Effect of BOPPPS Model Combined with Case-Based Learning Versus Lecture-Based Learning on Ophthalmology Training for Five-Year-Old Pediatric Undergraduate Students in Southwest China | BMC medical training


Ophthalmology is a clinical subject with professional characteristics. In recent decades, three themes have evolved in ophthalmic medical education. First, the focus has shifted from what to teach to how best to teach better. Second, medical education has shifted from a teacher-centered to a learner-centered approach. Finally, medical education has moved from an apprenticeship model to a new competency-based training model [19]. However, there are still many problems in the teaching of ophthalmology in the process of transforming the mode of teaching. Ophthalmology belongs to one of the smaller specialties and as such is allocated a smaller component of the total curriculum [20]. Academic experience and exposure to ophthalmology in medical school curricula has been in global decline for decades [1, 4]. Additionally, the COVID-19 pandemic has presented many challenges for ophthalmology training. [21, 22]. There have been many novel and unique international educational innovations in the content of ophthalmic curricula (competency-based curriculum [20]structured academic curriculum [23]), pedagogical methodologies (virtual learning [21, 24]virtual eye clinic online delivery [25]), instructional design (team learning [26]flipped classrooms [16]) to improve the teaching of ophthalmology to medical students.

In China, pediatric ophthalmology is a sub-specialty in ophthalmology and is a third-level subject. Ophthalmology teaching is a branch unit of sensory system teaching for five-year undergraduate pediatric students at the College of Pediatrics of Chongqing Medical University. The traditional pedagogical approach focuses on the LBL as a teaching center, emphasizing the delivery of curriculum and concepts [27]. Students passively accept knowledge, which reduces learning initiative and enthusiasm. Currently, traditional teaching methods cannot meet the needs of medical students. New teaching methods are constantly being tested and improved by educators. The CBL has been used in the medical field since at least 1912, when it was used by Dr James Lorrain Smith while teaching pathology at the University of Edinburgh. [28]. CBL’s goal is to prepare students for clinical practice through the use of authentic clinical cases. Unlike the traditional method, the CBL model links theory to practice through the application of knowledge to clinical cases using inquiry-based learning methods. [17]. CBL requires advanced preparation from students and provides a more structural learning strategy. It is based on concrete cases and characterized by effective and interactive teaching [17]. By discussing a clinical case related to the topic being taught, students assess their own understanding of the concept using a high level of cognition. This process encourages active learning and produces a more productive outcome. [29].

The BOPPPS model, originating in North America, is a completely new teaching model. The teaching process with a six-phase framework, including transition, goal, pre-assessment, participatory learning, post-assessment, and wrap-up phases, emphasizes student participation through feedback during the teaching process [30]. Additionally, this model accelerates the entire instructional cycle, including goals, behaviors, learning activities, and assessment. [31]. In recent years, the BOPPPS model, which pays more attention to the role of students’ initiatives in the teaching process and fully mobilizes their initiatives in the learning process, has been widely regarded in China. [32]. Much of the literature has shown the benefits of the BOPPPS model in various fields of health and medicine [33]like clinical medicine [34]dentistry [8]and histopathology [35].

In the present study, we applied the BOPPPS-CBL model to the ophthalmology education of five-year-old pediatric undergraduate students. Compared to the traditional LBL teaching method, the BOPPPS-CBL model has several advantages derived from the above two teaching strategies. First, it is based on analyzes of typical cases in ophthalmology. In the “transition” stage, students can see case data and information, which stimulates interest in learning. The “objective” stage allows students to fully understand the main content of this course in a framework. Our results showed that students in the BOPPPS-CBL group had better knowledge of the expected level of work and had more motivation to learn.

Second, the BOPPPS approach has changed the traditional relationship between teaching and learning. Classroom instruction is student-centered and places greater emphasis on teacher-student interactions. In “participatory learning”, students deliberately acquire knowledge and link theory to practice based on the analysis of real cases. Our survey results showed that the BOPPPS-CBL model is more effective in developing students’ analytical and problem-solving skills than the LBL model.

Finally, the final exam scores of the BOPPPS-CBL group were significantly higher than those of the LBL group, especially for case analysis. The score was not only an important and direct reference to evaluate the acquisition of students’ knowledge, but also an important parameter to measure the quality of teaching. [14]. The results showed that the BOPPPS-CBL model led to better performance on the final test, but there were no significant pressure differences between the two groups. In other words, the new teaching strategy did not increase the burden on students. Interestingly, more students in the LBL group thought the workload before class was too high. A lack of real cases and boring theoretical information overwhelms students. The integration of real cases improved students’ interest in learning, and students in the BOPPPS-CBL group did not feel that the workload before class was too high. By independently reviewing cases, discussing diagnoses and treatment suggestions, and offering advice to their peers, students consolidated their basic knowledge and benefited from the model. [14]. Therefore, the BOPPPS-CBL model is a very effective and acceptable method for teaching ophthalmology. Student perception scores indicated that the BOPPPS-CBL model was more beneficial for the development of problem-solving skills, analytical skills, and learning motivation.


This study has several limitations. First, the sample size was small. Research with additional samples is needed to validate the effect of this combined method. Second, the model was limited to a single ophthalmology unit. The results may not be generalizable to students of other specialties. Third, the current study only assessed final exam results and lacked pre- and post-class tests to assess learning effects. This can lead to a bias in learning performance. This study did not separately compare the differences between the CBL and BOPPPS models. A separate study could be designed to evaluate three distinct groups CBL, BOPPPS and LBL in the future. In addition, the future study could perform a follow-up examination at 1 year to determine the retention rate of ophthalmic knowledge among the groups and see if there is a difference in long-term retention for each teaching model.


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