Critical Illness, Endocrine System Diseases, Medical Education
Conditions
Keywords
Problem-Based Learning, Case-Based Learning, Clinical Self-Efficacy, Internal Medicine Residents, Randomized Controlled Trial
Brief summary
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.
Interventions
BEHAVIORALLecture-based learning (LBL)
In-person one-way didactic lectures with self-directed review after class. Total 12-hour standardized curriculum on endocrine and metabolic critical illness, including diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, and refractory hypoglycemia.
BEHAVIORALPBL plus LBL
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. Total 12-hour standardized curriculum.
BEHAVIORALIntegrated PBL-CBL-CTTM
Integrated closed-loop teaching: pre-class online 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.
Sponsors
Chaohu Hospital of Anhui Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
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.
Eligibility
Sex/Gender
ALL
Age
22 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* 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
Exclusion criteria
* 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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical skills assessment score | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Theoretical examination score | Immediately post-intervention | Closed-book written examination graded by blinded faculty. Total score range: 0-50 points, covering endocrine and metabolic critical illness knowledge. |
| General Self-Efficacy Scale (GSES) score | Baseline (pre-intervention) and immediately post-intervention | 10-item standardized self-efficacy scale (Cronbach's α=0.89), completed anonymously. Higher scores indicate greater general self-efficacy. |
| Endocrine High-Risk Management Self-Efficacy Source Questionnaire score | Baseline (pre-intervention) and immediately post-intervention | Self-developed 4-dimension questionnaire based on Bandura's self-efficacy theory (mastery experience, vicarious learning, verbal persuasion, positive affect; Cronbach's α=0.81, CVI=0.92), completed anonymously. |
| Teaching satisfaction scale score | Immediately post-intervention | 5-dimension teaching satisfaction scale (recognition rate and mean score), completed anonymously. |
| Focus group interview themes | Within 1 week post-intervention | Semi-structured focus group interviews (30-40 minutes each) with 24 residents selected via stratified purposive sampling, analyzed using Braun \& Clarke six-step thematic analysis method. Explores residents' experiences and psychological mechanisms underlying changes in clinical self-efficacy. |
Countries
China
Outcome results
None listed