Application of virtual diagnosis and treatment combined with medical record teaching method in standardized training of general practitioner

Abstract

The aim of this study was to explore the effect of virtual diagnosis and treatment combined with the medical record teaching method in standardized training of general practitioners. Eighty students who had standardized general practice training, from March 2020 to March 2022, in the grassroots practice base of general practitioner training in the affiliated Hospital of our Medical College were retrospectively analyzed and divided into 2 groups according to the teaching method that they received. The differences in assessment scores, critical thinking, clinical thinking ability, learning autonomy ability, and classroom teaching effectiveness were compared, and the students’ satisfaction with teaching was investigated. The scores of theoretical knowledge, skill operation, medical history collection, and case analysis in the study group were notably higher (P < .05). In the study group, scores in truth-seeking, openness to knowledge, analytical ability, systematic ability, self-confidence, curiosity, and cognitive maturity were significantly higher (P < .05). A notable improvement was observed in the study group’s scores on systematic thinking ability and evidence-based thinking ability, as well as the scores on critical thinking ability after teaching (P < .05). The scores of learning interest, self-management, plan implementation, and cooperation ability improved notably after teaching (P < .05). Learning target, learning processes, learning effects, classroom environment construction, teaching strategy, and technology application in the study group were significantly higher than those in the control group (P < .05). The satisfaction rate in the study group was significantly higher than that in the control group (P < .05). Virtual diagnosis and treatment combined with case-based learning teaching has a very good effect in the standardized training of general practitioners. Students are generally satisfied with their learning experience, which can improve their critical thinking ability and clinical thinking skills. This teaching method is worth further popularizing.

1. Introduction

With the high-quality development of China socio-economic landscape and the improvement in residents’ living standards, significant changes have emerged in the medical model and the spectrum of diseases and causes of death among residents, driven by population aging, industrialization, urbanization, and ecological shifts.^[1] These changes necessitate a transition from the traditional biomedical model to a biopsychosocial model, addressing the primary constituents of residents’ disease spectrum—basic health issues—to better meet their medical and healthcare needs.^[2,3] The primary healthcare services, the main bearers of this demand, are currently facing significant challenges.^[4,5] These include an inefficient allocation of resources and a low proportion of primary healthcare personnel within the total medical workforce (only 32.91%), impacting the quality and accessibility of grassroots medical and health services.^[6]

In this context, Community Health Service (CHS), a concept proposed by the World Health Organization based on a systematic analysis of global health and economic conditions, is recognized as an effective, convenient, high-quality, and affordable cornerstone of primary healthcare.^[7,8] General practitioners, the mainstay and key component of CHS, play a crucial role in its healthy development. Training competent general practitioners are vital for implementing preventive healthcare, diagnosing and treating common and frequent diseases, managing postrecovery rehabilitation, chronic disease management, and resident health management.^[9,10]

To meet the new challenges in medical education, an advanced teaching method is required. The virtual diagnosis and treatment teaching mode, a novel medical education model, employs virtual situational clinical thinking diagnosis and treatment teaching software to facilitate teaching.^[11,12] This mode allows for the simulation of medical scenarios, human anatomy, and other medical activities. It integrates the Case-Based Learning (CBL) model, where teachers select typical and representative clinical cases, design relevant questions effectively, and guide students to contemplate and study these cases, subsequently proposing diagnostic and therapeutic ideas to acquire a wealth of medical service methods and skills. This study aims to explore the effectiveness of combining virtual diagnosis and treatment with the CBL teaching model in the standardized training of general practitioners.^[13,14]

2. Materials and methods

2.1. General information

Eighty students in the standardized training of general practitioners in the grassroots practice base of the standardized training of general practitioners, from March 2020 to March 2022, in the Affiliated Hospital of the Medical College of our hospital were enrolled as the research subjects and divided into the research group (n = 40) and the control group (n = 40) according to the teaching method that they received. The control group adopted the traditional teaching mode, while the research group applied virtual diagnosis and treatment combined with CBL teaching. There was no statistical difference in the years of experience of the standardized training doctors. Inclusion criteria: all the trainees who participated in the training, regardless of gender, had undergraduate degrees; their reading and writing skills were basic, without any cognitive, linguistic, or intellectual impairments; all voluntarily took part in this study and signed the informed consent form of the experiment. Exclusion criteria: nongeneral practitioner interns; all teaching tasks could not be completed by those who refused to cooperate; those who dropped out of the study or did not match well were participating in similar researche. This study was approved by the Ethics Committee of Minhang Hospital.

2.2. Teaching methods

A traditional teaching mode was implemented in the control group, and a teacher responsibility system was used for the clinical teaching. The teaching content was completed according to the practical teaching syllabus. To teach theoretical knowledge and clinical skills in radiology, arrange teaching activities regularly, check the teaching plan regularly, and give feedback in advance. Interns’ satisfaction with the teaching situation was surveyed regularly to point out the problems in teaching on time. Finally, teachers change their teaching methods based on feedback from various aspects. A total of 2 months of training was conducted.

The research group applied virtual diagnosis and treatment combined with CBL teaching. The specific methods are as follows. The students entered the virtual laboratory, opened the computer virtual case database into the clinical diagnosis and treatment simulation environment, selected the prepared cases. Students acted as physicians to consult on virtual cases, and after completing history taking, performed visual, palpation, percussion, and auscultation physical examinations of the virtual cases to form a preliminary diagnosis in conjunction with the consultation. Then, according to the symptoms and positive signs of the virtual case, the corresponding laboratory tests and imaging examinations were performed. After completing the mock diagnosis and treatment exercise, students were engaged in a CBL teaching method centered around group case discussions. The instructor initiated this process by selecting and presenting typical clinical cases, formulated to challenge and stimulate the students’ clinical reasoning skills. These cases were designed to prompt students to apply theoretical knowledge to practical, complex medical scenarios. The CBL approach was structured in several phases:

1. Questioning: Students were prompted with specific, thought-provoking questions related to the cases.

2. Data collection: Students independently gathered relevant data and information from the provided medical records, supplemented by additional research as needed.

3. Group discussion: Students, divided into small groups of 6 to 8 members (3 groups with 6 members each, 2 groups with 7 members each, and 1 group with 8 members), collaborated to analyze the case, share insights, and formulate diagnostic and treatment strategies.

4. Classroom discussion: Following group discussions, each group selected a representative to present their findings and conclusions to the larger class, allowing for inter-group exchange and broader analysis.

5. Teacher’s role: Throughout this process, the instructor played a pivotal role in guiding, inspiring, and providing analytical feedback to the students, ensuring that discussions stayed on track and learning objectives were met.

6. Summarization: At the conclusion of the group discussions, the instructor summarized the key points raised, integrated the discussed knowledge aspects, and provided a comprehensive wrap-up of the exercise, reinforcing the learning outcomes.

This structured CBL process ensured an interactive, student-centered learning environment, where theoretical knowledge was seamlessly integrated with practical clinical problem-solving skills. The method facilitated active learning and critical thinking, essential for the development of proficient future practitioners. A total of 2 months was for training.

2.3. Observation index

2.3.1. Course assessment results.

After 2 months of training, the theoretical knowledge, skill operation, medical history collection, and case analysis of general practitioners were examined, which covered the requirements of the standardized training syllabus for general practitioners and paid attention to the application of the concept of general practice. Emphasis is placed on the diagnosis, differential diagnosis, and management of common and chronic diseases of the elderly in the community. Each examination score was calculated on a percentile basis, and the highest score was the best.

2.3.2. Critical thinking ability.

The Chinese version of the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) revised by Peng Meici et al was adopted for assessment.^[15] The scale includes 7 dimensions, namely, truth-seeking, openness, analytical ability, systematization ability, thirst for knowledge, self-confidence, and cognitive maturity, with 10 items in each dimension and a total of 70 items. Scores ranged from weakly disagree to strongly agree, resulting in a total of 70 to 420 points based on the Likert 6-level scoring method. The Cronbach α coefficient of this scale was 0.90. Before the course starts and afterward (before the training and 2 months after the training), the teachers will distribute them through the questionnaire star platform, and the effective recovery rate of the 2 questionnaires was 100%.

2.3.3. Clinical thinking ability score.

The clinical thinking ability rating scale compiled by Roberts et al was adopted to assess the thinking ability of radiology interns before and after training (before and 2 months after training), a total of 24 items.^[16] The Likert 5-grade scoring method indicated a positive correlation between the score and clinical thinking level. We chose systematic and evidence-based thinking dimensions for assessment, using a 5-level Likert scale matching the scale: 5 points for excellent, 4 points for good, 3 points for average, 2 points for poor, and 1 point for very poor. The total score for systematic thinking is 55, and for evidence-based thinking, it is 35. Higher scores reflect higher levels of clinical thinking. It was found that the questionnaire had a content validity of 0.89 and a reliability coefficient of 0.91 for Cronbach α.

2.3.4. Autonomous learning ability.

To assess interns’ self-learning ability before and after training (after 2 months of training), the autonomous learning scale was employed.^[17] Twenty items were included in the scale, which included learning interest, self-management, cooperation, and implementation of plans. Based on the reliability and validity of the scale, 0.85 is considered highly reliable and 0.79 is considered highly valid.

2.3.5. Evaluation of teaching effectiveness.

After 2 months of training, the effectiveness of classroom teaching was evaluated using the new curriculum effective teaching evaluation form edited by Sun.^[18] It was audited by other teachers who are not in the class of the subject group and evaluated from the 2 dimensions of nursing students and teachers. The dimensions of nursing students included 3 items: learning objective (10 points), learning process (30 points), and learning effect (20 points), which mainly assessed the realization of learning objectives, the participation degree of nursing activities, and the intervention degree of problem-solving. The dimensions included classroom environment creation (10 points), teaching strategies (20 points), and technology application (10 points), which mainly evaluated the grasp of teachers’ roles and the use of teaching strategies and media. The Cronbach α coefficient of this scale was 0.89.

2.3.6. Teaching satisfaction.

After 2 months of training, a questionnaire for teaching satisfaction was developed by our school, with a total of 100 points. Scores ≥90 were considered very pleased, scores <60 were considered displeased, and others were considered satisfactory. Satisfaction rate = (very pleased + pleased)/100%. In this study, 80 questionnaires were distributed and 80 were returned, all of which were valid questionnaires. The overall Cronbach α coefficient of the scale was 0.93, the Cronbach α coefficient of each factor was 0.83 to 0.89, and the CVI value was 0.9013. The reliability and validity were ideal, and the stability and reliability were high.

2.4. Statistical analysis

SPSS 17.0 statistical software was used for data analysis. For comparisons between groups, a t test was performed using independent samples from measurement data with a normal distribution and uniform variance presented by mean ± standard deviation. Paired t test was adopted for intragroup comparison, and the number or percentage of counting data was presented as χ² test, a P value of <.05 indicates that the difference is statistically notable.

3. Results

3.1. The comparison of general information

In both the study and control groups, the ratio of male to female students was 22:18 and 21:19, respectively. The age range was 20 to 23 years, with the average age being 21.31 ± 0.53 years in the study group and 21.44 ± 1.36 years in the control group. The average scores for the first 2 academic years were 81.33 ± 0.26 and 81.46 ± 0.41, respectively, with no significant difference observed (P > .05). Regarding the distribution of specialties, students in both groups were engaged in internships across various departments, including Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Infectious Diseases, Oncology, and Medical Imaging. All students were undergraduates holding junior professional qualifications, and their backgrounds were distributed between rural and urban areas (study group: 21 from rural areas, 19 from urban areas; control group: 21 from urban areas, 19 from rural areas). There were no significant differences in the basic data between the 2 groups (P > .05). The academic qualifications were all undergraduate, and all were junior professional qualifications (Table 1).

Table 1.

Comparison of general information.

Variables	The research group (n = 40)	The control group (n = 40)	t/χ2	P
Age (yr)	21.31 ± 0.53	21.44 ± 1.36
Gender
Male	22	21
Female	18	19
Average grades for the first 2 academic years	81.33 ± 0.26	81.46 ± 0.41
Residential Area
Rural	18	21
Urban	22	19
Department
Internal Medicine	10	9
Surgery	11	14
Obstetrics and Gynecology	5	4
Pediatrics	6	5
Infection	3	3
Oncology	2	3
Medical Imaging	3	2

3.2. The examination results of students

The scores of theoretical knowledge, skill operation, medical history collection, and case analysis in the study group were notably higher (P < .05), as shown in Figure 1.

Figure 1.

Comparison of the examination results between the 2 groups. (A) Theoretical knowledge; (B) skill operation; (C) medical history collection; (D) case analysis.

3.3. The critical thinking of students

The study group indicated higher scores on truth-seeking, open minds, analytical abilities, systematic abilities, self-confidence, curiosity, and cognitive maturity (P < .05) (Table 2).

Table 2.

Comparison of the critical thinking between the 2 groups.

Group	Seek the truth	Open mind	Analytical ability	Systematization ability	Self-confidence	Thirst for knowledge	Thermal cognitive maturity
R group (n = 40)	41.36 ± 2.27	42.46 ± 1.73	39.08 ± 1.34	39.61 ± 2.55	39.15 ± 2.41	39.22 ± 1.05	41.35 ± 2.66
C group (n = 40)	38.23 ± 1.42	39.62 ± 1.68	33.89 ± 1.57	34.87 ± 2.24	24.08 ± 1.45	35.62 ± 2.91	37.41 ± 1.55
T	7.393	7.448	15.903	8.832	33.887	7.36	8.094
P	.002	.018	<.001	.004	<.001	.029	.031

3.4. The clinical thinking ability of students

Before the teaching, there exhibited no notable difference in students’ systematic thinking ability and evidence-based thinking ability and other aspects of clinical thinking ability scores (P > .05). The clinical thinking ability was significantly higher in both groups after teaching (P < .05). Meanwhile, the clinical thinking ability in the study group was significantly higher than that in the control group after teaching (P < .05) (Table 3).

Table 3.

Comparison of the clinical thinking ability between the 2 groups.

Group	Systematic thinking ability		Evidence-based thinking ability
	Before teaching	After teaching	Before teaching	After teaching
R group (n = 40)	30.12 ± 2.63	42.05 ± 1.39a	18.27 ± 3.39	26.47 ± 0.49a
C group (n = 40)	30.07 ± 2.72	32.72 ± 1.94b	18.61 ± 3.47	21.29 ± 0.58b
T	0.084	24.725	0.443	43.148
P	.815	<.001	.691	.007

^aThere was a significant difference in the scores of the research group before and after the teaching (P < .05).

^bThere was a significant difference in the scores of the control group before and after the teaching (P < .05).

3.5. The scores of learning autonomy

Before teaching, there exhibited no notable difference in learning autonomy (P > .05). There was a marked improvement in students’ interest in learning, self-management skills, ability to implement plans, and cooperation abilities after the teaching (P < .05) (Table 4).

Table 4.

Comparison of the learning autonomy scores between the 2 groups.

Group	Interest in learning		Self-management		Cooperate with each other		Plan implementation
	Before teaching	After teaching	Before teaching	After teaching	Before teaching	After teaching	Before teaching	After teaching
R group (n = 40)	19.09 ± 4.39	25.28 ± 3.27a	28.65 ± 4.26	35.37 ± 3.19a	13.37 ± 2.16	18.32 ± 3.13a	18.66 ± 2.62	24.51 ± 4.31a
C group (n = 40)	18.74 ± 4.23	20.74 ± 3.63b	28.51 ± 4.59	30.34 ± 3.12b	13.09 ± 3.71	15.34 ± 3.31b	18.62 ± 2.81	20.16 ± 5.36b
T	0.363	5.877	0.141	7.129	0.413	4.137	0.066	4
P	.157	.011	.812	.016	.717	.021	.613	.035

^aThere was a significant difference in the scores of the research group before and after the teaching (P < .05).

^bThere was a significant difference in the scores of the control group before and after the teaching (P < .05).

3.6. The classroom teaching effectiveness

Learning target, learning processes, learning effects, classroom environment construction, teaching strategy, and technology application in the study group were significantly higher than those in the control group (P < .05) (Figs. 2 and 3).

Figure 2.

Comparison of results of student evaluation between the 2 groups. (A) Learning target; (B) learning process; (C) learning effect.

Figure 3.

Comparison of results of teacher evaluation between the 2 groups. (A) Classroom environment creation; (B) teaching strategy; (C) technology application.

3.7. The teaching satisfaction of students

In the research group, 23 people were very satisfied, 16 were satisfied, and 1 was dissatisfied, with a satisfaction rate of 97.50%. In the control group, 7 people were very satisfied, 23 were satisfied, and 10 were dissatisfied, with a satisfaction rate of 75.00%. The satisfaction rate in the study group was significantly higher than that in the control group (P < .05) (Fig. 4).

Figure 4.

Comparison of the teaching satisfaction between 2 groups.

4. Discussion

General medicine is an emerging discipline, which is a comprehensive medical professional discipline for individuals, families, and communities that integrates clinical medicine, preventive medicine, rehabilitation medicine, medical psychology, and humanities and social sciences.^[19] General practice is the future development mode of community medicine. At present, the state fully advocates standardized training for residents, especially investing more in general practice, hoping to train more qualified grassroots doctors to meet the needs of society.

Primary care hospitals are directly accessible to patients with chronic diseases in the community and are the most convenient places for health-related consultation and medical treatment. To train qualified general practitioners, trainees are required to participate in outpatient teaching in primary hospitals. The general practice clinic often adopts a 3-step teaching method. The students first receive the consultation under the supervision of their teacher. The teacher can watch the students’ consultation process through video in another room, and then take the teacher to the consultation room for supplementary consultation. After the patient leaves the reception room, the teacher will point out the mistakes and deficiencies of the students in this process. The students will explain their thinking, and the teacher will teach the students in terms of the specific situation of the patient and the thinking of the students. Through the practice of general practitioner training, trainees will gradually master the outpatient diagnosis and treatment process of diseases.^[20–22] In primary hospitals, basic medical care and public health are provided, and general practitioners should understand the diagnosis and treatment of common diseases, the dosage, function, and clinical application of common drugs. Various clinical operations should be done more and more frequently. In terms of doctor–patient relationship, general practitioners should live in harmony with patients and their families. Teachers should promptly explain the do’s and don’ts of doctor–patient communication and consider the problems and solve them from the other person’s perspective.

CBL teaching mode is an important form of case teaching method. It refers to a strategy that closely focuses on specific learning objectives, typically dealing with real cases in medical practice, guiding students to conduct in-depth research and active thinking about the cases, and improving their ability to solve practical problems by linking theory to practice. The biggest and most obvious advantage of this teaching mode is that it has strong authenticity. The selected cases have the characteristics of intuitiveness and vividness, which can bring students an immersive learning experience and help the students to play the main role, and notably improve students’ practical problem-solving ability.^[23–25] From this point of view, the CBL teaching mode is an important choice to improve the comprehensive quality and practical performance of general practitioners, and a lot of practical experience also proves this conclusion. The virtual diagnosis and treatment mode uses APP to interact with “virtual patients,” including clinical consultation, physical examination, auxiliary examination, diagnosis, differential diagnosis, treatment, and full-cycle simulation of disease outcomes. It is a newly emerging high-tech simulation. Teaching mode of diagnosis and treatment.^[26,27] The virtual simulation diagnosis and treatment combined with the CBL teaching mode is a comprehensive teaching mode, that has the characteristics of zero risk, low cost, high efficiency, and easy popularization, which is suitable for the field of clinical medicine.

The results indicated that the theoretical knowledge, skill operation, medical history collection, and case analysis in the research group were notably higher. This has suggested that the virtual simulation diagnosis and treatment combined with the CBL teaching mode can successfully enhance the teaching effect of the standardized training of general practitioners. Taking medical history is one of the most basic clinical skills that medical students must master. When students first enter clinical practice to collect medical history, they often forget to focus on consultation due to nervousness and shyness. Simulation and rehearsal of the history-taking process can help students better grasp the skills and strategies of clinical interviewing, ask more focused questions, and improve their ability to take a medical history. The use of virtual cases for clinical diagnosis and treatment enables students to conduct repeated consultations in simulated real medical scenarios, learn how to communicate with patients, and master doctor-patient communication skills. Therefore, after the application of virtual diagnosis and treatment combined with CBL teaching in the standardized training of general practitioners, the theoretical knowledge, operational ability, medical history collection, and case analysis ability of the trainees have been qualitatively improved, which can make them more suitable for future work and better for patients. It also helps to improve the comprehensive medical level of the hospital.

Critical thinking is a judgment process that uses scientific methods to logically reason, analyze, and evaluate specific problems in certain specific situations.^[28] It attaches importance to clinical practice and can effectively improve job satisfaction and clinical outcomes of patients.^[29,30] The results indicated that the scores of the students in the research group were notably higher in terms of truth-seeking, open-mindedness, analytical ability, systematization ability, self-confidence in judgment, intellectual curiosity, and cognitive maturity. This has indicated that the virtual simulation diagnosis and treatment combined with the CBL teaching mode can successfully enhance the critical thinking of general practitioners. A critical thinker utilizes an abstract thinking skill that emphasizes problem-solving with physicians as part of a hands-on process.^[31] Virtual simulation-based diagnosis and treatment combined with CBL teaching mode can help subject students to teach cases in simulated real medical scenarios, giving them more opportunities to exercise critical thinking. Students can easily realize that what they are learning is closely related to people’s health and careers, stimulating their curiosity while exercising their clinical thinking skills. During the teaching period, students’ interest in learning, self-management, plan implementation, and mutual cooperation abilities were significantly improved, according to this study. Additionally, students’ abilities improved significantly in all areas of the research group. Students in the study group scored notably higher in the 6 items of learning goals, learning process, learning effect, classroom environment creation, teaching strategies, and technology application, suggesting that virtual simulation diagnosis and treatment combined with CBL teaching mode is beneficial to motivate students and improve their learning autonomy, verifying the conclusion of the previous analysis again. The combination of clinical diagnosis and treatment virtual cases combined with CBL teaching method subverts the traditional lecture-based teaching method and focuses more on interaction and practice. It is important to maximize a student’s interest in learning through therapy. The biggest difference between the virtual simulation diagnosis and treatment combined with the CBL teaching mode and the traditional teaching method is that it can stimulate the students’ interest in learning, help to improve their subjective initiative and learning efficiency, and can notably improve the students’ comprehensive ability and professional level.

Clinical diagnostic thinking is the core factor of whether the clinical diagnosis and treatment decision is correct or not. The formation of clinical diagnostic thinking ability needs to raise the perceptual knowledge in clinical practice to rational knowledge, and then guide clinical practice. Training students to establish correct diagnostic thinking is an important part of diagnostics teaching.^[32,33] According to the results of this study, the study group scored higher on systematic thinking ability and evidence-based thinking ability. This is mainly because the virtual simulation diagnosis and treatment combined with CBL teaching method takes the teacher as the lead, the students as the main body, and the dynamic communication between teachers and students with specific cases as the carrier. Through the discussion and analysis of the cases, we can guide the students to actively adopt the knowledge they have learned and transform the theoretical knowledge into cognitive ability and practical ability. In the process of diagnosis and treatment, students can effectively realize the correlation between the knowledge points of various clinical disciplines. The correct utilization, analysis, and judgment of various disease information to obtain reasonable diagnostic results, the whole treatment process is beneficial to the effective cultivation of students’ clinical diagnostic thinking skills.^[34] In addition, 23 people were very pleased, 16 were pleased, and 1 was displeased in the study group, with a satisfaction rate of 97.50%, while in the control group, 7 people were very pleased, 23 were pleased, and 10 were displeased, with an excellent and good rate of 75.00%. It is recommended that the institute is more pleased with the virtual simulation treatment combined with CBL teaching mode. This is mainly due to the fact that the training process is interest-oriented rather than mechanically instilling knowledge. Therefore, learning efficiency is improved and the learning effect is maximized, which improves the students’ ability by getting twice as many results with half as much effort.

Additionally, this study has several limitations. First, as a single-center study with a relatively homogeneous participant population from a specific region, it might be influenced by varying levels of baseline medical education across different areas. Students from regions with higher levels of basic medical education might have greater receptivity to education, potentially making the implementation of the virtual diagnosis and treatment combined with the CBL teaching method more effective in widening the score gap between the 2 groups. Moreover, due to practical constraints, the training was conducted over a period of 2 months. While this duration was sufficient to effect changes in the students’ clinical thinking scores, it may not fully demonstrate the long-term impact of the combined virtual diagnosis and treatment with CBL teaching. In future studies, we might consider multiple training sessions over 2-month cycles to explore related outcomes.

5. Conclusion

To sum up, the traditional teaching mode inculcates the relevant clinical medical knowledge directly to the resident physician, but the resident physician’s ability to digest and absorb a large amount of clinical knowledge is limited. Therefore, the learning effect is not ideal, the learning initiative is not high, and the teaching efficiency is relatively low. The application of virtual simulation treatment and CBL teaching method can improve residents’ participation in teaching, promote the cultivation of residents’ independent clinical thinking ability, increase the communication and cooperation among residents, enhance their sense of learning value and achievement, and is more conducive to the cultivation of excellent residents.

Acknowledgments

None.

Author contributions

Resources: Fei Pan, Lunrui Ge.

Software: Fei Pan, Lunrui Ge.

Supervision: Fei Pan, Lunrui Ge, Mei Liu.

Validation: Fei Pan, Lunrui Ge.

Visualization: Fei Pan.

Writing—original draft: Fei Pan.

Writing—review & editing: Fei Pan, Mei Liu.

Methodology: Lunrui Ge, Mengting Hu, Mei Liu, Wei Jiang.

Project administration: Lunrui Ge, Mengting Hu, Wei Jiang.

Conceptualization: Mengting Hu, Wei Jiang.

Data curation: Mengting Hu, Wei Jiang.

Formal analysis: Mengting Hu, Wei Jiang.

Funding acquisition: Mengting Hu, Wei Jiang.

Investigation: Mengting Hu, Wei Jiang.