Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: A prospective randomized study from China

Figures & data

Table

Practice points

The nature of student learning in PBL to a large extent depends on the quality of the case presented to the student. The precise effect used in dermatology PBL curricula is yet unclear. Real patients and video triggers in PBL dermatology curricula were well accepted. Both triggers could improve students’ clinical problem-handling skills. Both triggers could complement with each other.

Table 1  Comparison of academic performances before the start of the course between LBL, PPBL, DPBL and RPBL groups (mean ± SD)

	Group	Written examination^a	Overall performance^b
Internal medicine	LBL	77.5 ± 5.5	2.83 ± 0.4
	PPBL	75.2 ± 10.0	2.73 ± 0.7
	DPBL	74.8 ± 17.2	2.67 ± 0.3
	RPBL	74.7 ± 7.8	2.63 ± 0.6
	p-Value	>0.05	>0.05
Surgery	LBL	76.8 ± 1.2	2.74 ± 0.4
	PPBL	77.3 ± 9.0	3.00 ± 0.5
	DPBL	73.8 ± 9.7	2.84 ± 0.4
	RPBL	74.6 ± 8.9	2.90 ± 0.5
	p-Value	>0.05	>0.05
Pathology	LBL	84.0 ± 7.5	–
	PPBL	85.9 ± 3.4	–
	DPBL	81.8 ± 10.9	–
	RPBL	82.4 ± 9.2	–
	p-Value	>0.05	–

Notes: ^aAnalysed by means of the one-way ANOVA.

^bAnalysed by means of the Kruskal–Wallis test.

Table 2  Grades of student performances evaluated by tutors (n = 30/group)^a (mean ± SD)

Items	LBL group	RPBL group	DPBL group	PPBL group
1. Analytical skills	1.97 ± 0.96*	3.93 ± 0.907****	3.83 ± 0.95	3.66 ± 0.84
2. Problem-solving skills	1.57 ± 1.01*	3.83 ± 0.75*****	2.63 ± 0.81	2.23 ± 0.73
3. Demonstrates viewpoints of initiative and curiosity	2.17 ± 0.59*	3.10 ± 0.92****	2.80 ± 0.81	3.03 ± 0.96
4. Utilizes relevant materials to get appropriate information actively and effectively	1.67 ± 0.99*	3.50 ± 0.90*****	2.27 ± 1.05	2.10 ± 0.96
5. Be capable of proposing hypotheses and issues	2.17 ± 1.01**	2.90 ± 0.88****	2.67 ± 0.84	2.70 ± 0.95
6. Be engaged in the course actively	1.80 ± 1.00*	2.80 ± 0.81****	2.40 ± 1.00	2.43 ± 0.82
7. Applies knowledge to new situations to solve problems and to reach decisions	1.93 ± 0.87*	3.43 ± 0.94*****	2.43 ± 0.82	2.63 ± 0.61
8. Interaction/collaboration skills	2.23 ± 1.04*	3.73 ± 0.74*****	2.86 ± 0.82	2.70 ± 0.75
9. Expression/communication skills	2.43 ± 0.97***	2.67 ± 1.03****	2.67 ± 0.84	2.47 ± 1.20
10. Shares thoughts and opinions with peer actively	2.93 ± 0.87***	3.47 ± 1.14****	2.80 ± 1.10	3.03 ± 0.81
Overall performance	2.09 ± 0.27	3.34 ± 0.25*****	2.74 ± 0.27	2.70 ± 0.34

Notes: ^aAnalysed by means of the Kruskal–Wallis test.

*p < 0.001, compared with the three PBL groups.

**p < 0.05, compared with the three PBL groups.

***p > 0.05, compared with the three PBL groups.

****p > 0.05, compared with the other two PBL groups.

*****p < 0.001, compared with the other two PBL groups.

Table 3  Comparison of student opinions on the learning style, quality of cases, and the content of the course in lecture-based (n = 30) and three PBL groups (n = 30/group)^a (mean ± SD)

Summary of student opinion	LBL group	RPBL group	DPBL group	PPBL group	H-value	p-Value
1. The learning style was effective in helping develop my self-directed learning skills	3.40 ± 0.93	4.70 ± 0.53	4.00 ± 1.05	4.17 ± 0.99	26.49 7.89	<0.001 ^b 0.019 ^c
2. The learning style was effective in helping increase my problem-solving skills	3.80 ± 1.00	4.63 ± 0.67	4.60 ± 0.567	4.53 ± 0.82	17.21	0.001 ^b
3. The learning style was effective in helping sharpen my analytical skills	4.20 ± 1.10	4.37 ± 0.96	4.07 ± 1.23	4.53 ± 0.82	2.47	NS^b
4. The learning style was effective in helping improve my expression/communication skills	3.87 ± 0.97	4.67 ± 0.61	4.40 ± 0.77	4.53 ± 0.73	15.02	0.002 ^b
5. The learning style was effective in helping increase my interaction/collaboration skills	2.97 ± 1.10	4.73 ± 0.64	4.50 ± 0.78	4.53 ± 0.78	46.12	< 0.001 ^b
6. The learning style greatly impacts my way of learning	3.53 ± 1.31	4.77 ± 0.43	4.83 ± 0.38	4.90 ± 0.31	35.95	<0.001 ^b
7. The learning style motivated and inspired my interest to learn	3.10 ± 1.06	4.60 ± 0.67	4.80 ± 0.41	4.43 ± 0.77	47.04	<0.001 ^b
8. The learning style improved my confidence in future patient encounters	3.67 ± 1.03	4.50 ± 0.82	3.87 ± 1.07	4.03 ± 0.89	11.65 7.46	0.01 ^b 0.024 ^c
9. The same should be replicated in other subjects (other than dermatology)	3.70 ± 0.88	4.47 ± 0.82	3.93 ± 1.20	4.03 ± 1.22	9.69	0.02 ^b
10. Cases were well designed	4.63 ± 0.56	4.77 ± 0.50	4.83 ± 0.38	4.50 ± 0.73	5.03	NS^b
11. Cases demonstrate appropriate knowledge of the subject area	4.40 ± 0.77	4.27 ± 0.78	4.57 ± 0.68	4.47 ± 0.78	2.75	NS^b
12. Cases are relevant to real-world clinical situations	4.10 ± 0.92	4.93 ± 0.25	4.70 ± 0.65	3.93 ± 0.94	28.27 24.66	<0.001 ^b <0.001 ^c
13. Using the cases has encouraged me to learn more about the discussed condition	3.13 ± 1.41	4.83 ± 0.38	4.10 ± 0.99	4.27 ± 0.98	29.82 10.64	<0.001 ^b 0.005 ^c
14. The course was well organized in a way that helped me achieve the learning objectives and outcomes	4.33 ± 0.96	4.53 ± 0.78	4.33 ± 0.92	4.27 ± 1.08	0.94	NS^b
15. The course created a positive learning environment where I felt supported in my learning	4.30 ± 0.84	4.37 ± 0.89	4.40 ± 0.97	4.23 ± 0.82	1.88	NS^b
16. Overall, I was satisfied with the quality of this course	3.83 ± 0.79	4.53 ± 0.68	4.13 ± 1.28	4.00 ± 1.26	10.88	0.012 ^b

Notes: NS, not significant.

^aAnalysed by means of the Kruskal–Wallis test.

^bCompared between the four groups (i.e. LBL, RPBL, DPBL and PPBL groups).

^cCompared between the three PBL groups (i.e. RPBL, DPBL and PPBL groups).

Figure 1. Comparison of LBL, RPBL, DPBL and PPBL groups regarding learning effectiveness measured in terms of the examination scores. Notes: *p < 0.05, compared with the three PBL groups. **p < 0.05, compared with the other two PBL groups (i.e. RPBL and DPBL groups).

Figure 2. Student opinions on the effectiveness of lecture-based and three PBL styles. The 16 items in the questionnaire ranges from strongly disagree to strongly agree. Numbers of respondents were shown in the corresponding areas, and data were analysed by means of the χ² test. Notes: *p < 0.05, compared with the three PBL groups. **p < 0.05, compared with the other two PBL cases (i.e. digital and paper cases).