Medical education aims to cultivate physicians who contribute to the overall health of the population, making it a top priority both domestically and internationally. Medicine is a highly practical discipline, requiring students to possess the ability to identify and solve problems. The acquisition of clinical skills by medical students is an essential part of medical education. Clinical skills training is an effective means of acquiring these skills, and the quality of such training plays a crucial role in the future clinical practice of medical students [14]. Clinical practice skills training for medical students can further consolidate the medical knowledge learned in the classroom, help to transform the role of students to doctors, and comprehensively cultivate the independent thinking ability and clinical thinking ability of medical students[1].
The selection of appropriate training methods is very important to improve the clinical skills of medical students, and the student’s demand for clinical practice skills teaching is also increasing[6].Innovative teaching methods, such as problem-basedl earning (PBL) and simulation-based teaching [2, 15], are used in clinical practice teaching. Gong J et al applied team-based learning (TBL) to the bedside clinical practice teaching of pediatrics of traditional Chinese medicine, which not only improved the clinical practice skills of medical students, but also improved the clinical thinking and consulting abilities of medical students [14]. In our study, both groups of medical students underwent intensive pre-internship training and received training in "General Surgery Operations" before the practice, and pre-training assessments were conducted to evaluate both theoretical and practical competencies. In the assessment of operation steps, fluency and clarity of thought, the number of students who did not meet the standards was large. It was observed that traditional teaching methods faced challenges such as students' lack of proficiency in operational steps, lack of fluency in procedures, and unclear overall understanding, hindering their mastery of practical skills. Hence, there is a pressing need to design better and more efficient teaching methods [9]. To address the aforementioned challenges, we propose a segmented teaching approach. This method involves breaking down theoretical knowledge and practical steps into stages, followed by practice training in debridement and suturing. This approach effectively addresses issues such as lack of proficiency in operational steps, procedural fluency, and overall clarity of understanding, good training effect can be achieved.
The segmented teaching method can be used in the teaching of other subjects: Huang P and other scholars combined the targeted teaching method and the stepped assessment method in the open tennis class of colleges and universities, which can improve the basic tennis skills of students, as well as their learning interest and motivation [16]. Wong H M et al. proposed a phased teaching ward round and pointed out that an effective bedside teaching ward round should be divided into three stages: preparation, teaching and evaluation [17]. Some scholars also pointed out that four-stage teaching is used in practical skill teaching, which divides the skill teaching process into four stages: demonstration, deconstruction, conception and performance. However, it is too complicated, cost-effective and time-efficient [18]. We simplified it into three stages: before operation, during operation and after operation, which were easy to understand and implement. We applied it to clinical practice skills training for the first time. It has the characteristics of strong pertinence, prominent focus, concentrated on key problems, and students are good at understanding and mastering. Firstly, the content and knowledge points involved in the operation in the textbook are divided into three stages: before operation, during operation and after operation. When teaching the theory to medical students, the relevant knowledge points are taught by stages, which is easy for students to grasp. The time of operation practice was recorded in each stage, and the comments were made for the three stages before, during and after the operation to find the weak stage in the three stages, so as to repeat and strengthen the training in the corresponding stage. It is helpful to cultivate medical students' ability of active learning, long-term memory, analysis and inductive thinking, enhance their understanding of theoretical and operational knowledge, promote students' initiative and participation, and promote their reflection and understanding of knowledge.
The operation of "debridement and suturing" needs to go through the steps of cleaning, cleaning and suture, and the process is relatively fixed. It needs to carry out the basic surgical operations such as inserting sterile items, disinfection, laying a sterile sheet, anesthesia and surgical suture. It is a relatively common and typical surgical operation project, which can well represent the surgical operation project, and is also a medical practice skill that needs to be mastered in clinical practice. Therefore, we first used the segmented teaching method to train medical students in clinical practice skills in the operation project of "debridement and suturing". In addition, "debridement and suture" is usually performed by emergency surgeons, orthopedic surgeons and other surgeons, so this training task is performed by clinical orthopedic surgeons with senior teaching experience. There was no significant difference in the scores of the teaching quality assessment scale for teachers and training content between the two groups (P > 0.05), indicating that the two groups received the same teaching resources, including textbooks, teachers, class hours and theoretical and operational examination questions, which were comparable.
In this study, the scores of "debridement and suture" in the experimental group were higher than those in the control group, and the difference was statistically significant (P < 0.05), indicating that the segmented method in clinical practice skills training is easier for medical students to understand and master the relevant skills, and the training effect is better. However, because the difficulties of debridement and suture mainly involved in the operation part, there was no significant difference in the theoretical examination scores between the two groups before and after the training (P > 0.05), and there was no significant difference in the theoretical examination scores between the two groups after the training (P > 0.05). At the same time, Mini-cex is introduced into clinical teaching evaluation as a formative evaluation tool, which can give feedback on students' performance in clinical practice and ultimately promote and develop their clinical skills[11].In terms of Mini-cex score, the score of Mini-cex in the experimental group was higher than that in the control group in the six aspects of history collection, physical examination, professional quality, doctor-patient communication, organizational effectiveness and comprehensive ability, and the differences were statistically significant (P < 0.05), indicating that the segmented teaching method in clinical practice skills training can make the overall process of operation more fluent and more skilled. The operation assessment mainly involved the overall operation process and operation proficiency, and involved relatively little clinical thinking. Therefore, there was no statistically significant difference in the scores of Mini-cex in the aspect of clinical judgment between the two groups (P > 0.05).
However, our study has several limitations, such as a small sample size, single-center design, and the exclusion of internal medicine procedures. Future research should consider these limitations and further explore the impact of segmented teaching methods on subjective outcomes such as students' confidence, attitudes, and communication skills.