Integrating Design Thinking into Basic Medical Innovation Projects: A Qualitative Study from the Perspective of Clinical Medicine Undergraduates

doi:10.21203/rs.3.rs-4857423/v1

Download PDF

Research Article

Integrating Design Thinking into Basic Medical Innovation Projects: A Qualitative Study from the Perspective of Clinical Medicine Undergraduates

https://doi.org/10.21203/rs.3.rs-4857423/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

In the reform of medical education, innovative teaching methods are increasingly valued. Integrating design thinking (DT) into basic medical courses is seen as a key approach to fostering students' innovation and practical skills. The "Creative Histology and Embryology Learning Skills Expansion Competition," an interdisciplinary project, aims to explore new teaching models, promote comprehensive student development, and provide a practical example for innovative basic medical education. This study used qualitative research methods to conduct interviews with 15 award-winning students, gathering their learning experiences and feedback. We applied grounded theory to analyze the interview data through three levels of coding (open coding, axial coding, and selective coding) to reveal how DT integration in basic medical courses impacts students' innovation awareness and abilities. Open coding clearly identified the primary experiences and feelings of the students. Axial coding grouped these experiences into key themes, and selective coding developed a theoretical framework to explain these experiences and feelings. The three-level coding revealed that clinical undergraduates participating in the interdisciplinary competition had rich experiences and profound insights, particularly in terms of motivation, preparation, collaboration, and gains. DT is an effective tool for improving medical education, particularly in histology and embryology courses. It significantly enhances students' innovation awareness and abilities. This finding confirmed the effectiveness of DT in medical education and supported the transformation of basic medical education models. Future medical education practices should emphasize the integration of DT to cultivate students with innovation and practical skills. This will promote the reform and development of medical education.

Design Thinking

Histology and Embryology

Learning Experience

Medical Education

Innovation Capacity Development

High-quality teaching in basic medical courses is the cornerstone of undergraduate clinical medicine education (Tie et al., 2024), It directly affects students' grasp of theoretical knowledge and profoundly impacts their future clinical practice and research capabilities (Krishnappa et al., 2023). As higher medical education reform progresses, educators and teaching researchers increasingly recognize the need to focus on cultivating students' practical skills, innovative thinking, and humanistic qualities(Guo, 2010; Li & Zhou, 2018; Qiao et al., 2023). Traditional lecture-based teaching methods are no longer fit for purpose in modern medical education. Consequently, many research teams have proactively sought to enhance talent cultivation by innovating in course design, teaching methods, and the integration of basic and clinical courses (Kim, 2020; Si, 2020; Yu, 2024; Zhang & Ma, 2023). Although these attempts have achieved some success, they still struggle to meet the demand for medical professionals with comprehensive innovative spirits and strong adaptability. Against this background, our research team delved into the application and effects of DT in interdisciplinary teaching of basic medical courses, aiming to provide valuable insights for innovation and development in clinical medical education.

To achieve this goal, we focus on the DT concept. Initially prominent in the business sector, DT is a unique, human-centered, systematic approach known for its disruptive problem-solving capabilities (van Velzen et al., 2024; Wolcott et al., 2021). In recent years, DT has been widely and deeply applied in guiding educational innovation, especially in project-based teaching, and has achieved considerable theoretical development (McLaughlin et al., 2022; Skywark et al., 2021). Applying DT in teaching means that teachers, as "designers," must start from the real needs of student "users," (Badwan et al., 2018), define specific problems, design courses and solutions (Smith & Nigro, 2023), and continuously optimize through iteration and feedback to achieve the best possible outcomes (Schaller et al., 2023). Our analysis of the training needs of clinical medicine undergraduates at applied universities had led us to conclude that DT can and should be integrated into all learning stages of basic and clinical medical courses as an educational philosophy. It can also provide specific, innovative steps and tools throughout these courses(Guo et al., 2024; McLaughlin et al., 2022; van Velzen et al., 2024), aligning perfectly with the current outcome-oriented mainstream teaching philosophy (Kondo et al., 2022; Li et al., 2023).

It is crucial for undergraduate education in clinical medicine to explore histology and embryology in depth (Guo et al., 2024; Hortsch, 2023; Tauber et al., 2021). Together with systematic anatomy, this course builds an important foundation of medical knowledge and hold a significant place in all undergraduate medical education (Cheng et al., 2021), It lays a solid foundation for subsequent studies in physiology, pathology, and clinical practice in internal medicine, obstetrics, and pediatrics (Hortsch et al., 2023; Lu et al., 2023). However, limited course hours and large class sizes (usually up to 200 students/classroom) constrain the teaching approach, necessitating a predominantly lecture-based method despite the student-centered teaching philosophy. This status quo has led to “habitual discomfort” such as students' lack of interest in learning, low classroom engagement and low learning satisfaction (Eng-Tat et al., 2023), which in turn affects the degree of achievement of the established teaching objectives and students' sense of achievement (Dennis & Creamer, 2023). Therefore, this course urgently needs reform and innovation, making it an important platform for our study.

The Jining Medical University DT Teaching Innovation Team and the Histology and Embryology Teaching Research Team jointly planned the Creative Histology and Embryology Learning Skills Expansion Competition (Creative H&E). This was an interdisciplinary extracurricular project for first-year undergraduates in clinical medicine, psychiatry, medical imaging and other medical specialties. This competition has been held for three consecutive years, with this year's theme being " Creative H&E Textbook play."(https://jcxy.jnmc.edu.cn/2024/0527/c233a157918/page.htm). The project consists of three stages: preliminary round—creative script writing; semifinal—creative scenario video shooting; final—live "Creative Histology" stage play (script murder) presentation. Each stage's content aligns precisely with the course's teaching schedule, as shown in Fig. 1. In the first stage, students learned basic DT knowledge in groups and practiced these steps through two assignments (filling out an empathy map and creating a pain point solution). From the preliminary round onwards, students were fully engaged in the project, confidently using DT methods to complete the script writing, video shooting, and live presentation stages. Students followed the DT steps meticulously, rigorously testing and iteratively optimizing each work (Liu, 2023; van Velzen et al., 2024). Throughout this process, feedback from instructors and other students provided valuable insights, helping students identify issues and propose specific improvements, significantly enhancing learning outcomes and project performance. (Badwan et al., 2018; Holt et al., 2022; Schaller et al., 2023). The final competition of this year's "Creative H&E " showcased 10 winning entries, including "The Mystery of the Epithelium," through serialized videos in news media.

To scientifically assess the actual impact of the interdisciplinary " Creative H&E " project, we employed qualitative research methods to delve into students' learning experiences. From the perspective of award-winning students, we meticulously analyzed their feedback to comprehensively understand the practical application of this innovative teaching method. Through such research, our aim was continuous refinement of teaching methods to ensure their effectiveness and feasibility in practical education. We firmly believe that this study not only strengthens the improvement of DT in teaching methods but also offers valuable insights and references for research into other innovative teaching approaches, thereby advancing continuous innovation and development in medical education.

Study design

This study employed qualitative research methods, focusing on three-level coding (open coding, axial coding, selective coding) to analyze in-depth the learning experiences of clinical undergraduate students participating in the histology and embryology creative competition.

Participants

The participants in this study were 15 clinical undergraduate students from Jining Medical University's College of Basic Medicine. They won first prize in the "Creative H&E" competition. The participants volunteered and represented the group of students who excelled in the competition.

Interview Content and Methods

To gain deeper insights into the experiences of these award-winning students during the competition, we employed a semi-structured interview approach. The interview covered six themes: motivation and preparation for the competition, creative background and process of the award-winning works, design and implementation of the award-winning works, team collaboration and communication during the project participation, competition experience and gains, and feedback and suggestions on the competition. This aimed to comprehensively explore students' learning experiences.

Interview Outline Draft

The interview outline draft was designed using Sojump, an online questionnaire platform. It was also reviewed by relevant experts from the Institute of Medical Education at Peking University and Beijing Normal University (Supplementary material 1).

Data collection

All interviews were conducted in the Histology and Embryology Laboratory of College of Basic Medicine, Jining Medical University. Before the interviews, each participant thoroughly read and understood the "Informed Consent Form for Undergraduate Participation in the Creative Histology and Embryology Project Learning Experience Interviews," clarifying the purpose, content, and potential risks and benefits of the interviews. We emphasized that interview results would not affect their course grades, and participants had the right to withdraw at any time to ensure they could provide candid feedback.

The interviews were conducted by three members of DT innovation team who had no teaching duties and no vested interests in the participants, ensuring fairness and impartiality. Each interview lasted between 40 to 60 minutes. With participants' permission, we recorded the interviews and meticulously documented each participant's responses. Audio recordings were used exclusively for research purposes and were not shared with third parties. Before data analysis, all participants and researchers verified the accuracy of interview transcripts to ensure data authenticity and reliability.

Data analysis

Nvivo12 Pro software was used to analyze interview data using a three-level coding method: open coding, axial coding, and selective coding. In the open coding phase, multiple initial concepts reflecting students' specific experiences and feelings during the activity were identified through detailed text analysis. During axial coding, initial concepts were categorized and integrated based on their inherent logical relationships, forming multiple subcategories and main categories. In the selective coding phase, core categories such as motivation and preparation, background and process, design and implementation, collaboration and communication, experience and gains, and feedback and suggestions were identified from axial coding results. Subsequently, relationships between these core categories were explored.

Open Coding Stage

The open coding stage identified numerous initial concepts, forming the foundation for subsequent categorization and integration. Table 1 presents initial concepts extracted through open coding, derived from a line-by-line analysis of interview transcripts. Through qualitative research on clinical undergraduate students' participation in the Creative H&E Textbook play, initial concepts were extracted using open coding. This included participation motivation, preparation of knowledge and skills before the competition, challenges in team formation and division of labor, sources of creativity, methods of discussion, production processes, and the artistic significance, etc. In terms of design and implementation, students faced technical difficulties such as video music editing, and demonstrated through their work how easy it is to understand textbook knowledge and how the body reacts to drug use. In terms of collaboration and communication, emphasis was placed on calm and patient communication, clear role definition, and adjustments during teamwork. Regarding experience and gains, students enriched their experiences, enhanced their skills, and continuously refined their performances under teachers' guidance. In the feedback and suggestions section, students expressed satisfaction with the fairness of the competition mechanism and hoped for more similar activities to enrich their lives and enhance their capabilities. The extraction of these initial concepts laid the groundwork for further analysis and theoretical construction in the study.

Table 2 displays subcategories extracted during the open coding stage along with their corresponding initial concepts. Through open coding, initial concepts were categorized into subcategories, revealing the primary experiences of clinical undergraduate students in the Creative H&E Textbook play. Before the competition, students' motivation and preparation included enriching personal lives and enhancing their course learning outcomes. They prepared all the knowledge, skills, materials and planned their time. During the competition, design and implementation covered clear understanding of textbook knowledge, technical challenges in video and music editing, insights into values during activities, concise and understandable presentations (PPT), rich and engaging performances, and depictions of reactions to drug use and the creativity of the body's cells. Collaboration and communication emphasized within teams involved calm and patient communication, clear role delineation, adjustments in mindset and capabilities as collaborative challenges, and mutual understanding and empathy among team members. Post-competition experience and gains encompassed enriched experiences, enhanced capabilities, utilization of DT methods, guidance from teachers, improvements in costume and movement design, and continuous optimization of performance during rehearsals. In feedback and suggestions, students expressed satisfaction with the fairness of the competition mechanism and expressed a desire for more similar activities to enrich their lives and enhance their capabilities. The organization of these subcategories provided a structured framework for further analysis and theoretical construction.

Table 1

Initial Concept
Interview transcripts	Initial Concept
I chose to participate in the creative histology and embryology competition because it not only enriches my personal life experiences but also enhances me to learn outcomes in this course.	Participation Motivation
During the preparation for the competition, we made certain preparations, such as knowledge preparation, skill preparation, material preparation, and effective time management.	Preparation Tasks
Team formation was relatively easy because we had already been divided into groups in the Histology and embryology class.	Team Formation
Within teamwork, reasonable division of labor was very necessary to save time and improve our work efficiency.	Division of Labor
Our creativity was inspired by watching videos about life from different perspectives.	Source of Creativity
For example, since our team has fewer members, it was challenging to assign roles.	Conceptual Challenges
Our team usually gathers in the dormitory or classroom for meetings to discuss our ideas.	Discussion Methods
We first found inspiration through videos, then created the script, determine the roles, and finally perform it; the impact on the team was very positive.	Production Processes
This winning moment reflects the spirit of unity and cooperation.	Artistic Significance
It was essential to include textbook knowledge in a way that is easy to understand.	Element Characteristics
Finding videos and music and doing the editing was quite difficult.	Design Difficulties
The elements that can enlighten the audience were cherishing life and staying away from drugs.	Gains and Improvements
The production of a concise and easy-to-understand PPT combined with the stage, with actors' expressions that were rich and interesting, was more engaging for the audience.	Advantages Demonstrated
It was reflected in presenting, scene by scene, the reactions of a person after using drugs and the reactions of the cells in their body.	Work Creativity
Communicating calmly and patiently.	Communication Methods
I played the role of a drug user and cocaine, which can be said to be the main character; my role was to rhythmically lead everyone to complete the whole work together.	Role Clarity
There were’t any significant challenges; it was mainly about adjusting my mindset and abilities.	Collaborative Challenges
Everyone needs to be understanding and considerate of each other and cannot act unilaterally.	Personal Competencies
Our insights enriched our experiences and enhanced our abilities.	Insights Gained
Our team used design thinking methods, such as brainstorming, to discuss and choose the best methods together.	Application Methods
The teacher has been providing us with help, assisting us in a deep understanding of our theme and helping us perform our characteristics more completely.	Guidance Received
Improvements can be made in costumes to enhance unity and professionalism.	Improvement Experiences
During rehearsals, we found that the movements lacked expressiveness, so I redesigned the actions and added props. This reminds us to continuously discover and solve problems	Optimized Presentations
I think there aren't any major issues; the competition mechanism is very fair and just.	Improvement Standards
I will continue to participate in such activities because they enrich my life and enhance my abilities.	Planning Direction
In terms of learning and work, I have learned to be diligent and serious in everything, not to waste a drop of sweat. I hope more of these activities can be held and allow more classmates to participate.	Application Outlook

Table 2

Open coding
ID	Subcategory	Initial Concepts (Quantity)
A1	Before the competition	Motivation and Preparation, Background and Process (2)
A2	During the competition	Design and Implementation, Collaboration and Communication (2)
A3	Post-competition	Experience and Gains, Feedback and Suggestions (2)

Axial Coding Stage

During the phase of axial coding, initial concepts were classified and integrated based on their inherent logical relationships, forming multiple subcategories and main categories. These subcategories and main categories enable a more systematic understanding of students' learning experiences and provided a structured framework for further analysis. Table 3 presented the main categories and corresponding subcategories extracted through axial coding. It revealed the primary experiences and relationships of undergraduate clinical students in the process of learning through Creative H&E Textbook play. In the Motivation and Preparation (B1) main category, it covered four subcategories: participation motivation, preparation tasks, team formation, and division of labor. Student motivations for participating in activities included enriching personal life experiences and enhancing learning outcomes. Preparation tasks involved acquiring knowledge, skills, and materials before competitions, along with effective time management. In the Background and Process (B2) main category, five subcategories included sources of creativity, discussion methods, conceptual challenges, production processes, and artistic significance. Students derived creative inspiration from external videos, emphasized teamwork in their discussion methods, faced challenges in role allocation during conceptualization, showcased the process from inspiration to script creation and enactment during production, and highlighted the significance of teamwork and collaborative achievements in their works.

In the main category of design and implementation (B3), the subcategories included element characteristics, design difficulties, gains and improvements, advantages demonstrated, and work creativity. Students made textbook knowledge easy to understand through design, but also faced technical difficulties in video music editing. They gained values such as cherishing life through improvements and showcased the creativity and advantages of their work during the performance. The main category of collaboration and communication (B4) encompassed communication methods, role clarity, collaborative challenges, and personal competencies. It underscored the importance of patient, calm communication, clear role definitions, challenges in collaboration, and mutual understanding among team members. Within the main category of experience and gains (B5), there were five subcategories: insights gained, application methods, guidance received, improvement experiences, and optimized presentations. Students enriched their experiences and enhanced their abilities through activities. They applied design thinking methods and continuously improved their costume and movement designs under the guidance of their teachers, optimizing the presentation effects. Finally, the main category of feedback and suggestions (B6) included improvement standards, planning directions, and application outlook. Students expressed satisfaction with the fairness of the competition mechanism and hoped to continue participating in and having more similar activities to enrich their lives and enhance their abilities. Through the integration of these main categories and subcategories, the research provided a structured framework for further analysis and theoretical construction.

Table 3

Axial Coding
ID	Main Category	Subcategory (Quantity)
B1	Motivation and Preparation	Participation Motivation, Preparation Tasks, Team Formation, Division of Labor (4)
B2	Background and Process	Source of Creativity, Discussion Method, Conceptual Challenges, Production Process, Artistic Significance (5)
B3	Design and Implementation	Element Characteristics, Design Difficulties, Gains and Improvements, Advantages Demonstrated, Work Creativity (5)
B4	Collaboration and Communication	Communication Methods, Role Clarity, Collaborative Challenges, Personal Qualities (4)
B5	Experience and Gains	Insights Gained, Application Methods, Usage Methods, Guidance Received, Improvement Experiences, Optimizad Presentation (5)
B6	Feedback and Suggestions	Improvement Standards, Planning Direction, Application Outlook (3)

Selective Coding Stage

During the selective encoding phase, core categories such as motivation and preparation, background and processes, design and implementation, collaboration and communication, experience and gains, and feedback and suggestions were identified from the results of axial coding. Subsequently, the relationships between these core categories were explored.

Table 4 illustrated typical relationship structures and their implications extracted through selective encoding. This phase of encoding identified core categories and elucidated their relationships with other categories, constructing a logically coherent theoretical model. It systematically revealed the complex experiences of undergraduate clinical students during their learning process in creative embryo courses. Firstly, motivation and preparation (C1-C4) serve as the premise and foundation for student participation in activities, providing psychological and emotional motivation for preparation tasks, team formation, and division of labor. Meanwhile, background and processes (C5-C9) accumulate rich experiences and knowledge for sources of creativity, discussion methods, conceptual challenges, production processes, and artistic significance. This fosters the generation and development of innovative thinking. Design and implementation (C10-C14) demonstrated the characteristics of elements through concrete application and practice, allowing their functional and aesthetic values to be highlighted. By addressing design challenges and continuously refining design solutions, the unique advantages of the design were fully showcased and utilized. Collaboration and communication (C15-C18) ensured accurate information transmission and mutual understanding. By defining role assignments and addressing collaboration challenges, it enhanced understanding and collaboration among team members, thereby improving efficiency and effectiveness of teamwork. Experience and gains (C19-C23) brought profound insights and cognitive enhancements to students through practical experiences. They provided valuable feedback for optimization and improvement. Lastly, feedback and suggestions (C24-C26) provided crucial references and guidance for developing and refining improvement standards, adjusting planning directions, and envisioning future applications, ensuring that plans were more rational and effective. Through the relationships among these core categories, this study provided a comprehensive explanatory framework and valuable insights for further educational improvements and student development.

Table 4

Selective coding
ID	Typical Relationship Structure	Connotation of the Typical Relationship Structure
C1	Motivation and Preparation → Participation Motivation	Motivation and preparation is the premise and foundation for participation motivation.
C2	Motivation and Preparation → Preparation Tasks	Motivation and preparation provide the psychological and emotional drive for effective preparation tasks.
C3	Motivation and Preparation → Team Formation	Provides the motivation and direction for team formation, promoting active participation and collaboration among team members.
C4	Motivation and Preparation → Division of Labor	Lays the foundation for clear and reasonable division of labor, ensuring that team members can fully leverage their strengths and enthusiasm in their work.
C5	Background and Process → Sources of Creativity	Provides a wealth of experience and knowledge accumulation, prompting the generation and development of innovative thinking.
C6	Background and Process → Discussion Methods	Offers necessary background knowledge and practical experience, enhancing the effectiveness and relevance of discussions.
C7	Background and Process → Conceptual Challenges	Provides necessary context and experience to help better solve problems in the innovation process.
C8	Background and Process → Production Processes	Provides theoretical foundations and reference experiences, guiding and optimizing the execution of the production processes.
C9	Background and Process → Artistic Significance	Offers important historical, cultural, and theoretical backgrounds, deepening the value and connotation of the work.
C10	Design and Implementation→ Element Characteristics	Showcases element characteristics through practical application, reflecting their functional and aesthetic values.
C11	Design and Implementation→ Design Difficulties	Promotes continuous innovation and optimization of creativity and technology, enhancing the quality and effectiveness of design.
C12	Design and Implementation→ Gains and Improvements	Provides valuable references and guidance for further improvements, continuously optimizing design schemes.
C13	Design and Implementation→ Advantages Demonstrated	Allows the unique strengths of the design scheme to be fully showcased and realized.
C14	Design and Implementation→ Work Creativity	Transforms the work creativity of the work from idea to specific form, allowing the creativity to be materialized and practically applied.
C15	Collaboration and Communication → Communication Methods	Ensures accurate transmission and mutual understanding of information, promoting teamwork and goal achievement.
C16	Collaboration and Communication → Role Clarity	Helps clarify and coordinate the roles of each member, ensuring clear responsibilities and reasonable division of labor in collaboration.
C17	Collaboration and Communication → Collaborative Challenges	Identifies and resolves collaboration challenges, enhancing understanding and cooperation among team members, improving collaboration efficiency and effectiveness.
C18	Collaboration and Communication → Personal Competencies	Enhances individuals' personal competencies, allowing them to better contribute their expertise and play a role within the team.
C19	Experience and Gains → Insights Gained	Provides profound insights and cognitive enhancement through actual experiences and encounters.
C20	Experience and Gains → Application Methods	Provides valuable practical feedback and specific suggestions for optimizing and improving usage methods.
C21	Experience and Gains → Guidance Received	Offers rich insights and practical references for guidance based on actual experiences, enhancing the effectiveness and relevance of the guidance.
C22	Experience and Gains → Improvement Experiences	Provides valuable experiences and suggestions for improving work or products through reflection and summary of actual experiences.
C23	Experience and Gains → Optimized Presentations	Provides practical feedback and insights, serving as important references for optimizing presentation effects and improving presentation quality.
C24	Feedback and Suggestions → Improvement Standards	Provides practical basis and specific direction for formulating and refining improvement standards, promoting the optimization and enhancement of standards.
C25	Feedback and Suggestions → Planning Directions	Provides important references and guidance for adjusting and determining planning directions, ensuring that plans are more reasonable and effective.
C26	Feedback and Suggestions → Application Outlook	Offers valuable references and predictions for future application prospects, assisting in better planning and achieving goals.

To better present the results of data analysis, we have created a hierarchical diagram (Fig. 2). This chart visually presented the relative importance of different concepts or categories. In the figure, each region represented a specific concept or category, and the larger the region, the higher the frequency of citation or discussion of that part in the writing. Use different colors to distinguish before, during, and after the competition. From the graph, we can see that the categories of Motivation and Preparation and Design and Implementation had a relatively large proportion, indicating that they were cited or discussed more frequently and have stronger importance.

In addition, we also constructed a model diagram (Fig. 3). This model diagram was based on our data and presented the hierarchical relationships between various concepts or categories in a graphical manner.

This study extensively investigated the learning experiences of undergraduate clinical students during the Creative H&E Competition, focusing on their motivations, preparation, collaboration, and outcomes. The findings revealed that students participate in the activity primarily to enrich personal lives, enhance academic skills, and gain practical experience. During the preparation phase, student groups applied DT methods, showcasing comprehensive knowledge, skills, and material preparation from their perspective as "designers". This laid a solid foundation for effective team formation and task allocation (Du et al., 2020; Tu, 2021; Wingo et al., 2019). Despite facing challenges such as role delineation, students successfully achieved the expected content and presentation outcomes of their works through effective communication and task assignment. Throughout this process, the guidance of DT principles in role assignment and communication proved crucial, enhancing both team efficiency and fostering mutual understanding among members (Heru, 2003; Luttenberger et al., 2014).

In comparison with other studies, this research employed qualitative research methods to gather rich subjective experience data, offering a unique perspective into students' inner worlds and learning processes (Guo et al., 2024; van Velzen et al., 2024). Particularly noteworthy, this study revealed the unique value of DT methods in basic medical education, demonstrating significant progress among students in teamwork, problem-solving, and innovative thinking. This complemented previous research on problem-based learning (PBL) and case-based teaching methods (Cerdio Domínguez et al., 2022; Fu, 2019; McDermott, 2022).

The application of the Creative H&E Competition in histology and embryology courses demonstrated multiple values. It not only sparked students' interest in learning but also deepened their understanding of complex tissue and embryonic development processes through project practice. Importantly, such projects significantly enhanced students' execution, innovative thinking, and critical thinking abilities. Moreover, the Creative H&E Competition integrated elements of medical humanities education, enhancing students' professional knowledge and skills while fostering a sense of professional mission, team spirit, and social responsibility. (Assing Hvidt et al., 2022; Bleakley, 2019; Costa et al., 2020).

In conclusion, integrating DT into basic medical innovation projects offered significant advantages in undergraduate clinical medical education. We encouraged more educators to explore and implement this innovative teaching method in practice, continuously refining it to meet diverse student learning needs and development goals. Additionally, we look forward to future research that further validates and promotes the application of this teaching approach.

Limitation

While this study shed light on the rich experiences of students participating in Creative H&E Competition, it also had several limitations. Firstly, the study sample was limited to award-winning students, which potentially limited the representativeness of the results. Secondly, data collection relied primarily on interviews, which may have introduced biases. Future research could have broadened the sample scope and employed various data collection methods (e.g. surveys, observations) to obtain more comprehensive and objective data.

This study delved into the learning experiences of undergraduate clinical students participating in the Creative H&E Competition, revealing the importance of integrating DT into basic medical projects to enhance students' academic abilities and practical experiences. Through qualitative analysis, we found that this competition significantly enhances students' disciplinary knowledge, innovation, teamwork, and medical humanities. This discovery offered valuable insights for educational practices, such as integrating ideological and political education, utilizing digital educational resources, and fostering innovative thinking.

DT: design thinking. Creative H&E: Creative Histology and Embryology Learning Skills Expansion Competition

Acknowledgements

Thank you to Professor Huaqin Cheng from the Institute of Medical Education at Peking University and Professor Juyan Ye from Beijing Normal University for their selfless assistance and professional guidance during the research process.

Funding

This work was supported by the Undergraduate Teaching Reform Research Project of Shandong Provincial Education Department [ No. Z2023133, M2021364]; The Research Topics on Ideological and Political Education at Jining Medical University [No. JYSZZ2023004]; the Research Project on Experimental Teaching and Teaching Laboratory Construction [SY2024001] and the Undergraduate Teaching Reform Research Project of Jining Medical University [yb202321].

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Xiaomei Wang, Yang Gao and Xiaojin Li. Kai Meng and Haiyan Yin performed the data acquisition and prepared figures and tables. The first draft of the manuscript was written by Xiaomei Wang and all authors commented on previous versions of the manuscript. Qun Ma and Yan Guo made significant contributions to the concept and design, critically revised the important knowledge content of the article, and supervised the project. All authors read and approved the final manuscript.

Ethics approval and consent to participate

All experimental protocols were approved by the Ethics Review Committee of Jining Medical University (No. JNMC-2023-YX-036). Informed consent was obtained from all the participants in this study.

Informed consent

The participants signed informed consent for publication before participation.

Disclosure of potential conflicts of interest

The authors report no conflicts of interests.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Assing Hvidt, E., Ulsø, A., Thorngreen, C. V., Søndergaard, J., & Andersen, C. M. (2022). Weak inclusion of the medical humanities in medical education: a qualitative study among Danish medical students. Bmc Medical Education, 22(1), 660. https://doi.org/10.1186/s12909-022-03723-x
Badwan, B., Bothara, R., Latijnhouwers, M., Smithies, A., & Sandars, J. (2018). The importance of design thinking in medical education. Medical Teacher, 40(4), 425–426. https://doi.org/10.1080/0142159x.2017.1399203
Bleakley, A. (2019). Invoking the Medical Humanities to Develop a #MedicineWeCanTrust. Academic Medicine, 94(10), 1422–1424. https://doi.org/10.1097/acm.0000000000002870
Cerdio Domínguez, D., de Los Ríos Uriarte, M. E., de la Molina, A. A., Félix Castro, J. M., Minutti, F., Del Campo Turcios, A., Alamillo, E. C. M., Cedillo Urbina, R., Millán, A. C., Zurita, P., & Nansen Martiarena, S. (2022). Medical Theatre as an Innovative Pedagogical Strategy in Medical Simulation. Med Sci Educ, 32(3), 719–722. https://doi.org/10.1007/s40670-022-01551-8. & León Pedroza, J. I.
Cheng, X., Chan, L. K., Cai, H., Zhou, D., & Yang, X. (2021). Adaptions and perceptions on histology and embryology teaching practice in China during the Covid-19 pandemic. Transl Res Anat, 24, 100115. https://doi.org/10.1016/j.tria.2021.100115
Costa, M., Kangasjarvi, E., & Charise, A. (2020). Beyond empathy: a qualitative exploration of arts and humanities in pre-professional (baccalaureate) health education. Adv Health Sci Educ Theory Pract, 25(5), 1203–1226. https://doi.org/10.1007/s10459-020-09964-z
Dennis, J. F., & Creamer, B. A. (2023). Destination integration: linking physiology, histology, and embryology content in foundational sciences. Frontiers In Physiology, 14, 1236562. https://doi.org/10.3389/fphys.2023.1236562
Du, Y. C., Fan, S. C., & Yang, L. C. (2020). The impact of multi-person virtual reality competitive learning on anatomy education: a randomized controlled study. Bmc Medical Education, 20(1), 343. https://doi.org/10.1186/s12909-020-02155-9
Eng-Tat, A., Liu, P., Jitesh, R., Chandrika, R., Satish, R. L., Lian, W. Q. D., Huppertz, B., Khamuani, M., & Minarcik, J. R. (2023). The challenges of histology education. Clinical Anatomy, 36(2), 308–314. https://doi.org/10.1002/ca.23989
Fu, B. (2019). Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education. Teaching and Learning in Medicine, 31(3), 342–355. https://doi.org/10.1080/10401334.2018.1537880
Guo, L. (2010). Ke Yang-reforming medical education in China Profile. Lancet, 376(9753), 1637–1637. https://doi.org/Doi 10.1016/S0140-6736(10)62086-7
Guo, Y., Wang, X., Gao, Y., Yin, H., Ma, Q., & Chen, T. (2024). Flipped online teaching of histology and embryology with design thinking: design, practice and reflection. Bmc Medical Education, 24(1), 388. https://doi.org/10.1186/s12909-024-05373-7
Heru, A. M. (2003). Using role playing to increase residents' awareness of medical student mistreatment. Academic Medicine, 78(1), 35–38. https://doi.org/10.1097/00001888-200301000-00008
Holt, J. M., Talsma, A., Woehrle, L. M., Klingbeil, C., & Avdeev, I. (2022). Fostering Innovation and Design Thinking in Graduate Programs. Nurse Educator, 47(6), 356–357. https://doi.org/10.1097/nne.0000000000001206
Hortsch, M. (2023). Histology as a paradigm for a science-based learning experience: Visits by histology education spirits of past, present, and future COMMENT. Anatomical Sciences Education, 16(3), 372–383. https://doi.org/10.1002/ase.2235
Hortsch, M., Girao-Carmona, V. C. C., de Melo Leite, A. C. R., Nikas, I. P., Koney, N. K., Yohannan, D. G., Oommen, A. M., Li, Y., Meyer, A. J., & Chapman, J. (2023). Teaching Cellular Architecture: The Global Status of Histology Education. Advances In Experimental Medicine And Biology, 1431, 177–212. https://doi.org/10.1007/978-3-031-36727-4_9
Kim, K. J. (2020). Project-based learning approach to increase medical student empathy. Medical Education Online, 25(1), 1742965. https://doi.org/10.1080/10872981.2020.1742965
Kondo, T., Nishigori, H., & van der Vleuten, C. (2022). Locally adapting generic rubrics for the implementation of outcome-based medical education: a mixed-methods approach. Bmc Medical Education, 22(1), 262. https://doi.org/10.1186/s12909-022-03352-4
Krishnappa, S., Das, S., Raju, K., Chaudhary, N., & Bevinakatti, S. H. (2023). Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology. Cureus, 15(8), e42801. https://doi.org/10.7759/cureus.42801
Li, H., & Zhou, X. (2018). Medical education reform in China. Postgraduate Medical Journal, 94(1118), 673–674. https://doi.org/10.1136/postgradmedj-2018-136145
Li, P., Lan, X., Ren, L., Xie, X., Xie, H., & Liu, S. (2023). Research and practice of the BOPPPS teaching model based on the OBE concept in clinical basic laboratory experiment teaching. Bmc Medical Education, 23(1), 882. https://doi.org/10.1186/s12909-023-04822-z
Liu, H. Y. (2023). Design thinking competence as self-perceived by nursing students in Taiwan: A cross-sectional study. Nurse Education Today, 121, 105696. https://doi.org/10.1016/j.nedt.2022.105696
Lu, C., Xu, J., Cao, Y., Zhang, Y., Liu, X., Wen, H., Yan, Y., Wang, J., Cai, M., & Zhu, H. (2023). Examining the effects of student-centered flipped classroom in physiology education. Bmc Medical Education, 23(1), 233. https://doi.org/10.1186/s12909-023-04166-8
Luttenberger, K., Graessel, E., Simon, C., & Donath, C. (2014). From board to bedside - training the communication competences of medical students with role plays. Bmc Medical Education, 14, 135. https://doi.org/10.1186/1472-6920-14-135
McDermott, J. (2022). Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement. Aacn Advanced Critical Care, 33(4), 376–381. https://doi.org/10.4037/aacnacc2022419
McLaughlin, J. E., Chen, E., Lake, D., Guo, W., Skywark, E. R., Chernik, A., & Liu, T. (2022). Design thinking teaching and learning in higher education: Experiences across four universities. PLoS One, 17(3), e0265902. https://doi.org/10.1371/journal.pone.0265902
Qiao, J., Wang, Y. Y., Kong, F., & Fu, Y. (2023). Medical education reforms in China. Lancet, 401(10371), 103–104. https://doi.org/10.1016/S0140-6736(22)02629-0
Schaller, M. D., Gencheva, M., Gunther, M. R., & Weed, S. A. (2023). Training doctoral students in critical thinking and experimental design using problem-based learning. Bmc Medical Education, 23(1), 579. https://doi.org/10.1186/s12909-023-04569-7
Si, J. (2020). Course-based research experience of undergraduate medical students through project-based learning. Korean J Med Educ, 32(1), 47–57. https://doi.org/10.3946/kjme.2020.152
Skywark, E. R., Chen, E., & Jagannathan, V. (2021). Using the Design Thinking Process to Co-create a New, Interdisciplinary Design Thinking Course to Train 21st Century Graduate Students. Front Public Health, 9, 777869. https://doi.org/10.3389/fpubh.2021.777869
Smith, M. A., & Nigro, S. (2023). Applying Design-Thinking Principles to Practice-Based Pharmacy Research. Annals Of Pharmacotherapy, 57(9), 1111–1116. https://doi.org/10.1177/10600280221147014
Tauber, Z., Lacey, H., Lichnovska, R., Erdosova, B., Zizka, R., Sedy, J., & Cizkova, K. (2021). Students′ preparedness, learning habits and the greatest difficulties in studying Histology in the digital era: A comparison between students of general and dental schools. European Journal of Dental Education, 25(2), 371–376. https://doi.org/10.1111/eje.12613
Tie, H. T., Luo, Y. X., & Chen, D. (2024). Thinkings on the reform of medical education system in China. Medical Education Online, 29(1). https://doi.org/Artn 230267710.1080/10872981.2024.2302677.
Tu, H. (2021). A Study on the Construction of Emotion Recognition Based on Multimodal Information Fusion in English Learning Cooperative and Competitive Mode. Frontiers In Psychology, 12, 767844. https://doi.org/10.3389/fpsyg.2021.767844
van Velzen, M., Boru, A., Sarton, E., & de Beaufort, A. J. (2024). Design thinking in medical education to tackle real world healthcare problems: The MasterMinds Challenge. Medical Teacher, 46(5), 611–613. https://doi.org/10.1080/0142159x.2024.2305713
Wingo, N. P., Roche, C. C., Baker, N., Dunn, D., Jennings, M., Pair, L., Somerall, D., Somerall, W. E. Jr., White, T., & Willig, J. H. (2019). Playing for Bragging Rights: A Qualitative Study of Students' Perceptions of Gamification. Journal Of Nursing Education, 58(2), 79–85. https://doi.org/10.3928/01484834-20190122-04
Wolcott, M. D., McLaughlin, J. E., Hubbard, D. K., Rider, T. R., & Umstead, K. (2021). Twelve tips to stimulate creative problem-solving with design thinking. Medical Teacher, 43(5), 501–508. https://doi.org/10.1080/0142159x.2020.1807483
Yu, H. (2024). Enhancing creative cognition through project-based learning: An in-depth scholarly exploration. Heliyon, 10(6), e27706. https://doi.org/10.1016/j.heliyon.2024.e27706
Zhang, L., & Ma, Y. (2023). A study of the impact of project-based learning on student learning effects: a meta-analysis study. Frontiers In Psychology, 14, 1202728. https://doi.org/10.3389/fpsyg.2023.1202728

No competing interests reported.

Supplementarymaterial1.pdf

Download PDF

Editor assigned by journal
04 Aug, 2024
Submission checks completed at journal
04 Aug, 2024
First submitted to journal
04 Aug, 2024

You are reading this latest preprint version

Integrating Design Thinking into Basic Medical Innovation Projects: A Qualitative Study from the Perspective of Clinical Medicine Undergraduates

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study design

Participants

Interview Content and Methods

Interview Outline Draft

Data collection

Data analysis

Results

Open Coding Stage

Axial Coding Stage

Selective Coding Stage

Discussion

Limitation

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1