The application of combining CBL with PBL in undergraduate ophthalmology teaching



Key words: case-based learning, problem-based learning, ophthalmology, medical teaching

Objectives: To improve the teaching efficiency and teaching quality of ophthalmology and to develop students’ ability to analyze and solve clinical problems, this paper will introduce Case-based (CBL) and Problem-based learning (PBL) teaching modes into the clinical teaching of ophthalmology. After the introduction, the author will evaluate the modes.

Methods: Taking 120 students in the clinical medicine specialty of 2013 undergraduates of Jilin University as objects. 60 students of the class are set as the control group, and among this group the combination of CBL and PBL teaching modes is applied. The rest of the class are set as experimental group in which the teacher using traditional classroom teaching mode. The teaching effect of the two teaching modes will be evaluated by theoretical assessment, clinical operation assessment and other comprehensive evaluation.

Results: The achievement of applying the combination of CBL and PBL is obviously better than that of the traditional classroom teaching mode.

Conclusions: The combination of CBL and PBL teaching mode can improve students’ interest in learning, promote students’ self-learning, and help improve students’ ability to analyze and solve problems.

Ophthalmology is a compulsory course of medicine major and also a clinical discipline with strong professional characteristics. It has a high requirement for basic theory, speciality check-up and operation. With the rapid development of medical science and the rapid updating of medical knowledge, the requirements of medical students’ theory and practical ability are also increasing. Anatomy knowledge involved in ophthalmology is too complex to get feeling and experience from the book, so the traditional indoctrinating teaching cannot meet the requirements of modern ophthalmology education. Therefore, how to arouse students’ interest in ophthalmology in limited time, to motivate students’ learning initiative, to improve the efficiency of teaching and learning, and to make students grasp ophthalmology knowledge and clinical skills well are problems that the clinical teachers should think and improve in their teaching process. In recent years, Problem-based learning (PBL) and Case-based learning (CBL) have been widely applied in the teaching process of many disciplines. Now, report of the effect of applying the combination of CBL and PBL teaching mode in undergraduate ophthalmology teaching is as follows.

Ⅰ. Data and Methods

1. Data

120 five-year clinical medical undergraduates are randomly selected from Jilin University. And they are randomly divided into experimental group (60 persons) and control group (60 persons). The former group applies the combination of CBL and PBL teaching mode, the latter group uses the traditional classroom teaching mode. Both groups are taught by the same teacher and the teaching materials and teaching hours are the same.

2. Teaching Methods

Experimental group: Taking the combination of CBL and PBL teaching mode, that is: teachers design questions according to syllabus in advance, students look up textbooks and reference books, and then discuss in group; after the discussion, group representatives introduce and show the results through multimedia, video, pictures, models, specimens and other props; finally, the teachers add and correct students’ findings and introduce typical clinical cases simultaneously. In this mode, cases are combined with theories. The teaching process is vivid and the evaluation is comprehensive.

Control group: Taking traditional teaching mode, i.e. teachers teaching book knowledge mainly according to syllabus.

3. Observation Item

After the teaching, theoretical assessment and operation assessment will be carried out. The total score of the assessment is 100 points, and the comprehensive grade = the theoretical assessment score * 50 % + the operation assessment score * 50 %. After the assessment, the comprehensive scores of the experimental group and the control group will be compared.

(1) Theoretical assessment: taking close-book classroom tests, 50 points for objective question in order to test students’ mastery of basic theory and knowledge; the other 50 points for subjective question for the purpose of testing students’ ability of analyzing cases.

(2) Operation assessment: selecting common or typical cases in the ward, then asking the students to make and identify the diagnosis as well as formulate the treatment regimens by asking the patients’ medical history and checking their bodies.

(3) Questionnaire: evaluating the teaching effect. It includes students’ satisfaction with the teaching mode and their learning interest, learning initiative, learning efficiency as well as their abilities of self-learning, retrieving information, thinking logically when in clinic, communicating with patients and expressing their opinions.

4. Statistical Analysis

SPSS19.0 statistical software is used for data analysis in this paper. The measured data are expressed by mean ± standard deviation (X±S), and the t test is used between the groups. If P<0.05, it is statistically significant.

Ⅱ. Results

Under the combination of CBL and PBL teaching mode, students’ comprehensive achievement is remarkably higher than that of the traditional classroom teaching mode (P<0.05). In the theoretical assessment, there are no significant differences between the two groups in objective questions, and the scores of subjective questions in the experimental group were significantly higher than those in the control group with statistical significance (P<0.05). In the operation assessment, scores of the experimental group were significantly higher than those in the control group with statistical significance (P<0.05). (Table 1). Questionnaire of students’ feedback to the teaching effect shows: the combination of CBL and PBL teaching mode wins students’ high acceptability. It has obvious advantages in mobilizing students’ enthusiasm of learning, improving their learning efficiency, cultivating their clinical thinking ability, improving their abilities of self-learning, looking up reference, collecting data, communicating with patients, and expressing their opinions.

Table 1 Comparison of the comprehensive achievement between the combination of CBL with PBL teaching mode and traditional teaching mode （X±S, mark）

Group	Amount	The Objective Questions	The Subjective Questions	Theoretical assessment	Comprehensive Achievement
TheExperimental Group	60	42.32±5.03	46.52±4.64	82.09±5.53	85.34±4.76
TheControl Group	60	41.79±4.96	35.58±5.11	73.15±5.26	73.27±5.29

Ⅲ. Discussion

The clinical teaching of ophthalmology usually includes theoretical study and clinical practice. Because the teaching content is extensive while the class hour is few, at present the theoretical study and the clinical practice are taking the traditional classroom teaching mode. Eyeball structure is complex and abstract, so it is not easy to dissect it. And, comparing to other clinical subjects, ophthalmologic examination needs special equipment and instruments. If the students just memorize the abstract theoretical knowledge passively, it is difficult to understand and grasp the content of classroom teaching, their learning initiative cannot be played fully, and the students are easily to be afraid of difficulty and feel bored. Then, the teaching effect will be affected. If the students lack active clinical thinking and exercise, they could not check, diagnose, identify the diagnosis, treat and communicate with the patients appropriately with their knowledge, even if the students’ performance of theoretical examination is well. All of these are not conducive to cultivating medical students’ comprehensive quality.

PBL is student-centred. Students look up textbooks and reference books, and discuss in groups instead of learning from the teachers. Results of discussion will be showed by multimedia, video, pictures, modes, specimens and other props. What’s more, the teachers will take diseases as a clue to ask questions, and the students acquire knowledge by self-learning, discussion or other forms. PBL connects the complex “disease” with medical knowledge, and integrates the foundation of related disciplines and clinical knowledge. It breaks the boundaries of disciplines, enables students to think divergently as well as acquire medical knowledge behind the problems and the skill to solve problems in limited time. CBL is a process that students directly face patients who come down with common or typical diseases, and simulate the doctor’s identity to diagnose and treat the patients. It requires teachers to prepare cases in advance, and to guide students to explore, identify, and solve problems. The effect is obvious, and also easy to be accepted by students in terms of training students to analyze and solve problems. When teaching theory in classroom, the PBL teaching mode can be chosen as the main part: before class, the teacher designs the relevant questions according to the content and purpose of the teaching, and organizes and guides the students to be divided into groups to look up reference. In the course of clinical probation and practice teaching, CBL teaching mode can be the main mode, and cultivate students’ clinical thinking and clinical operation ability through discussion and sharing typical cases.

This study combines PBL teaching mode with CBL teaching mode. By the combination, students’ satisfaction with the teaching and teachers’ assessment rate are higher than those of the traditional teaching mode. And students’ scores of theoretical exam and clinical assessment are also better than those of the traditional one. Different from the traditional classroom teaching mode, the combination of CBL and PBL teaching mode is student-centred which emphasizes students’ active participation. In the teaching process, teachers bring students into clinical practice by typical clinical cases; in the process of simulating clinical practice, students could learn theoretical knowledge. This mode is vivid and intuitive, it helps students to construct knowledge system, reduces strangeness and fear of clinical work, shortens transition time from learning basic medical knowledge to clinical practice, and helps to stimulate students’ learning initiative and cultivate their team spirit. Students’ learning is not limited to the simple classroom learning, and the study content is not limited to a single teaching material. Under teachers’ guidance, students learn knowledge by themselves, look up and organize reference, discuss in groups and speak in turn. In classroom, students can learn with initiative. Thus, in the teaching process, students can not only learn knowledge, but also improve their ability to express and communicate. It can also train students’ team spirit and improve their comprehensive quality. At the same time, it strengthens the exchanges between teachers and students, advocates teaching students in accordance with their aptitude, and makes teachers and students benefit each other.

In short, the application of combining CBL teaching mode with PBL teaching mode has a significant role in promoting students’ ability of self-learning, independent thinking, analyzing and solving problems, team cooperation and other aspects. What’s more, it contributes to cultivate comprehensive talents needed by the development of modern medicine, and has great significance on ophthalmology teaching.