Medical educational institutions perpetually engage in the exploration of pioneering pedagogical approaches to augment learning outcomes. Amidst an array of lesson planning tools and theories, numerous nascent teaching strategies and models have garnered significant attention in recent times, each presenting distinct methodologies to captivate students and foster efficacious learning encounters. Within the domain of lesson planning, it is of utmost importance to contemplate alternative tools and theories to cater to the heterogeneous needs of students and accommodate diverse teaching-learning modalities27,28. For example, traditional instructional design frameworks may lack specific models, while BOPPPS emphasizes a comprehensive teaching framework with a focus on student engagement. Additionally, Understanding by Design (UbD) emphasizes goal setting, assessment, and planning learning experiences, while the Madeline Hunter Lesson Cycle focuses on teaching sequence and steps, including anticipation and practice. Furthermore, the 5E model guides students through exploration and experimentation to understand new concepts, whereas the Direct Instruction model emphasizes imparting knowledge through direct teaching, monitoring, and adjusting learning processes. These different teaching frameworks each have their unique theoretical foundations, such as cognitive and behaviorist theories, and constructivist theory, among others. These teaching strategies provide diversity and flexibility in education, fostering student engagement, practical application, and deep comprehension. Table 4 presents a comparative analysis outlining the fundamental characteristics of these teaching strategies and designs. The primary aim of this comparative table is to provide educators with a comprehensive overview of diverse teaching strategies, empowering them to make informed decisions tailored to their specific teaching-learning context and educational objectives. While each strategy offers its unique merits, educators have the autonomy to choose and integrate them according to their individual pedagogical preferences and the requirements of their students.
BOPPPS stands out with its holistic framework, emphasizing comprehensive teaching. It has garnered widespread attention and recognition, as an all-encompassing framework that caters to diverse aspects of the teaching-learning process. Because BOPPPS teaching has so many features and advantages, we have a great deal of interest in BOPPPS teaching. We also created and developed BOPPPS teaching that we believe is suitable for Chinese medical students in our teaching. Table 5 shows our interpretation and exploration of BOPPPS teaching for medical education. There was A paper demonstrated that the BOPPPS teaching strategy is more effective than traditional teaching in medical education among Chinese medical 29, However, it is important to note that this paper has a limited scope and focuses on a specific population, and the incorporation of literature with lower standards into the study raised concerns about the overall quality and reliability of the included sources. Therefore, our research aims to investigate the effectiveness of the BOPPPS teaching strategy in medical education on a global scale, encompassing a broader range of students from various countries and cultural backgrounds with elevated inclusion standards.
In this systematic review, we examined international studies on the implementation of BOPPPS in medical education. Our findings indicated a significant improvement in the final examination scores of medical students, including nursing students when BOPPPS was employed. This improvement suggests that BOPPPS aids students in comprehending and applying knowledge more effectively during classroom learning, ultimately resulting in enhanced academic performance. Such improvement is pivotal for nurturing the clinical knowledge and skills of medical students, which are essential for their future roles as healthcare professionals. Another noteworthy outcome was the increase in student satisfaction. Most of the reviewed studies indicated that students favored BOPPPS teaching and reported higher satisfaction levels when compared to traditional teaching. This finding suggests that BOPPPS not only improves academic performance but also enhances student engagement and interest, ultimately leading to increased satisfaction. This is particularly significant in maintaining student motivation and interest, especially in challenging medical courses. Our review also revealed improvements in classroom interaction. Through the adoption of BOPPPS teaching, there was an increased level of interaction among students and between students and teachers. This heightened interaction is critical for promoting collaboration, communication, and engagement among students, contributing to the establishment of a more positive and cooperative learning environment. Such interaction can simulate future clinical environments, fostering effective communication and collaboration with patients and colleagues, a crucial skill for medical professionals. Furthermore, we observed enhancements in learning initiatives. Students exhibited higher levels of initiative in BOPPPS-modeled classrooms and were more willing to actively participate in the learning process. This reflects the success of BOPPPS in encouraging students to take an active role in mastering knowledge, rather than passively receiving information. Such learning initiative is vital for the long-term learning and professional development of medical students.
However, BOPPPS did not show significant improvements in problem-solving skills and critical thinking skills. There could be several potential reasons behind this observation. Firstly, the nature of BOPPPS, which focuses on a structured and holistic approach to teaching, may prioritize the delivery of content and student engagement over explicitly targeting problem-solving and critical thinking skills. The emphasis on clear learning objectives and predefined activities might not inherently stimulate the development of these higher-order cognitive skills. Secondly, the evaluation criteria used in the studies might not have adequately captured the nuances of problem-solving and critical thinking. If the assessment tools primarily measured factual recall or lower-order cognitive skills, it might not have effectively reflected the impact of BOPPPS on more complex cognitive processes. Additionally, the timeframe of the studies might play a role. Developing problem-solving and critical thinking skills is a gradual process that may require sustained exposure to the teaching strategy over an extended period. Short-term studies may not capture the long-term impact of these skills. Cultural and contextual factors could also contribute to the observed outcomes. The applicability and effectiveness of teaching can vary across different educational settings, and BOPPPS may interact differently with the existing educational culture and expectations in various regions. Lastly, the findings might underscore the importance of incorporating specific approaches or interventions explicitly designed to enhance problem-solving and critical thinking skills within the BOPPPS framework. It could be beneficial for educators using BOPPPS to integrate targeted activities or assessments that explicitly aim at fostering these skills.
It is important to note that the outcomes of classroom interaction and self-study ability varied depending on the use of continuous or categorical variables, which may be attributed to the limited sample size in some studies. In studies where sample sizes were constrained, the impact on statistical power becomes a pertinent consideration. Smaller samples may lead to increased variability, making it challenging to draw definitive conclusions. This emphasizes the need for future research endeavors to strive for larger and more diverse samples, ensuring the robustness and generalizability of findings.
Overall, the study comparing the BOPPPS teaching strategy with traditional teaching yielded a positive conclusion. There are several reasons why BOPPPS is considered superior to traditional teaching strategies. First and foremost, traditional medical theory instruction often relies on cramming teaching, lacking clearly defined teaching objectives. Consequently, students may struggle to comprehend the learning objectives, leaving them without specific learning targets or a clear direction. In contrast, BOPPPS places students at the center of the classroom teaching process. This approach enables teachers to better understand students' learning needs, leading to well-defined teaching objectives. Importantly, students can identify their own learning goals within BOPPPS, which provides direction and motivation, empowering them to become active participants in their learning journey. Teachers optimize the teaching mode by setting reasonable and effective teaching goals. Activities like pre- and post-tests allow for careful selection and tailoring of the teaching and learning content. Consequently, BOPPPS offers students clear teaching objectives and encourages active engagement, resulting in significant improvements in teaching effectiveness. Secondly, traditional teaching strategies often involve teachers delivering lectures while students passively receive information, characterized by rote learning and knowledge transfer. In contrast, BOPPPS places students at the forefront of the classroom, facilitating communication and discussion among peers and providing students with an active role in the learning process. Medical teaching teachers assume a guiding role, offering support and guidance throughout students' learning journey. This approach fosters increased peer-to-peer interaction, encourages active identification, and stimulates critical thinking among students. Consequently, students' independent learning abilities and their understanding of clinical knowledge are greatly enhanced. The application of BOPPPS cultivates students' autonomy and self-study skills, thereby fostering their learning thinking, enthusiasm, and initiative, all of which are valuable in their future professional contexts. Thirdly, the BOPPPS places strong emphasis on student-teacher interaction, requiring teachers to possess advanced teaching abilities, rooted in a solid foundation of medical teaching skills and relevant theoretical knowledge. Teachers are expected to promptly address student learning issues and actively engage with students. Consequently, teachers' teaching abilities are greatly improved, allowing them to achieve the desired medical practice teaching objectives more effectively.
It is imperative to recognize certain constraints in our review. Firstly, the studies incorporated in our analysis displayed heterogeneity in terms of their study design, sample sizes, and implementation methods, potentially leading to discrepancies in the findings. Moreover, we did not conduct a formal evaluation of publication bias, and this choice was influenced by several factors. Firstly, our search strategy was meticulously devised to ensure comprehensiveness, encompassing various databases, gray literature, and a wide range of study designs. As a result of this approach, we sought to minimize the risk of publication bias by gathering all types of research irrespective of their publication status, to minimize the risk of publication bias. Moreover, the consistent findings across the included studies, combined with the absence of a discernible pattern favoring positive or statistically significant outcomes, instilled confidence that publication bias may have had a limited impact on the overarching conclusions. The inclusion of diverse study designs and participant characteristics in our synthesis has contributed to the robustness of our findings. Although a formal evaluation of publication bias is an important aspect of systematic reviews, we assert that the comprehensive nature of our search strategy enhances the reliability of our results. In examining the studies on BOPPPS teaching strategy, a prominent trend emerges, showcasing a predominant focus on Chinese educational contexts within the period from 2018 to 2022, as outlined in Table 2. This observation prompts an intriguing exploration into the geographic concentration of these studies. Why is there such a pronounced prevalence of research in China, and does BOPPPS have roots inherently tied to Chinese educational practices? We think this is because Chinese educators may face distinct challenges and performance indicators, possibly prompting a heightened focus on innovative teaching strategies such as BOPPPS. In recognizing these constraints, we aim for transparency in our study's operational boundaries. Additionally, we acknowledge this as a limitation and urge future research to investigate the efficacy of BOPPPS teaching strategy in medical education within various international contexts, while considering the potential influence of publication bias. Although most of the research on BOPPPS teaching strategy has been conducted in Chinese educational contexts, medical education holds global significance. The fundamental principles and teaching methodologies in medicine share similarities across different countries and regions. Therefore, while these studies are primarily focused on China, their findings and the effectiveness of the teaching strategy may have implications for medical education in other countries and regions.
The BOPPPS teaching strategy demonstrates significant potential in medical education, enhancing academic performance, student satisfaction, classroom interaction, and learning initiative. These findings offer robust support for medical education but require additional research to further confirm and expand these results, including the application of BOPPPS in diverse cultural and environmental contexts. Additionally, future research should employ robust methods with adequate sample sizes and scientific approaches to gather evidence on the effectiveness of the BOPPPS teaching strategy in enhancing classroom interaction, problem-solving skills, and critical thinking abilities.