Research on the application of CBL combined with BOPPPS teaching mode in oral and maxillofacial surgery teaching: a randomized controlled study | Scientific Reports

Scientific Reports volume 14, Article number: 26510 (2024) Cite this article Metrics details To discuss the application value of Case-based Learning (CBL) combined with Bridge-In, Objective,

Scientific Reports volume 14, Article number: 26510 (2024) Cite this article

Metrics details

To discuss the application value of Case-based Learning (CBL) combined with Bridge-In, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary (BOPPPS) model into master students’ program of oral and maxillofacial surgery. 38 master’s students in oral and maxillofacial surgery at Y2 and Y3 from January 2022 to December 2022 are selected as the research objects. They are randomly assigned into two learning groups, namely the traditional LBL (Learn-based Learning) (19 participants) and CBL combined with BOPPPS mode (19 participants). Their theoretical knowledge was assessed after training and the modified Mini-Clinical Evaluation Exercise (Mini-CEX) scale was used to score their clinical thinking. At the same time, the Personal Teaching Efficiency and the Teachers’ Sense of Teaching Efficiency (TSTE) were evaluated, and students’ satisfaction with teaching outcomes was investigated. The basic theoretical knowledge, clinical case analysis and total scores of the experimental group were better than those of the control group, with statistically significant difference (P <0.05). Based on the evaluation of clinical speculative thinking by the modified Mini-CEX, it is found that except for the medical history writing level without statistically significant difference (P >0.05), the other four items and total scores in the experimental group were better than those in the control group, with statistically significant difference (P <0.05).The Personal Teaching Efficiency, TSTE and total scores were higher than those before adopting CBL combined with BOPPPS teaching mode, with statistically significant difference (P <0.05).The sampled master’s students in experimental group believed that the new teaching method could improve students’ ability to clinical speculative thinking, with statistically significant difference in all aspects (P <0.05).More participants in the experimental group suggested that the new teaching mode has increased learning pressure, but without statistically significant difference (P >0.05). CBL combined with BOPPPS teaching method can improve students’ clinical critical thinking ability and help them adapt to the clinical rhythm. It is an effective measure to ensure teaching quality and is worthy of promotion. It is worthwhile to promote the application of CBL combined with BOPPPS mode into master’s course of oral and maxillofacial surgery, which not only improve the basic theoretical knowledge and speculative thinking ability of master’s students, but also improve the teaching efficiency.

As a sub-discipline of stomatology, oral and maxillofacial surgery has the characteristics of difficult diagnosis and treatment, many types of diseases, and complex diagnosis and treatment methods. In recent years, the scale of graduate enrollment continues to expand, but with worrying student source and cultivation situation. The current master education is mainly based on self-study, supplemented by lectures. The lack of clinical thinking ability has led to many master’s students being not qualified for oral and maxillofacial surgery after graduation, or form a logical “Positioning Qualitative” diagnostic idea. Therefore, it is imperative to innovate practical teaching methods to stimulate students’ interest and enthusiasm in learning oral and maxillofacial surgery, as well as improve the effectiveness of clinical practice. The CBL teaching mode can integrate the core issues into the clinical case situation, facilitating students have a sound clinical thinking in the discussion of clinical problems1,2. This process can fully mobilize students’ initiative and better solve the problem of insufficient integration of clinical practice into traditional teaching3,4. BOPPPS is an effective teaching model proposed by the Instructional Skills Workshop (ISW) in North America, and has achieved good results in the clinical teaching of nursing, pediatrics and other disciplines5,6. The CBL combined with BOPPPS teaching mode is clinical cases-based and student-oriented, which can fully cultivate students’ peculative thinking, strengthen the combination of teaching and clinical practice, improve teaching quality, and enhance the training of oral and maxillofacial surgery talents.

From January 2022 to December 2022, 38 master’s students at Y2 and Y3 from Department of Oral and Maxillofacial Surgery of The First Affiliated Hospital of Zhengzhou University were included in the research (19 participants per grade) for feasibility and reality of the study. The random number method was adopted to group them into the experimental group and the control group (Fig. 1). All participants have given informed consent. There was no significant difference in general data such as age and gender between the two groups (P > 0.05). The experimental group adopts the teaching mode of CBL combined with BOPPPS, while the control group adopts the traditional LBL teaching method. Both groups have a 12-month clinical course. The inclusion criteria include (i) graduate students in the second and third years of the Department of Oral and Maxillofacial Surgery of our hospital from January 2022 to December 2022; and (ii) willing to participate in the study and signed the informed consent form. The exclusion criteria also include (i) students who did not complete the 12-month clinical study; and (ii) students who did not complete the questionnaire or the assessment.

Random assignment of graduate students.

The rationale of this study is to compare the teaching model of CBL combined with BOPPPS with the traditional LBL teaching method to evaluate its effect in oral and maxillofacial surgery graduate teaching. The teaching model of CBL combined with BOPPPS is a case-based, problem-oriented, and student-centered teaching method. It guides students to think and learn independently by introducing real cases, and cultivates students’ clinical critical thinking and problem-solving abilities. The traditional LBL teaching method is a teacher-centered teaching method with lectures as the main method. It focuses on the imparting and memorizing of knowledge, and ignores the initiative and participation of students. By comparing the differences between the two teaching modes in theoretical knowledge examination, clinical critical thinking ability examination, personal teaching efficacy and teacher efficacy evaluation, and graduate teaching satisfaction questionnaire survey, the advantages and disadvantages of the CBL combined with BOPPPS teaching mode in oral and maxillofacial surgery graduate teaching can be evaluated, providing a basis for improving teaching methods.

The inter-group variable of this study is the teaching method, as follows:

Observation group: CBL combined with BOPPPS teaching mode.

Control group: Traditional LBL teaching method.

The Y2 and Y3 master students were assigned randomly. The experimental group consisted of 8 Y2 and 11 Y3 master students, and the control group consisted of 11 Y2 and 8 Y3 master students.

The experimental group had a theoretical score of 82.47 ± 2.57 and a basic skills test score of 77.95 ± 4.19, while the control group had a theoretical score of 82.89 ± 2.02 and a basic skills test score of 78.26 ± 4.21. There was no significant statistical difference in the theoretical score and basic skills test scores between the two groups (P > 0.05).

Both groups underwent 12 months of clinical learning, and were compared in terms of theoretical knowledge examination, clinical thinking ability examination, personal teaching efficacy and teacher efficacy evaluation, and graduate teaching satisfaction questionnaire survey.

Taking the BOPPPS model as the framework, the details are as follows:

Bridge-in: A We Chat group is created and the teacher will send the case content and related questions to the We Chat group 3 days before each course, guiding the master’s students to pay attention to what to learn.

Objectives: A new teaching mode that can describe, operate and apply is emphasized to improve learning efficiency and make students clinically speculative gradually.

Pre-assessment: Quizzes are undertaken to fully recognize students’ understanding of knowledge and adjusts teaching strategies in a timely manner.

Participatory Learning: It is the core link of this model, teaching based on real cases to fully mobilize the subjective initiative of students and connect relevant knowledge points in series.

Post-assessment: Tests are taken to understand how well students have mastered knowledge.

Summary: Students are required to draw mind maps or knowledge trees to summarize the knowledge they have learned.

The teacher has employed the traditional teaching mode, namely the teacher speaking and the student listening without further interaction, to explain the disease according to the admitted patients.

CBL combined with BOPPPS teaching mode.

It includes basic theoretical knowledge (60 points) and clinical case analysis (40 points), with a total score of 100 points.

Participants have been arranged to receive patients’ independently in the emergency department of oral and maxillofacial surgery, observed by two attending physicians. The physicians were trained on the scale, did not participate in the teaching, and were blinded to the grouping situation. They have used the modified Mini-CEX scale to score students and taken the average scores as students’ final score7. Each master’s student is assessed 5 times, and the average score is obtained. The modified Mini-CEX scale evaluated master’s students from five aspects: clinical decision-making ability, communication and coordination ability, adaptive ability, treatment operation level, and medical history writing level. Each item is worth 20 points.

The Personal Teaching Efficacy Scale compiled by Ashton and TSES complied by Yu et al.8 have been adopted to observe and evaluate the application of CBL combined with evidence-based BOPPPS mode to oral and maxillofacial surgery teaching. The 6-Point Likert Scalewas used, with a total score of 27–162 points. The higher the score, the higher the teacher’s sense of teaching efficacy.

An autonomous evaluation scale was used to conduct an anonymous survey on the two groups of participants, understanding their satisfaction with the teaching methods. The Cronbach’s coefficient α of the scale was 0.75。.

Statistical software SPSS22.0 was used to analyze the relevant data, which conformed to the normal distribution were expressed as Mean ± SD, and the paired sample t-test was used for comparisons between groups. P < 0.05 means there is a difference with statistical significance.

The theoretical text results of the experimental group including basic theoretical knowledge, clinical case analysis and total scores were better than those in the control group, with statistically significant difference (P < 0.05), as shown in Table 1.

Each dimension was scored through the modified Mini-CEX. Except for the medical history writing level without statistically significant difference (P > 0.05), the other four items and total scores of the experimental group were better than those of the control group, with statistically significant difference (P < 0.05), as shown in Table 2.

After adopting the teaching mode of CBL combined with BOPPPS, the Personal Teaching Efficiency, TSTE and total score were all higher than those before the implementation, with statistically significant difference (P < 0.05),as shown in Table 3.

Compared with the traditional teaching mode, the teaching mode of CBL combined with BOPPPS makes the learning objectives clearer. It helps highlight the key points and difficulties, making the learning content easy to understand and improving the subjective initiative of students in learning. Thereby it enables to enhance students’ clinical thinking. The differences in all aspects are statistically significant (P < 0.05).More students in the experimental group suggested that the new teaching mode has increased the learning pressure, but compared with the control group, the difference is not statistically significant (P > 0.05),as shown in Table 4.

Reasons why current master’s students in oral and maxillofacial surgery are not competent for clinical work after graduation are suggested as follows. Firstly, the Oral and maxillofacial surgery Curriculum setting: During master degree study, students are required to complete standardized training for resident physicians, publish papers as part of graduation defense and conduct basic medical research. At the same time, the night shift and clinical trivial matters will make it impossible to complete all tasks in required timeframe. Secondly, the medical environment: With the tense relationship between doctors and patients, opportunities for master’s students’ clinical operations are gradually decreasing. Most of the students lack the ability of independent diagnosis and treatment, and their overall quality has dropped significantly. Therefore, it is imperative to innovate practical teaching methods to stimulate students’ interest and enthusiasm in learning and improve the effect of clinical practice.

The CBL case teaching method is based on clinical cases9,10. The teacher raises clinical questions which will be solved by students through their independent learning or discussion. Students can develop their subjective initiative in learning and discussion, gradually form a complete clinical thinking. To a certain extent, it can solve the problem of the insufficient combination of clinical practice and traditional teaching. The BOPPPS mode connects multiple originally independent subjects to form a scientific, complete, and clearly logical knowledge network to help students learn efficiently and apply clinically11,12. CBL combined with BOPPPS teaching mode transforms the obscure knowledge of oral and maxillofacial surgery into pictures and clinical scenes13,14. The knowledge is taught in a more intuitive and vivid way, which greatly improves learning efficiency. The results show that compared with the control group, the application of CBL15 combined with BOPPPS16 mode into the teaching of oral and maxillofacial surgery is beneficial to cultivate the clinical speculative thinking ability of master’s students, strengthen the combination of teaching and clinical practice, and improve the quality of teaching. The scores of the experimental group were significantly higher than those of the control group. Two reasons are analyzed as follows. Firstly, the new teaching mode adopted by the experimental group has improved the students’ subjective initiative in learning. Secondly, the integration of multiple knowledge points further improves the understanding of professional knowledge.

Mini-CEX was developed by the American Academy of Internal Medicine in 1995 based on the simplification of the traditional CEX scale17, which is not only widely used in foreign medical schools18, but also in major domestic medical schools and medical training institutions as one of the methods to evaluate the learning effectiveness of clinicians and nurses19,20.In this study, the modified Mini-CEX scale was used to evaluate the clinical ability of the two groups of master’s students. The results showed that except for the medical history writing level, the other four clinical abilities in the experimental group were higher than those in the control group, with statistically significant difference. Analyzing the reasons, it is related to the fact that the combined method pays more attention to the connection of knowledge points, and is more conducive to cultivating clinicians’ clinical speculative thinking ability. The core concept of CBL combined with BOPPPS model is student-oriented, advocating students to consult information, actively discuss and summarize, deepen understanding in the process of discussing with cases as the carrier. In the process of integrating theory with practice, the professional knowledge, clinical speculative thinking ability and comprehensive strength have been improved.

People with a high sense of teaching efficacy will be more proactive in their work and can better improve their learning efficiency. This study has shown that the application of CBL combined with BOPPPS model in the teaching of oral and maxillofacial surgery facilitates the teachers with higher Sense of Teaching Efficiency and higher Personal Teaching Efficiency than those of the teachers who did not adopt the new teaching method. It suggests that CBL combined with BOPPPS mode can not only improve students’ clinical practice ability, but also improve teachers’ sense of teaching efficacy. Teachers have clearer teaching objectives and higher teaching enthusiasm. The more frequent communication between teachers and students is able to exchange and review teaching content in a timely manner, allowing teachers to obtain feedback from students. It will help improve their teaching skills and teaching efficiency.

Limitations: The sample size of this study is small and the research time is short. It is necessary to further increase the sample size and extend the observation time. If a multi-center study is designed, it will better understand the learning ability of graduate students. This study also demonstrated the potential advantages of combining CBL with the BOPPPS model in oral and maxillofacial surgery teaching. Through small sample studies, multicenter designs are gradually being conducted in larger sample sizes in order to achieve better research results and thus promote the development of oral and maxillofacial surgery teaching.

CBL combined with BOPPPS teaching mode focuses on cultivating students’ independent thinking ability and improving their decision-making ability in clinical treatment. It will enable them to better solve oral and maxillofacial problems with the thinking as clinicians. It will help quickly adapt to the rhythm and changes of the clinic, which is an effective way to ensure the quality of teaching. We learn from the advanced experience at home and abroad, based on the actual situation of the major, not only can better help students clarify their thinking, exercise clinical logical thinking ability, but also help to improve the teaching efficiency, so as to better improve the teaching quality. It is worthy of clinical promotion and application.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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This work was supported by the Medical Education Research Project of Henan Province (Grant No. Wjlx2021481) and the Research and Practice of 2022 School-level Education and Teaching Reform of Zhengzhou University (Grant No. 2022ZZUJG077, 2022ZZUJG075).

Department of Oral and maxillofacial surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China

Ning Gao, Kun Fu, Na Li & Wei He

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NG performed the design and conceived the original idea. NG and NL were responsible for the drafting of the manuscript. KF and NL were responsible for the statistical analysis. WH supervised the study and coordinated the teaching management. All authors have read and approved the final manuscript.

Correspondence to Wei He.

This study was approved by the Ethics Committee of project of the First affiliated Hospital of Zhengzhou University (No.2020-KY-230). All methods were performed in accordance with the relevant guidelines and regulations by the research ethics board. All participants provided written informed consent including publication of images.

The authors declare no competing interests.

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Gao, N., Fu, K., Li, N. et al. Research on the application of CBL combined with BOPPPS teaching mode in oral and maxillofacial surgery teaching: a randomized controlled study. Sci Rep 14, 26510 (2024). https://doi.org/10.1038/s41598-024-77432-4

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Received: 22 May 2024

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DOI: https://doi.org/10.1038/s41598-024-77432-4

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