Online-Offline Integrated Multimodal Teaching Combining PBL, CBL, and CTTM to Enhance Clinical Self-Efficacy in Endocrine and Metabolic Critical Illness Among Internal Medicine Residents: A Convergent Parallel Mixed-Methods Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 90
- 试验地点
- 1
- 主要终点
- Clinical skills assessment score
研究概览
简要总结
This randomized controlled trial evaluates whether an integrated online-offline multimodal teaching approach combining Problem-Based Learning (PBL), Case-Based Learning (CBL), and Case Three-Dimensional Teaching Method (CTTM) improves clinical self-efficacy and hands-on proficiency in managing endocrine and metabolic critical illness among internal medicine residents, compared to traditional lecture-based learning (LBL).
Ninety internal medicine residents on their first endocrine rotation will be randomly assigned in a 1:1:1 ratio to three groups: (1) Control group receiving traditional LBL alone; (2) Experimental group 1 receiving PBL plus LBL; (3) Experimental group 2 receiving the integrated PBL-CBL-CTTM closed-loop teaching program. All groups receive a standardized 12-hour curriculum on endocrine and metabolic critical illness, including diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, and refractory hypoglycemia.
The primary outcome is the clinical skills assessment score (0-50 points). Secondary outcomes include theoretical examination scores, General Self-Efficacy Scale (GSES) scores, a self-developed Endocrine High-Risk Management Self-Efficacy Source Questionnaire (four dimensions based on Bandura's self-efficacy theory), teaching satisfaction, and semi-structured focus group interviews.
The study was conducted from September 2025 to August 2026 at the Fourth Affiliated Hospital of Anhui Medical University, Chaohu, China. This study aims to establish an evidence-based, replicable teaching model that addresses the gap between theoretical knowledge and clinical confidence in managing endocrine emergencies among residents.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Outcomes Assessor)
盲法说明
Outcome assessors (theoretical exam graders and clinical skills evaluators) were blinded to group allocation. Participants and teaching faculty could not be blinded due to the inherent differences among the three teaching modalities.
入排标准
- 年龄范围
- 22 Years 至 35 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Full-time internal medicine residents undergoing their first endocrine rotation at the Fourth Affiliated Hospital of Anhui Medical University
- •No prior endocrine remedial training or advanced study experience
- •No independent management experience with endocrine and metabolic critical cases
- •Ability to complete all 12 hours of standardized curriculum and all post-intervention assessments
- •Voluntary participation with written informed consent
排除标准
- •Prior completion of an endocrine rotation or specialized endocrine training
- •Prior independent management experience in diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, or refractory hypoglycemia
- •Inability to complete the full 12-hour teaching schedule due to clinical duties, leave, or rotation transfer
- •Concurrent participation in other teaching intervention research projects
- •Decline to provide written informed consent or withdrawal before randomization
研究组 & 干预措施
Control Group (LBL Alone)
Received only in-person one-way didactic lectures (lecture-based learning, LBL) with self-directed review after class. No online discussions, ward-based training, CTTM resources, or post-class debriefing. Total 12-hour standardized curriculum on endocrine and metabolic critical illness. n=30.
干预措施: Lecture-based learning (LBL) (Behavioral)
Experimental Group 1 (PBL+LBL)
Received pre-class online problem-based learning (PBL) via DingTalk (open-ended critical case questions, independent literature search, online group discussion) plus standardized in-person lectures (LBL), with self-directed review after class. No ward-based CTTM training or post-class debriefing. Total 12-hour standardized curriculum. n=30.
干预措施: PBL plus LBL (Behavioral)
Experimental Group 2 (Integrated PBL-CBL-CTTM)
Received integrated closed-loop teaching: pre-class PBL (identical to experimental group 1) plus standardized in-person lectures plus post-class ward-based case-based learning (CBL) with attending-supervised hands-on critical case training, case three-dimensional teaching method (CTTM) resources, and post-class debriefing. Total 12-hour standardized curriculum. n=30.
干预措施: Integrated PBL-CBL-CTTM (Behavioral)
结局指标
主要结局
Clinical skills assessment score
时间窗: Immediately post-intervention (upon completion of the 12-hour curriculum)
Assessed by group-blinded evaluators using a standardized clinical skills checklist immediately after the 12-hour intervention. Total score range: 0-50 points. Higher scores indicate better clinical proficiency in managing endocrine and metabolic critical illness.
次要结局
- Theoretical examination score(Immediately post-intervention)
- General Self-Efficacy Scale (GSES) score(Baseline (pre-intervention) and immediately post-intervention)
- Endocrine High-Risk Management Self-Efficacy Source Questionnaire score(Baseline (pre-intervention) and immediately post-intervention)
- Teaching satisfaction scale score(Immediately post-intervention)
- Focus group interview themes(Within 1 week post-intervention)
研究者
Jianyong Zhao
Associate Chief Physician, Department of Endocrinology
Chaohu Hospital of Anhui Medical University