The conventional lecture-style teaching method has long been considered the most economical and effective approach for theoretical instruction [11]. Nevertheless, traditional teaching methods may fall short for senior medical students, who require the development of robust communication and clinical reasoning abilities[12, 13]. With the advent of the internet and the widespread use of personal computers and mobile devices, e-learning has become an integral part of higher medical education. It assists medical students in actively acquiring relevant information within limited time, fostering proactive thinking and questioning abilities, and guiding them towards obtaining new knowledge, all of which have become indispensable components of teaching [14]. Unlike traditional teaching methods, Problem-Based Learning (PBL) and Case-Based Learning (CBL) aim to establish authentic medical scenarios, encouraging students to transition from a "what I learned" approach to a "what I want to learn" mindset [15, 16].
Previous studies have primarily focused on PBL or CBL individually and compared them with traditional lecture-based teaching methods, with some studies even demonstrating the advantages of PBL or CBL. For instance, PBL introduces a group-learning model that facilitates more effective communication between students and teachers, thereby achieving personalized educational objectives [17, 18]. On the other hand, CBL emphasizes teacher guidance through the preparation of clinical case materials, aiding students in developing more effective integrated clinical thinking habits [19, 20]. Considering the respective merits of these approaches, this study combines PBL and CBL teaching methods, allowing them to complement and reinforce each other.
This study examines the effectiveness and acceptability of a hybrid CBL-PBL teaching approach based on standardized cases in an internal medicine clinical course, comparing it with traditional lecture-based instruction. The results demonstrate that, despite the outstanding performance of the traditional group in the pre-test, the teaching reform group shows significant improvement in post-test scores, confirming the effectiveness of the combined CBL and PBL teaching model based on standardized cases. Additionally, the teaching reform group exhibits more significant improvement in self-directed learning and comprehensive capabilities, indicating that this teaching model is more conducive to cultivating clinical thinking. Through survey analysis, students also recognize the positive impact of this approach on skill assessment, theoretical knowledge, practical procedures, and doctor-patient communication.
By integrating CBL based on standardized cases with PBL, medical education can better cultivate students' clinical thinking, self-directed learning, and teamwork abilities, thus enriching and enhancing the teaching process. However, it is noteworthy that this study has certain limitations. Firstly, the research is limited to the results obtained from a specific department of internal medicine, which may not fully represent other specialties or teaching institutions. Secondly, due to the absence of a blind procedure, some analyses may be influenced by subjective factors. For example, assessments of the leadership traits of students by teaching assistants and mentors may be subject to personal biases, and the perceived improvement in perceptions and interpersonal relationships over time has not been validated in this study. Therefore, in the satisfaction survey of the teaching reform group and the traditional group, there may be a tendency towards favoring the teaching reform approach. Another limitation is that our study only focuses on clinical teaching within a specific department of internal medicine. To obtain more robust and reliable results, long-term observation and practice are required. Furthermore, although our study provides in-depth exploration of the effectiveness of a hybrid CBL-PBL teaching approach based on standardized cases in medical education, further research is needed to assess its applicability to students with different educational backgrounds and training types, as well as different educational fields.
In summary, our study aims to investigate the application of a hybrid CBL-PBL teaching approach based on standardized cases in medical education. Despite some limitations, the results of this research indicate that this approach can enhance students' professional understanding, communication skills, clinical thinking abilities, self-directed learning capabilities, teamwork skills, and knowledge absorption. The successful implementation of this teaching model requires further research and support from practice to ensure its effectiveness and feasibility in different contexts.