An exploration into the application of Internet plus PBL pedagogy in clinical teaching of orthopedics

doi:10.21203/rs.3.rs-4801855/v1

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Research Article

An exploration into the application of Internet plus PBL pedagogy in clinical teaching of orthopedics

https://doi.org/10.21203/rs.3.rs-4801855/v1

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Objective

To explore the effect of Internet plus problem-based learning (PBL) pedagogy in clinical teaching of orthopedics.

Method

A total of 40 orthopedic residents (junior, first-year graduate students) were selected as the research object. They were randomly divided into two groups. For group A, traditional teaching method was adopted, there were 11 males and 9 females, aged from 22 to 24 years, with an average of 23.15 years. For group B, Internet plus PBL pedagogy was adopted, there were 10 males and 10 females, aged from 22 to 24 years, with an average of 23.45 years. After the teaching, all participants were evaluated on the theoretical knowledge and practical operation of Orthopedics. At the end of the examination, all participants filled out a teaching satisfaction questionnaire.

Results

The scores of theoretical knowledge examination in group A and group B were 75.2 ± 14.3 and 79.3 ± 14.7, respectively, and the difference was statistically significant (P < 0.05). The scores of clinical practice skill examination in group A and group B were 75.4 ± 8.12 and 79.8 ± 8.07, respectively, and the difference was statistically significant (P < 0.05). Compared with group A, the questionnaire satisfaction of residents in group B was significantly higher (P < 0.05).

Conclusion

Internet plus PBL pedagogy can significantly improve the learning interest and learning efficiency of students in clinical teaching of Orthopedics, excavating students' interests and hobbies and autonomous learning ability, and effectively improving students' mastery of theoretical knowledge and skill operation, which is worthy of promotion.

Internet

Problem-Based Learning

Orthopedics

Clinical teaching

Traditional teaching method

Clinical medicine has the characteristics of large knowledge span and high difficulty of training because it involves many different fields, such as theoretical knowledge, professional skills, basic scientific research theory and technology. Therefore, much attention has been paid to how to effectively shorten the transition time from medical students to doctors and how to train excellent residents quickly[1]. Orthopedics is a complex specialty, including spinal surgery, joint surgery, trauma surgery, orthopaedic surgery, bone tumor and other sub-professional discipline. Its complex and huge knowledge content and high knowledge barriers provide difficulties for medical students to learn. This has greatly affected the development of medical students, especially for clinical graduate students. At present, the traditional teaching method still occupies a dominant position in school and hospital teaching[2]. Students' acceptance and understanding of knowledge are limited, so the effect of clinical teaching needs to be further improved.

In recent years, a problem-based learning (PBL) model[3] has been introduced into the field of medical education and has been gradually adopted by many colleges and universities in China. Different from traditional indoctrination education, in the PBL pedagogy, problem-based teaching method is used to guides students to actively explore and discuss, which is helpful to improve students' thinking ability, exploration ability and teamwork ability[4, 5]. However, the PBL pedagogy has high requirements on time and space, and the teaching content is mainly collected and summarized by teachers, so the timeliness of the content and the breadth of knowledge are limited. With the popularity of the Internet and its organic integration with the field of education[6, 7], the combination of the Internet and traditional PBL pedagogy can be effectively support and enhance the teaching results, that is, Internet plus PBL pedagogy.

“Internet plus” is an emerging conception, simply put, it is a model that combines traditional industries with modern Internet[8]. However, this is not a simple addition of the two, but the use of Internet platform and information and communication technology to deeply integrate the Internet with traditional industries and create a new development ecology. In 2015, China put forward the strategy of “Internet plus”, which was a powerful boost to develop the mobile medical technology[9].

In the Internet plus PBL pedagogy, teachers are no longer in an absolutely dominant position. They should define their own role as guides, strengthen guidance to students, highlight students' dominant position, and give full play to students' subjective initiative, so as to guide students to learn relevant knowledge independently[10]. Carry out work with the help of “Internet plus” to improve the interest and enrich the content of clinical teaching, so as to stimulate students' enthusiasm for learning and reduce the difficulty of clinical teaching[11]. In addition, the Internet plus PBL pedagogy pays more attention to the cultivation of students' practical ability. Teachers should provide students with the opportunity to practice while explaining theoretical knowledge, which can promote the students' comprehensive ability and be of great help to students' future development. Therefore, in the present article we establish the teaching platform of “Internet plus” PBL mode, and apply it in Orthopedics and compare with the traditional teaching mode, aim to explore the teaching result of Internet plus PBL pedagogy.

General data

From January 2022 to June 2023, a total of 40 orthopedic residents in Qilu Hospital of Shandong University (junior, first-year graduate students) were selected as the research object. They were randomly divided into two groups, with 20 students in each group. In group A, students receive traditional teaching, there were 11 males and 9 females, aged from 22 to 24 years, with an average of 23.15 years. In group B, students are under Internet plus PBL pedagogy, there were 10 males and 10 females, aged from 22 to 24 years, with an average of 23.45 years. After the teaching, all participants were evaluated on the theoretical knowledge and practical operation of Orthopedics. All participants signed the informed consent form.

Methods

For group A, traditional teaching method was adopted, which lasted for one month. The main teaching contents were as follows: (1) Diagnosis of common diseases in Orthopedics, including history-taking, physical examination methods, imaging reading and interpretation of laboratory examination results; (2) Classical theoretical knowledge, including classification of fractures, classification of cervical spondylosis and lumbar disc herniation and so on; (3) Anatomical structure and common surgical methods. Combined with the teaching syllabus and reference books, the theoretical knowledge and surgical procedures are taught in class or on the spot by means of graphic courseware teaching and practical operation. After the teaching, the theoretical knowledge and operational skills will be assessed. After the examination, all participants fill out a teaching satisfaction questionnaire.

For group B, Internet plus PBL pedagogy was adopted. First of all, we need to establish a PBL teaching platform based on mobile Internet: (1) Collection and compilation of related clinical case materials, which provide online resources so that students can easily access rich online resources, including e-books, academic literature, learning videos, virtual experiments and simulations, etc. (2) Construction of digital integrated teaching platform. Through interviews with relevant technical personnel, clinical teachers and participating medical students, the network medical case resources to be included in the “Internet plus PBL teaching system” were determine. (3) Integration of digital integration platform and PBL teaching mode: to construct an online medical case teaching platform based on PBL model (including but not limited to subject video, case explanation, exercise questions, virtual experiment and simulation, mutual evaluation between teachers and students, etc.). Meanwhile, the total teaching time was the same as that of the group A. The teaching process follows the classical model of “asking questions – finding information – discussing – summarizing”. Teachers raise problems through the Internet platform before class, and students learn independently and discuss and solve problems with each other through the platform. In class, students answer the questions in team, and teachers raise problems again around the key points and difficulties in a hierarchical, progressive and heuristic way. After that teachers give oriented analysis, and finally the teacher makes a summary on the whole class. After class, teachers share the teaching results through the Internet platform, push the expanded content, and students can choose the content to continue their study. The examination of theoretical knowledge and operation skills will be carried out after the end of teaching. At the end of the examination, all participants filled out a teaching satisfaction questionnaire.

Data evaluation

In this study, the teaching results were evaluated through a basic theoretical exam, a clinical practice skill exam, and satisfaction questionnaire surveys. The theoretical exam takes the form of closed-book examination according to the teaching content. Objective items are selected from the relevant questions provided by senior doctors, mainly focusing on students' mastery of knowledge. Subjective items (case analysis questions) are formulated by the Department of Orthopedics, focusing on students' systematic mastery and analysis of diseases. Finally, the teachers who do not participate in teaching score the students. The full score is 100 points, and the objective and subjective questions each account for 50% of the total score.

The assessment of clinical practice skill is divided into urinary catheterization, dressing change, surgical hand washing, wearing and removing surgical gowns and surgical disinfection, focusing on the aseptic consciousness in the operation process, with 20 points for each item, a total of 100 points, scored by the doctors in practice.

At the end of the course, all participants received a satisfaction questionnaire, which included seven aspects: learning interest, classroom atmosphere, classroom interaction degree, teacher-student communication satisfaction, knowledge mastery satisfaction, learning burden satisfaction, and learning depth satisfaction. Participants answer questions based on these items, with a maximum score of 10 and a minimum score of 1 for each question. The higher the score, the higher the student satisfaction.

statistical analysis

Statistical analyses were performed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). All continuous data are expressed as mean ± standard deviation, and the significance was evaluated by the independent-sample T test. The enumeration data were subject to the Chi-square test to compare the two groups. A p-value of < 0.05 was considered statistically significant.

The scores of theoretical knowledge examination in group A and group B were 75.2 ± 14.3 and 79.3 ± 14.7, respectively, and the difference was statistically significant (P < 0.05). The scores of clinical practice skill examination in group A and group B were 75.4 ± 8.12 and 79.8 ± 8.07, respectively, and the difference was statistically significant (P < 0.05). (Table 1). Compared with group A, the questionnaire satisfaction of residents in group B was significantly higher (P < 0.05). (Table 2)

Table 1

The theoretical knowledge and clinical practice skill of the two groups.
	Group A	Group B	T	P
Theoretical knowledge examination	75.2 ± 14.3	79.3 ± 14.7	2.70	0.008*
Clinical practice skill examination	75.4 ± 8.12	79.8 ± 8.07	2.43	0.018*
*P<0.05

Table 2

Results of satisfaction questionnaire survey.
	Group A	Group B	T	P
learning interest	5.7 ± 1.4	7.4 ± 1.1	6.21	<0.001*
classroom atmosphere	5.7 ± 1.3	7.1 ± 1.3	5.65	<0.001*
classroom interaction degree	5.3 ± 1.2	8.1 ± 1.5	7.30	<0.001*
teacher-student communication satisfaction	6.8 ± 1.2	7.5 ± 1.4	3.35	0.001*
knowledge mastery satisfaction	6.1 ± 1.8	7.9 ± 1.5	2.44	0.016*
learning burden satisfaction	6.4 ± 1.2	7.5 ± 1.5	4.23	<0.001*
learning depth satisfaction	5.8 ± 1.3	7.5 ± 1.4	5.15	<0.001*
*P<0.05

In the current society, traditional lecture teaching is still mainly adopted in hospital training of medical students[12]. However, clinical teaching has many characteristics such as wide range of knowledge, complex system, long time span and difficult combination of theory and practice, which bring great trouble to teaching work. Medical students need to cultivate strong communication skills and clinical thinking skills, which is also a problem that can not be solved by traditional teaching. The emergence of problem-oriented PBL teaching model can significantly improve the above problems. However, the current PBL teaching content is mainly collected by teachers, which is limited by traditional technical means, and its timeliness and breadth of knowledge are affected.

In recent years, with the emergence of the Internet and the explosive growth of information, the popularity of personal computers and mobile devices makes e-learning a part of higher medical education[13]. It can help medical students to obtain a large number of effective information in a limited time, actively think and summarize, and constantly obtain new information, which is convenient and efficient. With the continuous attempts of scholars in the field of education, the Internet and education began to integrate organically. Bove et al.[14] pointed out that the impact of the Internet on medical teaching is huge and inevitable. However, Vogelsang et al.[15] shows that Internet-based teaching still plays a small role in the field of medicine. In the present study, the establishment of PBL teaching model based on mobile Internet requires teachers to change their ideas, clarify the requirements of the strategy of “Internet plus” on medical education. Teachers should adhere to problem orientation and strengthen guidance to students, highlight students' dominant position, and give full play to students' subjective initiative, so as to guide students to learn relevant knowledge independently. Meanwhile, they should encourage students to change their ideas from “what I have learned” to “what I want to learn”[16]. Sun et al.[17] proposed that 3D visualization model combined with PBL teaching can improve students' learning efficiency and interest. In the present Internet plus PBL pedagogy, students can easily access a wealth of online resources, including e-books, academic literature, surgical videos, 3D virtual model and simulation operations. In addition, PBL teaching platform based on mobile Internet provide extra content that they are interested in according to their individual choices.

As far as the results are concerned, the examination results of theoretical knowledge in this study show that the mastery of theoretical knowledge in group B was significantly higher than that in group A (79.3 ± 14.7 vs 75.2 ± 14.3, respectively, P < 0.05). In the process of teaching, teachers will not blindly impart knowledge to medical students, but guide students to learn knowledge independently and actively. At the same time, because students are encouraged to consult a large number of literatures for knowledge sharing, it can increase the depth and breadth of students' learning, and help students to master specialized knowledge. Meanwhile, the examination results of clinical practice skill in this study showed that the mastery of skill operation in group B was significantly higher than that in group A (79.8 ± 8.07 vs 75.4 ± 8.12, respectively, P < 0.05). Under the Internet plus PBL pedagogy, students can not only watch the operation video, but also carry out simulation exercises on the Internet, allowing students to have room for trial and error, which greatly promotes students' mastery of skill operation. Rhodes et al.[18] proposed the importance of simulation operation in teaching, which can enhance knowledge, master skill operation and improve clinical thinking ability.

According to the results of the two groups of satisfaction questionnaires, students under the Internet plus PBL pedagogy were more satisfied with the teaching methods. From the seven aspects of learning interest, classroom atmosphere, classroom interaction degree, teacher-student communication satisfaction, knowledge mastery satisfaction, learning burden satisfaction, and learning depth satisfaction, the satisfaction of group B was higher than that of the group A. No matter theoretical knowledge or skill operation, Internet plus PBL pedagogy can provide a platform where can simulate the medical scene, allowing students to solve problems independently like surgeons. In addition, Internet plus PBL pedagogy encourages students to consult relevant specialized knowledge independently in their spare time so as to expand the breadth and depth of knowledge. Through the change from passive acceptance to active acquisition of knowledge, students' interest in learning has been significantly improved. Finally, Internet plus PBL pedagogy continues to provide content that students are interested in learning according to their individual choices, so that students have a clear understanding of their own interest direction and independently explore more professional knowledge.

Author Contribution

The conception and design of the work were completed by XYL and LLW. Data collection, analysis, and writing were conducted by SW. XLH and ZQZ made substantial revisions to the initial draft. All authors have approved the submitted version and agree to take personal responsibility for their own contributions to ensure the accuracy or completeness of the work.

Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose.

Ethics approval: This study was approved by the ethics committee of Qilu Hospital of Shandong University [KYLL-2021(KS)-055]. All methods were carried out in accordance with relevant guidelines and regulations.

Consent to participate: This study assessed participants using a developed scale, questionnaire, and evaluation of their functional capabilities. The scoring process was anonymous and solely utilized for the purposes of this study, with all information anonymized. There is no concern about identifying information in the submission.

Consent for publication: All participants in this study have obtained consent. The authors agree to publication. This manuscript has not been published in any journals.

Acknowledgement

We would like to express our gratitude to all the students who participated in this study, as well as to the healthcare workers who assessed them.

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No competing interests reported.

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An exploration into the application of Internet plus PBL pedagogy in clinical teaching of orthopedics

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Abstract

Objective

Method

Results

Conclusion

Introduction

Materials and Methods

General data

Methods

Data evaluation

statistical analysis

Results

Discussion

Conclusion

Declarations

Author Contribution

References

Additional Declarations

Status:

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