Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i3.5533
Abstract
Objective To compare the application effects of four teaching modes, namely the Feynman Learning Technique, Problem-Based Learning (PBL), the Standardized Quality Control Teaching Method, and Case-Based Learning (CBL), in standardized residency training for spine surgery, and to provide evidence for optimizing residency training curricula. Methods A prospective comparative study was conducted among 120 residents undergoing standardized training in the Department of Spine Surgery at Peking University People's Hospital from April 2022 to April 2026. Using a random number table method, residents were divided into four groups of 30 each. Group A received the Feynman Learning Technique, Group B received PBL, Group C received the Standardized Quality Control Teaching Method, and Group D received CBL. The training period was 12 months. After completion of training, the four groups were compared with respect to theoretical examination scores, clinical skill performance scores, medical record writing quality, clinical reasoning ability, and teaching satisfaction. Results The theoretical examination score of Group A was 92.15±3.87 points, which was significantly higher than that of Group B (88.34±4.26 points), Group C (86.47±4.58 points), and Group D (85.62±4.91 points), with statistically significant differences (F=12.563, P<0.001). Group B achieved the highest clinical skill performance score (91.78±3.95 points), clinical reasoning ability score (92.36±3.72 points), and overall teaching satisfaction rate (96.67%), all significantly higher than the other three groups (P<0.05). The medical record writing quality score of Group C was 91.23±4.08 points, significantly higher than Group A (85.47±5.12 points), Group B (88.65±4.35 points), and Group D (87.34±4.67 points), with statistically significant differences (F=10.284, P<0.001). Conclusions Each of the four teaching modes has unique advantages. The Feynman Learning Technique is most effective for mastery of theoretical knowledge; PBL demonstrates superior performance in clinical skill acquisition, clinical reasoning development, and teaching satisfaction; and the Standardized Quality Control Teaching Method excels in medical record writing quality. It is recommended that multiple teaching modes be flexibly combined according to different training objectives in spine surgery residency education.
Keywords
spine surgery; standardized residency training; PBL teaching method; Feynman Learning Technique; CBL teaching method; Standardized Quality Control Teaching Method
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[2] Ge W, Zhu X, Lin J, et al. Critical thinking and clinical skills by problem-based learning educational methods: an umbrella systematic review[J]. BMC Medical Education, 2025, 25: 455.
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[4] Zheng Q, Li Y, Yin Q, et al. The effectiveness of problem-based learning compared with lecture-based learning in surgical education: a systematic review and meta-analysis[J]. BMC Medical Education, 2023, 23(1): 387.
[5] Liu C, Ouyang W, Wang X, et al. Comparing hybrid problem-based and lecture learning (PBL + LBL) with LBL pedagogy on clinical curriculum learning for medical students: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(16): e19687.
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[7] Zhang S, Ren S, Zhu D, et al. Which novel teaching strategy is most recommended in medical education? A systematic review and network meta-analysis[J]. BMC Medical Education, 2024, 24(1): 1342.
[8] Li T, Song R, Zhong W, et al. Use of problem-based learning in orthopaedics education: a systematic review and meta-analysis of randomized controlled trials[J]. BMC Medical Education, 2024, 24(1): 256.
[9] Zhao J, Wang M, Ma Y, et al. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in comparison with traditional lectures: a systematic review and meta-analysis[J]. BMC Medical Education, 2020, 20(1): 369.
[10] Chen Y, Zhao L, Zhang X, et al. Effectiveness of case-based learning combined with problem-based learning versus lecture-based learning in Chinese medical education: a systematic review and meta-analysis[J]. Postgraduate Medical Journal, 2026, 102(1208): 402-412.
[11] Zhang W, Wei J, Guo W, et al. Comparing the effects of team-based and problem-based learning strategies in medical education: a systematic review[J]. BMC Medical Education, 2024, 24(1): 172.
[12] Yang W, Li H, Su A, et al. Application of problem based learning (PBL) and case based learning (CBL) in the teaching of international classification of diseases encoding[J]. Scientific Reports, 2023, 13(1): 15220.
[13] Yuan H, Williams BA, Fan Z, et al. Comparing the effect of PBL and LBL in Chinese nursing education: a systematic review and meta-analysis[J]. Nurse Education Today, 2023, 128: 105916.
[14] Fatmi M, Hartling L, O'Brien K, et al. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30[J]. Medical Teacher, 2016, 38(12): e408-e425.
[15] Thistlethwaite JE, Davies D, Ekeocha S, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23[J]. Medical Teacher, 2012, 34(6): e421-e444.
[16] Chytas D, Mitrousias V, Raoulis V, et al. A Review of the Outcomes of the Implementation of Case-Based Anatomy Learning[J]. Cureus, 2021, 13(11): e19179.
[17] Joshi T, Budhathoki P, Adhikari A, et al. Team-Based Learning Among Health Care Professionals: A Systematic Review[J]. Cureus, 2022, 14(4): e23814.
[18] Wang H, Yang T, Hua W, et al. Integrated 3D printing and case-based learning in orthopedic residency education for geriatric hip fracture management[J]. Frontiers in Surgery, 2025, 12: 1659207.
[19] Yang F, Wang J, He L. Application of AI-assisted PBL-CBL combined teaching in the diagnosis and treatment of post-herpetic neuralgia: a randomised controlled trial[J]. BMC Medical Education, 2026, 26(1): 158.
[20] Liu Y, Zhang S, Chen S, et al. Efficacy of problem-based learning combined with case-based learning versus lecture-based learning in orthopedic education: a meta-analysis[J]. Journal of Orthopaedic Surgery and Research, 2025, 20(1): 135.
[21] Dunlosky J, Rawson KA, Marsh EJ, et al. Improving students' learning with effective learning techniques: promising directions from cognitive and educational psychology[J]. Psychological Science in the Public Interest, 2013, 14(1): 4-58.
[22] Reyes JDR, Resurreccion AP, Reyes MDCV. Feynman Technique as a Heutagogical Learning Strategy in an Online Learning Environment[J]. Recoletos Multidisciplinary Research Journal, 2021, 9(2): 1-10.
[23] Mattox MR, Hutchins N, Jirout JJ. Talking to Learn: A SoTL Study of Generative AI-Facilitated Feynman Reviews[C]. Proceedings of the Artificial Intelligence in Measurement and Education Conference (AIME-Con): Works in Progress. Pittsburgh: National Council on Measurement in Education, 2025: 117-124.
[24] Li Y, Wang J, Chen M. Application of the Feynman Technique combined with micro-lecture teaching in otolaryngology residency training[J]. Advances in Medical Education and Practice, 2025, 16: 3285-3295.
[25] Zhang L, Liu J, Sun X, et al. Application of Feynman technique combined with TBL teaching mode in the standardized training of anesthesiology residents[J]. BMC Medical Education, 2026, 26(1): 89.
[26] Canal DF, Torbeck L, Djuricich AM. Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents[J]. Archives of Surgery, 2007, 142(5): 479-482.
[27] Jiménez Báez MV, Gutiérrez De la Cruz ME, Chávez Hernández MM, et al. Digital Quality Resources Resulting from Standardized Program for Rubric Training in Medical Residents[J]. Healthcare (Basel), 2022, 10(11): 2209.
[28] Lio J, Dong H, Ye Y, et al. Standardized residency programs in China: perspectives on training quality[J]. International Journal of Medical Education, 2016, 7: 220-221.
[29] Hirpara DH, Wong BM, Safieddine N. Co-learning curriculum in quality improvement for surgical residents - five-year experience from the University of Toronto[J]. Journal of Surgical Education, 2022, 79(1): 46-50.
[30] Arigo JD, Juviler P, Levatino E, et al. Effectiveness of a Formal Surgical Residency Quality and Safety Curriculum[J]. Journal of Surgical Education, 2026, 83(2): e397-e404.
[31] Morrison RS, Bowe S, Brenner M. Teaching quality improvement and patient safety in residency education: strategies for meaningful resident quality and safety involvement[J]. JAMA Otolaryngology-Head & Neck Surgery, 2017, 143(10): 995-1000.
[32] Zhang Y, Xia X, Zeng J, et al. Application of the Cognitive Apprenticeship Teaching Model in the Standardized Training of Critical Care Medicine Resident Physicians: A Randomized Clinical Trial[J]. Advances in Medical Education and Practice, 2025, 16: 1825-1833.
[33] Zhang H, Li S, Wang Y, et al. Effectiveness of multiple teaching methods in standardized training of internal medicine residents[J]. BMC Medical Education, 2025, 25: 281.
[34] Nichat A, Gajbe U, Bankar NJ, et al. Flipped Classrooms in Medical Education: Improving Learning Outcomes and Engaging Students in Critical Thinking Skills[J]. Cureus, 2023, 15(11): e48199.
[35] Mishall PL, Abdel Meguid EM, Elkhider IA, et al. The Application of Flipped Classroom Strategies in Medical Education: A Review and Recommendations[J]. Medical Science Educator, 2025, 35(3): 531-540.
[36] Roy M, Nandini D, Murugan J, et al. Advancements in orthopaedic medical Education: Exploring novel teaching strategies – A qualitative systematic review[J]. Journal of Clinical Orthopaedics and Trauma, 2025, 67: 103059.
Copyright © 2026 Fanxing Meng, Yan Liang, Hongzhen Li, Weiwei Xia, Chenfu Hu
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