Effects of six teaching strategies on medical students: protocol for a systematic review and network meta-analysis

Introduction

Medical education is inherently challenging and demanding, leading to chronic physical and mental stress for medical students.1 This stress is caused by various factors, including vastness of academic curriculum, dissatisfaction with class lectures, frequency of examinations, fear of failure and high parental expectations.2–4 The teaching strategy employed by the medical colleges plays a crucial role in determining the effectiveness of their students.5 Traditionally, medical education has relied heavily on lecture-based learning (LBL), which is a teacher-centred approach that provides a systematic and comprehensive understanding of the curriculum.6 7 However, in the current era of abundant information, this passive method is insufficient to inspire the enthusiasm for learning among medical students. Additionally, it hinders the mastery of knowledge in terms of depth and breadth, as well as the flexible application of acquired knowledge.8 Hence, the current teaching strategies need to be modernised to enhance academic performance and learning quality and meet the emerging healthcare demands.9–11

In recent years, multiple novel teaching strategies, including problem-based learning (PBL),12 case-based learning (CBL),13 14 team-based learning (TBL),15 flipped classrooms (FC),16 simulation-based education (SBE)17 and bridge-in, objective, preassessment, participatory learning, postassessment and summary (BOPPPS),18 have been adopted by medical colleges and showed positive effects and higher acceptance for both teachers and students. These innovative teaching methods have been shown to be excellent in improving academic performance, subjective enthusiasm and integrated development of medical students. Comparative studies have demonstrated that PBL methodology, in particular, has garnered high levels of student satisfaction and has been associated with superior examination marks.6 19 Additional, CBL pedagogy is regarded as an active teaching method that effectively educates medical students and helps to improve their academic performance, the mastery of professional knowledge and course satisfaction.20 21 Results of an RCT conclude that TBL has been recognised as an important pedagogic tool, as medical students show a higher gain in theoretical and practical test of basic musculoskeletal ultrasound skills compared with the conventional learning.22 Moreover, FC approaches have gained popularity as an educational method that optimises classroom time for knowledge acquisition and retention and long-term benefits of high scoring.23 24 SBE is a rapidly developing medical strategy, which supplements and enhances clinical education, especially the clinical skills scores of medical students.17 25 26 A previous meta-analysis revealed that BOPPPS contributed to increase knowledge examination scores, skill scores and satisfaction of medical students compared with the LBL.18

Although previous evidence from several pairwise meta-analyses favoured the specific novel teaching methods’ efficacy compared with LBL, contradictory results also existed among different studies. For instance, Townsend et al27 and Polyzois et al28 demonstrated that PBL failed to increase the test scores compared with traditional teaching in class teaching. However, another meta-analysis from Zhang et al29 revealed significantly higher examination scores and examination pass rate after applying PBL in class teaching. Similar conflicting results were also found in clinical teaching from various studies. Luke et al30 demonstrated that PBL helps to improve the acquisition of radiographic interpretation skills, while another study argued that PBL and traditional methods did not differ on tests of factual knowledge and clinical knowledge.31 These discrepancies may limit the widespread adoption of novel teaching methods in both classroom and clinical settings. Furthermore, while multiple teaching methods, such as CBL,20 TBL32 and FC,33 have showen higher academic performance than LBL, the superiority of different novel teaching methods in different medical courses has not been well concluded.

Unlike pairwise meta-analysis, network meta-analysis (NMA) provides a way to simultaneously compare various interventions and the ranking of interventions based on relative parameter.34 35 To address these gaps in knowledge, we plan to perform a systematic review and NMA by retrieving studies using six main teaching strategies, including CBL, PBL, TBL, FC, SBE and BOPPPS. By examining the possible advantages of the six strategies on test scores and other skills or abilities in various medical subjects excluding pharmacology,36 which has been well determined, we aim to determine the optimal teaching strategy for medical curriculum designers and educators.

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