines social media applications with online learning, has gradually emerged ^[4]. Correspondingly, the use of WeChat, a social media application, has been recommended. WeChat has the benefits of being free, simple, and adaptable to use, as well as offering high-quality images, instant messaging, screen sharing, and call recording, among others(Ma, R., et al.,2023; Zhang, X., et al.,2018;Zheng G et al.,2023;Wang Y.et al.,2023). Thus, designing a variety of teaching activities and lessons, documenting the teaching and learning process in detail, answering student questions, analyzing their responses, and exchanging feedback with autonomy is possible in real time(Wang Y.et al.,2023;Zhang G.J.,2023;Zou H.,2022). With the WeChat sharing function, teachers can also help students review and extend their knowledge outside of class, broaden their horizons, and enhance the quality oftheir learning(Zou H.,2022;Du W., et al.,2022;Zhang Y.F.,et al.,2022). Additionally, students can share learning resources and learning experiences with each other(Sun Y.P.,2015;Che S.Q.,2017). However, drawbacks such as communication delay, poor audio quality, the inability to connect to other calls during a call, difficulty reading messages received in video chat, and the absence of all-weather technical supportpersist(Ma, R.,et al.,2023;Gao C, et al.,2017). Combining MOOC courses with WeChat software features can, therefore, accommodate students' needs and preferences while also streamlining operational procedures. Correspondingly, exploring a combined online and offline teaching model to address these issues has become a topic of testing the learning effect of self-study and group discussion, deepening the application of knowledge, fully engaging students in the learning process, improving their communication and collaboration skills, establishing a dynamic student-centered teaching method, and transforming traditional teaching (lecture-based learning, LBL). In addition, this creates opportunities for pedagogical reform and presents significant challenges to the traditional teaching of LBL. Moreover, the implementation of project/problem-based learning (PBL) encourages students to learn and solve relevant real-world problems independently with the assistance of teachers (Webster, A., et al.,2022). In PBL, after the process of identifying projects, creating teaching situations, personalized instruction, and independent inquiry, "personalized instruction", "independent inquiry", and "collaborative learning" are typically guided through the project. Before, during, and after class, the project integrates "personalized instruction", "independent inquiry", and "collaborative learning".Thus, teachers and students can exchange and interact online at any time, answer questions, and resolve doubts, and students can also supervise each other and discuss problems through the WeChat group(Ma R.,et al,2022). This has enabled the redistribution of teaching time, transformed the teaching mode from one centered on teachers' teaching to one centered on students' autonomous learning and instant teacher-student communication, and increased the interactivity and interest of the classroom (Kim K. J., 2020). Typically, the project has a time limit and culminates in a report or oral presentation of the resolved issue. In this process, the teacher's role is to advise and motivate students rather than lecture, thereby optimizing the learning experience, motivating learning, improving learning outcomes and the efficacy of the course education, satisfying students' curiosity and conscious participation, recognizing the role of the self in learning, and developing the skills and comfort level of collaboration(Pascon, D. M.,et al.,2022). However, in PBL teaching, there are frequently a number of students who are not actively engaged in the learning process. Thus, the question of what must be mastered and what need not be mastered persists. In other words, students cannot grasp the key points, the degree of project knowledge mastery, the size of the project, and the openness of the selected topic. Accordingly, the teacher's PBL competence development and how to collaborate, how students share and share the content, how the teacher intervenes and manages the project execution process, and how the process is evaluated are all issues worthy of investigation(Chan, S. C. C., et al., 2022)..

The disadvantages of PBL can be mitigated by flipping the classroom. Accordingly, the flipped classroom teaching mode is predicated on adequate preparation before class, as well as the class under the guidance of the teacher. Through the teacher's focus, students have a high level of enthusiasm to participate in classroom discussions with a positive attitude. Instead of lecturing to develop students' independent learning ability and prolonging the course learning time, the limited class time should be more focused on the practical problems to be solved and working together on high-level topics. This changes the traditional model of teaching in which the teacher speaks and the students listen, allowing students to actively participate in the classroom, transferring decision-making authority to the students, and putting the initiative of the students into play(Qutob H., 2022).

With regards to the content in the fields of biochemistry and molecular biology (BMB), knowledge points are usually fragmented and abstract, and the content is updated frequently, makingBMB difficult to teach and learn, thereby diminishing students' interest in learning (Chen, Y., et al.,2022).

Accordingly, the current study employs the "Chinese University MOOC + WeChat group"(MW) platform and adopts PBL-based learning style to address the aforementioned issues. In addition, the Flipped Classroom (MW-PBL-FC) was used to teach BMB courses in a hybrid online and offline format in orderto examine the effect of MW-PBL-FC on the quality of BMB teaching.

2.1 Research Subjects

The 1545 students enrolled in preventive medicine and clinical medicine during 2019–2021 were divided at random into groups A and B. A total of 745 students comprised group A, while 800 students comprised group B. Table 1 details the gender, age, major, and entrance score. The first half of the biochemistry course (introduction to amino acid metabolism, referred to as "the first half") was taught in the "MW-PBL-FC" mode in the classroom of group A, whereas group B was taught using the conventional teaching mode. The second half of the biochemistry course (molecular biology and clinical biochemistry, referred to as the "second half") is taught in a different way.

Table 1

Comparison of general information between the two groups.
Group	n	Gender		Age (mean ± SD)	Specialties		Admissions Results (mean ± SD)
Group	n	Male [n(%)]	Female [n(%)]	Age (mean ± SD)	Preventive Medicine [n(%)]	Clinical Medicine [n(%)]	Admissions Results (mean ± SD)
A	745	285 (38.26)	460 (61.74)	18.20 ± 0.69	214(28.72)	531 (71.28)	384.21 ± 9.71
B	800	292 (36.50)	508 (63.50)	18.20 ± 0.68	222(27.75)	578 (72.25)	384.55 ± 9.70
χ²/t	-	0.51		0.39	0.18		0.69
p	-	0.476092		1.000000	0.670537		1.000000

Prior to requesting questionnaire responses, the research was approved by the university ethics committee, respondents' information was kept confidential, and verbal consent was obtained.

2.2 Implementation of MW-PBL-FC teaching model

2.2.1 Building the MW Platform

① First, a course team meeting was held to discuss the division of course content intomodules,and the BMB course was divided into four modules: biomolecular module, metabolism module, genetic information transfer and expression module, and clinical biochemistry module. In addition, in the biomolecular module, which is comprised of protein and nucleic acid sub-modules, proteins were separated into common proteins and special proteins (including enzymes).

② The knowledge points of the split module were then discussed. To enhance students' interest in learning, the inherent content framework was modified, and the content was divided into knowledge points, beginning with the content that students found most interesting. The knowledge points of the glucose metabolism module, the majority of which are concise, are shown in Fig. 2.

③ Cases and thinking materials relevant to the important knowledge points were then collected.

④ Material scripts, animations, or video explanations were generated.

⑤ Assignments and tests for the corresponding knowledge points were set.

⑥Before the students attended classes, a class WeChat group was created; subsequently, all the students were grouped, and a group for each individual group was created separately.

2.2.2 Design project tasks

After researching and summarizing the teaching mode and becoming acquainted with the teaching methods, we formulated a plan and designed project tasks based on the "MW-PBL-FC" teaching mode. The project tasks were based on the effective stimulation of students' higher-order thinking ability, emphasizingthe teaching characteristics of "small, precise, deep, practical, and new", seeking "the combination of theory and reality", "classical and current affairs", "integration of this course with other courses", and "integration of this course with other courses". The course was based on actual clinical needs and the current situation, as well as on the principles of reflecting important and challenging points, integrating the ideological elements of the course, as well as social and political issues. The guidelines reflected important and challenging points, as well as incorporated elements of curriculum ideology and politics and socially hot issues. For instance, the introduction of major scientific achievements is included on the task list in order to promote the spirit of active exploration, innovation, and perseverance, as well as to arouse a strong desire among students to engage in scientific research. In addition, the flipped classroom task of the protein module and its three-dimensional structure is timed to coincide with the announcement of the Nobel Prize in Physiology or Medicine, so the flipped classroom task list can tell the story of the Nobel Prize winner to broaden students' horizons and knowledge, let them aim at the frontiers of science in real-time, and encourage them to explore the path of science and use their professional knowledge to think and solve scientific problems. Accordingly, students were encouraged to investigate science and apply their knowledge to consider and solve scientific issues.

The tasks were presented in the form of PPTs, dramas, case studies, etc., which were designed as necessary, and the flipped classroom teaching was implemented based on the pre-teaching questionnaire (Fig. 3).

2.2.3 Flipped classroom approach.

① Pre-course-project exploration stage

In five steps.

First step release: Based on the platform-use tutorials that students can comprehend, teachers released the platform resources.

The second step of self-learning: The online flipped classroom utilized the China University MOOC platform, where students studied online course materials such as lecture videos, presentation animations, PPTs, and text files prior to attending class.

Step 3 Quiz: The use of self-assessment electronic test papers for formative evaluation enabled students to track and continuously improve their learning strategies.

Step 4 Summary: Students who passed the tests created their own "summary report feedback" videos and uploaded them to the platform. In addition, the students evaluated the "summary report feedback" videos of their peers.

Step 5 Grouping: This section is vitally important. The students were categorized (four students) through WeChat according to their dormitory to create groups for discussion and exchange. Subsequently, a teacher was assigned to each group.

Instructors assigned project tasks via the MOOC platform. Multiple project tasks were assigned so that students were able to select the learning content based on their individual learning interests. This was also carried out to increase the subjectivity of students in teaching so that even those who were less motivated to learn could choose the knowledge they wished to acquire, based on their own interests, rather than passively accepting the learning content. Moreover, students with a good foundation were able to expand their learning resources in addition to their learning.

Although the majority of students were independent learners, they also engaged in collaborative group learning. Thus, knowledge was internalized through collaborative inquiry and interactive communication among group members in order to complete presentation assignments. When arranging group discussions the night before class, students were instructed to come up with their own solutions to problems that arise; if they were not able to do so, they were advised to seek assistance from their group members. Upon failing, they were advised to ask the teacher. During group study and discussion, it was suggested that the teacher should not only ask students questions frequently to stimulate active thought but should also respond to questions in a timely manner. This would not only supervise students' learning before class but would also ensure that they understand how to complete the assignment and summarize their learning outcomes.

② In class-project implementation phase

There were two distinct levels. First, knowledge understanding: At first, reporting of results and inter-group questions and answers (Q&A) were carried out. The students were informed beforehand that they would need to answer each other's questions and that the results would be included in their course grades, so even those with less autonomy in learning would pay close attention to the reports of other groups. Subsequently, the teachers focused on pre-course quizzes and student questions; secondly, they internalized knowledge through the integration of "summary and refinement + course thinking". Instead of simply responding to students' questions, the teacher summarized, commented on, and sorted out the omissions and errors that occurred during the presentation of the task.

③ After class-project evaluation phase

After the course has concluded, the teacher tracked and processed the data related to the students' learning process, assessed the students' understanding and mastery based on the feedback of the data information to accurately and exhaustively reflect the students' learning effect, and continuously adjusted and corrected the teaching methods and teaching contents. Students were instructed to summarize what they have learned in class on the MOOC platform, reflect on the completion of their learning tasks, write down their learning reflection summaries, and publish them on the WeChat group platform in order to promote students' knowledge mastery, stimulate their enthusiasm for active thinking, and cultivate their innovative thinking skills. The teacher then graded the students' homework and group reports based on the difficulty of the assignment, as well as inter-group and intra-group evaluations, and then created open-ended exam questions for the final exam to assess students' knowledge. Correspondingly the diverse evaluation strategies aided in motivating and assessing students' participation in flipped classrooms.

2.3 Effectiveness evaluation

2.3.1 Student Satisfaction Survey

For the 1545 students in the three grades (2019–2021) at our college, a total of 10 items were designed. Among these, items 3, 8, and 11 pertain to pre-class satisfaction, items 1, 2, and 6 to in-class satisfaction, and items 9 and 11 to post-class satisfaction. Furthermore, items 2, 3, and 12 pertain to overall satisfaction, and items 7 and 10 pertain to polygraph questions. Accordingly, the survey comprised a total of100 points, as shown in Table 2. Using the questionnaire's star answer questions, each item was divided into four levels: very satisfied, satisfied, basic satisfaction, and dissatisfied, each of which was assigned a point value of 10, 8, 6, and 4, respectively. Using extremely satisfied and satisfied as measures of satisfaction, the satisfaction rate was then determined (Gopalan C. ,2019).

Table 2

Content and results of the student satisfaction survey.
Projects	MW-PBL-FC Teaching Group					LBL Teaching Group
Projects	Very satisfied [n/%]	Satisfaction [n(%)]	Basically satisfied [n(%)]	Dissatisfied [n(%)]	Score	Very satisfied [n/%]	Satisfaction [n(%)]	Basically satisfied [n(%)]	Dissatisfaction [n(%)]	Score
1	1059/73.19*	318/21.98**	38/2.63***	32/2.21#	13490	721/54.81	231/15.96	321/22.18	174/1.20	11680
2	1036/71.60*	386/2.67**	22/0.15 ***	3/0.02 #	13592	312/23.72	123/8.50	723/49.97	289/2.00	9598
3	964/66.62*	330/2.28**	122/0.84 ***	31/0.21#	13136	112/8.51	102/7.05	468/32.34	765/5.28	7804
4	961/66.41*	404/2.79**	46/0.32 ***	36/0.25#	13262	101/7.68	353/24.40	362/25.02	631/4.36	8530
5	882/60.95 *	409/2.83**	90/0.62 ***	66/0.46#	12896	342/26.00	421/29.09	487/33.66	197/1.36	10498
6	629/43.47 *	599/4.14**	150/1.04***	69/0.48 #	12258	91/6.92	152/10.50	241/16.66	963/6.65	7424
7	280/19.35	598/41.33	492/34.00	77/5.32#	-	280/19.35	598/41.33	492/34.00	77/5.32	-
8	906/62.6*	493/3.41**	34/0.23 ***	14/0.10#	13264	34/2.58	276/19.07	643/44.44	494/3.41	8382
9	948/65.51 *	487/3.37**	8/0.06 ***	4/0.03 #	13440	92/6.99	363/25.09	371/25.64	621/4.29	8534
10	278/19.21	595/41.12	490/33.86	84/5.81#	-	278/19.21	595/41.12	490/33.86	84/5.81	-
11	1014/70.08 *	418/2.89**	10/0.07 ***	5/0.03 #	13564	361/27.44	421/29.09	221/15.27	444/3.07	10080
12	1086/75.05 *	350/2.42 **	6/0.04 ***	5/0.03 #	13716	61/4.64	162/11.20	376/25.98	848/5.86	7554
Total	9485/65.55*	4194/28.98**	526/3.64***	265/1.83#	132618	2785/21.17	3797/26.24	5195/35.90	5587/38.61	90084
Note: 1. The lectures are clear, organized, and inspiring; 2. The teaching activities motivate learning; 3. The learning resources help a lot; 4. I fully understand the content; 5. I use class time efficiently; 6. The problems discussed in class are challenging (or innovative, pioneering, critical thinking, etc.); 7. I am usually calm under pressure; 8. (Teaching schedule, difficulty level, key points, etc.) is relatively satisfactory; 9. Classroom teaching (or homework review, question and answer, out-of-class instruction, etc.) is good at explaining the difficulties and priorities of teaching; 10. My emotions under pressure are generally unaffected by the environment; 11. Assignments or design and other aspects can promote my effective learning; 12. The teacher creates a good atmosphere.
* Same project MW-PBL-FC teaching group as LBL teaching group (p < 0.01)

2.3.2 Assessment of learning attitude

A total of 20 items were designed. Item 13 was designated as a lie detector question, and each item was divided into four levels: fully conform, basically conform, a few conform, and do not conform, to a total score of 2, 3, 4, and 5, respectively( Gopalan C., 2019). Each item was multiplied by the number of individuals multiplied by 0.1, 0.2, 0.3, and 0.4, respectively, and add the results were summarized. The details are shown in Table 4. The questionnaire was used to answer questions containing a total of 20 factors, of which "a few met and did not meet" indicated a better learning attitude, and the rate of a better learning attitude was calculated without any implication or hint. Before, during, and after the first half of class, an evaluation was administered.

2.3.3 Achievement test

Ten instant tests and one stage test were conducted in the first and the second halves respectively. The test paperswere prepared by other teachers in the teaching and research section (separate teaching and examination), and the questions consisted of single choice questions, true or false questions, explanations of nouns, and quizzes, which were separated into basic and comprehensive categories. At the time of the instant test, the students were separated by a great distance and did not interact normally. For the instant test, the number of questions was 10, and the sub-times were one of the above question types respectively, 20 times, i.e., five times for each question type; the test was administered at the end of each class, and the purpose of the test and note that the test score does not count towards the total score prior to the test. The stage test was carried out at the end of the first and the second halves. Strict discipline was maintained in the examination room, with no instances of cheating during the test. A total of 85 points and above was considered as excellent, while a score below 60 points was considered a failure.

2.3.4 Statistical treatment

Quantitative data were expressed as mean ± standard deviation (SD), and rates were compared using theWilcoxon Rank Sum test, with p < 0.05 indicating a statistically significant difference.

3.1 General information about the study subjects

By comparing the general information of the two groups of study subjects, the results indicated that there was no statistically significant difference (p > 0.05) between the two groups of study subjects in terms of gender, major, and high school entrance examination scores, as shown in Table 1.

3.2 Student satisfaction survey

The student satisfaction survey was conducted among the 2019–2021 class of preventive medicine and clinical medicineMW-PBL-FC teaching group, using voluntary participation and anonymous questionnaires, with a total of 1540 questionnaires distributed (due to some students' leave of absence), excluding those who did not complete the questionnaire, 1447 valid questionnaires were returned, with a recovery rate of 93.96%.

The fact that there was no statistically significant difference between responses to questions 7 and 10 (χ² = 0.96, p = 0.811096) suggests that the students answered the questions thoughtfully and that the survey was meaningful.

Table 2 displays the number and percentage of extremely satisfied, satisfied, basic satisfaction, and dissatisfied students in the MW-PBL-FC and LBL teaching groups. The combined very satisfied and satisfied MW-PBL-FC teaching group was higher than the LBL teaching group (χ² = 7555.56, p = 1;χ² = 486.07,p = 0.000003), whereas the combined basic satisfaction and dissatisfaction MW-PBL-FC teaching group was lower than the LBL teaching group (χ² = 13996.83, p = 1;χ² = 5826.04,p = 1). The satisfaction rate in the MW-PBL-FC teaching group was 94.53% (13679/14470) compared to 45.49% (6582/14470) in the LBL teaching group (χ² = 8289.29,p = 1), and the satisfaction score in the MW-PBL-FC group was higher (13261.80 ± 427.88) than that in the LBL teaching group (9008.40 ± 1405.34; t = 110.14, p = 0.000000).

Table 3 displays the satisfaction scores and satisfaction rates of the two teaching groups after the first and second halves of instruction. The scores and satisfaction rates of the MW-PBL-FC teaching group were statistically significantly higher than those of the LBL teaching group in both segments (p < 0.001).

Table 3

Student satisfaction scores.
GROUP	n		First half (mean ± SD/%)	Second half (mean ± SD/%)
A	725	Score	13125.62 ± 414.60^*	8942.45 ± 1388.43^***
A	725	Satisfaction rate	655(90.34)^**	333(45.932)^#
B	722	Score	9191.15 ± 1511.18	13421.46 ± 437.23
B	722	Satisfaction rate	327(45.29)	700(96.95)
Note: First half of groups A and B compared, : t = 15.34, p = 0.000000, *:χ² = 336.70, p = 0.000002
Second half A and B groups compared, ***; t = 29.18, p = 0.000000, #:χ² = 461.06, p = 0.00000 3

Among them, 60.95% (882/1447) of students selected "very satisfied" for the item "efficient use of class time", which is lower than the average of 65.55% (9485/14470) (χ² = 12.33, p = 0.00047); the satisfaction rate was 81.94% (1291/1447), which is lower than the average of 92.70% (13679/14470)(χ² = 66.40, p = 0.000001).

In contrast, 43.47% (629/1447) of students chose "very satisfied" for the item "The questions discussed in class were challenging (or innovative, pioneering, or critical thinking, etc.), much lower than the average of 65.55% (9485/14470) (χ² = 391.51, p = 0.000002); the satisfaction rate was 77.79% (1215/1562), much lower than the average satisfaction rate of 92.70% (14479/15620) (χ² = 276.84, p = 0.000002).

3.3 Learning attitude assessment

All students were evaluated on their learning attitudes prior to and after the implementation of instruction, and a questionnaire survey with voluntary participation and anonymous responses was administered.

Table 4 demonstrates the results. Item 13 is a lie detector question, and only 0.37% and 0.43% of students answered incorrectly before and after the teaching implementation, respectively, indicating that students took the questions seriously and that the survey was significant. The rateof better learning attitude was 43.297% (14863/32700) before the teaching reform and 92.77% (30337/32700) after the teaching reform, with a significant difference between the two groups (χ² = 17151.15, p = 1); the points before the teaching reform of 20 items (except item 13) were 1341.12 ± 518.02; the total points after the teaching reform were 2521.39 ± 179.97, a statistically significant difference (t = 89.00,p = 0.00000).

Table 4

Content and results of student learning attitude measures before and after the implementation of the instructions.
Projects	Before teaching implementation				After teaching implementation
Projects	Better/rate N/%	χ^2*	P^*	Points	Better/rate N/%	χ^2**	P^**	Points
1	1367/83.61	1024.66	0.000004	2425.2	1606/98.23	211.54	0.000002	2903
2	817/49.97	28.33	0.000001	1540.4	1256/76.82	253.97	0.000002	2084.2
3	235/14.37	535.75	0.000003	866	1316/80.49	1433.22	-	2374.6
4	359/21.96	290.92	0.000002	961.6	1259/77.00	990.93	0.000004	2315.2
5	915/55.97	101.83	0.000001	1628	1242/75.96	145.65	0.000001	2373.8
6	91555.97	101.83	0.000001	1620.8	1436/87.83	145.65	0.000001	2535
7	72/4.4	971.85	0.000004	599.8	1475/90.21	2414.84	-	2579.2
8	496/30.33	107.00	0.000001	1098.2	1403/85.81	19.83	0.000009	2503.2
9	1116/68.26	394.10	0.000003	1912.2	1476/90.28	241.15	0.000002	2577.8
10	369/22.57	274.43	0.000002	1016	1310/80.12	1083.94	0.000005	2381.4
11	796/48.69	18.49	0.000017	1603.4	1298/79.39	334.63	0.000002	2344.2
12	1546/94.56	1653.57 1	-	2271	1603/98.04	27.88	0.000000	2750.8
13	1629/99.63	-	-	3259.2	1628/99.57	-	-	3257.4
14	274/16.76	452.43	0.000003	917.4	1344/82.21	1400.64	0.000002	2404.2
15	408/24.95	214.73	0.000002	1039.8	1501/91.80	1503.57	-	2600.4
16	1260/77.06	717.27	0.000003	2072.6	1556/95.17	224.1	0.000001	2650.6
17	670/40.98	3.39	0.06547	1306.2	1544/94.43	1068.39	0.000004	2606.2
18	539/32.97	67.91	0.000001	1119.2	1532/93.70	1298.51	0.000005	2621.4
19	261/15.96	22642.14	-	810.8	1495/91.44	1872.96	-	2574.4
20	326/19.94	348.78	0.000002	909.4	1494/91.38	1690.42	-	2577.4
21	493/30.15	110.06	0.000001	1104.4	1563/95.60	1499.94	-	2670.8
Total	14863/43.29	-	-	30082	30337/88.36	-	0.000002	53683.8
NOTE:1. "BMB" is not important in the future?2. My mind is thinking about other things during class.3. Do you want to get excellent academic results without working hard?4. Wouldn't you be happy not to take the BMB course for a few days?5. If there is a problem that you do not understand, you do not try to figure out the problem by all means?6. Do you think students do not have to do well in all subjects?7. Can't you usually preview what will be taught in class the next day?8. If you don't understand something in class, won't you ask your teacher or classmates?9. You never review the new content you just learned in class?10. You don't go to study as planned when you are in a bad mood?11. Do you pay attention to the lecture?12. You won't revise the tasks you completed before class after the teacher explained them?13. The People's Republic of China was founded on October 314. Don't like to search for the root of some difficult problems?15. To study under the supervision of others?16. You do not like cooperative group learning.17. Dislikes classroom tests.18. Do not like to audition on the podium.19. Learning simplified presentations such as MW-PBL-FC, which you do not think will help you.20. I am not interested in studying if there are no exams.21. This is an effective teaching method and worth promoting
Compared to total, *Compared to before instructional implementation.

Table 5 compares the scores of the two groups of students regarding their learning attitudes. Before teaching, there was no significant difference between the two groups (t = 0.05, p = 0.957947), and the learning attitudes of students in groups A and B were both poorer. After the first half of the teaching period, compared to the pre-course period, the learning attitudes of both groups improved (t = 71.56, p = 0.000000 in group A; t = 11.03, p = 0.000000) in group B; however, the improvement in learning attitudes was most pronounced in the MW-PBL-FC group. After the second half of instruction, the learning attitude score was significantly higher than that of the LBL group (t = 58.43, p = 0.00000) and that of the pre-initiation group (group A t = 10.99, p = 0.000000; group B = 72.87, p = 0.000000).

Table 5

Comparison of the students' learning attitude scores between the two groups.
Group	n	Before class starts (mean ± SD)	First half (mean ± SD)	Second half (mean ± SD)
A	725	1040.71 ± 516.79	2491.41 ± 175.85^*	1340.31 ± 521.52^**
B	722	1042.15 ± 521.85	1342.25 ± 512.43^***	2541.76 ± 182.77^#
t		0.05	57.10	58.43
P		0.957947	0.00000	0.00000
Note: * First half of group A compared to before the start of the course (t = 71.56, p = 0.000000); * First half of group B compared to before the start of the course (t = 11.03, p = 0.000000); Later half of group A compared to before the start of the course (t = 10.99, p = 0.000000); #Later half of group B compared to before the start of the course (t = 72.87, p = 0.000000).

3.4 Learning achievement test

Tables 6 and 7 display the results of the first and second halves of the immediate test. The overall average score, the basic average score, the comprehensive average score, and the excellent rate of the MW-PBL-FC group were significantly higher than those of the LBL group (p < 0.001), whereas the failure rate of the MW-PBL-FC group was significantly lower than that of the LBL group (p < 0.001).

Table 6

Immediate test scores of the students in the first half.
Group	n	Overall average score (mean ± SD)	Basic average score (mean ± SD)	Comprehensive average score (mean ± SD)	Excellent / Rate [n(%)]	Failure /rate[n(%)]
A	745	84.58 ± 5.03	52.57 ± 2.99	32.01 ± 2.93	72(9.66)	4(0.54)
B	800	74.99 ± 8.89	45.03 ± 5.33	29.96 ± 4.88	15(1.88)	37(4.63)
t/χ²		25.84	33.96	9.92	50.45	24.96
P		0.000000	0.000000	0.000000	0.000001	0.000001

Table 7

Immediate test scores of the students in the second half
Group	n	Overall average score (mean ± SD)	Basic average score (mean ± SD)	Comprehensive average score (mean ± SD)	Excellence/rate [n(%)]	Failure/rate [n(%)]
A	745	72.64 ± 9.00	46.50 ± 6.22	26.14 ± 4.88	22(2.95)	29(3.89)
B	800	84.93 ± 6.09	52.93 ± 3.77	32.00 ± 3.16	159(55.29)	6(0.75)
t/χ²		31.62	24.76	28.20	106.80	17.21
P		0.000000	0.000000	0.000000	0.000001	0.000034

Tables 8 and 9 display the results of the first half and second half of the stage test. The overall average score, basic average score, and comprehensive average score of the MW-PBL-FC group were significantly higher than those of the LBL group (p < 0.001), while the failure rate of the MW-PBL-FC group was significantly lower than that of the LBL group (p < 0.001). The excellent rate in the first half of the MW-PBL-FC group was greater than that of the LBL group (p < 0.05), while the excellent rate in the second half was not significantly different between the two groups (p > 0.05).

Table 8

Students' performance of the stage test in the first half
Group	n	Overall average score (mean ± SD)	Basic average score (mean ± SD)	Comprehensive average score (mean ± SD)	Excellent / Rate [n(%)]	Failure /rate [n(%)]
A	745	80.66 ± 6.83	53.92 ± 5.52	26.74 ± 1.99	49(6.58 )	17(2.28)
B	800	75.40 ± 12.87	50.09 ± 9.76	25.31 ± 3.71	34(4.25)	116(1.45)
t/χ²		9.93	9.40	9.34	4.11	73.20
P		0.000000	0.000000	0.000001	0.042638	0.000001

Table 9

Students' performance of the stage test in the second half.
Group	n	Overall average score (mean ± SD)	Basic average score (mean ± SD)	Comprehensiveaverage score (mean ± SD)	Excellence/rate [n(%)]	Failure/rate [n(%)]
A	745	75.59 ± 13.08	50.21 ± 9.93	25.38 ± 3.73	37(4.97)	110(14.77)
B	800	80.85 ± 6.16	54.08 ± 5.03	26.77 ± 1.80	53(6.63)	14(1.75)
t/χ²		10.22	9.76	9.43	1.93	88.52
P		0.000000	0.000000	0.000000	0.164286	0.000001

Table 9 displays the stage test scores in the second half. The overall average score, basic average score, and comprehensive average score of the MW-PBL-FC group were significantly higher than those of the LBL group, whereas the failure rate of the MW-PBL-FC group was significantly lower than that of the LBL group (p < 0.001). Additionally, there was no distinction between the two groups in terms of excellent rate.

To avoid large gatherings of people during the prevention and control of the new crown epidemic, offline instruction was replaced with online instruction, which was rolled out in its entirety across the Chinese mainland. However, there are inherent flaws in online instruction, as the time and space gap results in insufficient discussions, short lectures, incomplete interactions, and low efficiency, so the quality of online instruction cannot be guaranteed.

The BMB course teaches core knowledge and concepts. However, it is difficult to understand and prone to confusion, and may be forgotten before and behind, resulting in fear of difficulties and disinterest in learning. Thus, teachers are constantly exploring practical teaching methods with better teaching effects. The traditional offline LBL is also recognized by students, but how to combine online and offline to improve the quality of instruction makes MW-PBL-FC a worthwhile teaching mode to promote.

4.1 Advantages of MW-PBL-FC teaching model

The MW-PBL-FC teaching mode can cultivate active learning, teamwork, problem-solving skills, and the capacity for lifelong learning, which is a subject worthy of investigation. The advent of the mobile learning era and the influx of a large number of information-based resources has provided an impetus for teaching reform, and there is already a consensus to fully integrate the Internet platform with teaching methods to increase students' interest in learning and improve teaching effectiveness.

MOOC courses offered by BMB are developed by our university, and their content is closely aligned with the course objectives and curriculum, making them appropriate for our students. WeChat has more than 2 billion users and is the largest social networking platform on the planet. Teachers and students can use WeChat to communicate instantly, answer questions, and share resources(Ma, R., et al.,2023;Huang X.,2019) to compensate for the shortcomings of the MOOC.

PBL is student-centered, which brings into play students' independence and active participation in learning, develops students' teamwork and communication skills, fosters critical thinking and the ability to analyze and solve problems, improves students' creative thinking skills, and promotes the integration of professional knowledge with clinical practice(Zhang, F., et al.,2022;Zhang, X.,et al.,2023)

In addition, it exercises students' expression skills, develops students' clinical thinking, and improves students' teamwork skills(Zhang,X.,et al.,2018;Zheng G,et al.,2023;Wang Y. et al.,2023;Zhang G.J.,2023; Zou H.,2022;Du W.,et al.,2022,Zhang Y.F., et al.,2022). However, PBL-centric approaches do not always allow students to grasp the key contents, or aid in the intervention, management, and assessment of teachers, etc.(Pascon, D. M., et al., 2022;Chan, S. C. C., et al.,2022), the use of the flipped classroom offers a promising solution. Accordingly, based on the teacher’s focus, students could be driven to achieve a high level of enthusiasm to participate in classroom discussions with a positive attitude, and the develop students' self-learning ability, put into the course learning time, becomes longer(Qutob H.,2022).

Combining MOOC, WeChat, PBL, and flipped classroom brings out the strengths of each and compensates for its weaknesses, thereby improving the quality of instruction. However, the role of MW-PBL-FC online and offline hybrid teaching modes in enhancing the quality of medical instruction has not yet been investigated.

4.2 Analysis of the effect of the implementation of MW-PBL-FC teaching model

Jiangsu students of clinical medicine and preventive medicine majors were used as the research subjects, as their class hours, entrance subjects, and examination papers are similar, making it possible to conduct a controlled study that is representative, with easy-to-obtain samples, and is conducive to implementing teaching reform.

Prior to implementation, the teaching reform implementation staff received unified training to ensure the validity of the research results. Once a week, we conducted a group lesson preparation for all teachers, gathered the wisdom of all teachers, prepared and used the instructional lesson plans, discussed the specific use of the lesson plans, and standardized the design of the week's tasks, the pre-class requirements and the form of classroom organization, when to conduct what model, how to implement it, and when to release the instant test. Accordingly, the implementation of this standard was observed and any discrepancies were promptly corrected.

4.2.1 Satisfaction analysis of the implementation of MW-PBL-FC teaching model

In the satisfaction survey, in order to prevent students from not examining the questions carefully or not examining the questions, filling in the answers randomly, or selecting "very satisfied"or "satisfied"in order to complete the task and avoid offending the teacher, polygraph questions with similar meanings were included, specifically,items 7 and 10, which read, "I am typically calm under pressure." After analysis, there was no statistically significant difference, indicating that students took the questions and survey seriously. Based on this analysis, 59.23% of the students were very satisfied with the MW-PBL-FC teaching model, 33.46% were satisfied, 3.99% were basically satisfied, and 3.40% were dissatisfied, resulting in a satisfaction rate of 92.70%, indicating that the students had a favorable attitude toward the MW-PBL-FC teaching model and approved this teaching method and process, which should be promoted. Similar to the studies of Taliaferro SL(Taliaferro,S. L.,et al., 2022) and Siah CR(Siah,C. R.,et al.,2022), the satisfaction rate was higher than Ramanarayanan V(Ramanarayanan, V., et al.,2022)with 80% but slightly lower with 21% of very useful and 78% of generally useful than Ramanarayanan V(Ramanarayanan, V., et al.,2022). FollowingMW-PBL-FC instruction, the satisfaction rate and satisfaction score of the MW-PBL-FC group were greater than those of the traditional instruction group, indicating that students appreciate the MW-PBL-FC teaching model.

Students in the MW-PBL-FC group were significantly less satisfied with the "efficient use of class time" and "challenging (or innovative, pioneering, or critical thinking) issues discussed in class" than the average student. This suggests that our MW-PBL-FC teaching model is deficient in areas such as the efficient use of class time and the topics discussed in class. In order to resolve these issues, we will make enhancements to the three facets listed below:

Initially in front of the class

① Content reconstruction:On the basis of an understanding of the stage teaching objectives as a whole, we focus on the reconstruction of teaching content and the refinement of objective allocation for each lesson (Liu L.,2022);

② Practice personalized design:We design exercises of different levels based on the individual differences of students;

③Question design: When designing classroom questions, we take each student's actual learning situation into account so that students can have a positive learning experience(Li, Z., et al.,2022).

Second, during the lesson,

① Improvement of teaching methods: teaching methods are visual and adaptable, and provided materials should appeal to students;

② Full use of class time: the information transfer portion of traditional face-to-face lectures (traditional teaching) is removed and replaced with active and collaborative tasks, and students prepare for the lesson using a variety of resources that cover the content covered in the traditional classroom (Gallardo, N. E., et al.,2022).

③ Hierarchical content: the content should make it simple for the instructor to organize the lecture and facilitate student comprehension;

④ Stimulate interest: Create teaching situations and use rich language, multimedia, and other tools to pique students' curiosity;

⑤ Flexible grouping: it can be divided into whole-class group training and individual training, which can be matched with the best and the worst performers, and the top performers participate in tutoring.

Finally, teachers should analyze the gains and losses in teaching and learning after the class, defend and display the students' submission to the cloud space file as a group, and carefully review the submitted project materials or organize a defense review meeting.

4.2.2 Analysis of students' learning attitudes for the implementation of MW-PBL-FC teaching model

To prevent students from not examining the questions carefully or not examining the questions and filling in the answers randomly, we set a lie detector question with a similar meaning, i.e. item 13, which reads, "The People's Republic of China was founded on October 3", and the error rate was only 0.35% and 0.46% before and after the implementation of the teaching strategy, respectively.

After implementing the MW-PBL-FC teaching model, the percentage of students with a positive learning attitude and the total number of points increased significantly, indicating that the MW-PBL-FC teaching model can effectively improve students' learning attitudes.In addition, the following six points viz." Do you want to get excellent academic results without working hard?", " Can't you usually preview what will be taught in class the next day?", “I am not interested in studying if there are no exams.”, have improved significantly. This demonstrates that the students have fundamentally solved the problems of "diligence shown by appearance", "procrastination", "ignorance of knowledge learning", etc. In addition, it aided in their understanding of "what diligence is for", taught them the "reasonable use of time", "how to plan and implement", think independently, and not give up easily. Furthermore, they learned to "discuss with classmates" and "consult teachers". Moreover, students understood "finding answers online"; thus, they knew how to get to the bottom of the matter. Thus, the implementation of the MW-PBL-FC teaching model has effectively increased the students' motivation and interest in learning, as well as their enthusiasm and willingness to speak up in class.

4.2.3 Comparison of the performance of MW-PBL-FC teaching model implementation

The mobile learning age has arrived. Combining teaching methods with Internet platforms to increase students' interest in courses, maximize time outside of class, and enhance teaching effectiveness is an effective way to address teaching issues.

This study demonstrated that the MW-PBL-FC instructional model significantly improved learning outcomes in BMB courses and enhanced learning outcomes effectively. This is consistent with the findings of similar studies conducted previously(Chen, Y., et al.,2022;Zhang, F., et al.,2022;Zhang, X., et al.,2023; Qutob H.,2022; Li, Z., et al.,2022;Gopalan C.,2019; Chan, M. et al.,2019). Obviously, the quality of the network, teacher-student interaction, and the instructor's power factor(Gopalan C.,2019) may also affect learning performance; however, this study does not address these variables and will be investigated in greater depth in future work.

This is the first study to apply the MW-PBL-FC online and offline hybrid teaching model to the instruction of BMB in clinical and preventative medicine. By integrating the four models and maximizing their strengths, it is more effective and beneficial than traditional teaching methods for enhancing students' abilities, mastery of the material, and academic performance.

Acknowledgments

This work was supported by Jiangsu Provincial Key Project of Educational Reform in China (No. 2021JSJG188); 2019 Jiangsu Provincial Higher Education Teaching Revolution Research Projecin China(2019JSJG509); the construction project of high-level professional group of higher vocational education in Jiangsu Provincein China(Su Jianjiao Vocational Letter [2021] No. 1).Key Project of Educational Reform in Jiangsu Vocational College of Medicine(No.Z202104).

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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No competing interests reported.

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A Practical Study on Improving the Teaching Quality of Biochemistry and Molecular Biology: A Combined Online and Offline Teaching Model of MW- PBL-FC

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Abstract

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1. Introduction And Literature Review

2. Objectives And Methods Of The Study

2.1 Research Subjects

2.2 Implementation of MW-PBL-FC teaching model

2.2.1 Building the MW Platform

2.2.2 Design project tasks

2.2.3 Flipped classroom approach.

2.3 Effectiveness evaluation

2.3.1 Student Satisfaction Survey

2.3.2 Assessment of learning attitude

2.3.3 Achievement test

2.3.4 Statistical treatment

3. Results

3.1 General information about the study subjects

3.2 Student satisfaction survey

3.3 Learning attitude assessment

3.4 Learning achievement test

4. Discussion

4.1 Advantages of MW-PBL-FC teaching model

4.2 Analysis of the effect of the implementation of MW-PBL-FC teaching model

4.2.1 Satisfaction analysis of the implementation of MW-PBL-FC teaching model

4.2.2 Analysis of students' learning attitudes for the implementation of MW-PBL-FC teaching model

4.2.3 Comparison of the performance of MW-PBL-FC teaching model implementation

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References

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