Abstract
Outcome-based education (OBE) has changed the previous teacher-centered education model. This study was performed to evaluate the effect of practice of blended teaching mode of emergency first aid specialty based on OBE concept in teaching. In this study, 23 undergraduate students (observation group) at the level of 2017 and 23 undergraduate students (control group) at the level of 2016 majoring in emergency medicine who take part in clinical practice were selected as the study subjects. By setting the expected learning achievement goals in 6 aspects, the mixed teaching method is used to reorganize teaching content and carry out teaching evaluation, and a mixed OBE concept teaching model is constructed and implemented. The number of high scoring students with a score above 90, the number of pass subjects, and the mean score at the class level were significantly improved compared with those who practiced the traditional teaching mode. At the 3 time points of pre internship, in practice and after post internship, the achievement of the 6 expected learning outcomes (19.92 ± 3.68, 23.89 ± 2.93, 25.44 ± 3.33, F = 77.87, P < .001) and critical thinking abilities (283.39 ± 25.84, 287.43 ± 24.33, 300.07 ± 23.87, F = 49.82, P < .001) were significantly improved. Blended teaching mode of emergency first aid specialty based on OBE concept significantly improved education.
Keywords: blended teaching, clinical practice, emergency first aid, outcome-based education, significantly improved output
1. Introduction
With the innovation of health medical technology and the continuous improvement of the life quality of patients and their families, the previous teaching model of training medical professionals can’t meet current needs, so it is currently necessary to train graduates with more professional knowledge, skills and higher quality medical professionals to meet the actual needs. However, the existing teacher-centered education model suggests that students are clinically poor and less professionally competent.[1–3] Because diagnostic (misdiagnoses and missed diagnoses) and treatment errors account for 6% to 17% of hospital adverse events, most emergency physicians want feedback to learn whether their diagnoses and treatments were correct, especially in the patients at the highest risk.[4–6] Hence, it is necessary to identify effective education methods as the most promising intervention category in enhancing diagnostic performance and patient outcomes.
The outcome-based education (OBE) model is often considered alternative to traditional teacher-centered education model.[7–9] Since the OBE was first introduced to the medical community in the 20th century, related courses have developed in various fields. In the OBE-based concept teaching model, each part of the teaching is centered on the learning goals or achievements students expect to achieve when completing the course. Therefore, the results determine the educational content and learning process, and the aim is to train qualified emergency care professionals. In addition, teaching based on the concept of OBE overcomes the shortcomings of the traditional teaching model that relies heavily on theory, which is mainly centered on application, work and experience.[9] In clinical education, “ability” is an important part of the learning outcomes of health science educators.[10,11] At the same time, information technology continuous development has been further applied to higher education, resulting in a hybrid teaching model of online and offline combination, which provides new way for OBE concept application in all kinds of education.[12,13]
Emergency first aid is a comprehensive discipline involving multiple medical professions, generally refers to the medical staff in a short period of time, for a variety of acute lesions and acute trauma that threaten human life safety. The emergency rescue measures taken by science are the necessary professional knowledge of all medical students. The professional ability of first aid is the embodiment of individual ability.[14–16] The main goal is to enable students to improve their clinical abilities when providing clinical practice teaching for first aid and first aid professions. The teaching of emergency and emergency care majors based on the concept of OBE aims to comprehensively interact with patients through clinical practice so that students can learn how to combine theory and practice to adapt to clinical emergencies in a new situation.[17,18] Education based on the concept of OBE has been applied to medical education to overcome of traditional education focusing on imparting knowledge limitation. Learning goals provided to students by educators, while in clinical practice based on the concept of OBE, learning goals were set by students themselves. New model emphasizes student experience-based self-directed learning through a combination of qualitative and quantitative methods to develop structured evaluation criteria to assess academic performance.[19] Therefore, emergency educators should assess students’ differences in blended teaching according to the concept of OBE and prepare them for a higher-level emergency professional education plan. Therefore, this study will analyze the effectiveness of the mixed OBE concept teaching model by investigating changes in students’ learning achievement, expected learning results and critical thinking skills before, during and after the clinical practice.
2. Materials and methods
2.1. General information
This study was approved by the Ethics Committee of The First Affiliated Hospital of Fujian Medical University. In order to compare the difference of teaching effectiveness between traditional teaching mode and the mixed teaching mode of the OBE, this paper used the method of teaching experiment to verify, and set up an observation group (23 participants) and a control group (23 participants). The study applied the constructed mixed teaching model of emergency specialty based on the concept of OBE to undergraduate teaching in the direction of emergency medicine in clinical medicine students at the 2017 level, which was delineated as the observation group, and the number of participants in teaching experiments was 23, taught in the 5th semester. To compare the effects of the teaching modes constructed, 2016 undergraduate grades in the direction of emergency medicine for clinical medicine students were also included in the comparative analysis, delineated as a control group, and the number involved in the teaching experiments was similarly 23. According to the training program curriculum of emergency medicine for clinical medicine, the class hours and credits of grade 2016 and grade 2017 are the same. The teaching content is the emergency first aid clinical practice course, and the mixed teaching mode based on OBE concept is mainly used for online and offline teaching, while traditional teaching mainly uses offline teaching. Among them, online teaching takes video related to clinical knowledge and skills of emergency first aid in superstar Fanya platform (http://superstar.fy.chaoxing.com/portal) as the teaching content to carry out basic theory and skills online learning, and offline teaching includes bedside teaching, theoretical lectures, operation training, ward rounds and so on.
2.2. Teaching methods
2.2.1. The theoretical Framework of mixed OBE concept Teaching Model.
Based on OBE concept, implement a clinical hybrid teaching model online and offline: To develop learning output goals. The OBE concept focuses on learning output-oriented teaching activities, under which teaching activities are reorganized to use online teaching resources and offline teaching equipment facilities to achieve the expected learning output goals. Under the guidance of OBE concept, teaching objectives are set by students’ ability characteristics, and teaching content organization is reorganized, the offline and online teaching methods are effectively selected and the teaching activities are flexibly arranged, so as to promote achievement of teaching objectives and improve comprehensive quality of students’ emergency first aid specialty.[20,21] Assessing the completion of learning outcome goals not only considers the results of the teaching assessment, but also evaluates the degree of completion of the learning output goals, highlights the phased assessment and process assessment, and continuously improves teaching based on the results of the evaluation feedback. Form a virtuous circle of “goal setting - goal implementation - evaluation feedback - teaching improvement.”
2.2.2. Construction of Blended Teaching Mode Based on OBE Concept.
2.2.2.1. Teaching model framework.
The full teaching mode is divided into 3 parts. Pre-class: teachers set and refine learning output goals, requiring students to conduct online pre-class preparation and discuss relevant knowledge points; in the course, under the established objectives, students participate in emergency first aid activities offline to follow the teachers to learn emergency first aid related knowledge and skills, and discuss and report the learning results in group form; after class: students review and reflect on the relevant records and feedback information of discussion and online learning in class to consolidate the theoretical knowledge and skills of emergency first aid specialty, and teachers evaluate the achievement of students’ output goals. Under this teaching mode, students’ online learning is taken as starting, the achievement of learning output goals is continuously tracked through online feedback and classroom test. Combined with the evaluation results, the contents and methods of online and offline teaching are continuously improved. Through teaching, case analysis, group discussion and online live broadcast teaching, students master key and difficult points of emergency first aid specialty learning, carry out thinking training, and finally reach the established learning output goals.
2.2.2.2. Teaching organization.
This study is based on Superstar Fanya platform to carry out the mixed clinical practice teaching of emergency specialty under the concept of OBE. First of all, rely on the platform to establish online teaching classes, establish corresponding connection points, provide emergency professional knowledge points video, teaching PPT, online tests, and other resources, and set up check-in, online discussion, content release and homework submission and other functions, in order to effectively coordinate online and offline links, timely record, feedback and evaluate the learning situation of students.
2.2.2.3. Teaching process design.
Various online and offline education and teaching methods are applied to achieve all the expected learning results. Combined with the requirements of clinical practice of emergency specialty,[22,23] this study sets 6 expected learning achievement goals (Table 1). They are emergency knowledge and skills integration, emergency skills, therapeutic communication and relationship, emergency first aid process based on critical thinking, role of emergency medical personnel in a multidisciplinary team, and the professional standard of emergency medical personnel. In order to achieve these goals, this study adopts the combination of online and offline teaching activities, and the related teaching methods and methods include flipped classrooms, online tests, teaching reflection, group discussion, case analysis, and so on. It has realized the reorganization of the emergency specialty clinical practice teaching content system and the creation and enrichment of the educational environment and effectively promoted students to participate in teaching practice and achieve expected of learning output goal.
Table 1.
Expected learning output and its teaching methods.
| Expected learning outcomes | Method |
|---|---|
| Emergency knowledge and skills integration | Offline teaching |
| Online Teaching, Flipped Classroom | |
| Online test | |
| Review of the latest research progress in emergency first aid | |
| Blended teaching resources development | |
| Case analysis | |
| Emergency first aid skills | Offline teaching |
| Nursing skill simulation and test | |
| Therapeutic communication and relationship | Offline teaching |
| Offline face-to-face conversation with patients and medical staff | |
| Reflective journal | |
| Emergency first aid process based on critical thinking | Offline teaching |
| Case study | |
| Topic discussion + group task + live broadcast (video display) | |
| Role of emergency medical staff in the multidisciplinary team | Offline teaching |
| Case study | |
| Topic discussion + group task + live broadcast (video display) | |
| Occupational standards for emergency medical personnel | Offline teaching |
| Topic discussion + group task + live broadcast (video display) |
As can be seen from Table 2, the teaching content includes clinical practice and lectures, group discussions, and simulation courses, in which basic emergency skills are taught and evaluated. In clinical practice, students can experience the role of emergency medical staff through an internship, which helps achieve 6 expected learning results. Through case studies or group discussions, students can complete integration knowledge and skills, cultivate critical thinking based on emergency process, and understand the role of emergency medical personnel in multidisciplinary teams and the professional standards of emergency medical personnel. Face-to-face contact with patients and health care staff and updating reflection logs play an important role to help achieve therapeutic communication and relationships. Students are required to complete a final report (including case studies). Teachers use relevant teaching methods to complete the expected results, answer questions related to emergency and emergency majors for students, help students master the operational skills of emergency intervention, and more comprehensively understand the various emergency problems encountered. In clinical practice, the teaching contents of emergency and first aid are varied, involving all kinds of professional knowledge, skills, and ethical issues related to the emergency.
Table 2.
Expected learning output and its contents.
| Expected learning outcomes | Content |
|---|---|
| Emergency knowledge and skills integration | Participating in patrol and emergency first aid activities |
| Explain disease, medical examination, intervention knowledge | |
| Anatomical physiology, terminology, medical knowledge | |
| Clinical guidelines, emergency first aid research, emergency first aid intervention | |
| Patient-centered information, health promotion history collection, physical assessment, nursing diagnosis | |
| Patient-centered information, health promotion history collection, physical assessment, nursing diagnosis | |
| Emergency first aid skills | Participating in patrol and emergency first aid activities |
| Practice of case nursing skills | |
| Therapeutic communication and relationship | Participation in visits, communication and interaction with patients and nurses |
| Emergency first aid history, emotional support, education | |
| Review and analysis of dialogs with patients and medical staff | |
| Emergency first aid process based on critical thinking | Participating in patrol and emergency first aid activities |
| Medical history collection, physical assessment, nursing process | |
| Introduction of emergency treatment process and feedback | |
| Role of emergency medical staff in the multidisciplinary team | Participation in patrols, emergency first aid activities, patient education programs |
| Medical history collection, physical assessment, diagnosis and treatment | |
| Demonstrations by using examples of roles and feedback of emergency medical staff in multidisciplinary teams | |
| Occupational standards for emergency medical personnel | Participating in patrol and emergency first aid activities |
| Review the ethics of emergency medical staff, raise ethical issues and feedback |
2.2.2.4. Teaching evaluation.
This study uses the blended teaching method to implement the results-oriented teaching mode, so optimizing the teaching assessment method is necessary. This study comprehensively examines students’ online and offline performance in teaching practice and examines students’ mastery of skills and related abilities and accomplishments.
2.3. Evaluation method
2.3.1. Academic achievement evaluation.
Students’ grades consist of 3 parts. They are ordinary performance (30%), classroom assessment (20%) and final performance (50%). The usual performance mainly examines attendance rate, independent expression, participation in teaching activities and teamwork.
2.3.2. Evaluation of expected learning results.
Expected learning results are assessed through this aspects: knowledge and skills integration; emergency first aid skills; therapeutic communication and relationship; nursing diagnosis based on critical thinking; the role of emergency medical staff in multidisciplinary teams; professional standards for emergency medical staff. The Likert 5-point scale assessed the expected learning outcomes. The higher the score, the better the learning results. The internal consistency of the scale (measured by Cronbach α) is 0.85.
2.3.3. Critical thinking evaluation.
Critical thinking of emergency first-aid students is evaluated by the Chinese version of the critical thinking disposition inventory.[24] The scale with 70 items was subdivided into 7 sub-scales. Likert’s 6-point scale, with 1 saying “very disagree” and 6 saying “very agree,” scored between 70 and 420 points. There are 30 positive items and 40 negative items. The higher the score, the higher the students’ critical thinking tendency. The score of a certain dimension is greater than or equal to 40 points, indicating that the characteristics of this aspect are strong. The Cronbach’s α of the original text was 0.54 to 0.77, which was 0.82 in this study.
2.4. Statistical analysis
SPSS 23.0 software was used for data analyze. In addition to the descriptive statistics of participants’ general characteristics, academic performance, expected learning achievement and critical thinking ability, this study also set up 3-time points to analyze the influence of time on the change of evaluation index by repeated measures analysis of variance, namely, before teaching, during teaching and after teaching.
3. Teaching practice and result analysis
3.1. Academic performance
The learning performance can more intuitively reflect the difference of the learning outcomes achieved by the 2 groups of students under the influence of different teaching modes, and then effectively distinguish the mechanism of the influence of the mixed teaching modes on the students’ learning performance. In this study, the academic performance of the reformed class was compared with the assessment upper-level students who practiced traditional teaching mode results. The comparison results are shown in Figure 1. Obviously, compared with the students at the previous level, the teaching reform class that implements the blended OBE concept teaching model has significantly improved students’ grades (P < .05), and the proportion of high-scoring students with scores above 90 has increased. The number of students in the teaching reform has also decreased significantly (P < .05). The reformed class average score is 4.7 points higher than that of the students at the previous level, which shows that the new teaching model is easier for students to master knowledge and skills of emergency first aid. Specifically, there were 23 students in the control group who adopted the traditional teaching mode, including 2 students with scores above 90, and 8 students located in the 80 to 90 partition. There were 23 students in the observation group who adopted a mixed teaching mode based on the OBE philosophy, including 4 students with scores above 90 and 10 students located in the 80 to 90 partition. The observation group had a slightly better rate of good than the control group students when considering students with a score of 80 or more as “good” reflecting the higher positive impact of the blended teaching model on students’ academic performance than the traditional teaching model.
Figure 1.
Student achievement test results comparison. (The academic performance of the reformed class was compared with the assessment results of the upper-level students who practiced the traditional teaching mode).
3.2. Expected learning outcomes
3.2.1. Expected achievement of learning.
From the commonalities of the observation and control groups, outcomes increased significantly before, during and after internship (19.92 ± 3.68, 23.89 ± 2.93, 25.44 ± 3.33, F = 77.87, P < .001). Expected accomplishments in learning outcomes improved significantly between the 3-time points during and after the internship (P < .001). Knowledge and skills integration and the professional level of emergency first aid medicine and nursing have been greatly improved after 1 year of learning. Still, the improvement of emergency first aid skills is less. However, all 6 expected learning outcomes have significantly improved at time points before and after the internship (P < .05) (Table 3).
Table 3.
Academic performance and expected learning outcome achievement.
| Variables (value range) | Before internship | In practice | After the internship | F value (P value) |
|---|---|---|---|---|
| Expected learning achievement (6–30) | 19.92 ± 3.68 | 23.89 ± 2.93 | 25.44 ± 3.33 | 77.87 (<.001) |
| Emergency first aid knowledge and skills integration (1–5) | 3.18 ± 0.69 | 3.92 ± 0.58 | 4.18 ± 0.62 | 52.84 (<.001) |
| Emergency first aid skills (1–5) | 3.47 ± 0.80 | 4.19 ± 0.57 | 4.16 ± 0.63 | 28.17 (<.001) |
| Treatment Communication and Relationship (1–5) | 3.55 ± 0.86 | 4.23 ± 0.66 | 4.40 ± 0.71 | 30.73 (<.001) |
| Emergency diagnosis based on critical thinking (1–5) | 3.31 ± 0.80 | 3.94 ± 0.70 | 4.29 ± 0.66 | 45.56 (<.001) |
| Role of emergency medical staff in multidisciplinary team (1–5) | 3.23 ± 0.76 | 3.79 ± 0.60 | 4.21 ± 0.68 | 59.27 (<.001) |
| Occupational Standards for Emergency Medical Staff (1–5) | 3.19 ± 0.96 | 3.82 ± 0.71 | 4.19 ± 0.72 | 33.15 (<.001) |
From the characteristics of the observation and control groups, some differences were observed between the 2 groups regarding their evaluation of learning outcomes before, during and after the internship. In terms of total expected learning outcomes, the observed group had a higher growth rate than the control group in the pre internship, middle and post internship period, and the evaluation total scores of each stage were better than the control group, as shown in Figure 2. For the integration of knowledge skills in emergency first aid, the score of both observation group and control group before internship was 3.47, respectively, after receiving the teaching mode, the score of observation group was significantly higher than that of control group (4.18 > 3.68), which indicated that the mixed teaching mode was more capable of integrating the knowledge skills than the traditional teaching mode, helping students to effectively tease out the relevant emergency first aid knowledge and form a systematic knowledge framework. In terms of emergency first aid skills, the students of both groups maintained a homogeneous level of 3.47 before internship, which was significantly higher than that of the observation group (4.19 > 3.82) by mid internship, and this was more obvious in the post internship period. For treatment communication and relationship, the average score of students in the observation group before the internship was lower than that of the control group (3.55 < 3.67), but in the middle and post internship stages, the average score of the observation group improved to 4.23 and 4.40, respectively, which were significantly higher than that of the control group (3.64 and 3.71). Demonstrated that the positive effect of the mixed teaching model on the learning outcomes of the communication and relationship dimensions of treatment was significantly higher than that of the traditional teaching model. In terms of emergency first aid diagnosis, the students of the 2 groups were almost maintained at the same level during the pre-internship period, and during the post internship period, the average score of the observation group improved to 4.29, which was significantly higher than the value of 3.85 in the control group. In terms of role and career standards within multidisciplinary teams, the mean score difference exhibited by the 2 groups of students basically kept similar characteristics with other dimensions, and the mean score of the 2 groups of students during the pre-internship period was basically maintained at the same level, but after having experienced different teaching modes, the mean score of the observation group was significantly higher than that of the control group.
Figure 2.
Comparison of change in the total score of critical thinking between the 2 groups.
3.2.2. Critical thinking.
The critical thinking ability was significantly improved at 3-time points before, during, and after the internship (67.27 ± 8.02, 68.23 ± 7.55, 71.23 ± 7.41, F = 13.82, P < .001). Although the mean difference in scores before and during the internship was not significant (P = .253), there was a significant change of scores before and after internship, and between the scores during and after the internship (P < .001). Among the 7 subscales of critical thinking, truth-seeking, analytical ability, and intellectual curiosity were significantly improved at 3 time points (F = 17.98, P < .001; F = 18.45, P < .001; F = 10.88, P < .001; F = 10.88, P < .001, respectively) (Table 4).
Table 4.
Critical thinking changes.
| Variables (value range) | Before internship | In practice | After the internship | F value (P value) |
| Critical Thinking Overall Score (70–420) | 283.39 ± 25.84 | 287.43 ± 24.33 | 300.07 ± 23.87 | 49.82 (<.001) |
| Looking for the truth (10–70) | 36.88 ± 5.38 | 39.00 ± 5.30 | 40.47 ± 5.39 | 17.98 (<.001) |
| Open mind (10–70) | 41.08 ± 4.99 | 40.66 ± 4.72 | 41.91 ± 4.53 | 4.16 (.120) |
| Skills of analyze (10–70) | 43.38 ± 4.71 | 44.67 ± 4.32 | 47.16 ± 3.93 | 18.45 (<.001) |
| Systematization ability (10–70) | 37.29 ± 4.56 | 35.18 ± 5.27 | 37.88 ± 5.45 | 6.60 (.078) |
| Critical thinking confidence (10–70) | 40.78 ± 4.84 | 38.99 ± 4.92 | 40.32 ± 4.83 | 4.72 (.105) |
| Curiosity (10–70) | 43.84 ± 5.28 | 44.75 ± 5.45 | 46.64 ± 5.35 | 10.88 (<.001) |
| Cognitive Maturity (10–70) | 41.36 ± 5.25 | 38.15 ± 5.40 | 40.08 ± 5.30 | 6.34 (1.381) |
From the characteristics of the observation and control groups, students in both groups showed some personality characteristics in terms of critical thinking, mainly as follows: In terms of the total score of critical thinking, the observed group had a higher growth rate than the control group in the pre internship, middle and post internship period, and the total score of evaluation in each stage was better than the control group, as shown in Figure 3. In searching for the truth dimension, the evaluation scores of observation group and control group before internship were (36.88 ± 5.38) and (35.12 ± 4.18). Student evaluation scores during the mid-internship period decreased in both groups, but there was again a rebound in evaluation scores during the post internship period, which increased to (40.47 ± 5.39) and (38.17 ± 3.29), respectively. Similar characteristics were found in the open mind, systematized competence, self-confidence, and cognitive maturity dimensions, which all showed “lower critical thinking scores during internship and rebound improvement of critical thinking scores after internship,” especially the most significant in the cognitive maturity dimension. In this evaluation dimension, the evaluation scores of the observation group and the control group before the internship were (41.36 ± 5.25) and (40.81 ± 3.56), respectively, and the evaluation scores of the 2 groups of students in the middle of the internship period decreased to a nadir, at (38.15 ± 5.40) and (39.10 ± 4.32), respectively, but there was again a rebound in the evaluation scores in the late internship period, which increased to (40.08 ± 5.30) and (40.21 ± 4.56), respectively. It should be noted that the critical thinking evaluation of students after internship in both groups did not exceed that of those before the internship, and the significant statistical significance (P < .01) is shown in Figure 4. (4) In addition to this, there are 2 dimensions in this review that still maintain consistent results with the critical thinking total score evaluation. Specifically, students in both groups showed a progressive trend in their critical thinking scores before, during, and after the internship, and the average score reached its highest level by the post internship period. For example, in the analysis of the ability dimension, the evaluation scores of the observation group and the control group before internship were (43.38 ± 4.71) and (41.40 ± 3.21), respectively, and the evaluation scores during internship were (44.67 ± 4.32) and (42.77 ± 4.56), respectively, until the evaluation score after internship reached the highest value, which was (47.16 ± 3.93) and (43.95 ± 3.14), respectively.
Figure 3.
Comparison of change in the total score of critical thinking between the 2 groups.
Figure 4.
Comparison of change in the total score of critical thinking between the 2 groups.
4. Discussion
With living standards and health concepts improvement, demand for high-quality medical and high-level medical professionals is also increasing, creating favorable conditions for the development of emergency first aid medical work.[25–27] In addition, the increasingly frequent natural disasters and traffic accidents in recent years have also increased the practical needs of the whole society for emergency rescue of critically ill patients. Therefore, it is urgent to cultivate high-quality emergency rescue professional teams.[28] In clinical practice, how to better cultivate qualified and qualified emergency rescue professional medical staff is facing greater pressure.[29] Emergency first aid professional education mainly takes the achievement of the core competence and learning output goals of medical staff as the main destination of this education and uses various strategies to evaluate it.[30,31] However, few studies have verified the teaching mode and practice of emergency first aid based on the OBE concept, especially the teaching practice related to emergency first aid clinical practice that requires a close combination of theoretical knowledge and clinical practice. Therefore, this study analyzed expected learning results, academic performance, and critical thinking for students who received emergency first aid clinical practice based on the OBE concept at different time points.
In this study, compared with the higher-level students in traditional teaching mode implementation, the academic performance scores of the teaching reform class before and after the internship are significantly improved, and the number of high-score students and passersby is more than those in the traditional teaching mode. According to the students who participated in clinical practice. After a year of clinical practice, their clinical manifestations in emergency care and ability to provide emergency treatment have significantly improved. Therefore, OBE concept teaching mode improves students’ emergency first aid professional ability and promotes the integration of emergency first aid theory and clinical practice.
The results show that the students who participate in the blended teaching mode of emergency first aid specialty based on the OBE concept show relatively high scores in learning output evaluation. The average score of expected learning results increased from 3.32 to 4.24. Compared with the scores before the internship, the average critical thinking score increased significantly in middle of the internship and after the internship. This increase may be attributed to school teachers living in clinical wards with students who provide training in using critical thinking skills to diagnose emergency problems and conduct emergency procedures through evidence-based intervention. Obviously, critical thinking is a sub-factor affecting clinical performance. It emphasizes the developing clinical practices to strengthen critical thinking among emergency students.
This study shows that the above characteristics of the mixed OBE concept teaching model in teaching practice are helping to improve students’ proficiency in emergency professional knowledge and skills. The core competence of emergency medical professionals, as “interpersonal understanding and communication” is mainly improved through self-evaluation communication ability. Throughout internship, students must continuously record the treatment communication process or write a daily reflection journal about clinical learning, which also promotes autonomous learning. Reflection or self-awareness can improve emergency medical professionals’ clinical communication skills and learning achievements, which valuate strengths and weaknesses in clinical practice.
In addition, emergency professional attitude is another important core competence.[32] The effective teacher configuration provided by the teaching staff participating in OBE concept model has also been enhanced, including expert teachers who provide lecture tutoring, each module provides a full-time tutor and a clinical tutor who provides on-site tutoring.[33–35] These educators teach students in accordance with emergency clinical practice requirements and professional emergency standards and maintain a professional attitude (such as punctuality, neatness, enthusiasm and compassion, etc.). Respect patient privacy, financial status and patient opinions at all stages of an emergency. In addition, “general clinical manifestations” and “specific clinical manifestations” may have been improved, as students are evaluated through simulation and practical assessment in case scenarios that prompt the use of basic emergency professional skills, this means that students need to master general clinical skills and special emergency clinical skills required to pass specific situations.
Regardless of the curriculum, students are usually more skillful in mastering emergency professional knowledge and skills after completing the hybrid OBE concept teaching model than before learning. So the learning endpoint of this teaching model may be unified. However, the courses related to emergency and first aid offered by different schools may be different, the teaching content and evaluation time selected by different schools are different. In this study, the phased evaluation was carried out of emergency clinical practice program, and the achievement of 6 expected learning outcomes was mastered. In addition, the students also made a self-evaluation of their emergency clinical practice. This dynamic assessment of academic achievement and performance may reveal students’ differences in achieving expected learning goals. Evaluating students’ academic progress is more helpful in optimizing educational methods. For example, teaching method used to achieve that learning output goal can be reevaluated and replaced with a more appropriate tool if needed as a student is underperforming in a particular learning outcome or at a particular stage.
This study has some limitations. First of all, this study only selects the higher-level students as the control group when comparing their academic performance because the hybrid OBE concept teaching model is newly implemented and cannot obtain evaluation results of higher-level students in achieving the expected learning goals and critical thinking. Therefore, these 2 indicators cannot be compared. Secondly, the potential contribution of theoretical courses and clinical practice to the achievement of learning output goals is not excluded from the design of this study because these 2 processes are parallel in the teaching model designed in this study. Finally, because the study population is composed of undergraduates majoring in emergency first aid from a single medical university, it is necessary to further study the applicability of the results of this study to other medical schools.
5. Conclusion
The application of blended teaching mode of emergency first aid specialty based on OBE concept significantly improved learning outcome.
Author contributions
Conceptualization: Hongkun Guo.
Data curation: Hongkun Guo.
Formal analysis: Hongkun Guo.
Funding acquisition: Hongkun Guo, Yiming Li.
Investigation: Hongkun Guo, Yiming Li.
Methodology: Hongkun Guo, Yiming Li.
Project administration: Yiming Li.
Resources: Yanjing Huang, Yiming Li.
Software: Yanjing Huang, Yiming Li.
Supervision: Yanjing Huang, Yiming Li.
Validation: Yanjing Huang, Yiming Li.
Visualization: Yanjing Huang.
Writing – original draft: Yanjing Huang.
Writing – review & editing: Yanjing Huang.
Abbreviation:
- OBE
- Outcome-based education
YH and HG contributed equally to this work.
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Huang Y, Guo H, Li Y. Study on the construction and practice of blended teaching mode of emergency first aid specialty based on OBE concept. Medicine 2023;102:28(e34252).
Contributor Information
Yanjing Huang, Email: 25806535@qq.com.
Hongkun Guo, Email: 4806535@qq.com.
References
- [1].Andre K, Barnes L. Creating a 21st century nursing work force: designing a bachelor of nursing program in response to the health reform agenda. Nurse Educ Today. 2010;30:258–63. [DOI] [PubMed] [Google Scholar]
- [2].Matlhaba KL, Pienaar AJ, Sehularo LA. Community service nurses’ experiences regarding their clinical competence. Health SA. 2019;24:1284. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Hussein R, Everett B, Ramjan LM, et al. New graduate nurses’ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC Nurs. 2017;16:42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Kattel S, Manning DM, Erwin PJ, et al. Information transfer at hospital discharge: a systematic review. J Patient Saf. 2020;16:e25–33. [DOI] [PubMed] [Google Scholar]
- [5].Dave N, Bui S, Morgan C, et al. Interventions targeted at reducing diagnostic error: systematic review. BMJ Qual Saf. 2022;31:297–307. [DOI] [PubMed] [Google Scholar]
- [6].Lyundup AV, Balyasin MV, Maksimova NV, et al. Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies. Int Wound J. 2022;19:871–87. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Liang J. “OBE” concept for new training mode of electronic information science and technology professionals under big data analysis. Comput Intell Neurosci. 2022;2022:8075708. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Er HM, Nadarajah VD, Chen YS, et al. Twelve tips for institutional approach to outcome-based education in health professions programmes. Med Teach. 2021;43:S12–7. [DOI] [PubMed] [Google Scholar]
- [9].Gruppen LD. Outcome-based medical education: implications, opportunities, and challenges. Korean J Med Educ. 2012;24:281–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Hodges BD. A tea-steeping or i-Doc model for medical education? Acad Med. 2010;85:S34–44. [DOI] [PubMed] [Google Scholar]
- [11].Morcke AM, Dornan T, Eika B. Outcome (competency) based education: an exploration of its origins, theoretical basis, and empirical evidence. Adv Health Sci Educ Theory Pract. 2013;18:851–63. [DOI] [PubMed] [Google Scholar]
- [12].Le W, Yang WT, Gong NC. The practice of mixed teaching model based on OBE in inorganic and analytical chemistry course. Chem Educ. 2021;42:11–7. [Google Scholar]
- [13].Sun Y, Li Y, Tian Y, et al. Construction of a hybrid teaching model system based on promoting deep learning. Comput Intell Neurosci. 2022;2022:4447530. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Goolsby CA, Schuler K, Rodzik R, et al. The FAST VIP (First Aid for Severe Trauma “Virtual” in-Person) educational study. West J Emerg Med. 2021;22:951–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Abelsson A, Odestrand P, Nygårdh A. To strengthen self-confidence as a step in improving prehospital youth laymen basic life support. BMC Emerg Med. 2020;20:8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Chacon-Lozsan F, Davila F. First aid UCV (Green Cross) for prehospital medicine in social commotion situations. J Spec Oper Med. 2021;21:126–33. [DOI] [PubMed] [Google Scholar]
- [17].Xu YS, Wu JH, Wang G, et al. Research on the application of case-based and problem-oriented teaching mode based on OBE concept in emergency clinical teaching. Hosp Manage Forum. 2020;37:60–2. [Google Scholar]
- [18].Guo ZD, Fang JY, Zhao X. Research on the teaching reform of “emergency medicine” based on the concept of OBE. Chin Med Educ Technol. 2021;35:495–9. [Google Scholar]
- [19].Liu ML, Li JH, Guan CB. Exploration of mixed teaching method of Python programming language course based on OBE concept. Comput Eng Sci. 2019;541:203–6. [Google Scholar]
- [20].Gao LX, Liu AX, Li YJ, et al. Exploration of mixed course teaching based on OBE teaching concept – taking the course of animal nutrition and feed in baotou vocational and technical college of light industry as an example. Heilongjiang Anim Husb Vet Med. 2020;13:159–61. [Google Scholar]
- [21].Wang FW, Zhang SY, Song FZ, et al. Teaching reform and exploration of postgraduate courses based on OBE concept: taking modern environmental analysis and testing technology as an example. High Educ Sci. 2022;2:48–53. [Google Scholar]
- [22].Wang M, Xu GJ, Lin DM, et al. Teaching reform of critical nursing based on small-scale restricted online courses. J Nurs. 2017;32:1–3. [Google Scholar]
- [23].Jin RH, Shen R, Wang JX. Teaching reform in the course of Emergency and Critical Care Nursing based on a small private online course. Chin J Disaster Med. 2018;6:618–21. [Google Scholar]
- [24].Peng M, Wang G, Chen J. Validity and reliability of the Chinese critical thinking disposition inventory. Chin J Nurs. 2004;39:644–7. [Google Scholar]
- [25].Kara P, Karaçay Yikar S, Çerçer Z, et al. Perception and readiness for inter-professional education of health discipline students: a cross-sectional study. Nurse Educ Today. 2022;112:105333. [DOI] [PubMed] [Google Scholar]
- [26].Meyer-Frießem C, Enax-Krumova E, Kruppa C. Between clinical practice, teaching and research - a project report on the development and implementation of a career mentoring curriculum for female clinician scientists. GMS J Med Educ. 2022;39:Doc35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [27].Abdel Raheem A, Song HJ, Chang KD, et al. Robotic nurse duties in the urology operative room: 11 years of experience. Asian J Urol. 2017;4:116–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [28].Szawarski P, Hillebrandt D. Patient-centred mountain medicine. Postgrad Med J. 2016;92:482–3. [DOI] [PubMed] [Google Scholar]
- [29].Deng H, Tan YH. Investigation on post competency of nursing students in emergency nursing specialty and nursing specialty in Chongqing. Nurs Res. 2018;32:286–8. [Google Scholar]
- [30].Alisic E, Tyler MP, Giummarra MJ, et al. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers. Eur J Psychotraumatol. 2017;8:1273587. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [31].Alisic E, Hoysted C, Kassam-Adams N, et al.; Pediatric Emergency Research Canada (PERC). Psychosocial care for injured children: worldwide survey among hospital emergency department staff. J Pediatr. 2016;170:227–33.e1–6. [DOI] [PubMed] [Google Scholar]
- [32].Chang YC, Xiao X, Nkambule N, et al. Exploring emergency physicians’ professional identities: a Q-method study. Adv Health Sci Educ Theory Pract. 2021;26:117–38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [33].Kaliannan M, Chandran SD. Empowering students through outcome-based education (OBE). Res Educ. 2012;87:50–63. [Google Scholar]
- [34].Macayan JV. Implementing outcome-based education (OBE) framework: implications for assessment of students’ performance. Educ Meas Eval Rev. 2017;8:1–10. [Google Scholar]
- [35].Mulaudzi P, Runhare T, Ramakhanya TE. Teachers’ reflections on their conceptualisation and utilisation of continuous assessment within an outcomes-based education (OBE) context: the South African experience. J Educ Stud. 2014;13:186–215. [Google Scholar]