Using Nobel Prize case-based learning in Medical Immunology to cultivate critical thinking dispositions for medical undergraduates

Abstract

Background

Critical thinking has been regarded as an essential skill for college students, which is especially imperative for medical students to possess the ability to have in-depth insight into complex clinical situations. Medical Immunology is an overarching principle connecting multiple medical subjects, which emphasizes that immunity is both beneficial and harmful to the host, thus putting higher demands on students’ critical thinking. The utilization of Nobel Prize stories has been cited as a thematic framework for classroom teaching of other courses, showing numerous educational benefits. Therefore, this study rejuvenated a case-based teaching approach by creating and introducing a vibrant material library centered on numerous iconic Nobel Prize cases in Medical Immunology and evaluating its effects on the critical thinking of medical students.

Methods

A total of 70 second-year medical undergraduates from the Beijing University of Chinese Medicine were divided into a control group and an experimental group of 35 cases each. Throughout the semester, the control received the traditional teaching method, and the experimental group adopted case-based teaching based on the Nobel prize-centered material library. The process of teaching design and practice was described using “Antitoxin and immunoserum therapy” as a classical example. A unified assessment of the critical thinking dispositions of participants was conducted at the beginning and end of the semester using the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV).

Results

Intra-group longitudinal comparisons and inter-group parallel evaluations indicated that, compared with the conventional teaching approach, Nobel Prize case-based learning induced a statistically significant increase in the overall score of the CTDI-CV, as well as the scores within the subdimensions of truth-seeking, analyticity, and maturity in judgment (p < 0.05). Pearson correlation analysis further indicated a positive correlation between the total score of the CTDI-CV and the final grade (p < 0.05), which emphasized the crucial role of critical thinking dispositions in academic achievement.

Conclusion

The case-based classroom teaching centered on Nobel Prize cases for Medical Immunology can effectively improve the critical thinking dispositions of medical undergraduates, which contributes to cultivating high-level medical and healthcare talents with excellent comprehensive quality in the new era.

Introduction

In the complex age of intelligence and information technology, critical thinking ability is crucial to the survival, development, and creativity of college students, as well as to the formation of humanistic and constructivism education concepts. A recent definition indicated that critical thinking consists of cognitive skills (e.g., analysis, evaluation, inference, etc.) and dispositions (e.g., truth-seeking, open-mindedness, systematicity, etc.) [1, 2]. Critical thinking dispositions shape an individual’s inclination to employ critical thinking skills and to self-regulate the application of these skills [3]. Moreover, multiple pieces of evidence have demonstrated a positive correlation between critical thinking dispositions and the academic achievements of college students [4] and high school participants [5]. Therefore, understanding and cultivating college students’ critical thinking dispositions is of great significance for the in-depth development of higher education classroom teaching reform. Some Western countries, such as the United States, have long established critical thinking as the core objective of national science education and gradually made it the mainstream philosophy of their education [6]. In the 21st century, the cultivation of critical thinking dispositions has also gradually attracted the great attention of Chinese higher education institutions. Despite that, there are still limited reports on improving the critical thinking dispositions of Chinese college students through classroom teaching reform measures.

In medicine, many situations including disease/health and treatment/side effects are common relations of opposites [7, 8]. Critical thinking has the potential to equip medical students with the ability to more profoundly understand these complexities and facilitate informed decision-making that is central to effective clinical practice [7, 8]. Medical Immunology, a discipline that delves into the intricacies of pathogen infection and host immune responses, remains a cornerstone of life science education, especially within medical curricula. The concept of immunity itself embodies the duality inherent in critical thinking and it can be both beneficial and harmful to the host, underscoring the importance of weighing the full spectrum of outcomes. Immunology instruction should aim to cultivate a critical approach in students, enabling them to evaluate cases, experimental results, or treatment options and raise in-depth questions, ultimately fostering the capabilities to think independently and solve problems robustly [9]. However, at present, relevant research focusing on the cultivation of critical thinking in the immunology curriculum of college students remains lacking. Under the concept of current student-centered active learning, there is an urgent need for innovative teaching strategies that stimulate critical thinking to attract students’ interest in the hot frontiers of immunology and enable them to grasp the multifaceted nature of the immune system ranging from the molecules and cells to organ systems.

The utilization of the Nobel Prize stories as a thematic framework for the classroom teaching of [10] has been reported to yield numerous educational benefits [11–13]. Given the rich history of medical immunology, a mass of iconic Nobel Prize cases can also serve as exceptional scientific resources to foster critical thinking. Therefore, we embarked on a novel initiative to rejuvenate teaching contents, objectives, design, and evaluation by creating and introducing a vibrant teaching material library centered on these Nobel Prize cases in Medical Immunology. This study introduced the teaching reform and practice process of this course based on critical thinking training in detail. Medical sophomores at Beijing University of Chinese Medicine (BUCM) participated in this study to assess the impact of Nobel Prize-based education on their critical thinking dispositions. We systematically measured the status quo and changes in the critical thinking dispositions of students by using the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) [8, 14, 15]. This study focused on seeking effective approaches to cultivating and improving the advanced critical thinking ability of college students. Our findings presented the potential and effectiveness of Nobel Prize cases as a powerful tool for teaching Medical Immunology, which would provide a valuable framework for critical thinking-based curricula in higher education.

Methods

Research participants and design

We used a quantitative descriptive pretest-posttest control group design to assess the impact of Nobel Prize-inspired pedagogical reforms on the critical thinking dispositions of medical students (Fig. 1). Due to the lack of research on cultivating critical thinking in Medical Immunology, we calculated the sample size by referring to a published study [16]. In that study [16], the average score of critical thinking in the experimental group was 9.47 ± 2.669, while that in the control was 11.00 ± 2.591. We set the significance level at α = 0.05 and the 90% confidence level at 1-β = 0.9. According to the formula n= (Z_α+Z_β)²×σ²/δ² for the pretest-posttest study design [17], with Z_α=1.96, Z_β=1.28, σ = 2.669, and δ = 11.00-9.47 = 1.53, we estimated the required sample size for each group to be approximately 32 cases. Considering a potential dropout rate of 10%, we finally determined the total number of cases in each group to be 35. Therefore, a convenience sample of 70 medical students from 4 classes in BUCM, China, were invited to take part in the study. Over the course of a semester, two of these classes, totaling 35 students, served as the control group to receive conventional teaching methods. The remaining two classes, also numbering 35 students, formed the experimental group that underwent critical thinking-based instruction. The inclusion criteria included having registered for the Medical Immunology curriculum and being a second-year undergraduate medical student. The exclusion criteria were defined as studying a non-medical major, not being a sophomore, expressing reluctance to participate, and involvement in other case-based educational reforms.

Fig. 1.

Flow chart of the teaching process of Medical Immunology for two groups

Teaching methods

Both the experimental group and control group were instructed by the same experienced lecturers with the same syllabus and class hours, which mainly included theoretical learning and practical operation. We outlined the methods taken to ensure that participants were blind to the group allocations, thereby reducing the potential for bias in the learning process.

The control group

This method is regarded as a traditional educational approach, which emphasizes that the lecturer proactively transmits theoretical knowledge and the students passively receive knowledge. Students received a three-step teaching method consisting of self-study before class, followed by in-class or laboratory lectures, and concluded with post-class quizzes or assignments. Each step was executed with strict adherence to the textbook, curriculum, and the established teaching schedule, with a lack of access to our Nobel Prize material library.

The experimental group

This method was grounded in traditional knowledge teaching, further incorporating our characteristic Nobel Prize material library, and implemented as a case-centered approach to fully developing students’ critical thinking. Our teaching process implementation mainly included pre-class learning, classroom introduction, group discussion, experimental teaching, and post-class assessment. We informed this approach by the integration of Nobel Prize cases throughout the curriculum, as illustrated in Fig. 1.

“Antitoxin and immunoserum therapy” (Emil Adolf von Behring, 1901) is a classical Nobel Prize case in the chapter on “Antibody”, which represents a fundamental topic of immunology basis as well as a critical area for guiding the defense against pathogenic infections. Therefore, given this connecting link between the preceding and the following in the curriculum, this paper adopted “Antitoxin and immunoserum therapy” as a classical example to elaborate the design and implementation of a critical thinking-based teaching methodology.

Step 1: Pre-class learning assignments containing the narratives of Nobel Prize-winning immunologists via an online digital platform

Firstly, we produced personalized classroom teaching slides incorporating the scientific narrative and the Nobel-winning legacy of Emil Adolf von Behring, who won the Nobel Prize for his pioneering work on “Antitoxin and immunoserum therapy”. One week before the scheduled class, students received a pre-class learning task list about “Antibody” and slides on “Antitoxin and immunoserum therapy” through the online digital platform “Rain Classroom”. We expected students to engage with the self-study materials and complete a corresponding self-assessment quiz by the night before class. The approach ensured that students had a foundational understanding of the history behind the discovery of antitoxin and the development of animal serum therapy, preparing them for the ensuing online class discussions. Relying on the quick and convenient statistical function of these intelligent classroom platforms, we could adjust the online class content, check leakage, and fill a vacancy in class according to the student’s completion and participation of self-test questions.

Besides, five minutes before class, we broadcasted documentaries or interesting videos to review the arduous research journey of Behring and encouraged students to hold the values of truth-seeking, critical questioning, innovation, objective realism, and perseverance which are essential traits in the scientific endeavor.

Step 2: Construction and application of paper and electronic textbook resources containing Nobel Prize-related materials for classroom teaching

In class, we selected “Medical Immunology and Pathogen Biology”, a national planning textbook published by Science Press [18], as the textbook for this course. Three famous teachers of Chinese medicine universities compiled this textbook for the extensive use of medical majors and other medical majors. Our course team developed an array of dynamic digital learning resources to enrich the most recent edition of this textbook. These resources included illustrative diagrams and engaging animations that corresponded to the course contents, offering students a more interactive and visually stimulating learning experience. As well, students could also access diversified slides incorporating immunological scientist materials and mind maps through QR codes, which aimed to improve their learning interest, enhance their intellectual curiosity, and open their scientific thinking.

Step 3: Implementing a series of class seminars on classical Nobel Prize-related materials for classroom teaching

To foster academic engagement among our students, we implemented a series of class seminars on “Antitoxin and immunoserum therapy”, to inspire a deep dive into Behring’s significant contributions from his discovery and experimentation of Corynebacterium diphtheriae to his groundbreaking work in the field of Immunology. By selecting different stages of Behring’s story, we motivated students to delve into topics such as pathogenic bacteria, disinfection, and sterilization techniques. This way encouraged students to embody the spirit of hard work, persistence, continuous innovation, and the courage to make mistakes. Furthermore, through highlighting the collaborative efforts of Behring, Shisaburo Kitasato, and other bacteriologists in developing antitoxin and immunoserum therapies, we cultivated an appreciation for integrating multi-team research findings and scientific cooperative spirit. During this process, the introduction of the diphtheria vaccine serves as a springboard for students to actively explore the immunological mechanisms behind antitoxins and vaccines.

Step 4: Introducing the flipped classroom mode for small group discussions on classical Nobel Prize-related materials

In addition to traditional classroom settings, we utilized the flipped classroom model, allowing students to present the scientific literature published by Behring in small group discussions. We also encouraged them to explore the corresponding scientific papers involved in Behring’s Nobel Prize, such as “Disinfection in the living body” [19], “Emil Behring’s medical culture: from disinfection to serotherapy” [20], and “Emil von Behring: translational medicine at the dawn of immunology” [21].

Step 5: Recording classical experimental video resources related to the Nobel Prize for extra-curricular learning

To further enrich their learning experience, our teaching team recorded an operation video demonstrating the preparation of immune serum for students’ extracurricular learning, to enhance their awareness of immune serum therapy and improve their practical skills during laboratory sessions. Through these diverse methods, we not only aim to impart knowledge but also to inspire students to draw lessons from Behring’s journey. His narrative of ascending from humble origins to becoming a highly proficient and accomplished researcher stands as a testament to the value of diligence and perseverance.

Step 6: Multi-level assessment and long-term tracking of Nobel Prize-based teaching effectiveness

After a week of instruction, the teacher implemented questionnaire surveys to assess the teaching effectiveness among the students in the class. The students uniformly expressed high satisfaction with the quality of the class, stating that this teaching mode made the knowledge points clearer, enhanced learning efficiency, and sparked greater interest in learning. Finally, we included the pertinent case study questions in the final examination of both groups to evaluate students’ analytical and critical thinking dispositions, thus reflecting the impact of Noble Prize-based classroom reforms combined with the usual performance. As well, we encouraged open academic discussions as an extension of learning beyond the classroom, fostering a valuable exchange between teachers and students that would persist throughout the semester and even after graduation.

Assessment instruments

California Critical Thinking Dispositions Inventory (CCTDI), a standardized commercially prepared tool based on robust theory and one of the most widely used to measure critical thinking disposition, was further revised to CTDI-CV according to the local characteristics in China by Peng et al. [14]. Therefore, this study applied CTDI-CV to assess the critical thinking dispositions of the included Chinese subjects. The content validity of CTDI-CV is 0.89, the α value is 0.90, and the internal consistency of each dimension is between 0.54 and 0.77. The same validity and reliability values have been validated in two large cohorts of medical students from different medical institutions in China [8, 15], which confirmed the suitability as a measurement tool for medical students’ critical thinking disposition within the context of this study. CTDI-CV contains 7 subscales that are truth-seeking, open-mindedness, analyticity, systematicity, confidence in reasoning, inquisitiveness, and maturity in judgment. Each dimension consists of 10 questions, for a total of 70 questions, with 6 choices after each question.

This research used a Likert six-point scale to score positive and reverse questions [1]. There were six grades for positive questions: strongly agree, quite agree, somewhat agree, generally agree, quite disagree, and strongly disagree, corresponding to 1 to 6 points, respectively. In contrast, reverse questions corresponded to 6 to 1 points, respectively. A total score ≤ 210 indicates a negative overall critical thinking disposition, a total score of 211 to 279 signifies an ambivalent disposition, a total score ≥ 280 refers to a positive disposition, and a total score ≥ 350 means a strongly positive disposition. As for the critical thinking disposition in a single dimension, a score ≤ 30 represents negative, a score of 31 to 39 means ambivalent, a score ≥ 40 suggests positive, and a score ≥ 50 refers to strongly positive.

Questionnaire distribution and data collection

All students in the control and experimental groups received CTDI-CV before and after the semester. The course instructors provided clear instructions on how to properly undertake the test and elucidated the purpose and nature of this questionnaire. Through the entire process of filling out the questionnaire, we mandated each student to complete it independently without any form of consultation or discussion with their peers to ensure the integrity of the individual responses.

Data analysis

We used the GraphPad Prism 9.0 software to perform statistical analysis of the variance and difference of the measured data, as well as generate the visualized charts showing statistical differences. Before proceeding with the comparison between and within groups, we performed the Normality and Lognormality Tests via GraphPad Prism 9.0 software. The resulting p values all exceeded 0.05, suggesting that the data conformed to a normal distribution. Therefore, we subsequently conducted unpaired t-tests to determine statistical significance in the scores of CTDI-CV between control and experimental groups, as well as assigned paired t-tests to determine statistical significance between pre-test and post-test in the experimental group. Pearson correlation analysis acted as an approach to exploring the correlation between the total scores of CTDI-CV and the final grades. p values below 0.05 indicated a significant difference. We presented data as mean ± standard error of the mean (mean ± SEM).

Results

We collected a total of 140 valid questionnaires from 4 classes majoring in medicine at the beginning and end of the tested semester. Of the total of 70 students, 38.6% (n = 27) were male and 61.4% (n = 43) were female.

Difference in the critical thinking disposition between control and experimental groups

The mean and SEM of the critical thinking disposition scores for the sample of control and experimental groups are shown in Table 1. We used unpaired t-tests to compare the subscales and total scores of CTDI-CV between control and experimental groups.

Table 1.

Mean scores of CTDI-CV in the control and experimental group (Mean ± SEM)

Subscale/Attribute	Pre-test		Post-test
	Control	Experimental	Control	Experimental
Total score	241.09 ± 2.95	242.03 ± 3.20	234.74 ± 2.86	247.63 ± 3.23**
Truth-seeking	36.91 ± 1.07	39.06 ± 0.91	37.03 ± 1.08	40.89 ± 0.96**
Open-mindedness	36.89 ± 0.72	35.46 ± 0.65	35.74 ± 0.88	35.80 ± 0.61
Analyticity	29.91 ± 0.71	30.89 ± 0.84	29.71 ± 0.76	31.69 ± 0.62*
Systematicity	33.26 ± 0.75	34.23 ± 0.71	32.8 ± 0.50	34.49 ± 0.71#
Confidence in reasoning	29.37 ± 0.95	28.37 ± 1.02	28.43 ± 0.92	28.97 ± 1.17
Inquisitiveness	31.91 ± 0.64	30.89 ± 0.89	30.71 ± 0.72	31.77 ± 0.92
Maturity in judgment	42.84 ± 0.93	43.14 ± 0.91	40.31 ± 1.21	44.03 ± 1.01*

Note^**p < 0.01, ^*p < 0.05, and ^#p < 0.10, compared with the control group, calculated by unpaired t-tests

The results showed that at the beginning of the semester (Before the teaching reform of their course), there was no statistically significant difference in the overall mean scores and seven subscales of critical thinking dispositions between control and experimental groups (p > 0.05).

However, at the end of the semester (after performing the Nobel Prize-based instruction), the overall mean scores of students were 247.63 ± 3.23, which showed a statistically significant improvement (p < 0.01) compared to the control (234.74 ± 2.86) with traditional teaching. According to the definition of the total score of the scale, a total score between 211 and 279 in the experimental group meant that they had an ambivalent overall disposition. Meanwhile, the students with the Nobel Prize-based teaching obtained significantly higher scores in three of the subscales, including truth-seeking (p < 0.01), analyticity (p < 0.05), and maturity in judgment (p < 0.05) than controls (37.03 ± 1.08; 29.71 ± 0.76; 40.31 ± 1.21). The score of systematicity tended to significantly increase relative to controls (p < 0.10). It was worth noting that the scores of truth-seeking (40.89 ± 0.96) and maturity in judgment (44.03 ± 1.01) were both greater than 40 points, indicating that our classroom reforms have made students have a positive disposition toward these two dimensions. A score between 31 ~ 39 for analyticity (31.69 ± 0.62) and systematicity (34.49 ± 0.71) was considered to be an ambivalent inclination of students towards these two dimensions.

Difference in the critical thinking disposition before and after the teaching reforms

To fully demonstrate the benefits of our teaching reform on students’ critical thinking dispositions, we further compared the overall scores and subscales of CTDI-CV questionnaires before and after classroom instruction using paired t-tests (Table 2). To our surprise, the traditional teaching induced a significantly lower total score of CTDI-CV (234.74 ± 2.86, p < 0.05) compared with the baseline level (241.09 ± 2.95). Likewise, the mean score of the dimension of maturity in judgment was also decreased after performing the traditional teaching (40.31 ± 1.21 vs. 42.84 ± 0.93, p < 0.05). On the contrary, compared with the baseline, the total score of CTDI-CV (247.63 ± 3.23 vs. 242.03 ± 3.20, p < 0.05) and the truth-seeking subscale (40.89 ± 0.96 vs. 39.06 ± 0.91, p < 0.01) were significantly higher after receiving Nobel Prize-based classroom instruction. This finding was consistent with the before-mentioned observation between control and experimental groups after the teaching reforms. We observed no statistically significant difference on the remaining subscales of CTDI-CV (p > 0.05).

Table 2.

Mean scores of CTDI-CV before and after the teaching reforms (Mean ± SEM)

Subscale/Attribute	Control group		Experimental group
	Pre-test	Post-test	Pre-test	Post-test
Total score	241.09 ± 2.95	234.74 ± 2.86*	242.03 ± 3.20	247.63 ± 3.23*
Truth-seeking	36.91 ± 1.07	37.03 ± 1.08	39.06 ± 0.91	40.89 ± 0.96**
Open-mindedness	36.89 ± 0.72	35.74 ± 0.88	35.46 ± 0.65	35.80 ± 0.61
Analyticity	29.91 ± 0.71	29.71 ± 0.76	30.89 ± 0.84	31.69 ± 0.62
Systematicity	33.26 ± 0.75	32.8 ± 0.50	34.23 ± 0.71	34.49 ± 0.71
Confidence in reasoning	29.37 ± 0.95	28.43 ± 0.92	28.37 ± 1.02	28.97 ± 1.17
Inquisitiveness	31.91 ± 0.64	30.71 ± 0.72	30.89 ± 0.89	31.77 ± 0.92
Maturity in judgment	42.84 ± 0.93	40.31 ± 1.21*	43.14 ± 0.91	44.03 ± 1.01

Note^**p < 0.01 and ^* p < 0.05, compared with the pre-test values at each group, calculated by paired t-tests

We again applied unpaired t-tests to test the gender effect of CTDI-CV scales collected after the teaching reforms. As shown in Table 3, there were no statistically significant differences for overall scores (p > 0.05) and 7 subscales (p > 0.05).

Table 3.

Mean scores of CTDI-CV in males and females (Mean ± SEM)

Subscale/Attribute	Experimental group after teaching reform
	Male	Female
Total score	242.33 ± 4.03	240.47 ± 2.75
Truth-seeking	39.44 ± 1.12	38.65 ± 1.01
Open-mindedness	35.15 ± 0.70	36.16 ± 0.74
Analyticity	31.00 ± 0.65	30.51 ± 0.72
Systematicity	34.33 ± 0.84	33.31 ± 0.49
Confidence in reasoning	29.33 ± 1.27	28.30 ± 0.91
Inquisitiveness	30.59 ± 0.95	31.65 ± 0.74
Maturity in judgment	42.48 ± 1.24	41.98 ± 1.08

The correlation of the CTDI-CV score and the term final grade

To evaluate the correlation between the dispositions to think critically and to achieve academically, we performed the Pearson correlation analysis on the total score of CTDI-CV and the academic achievement in terms of the term final grade. As presented in Fig. 2, the total score of CTDI-CV was significantly positively correlated with the final grade (r = 0.261, p < 0.05). In other words, the stronger critical thinking disposition was associated with the higher term final grade.

Fig. 2.

The correlation between the total score of CTDI-CV and final grades of students. r was the Pearson correlation coefficient

Discussion

Critical thinking disposition is imperative for medical education. The case-based learning method has gained recognition as a pivotal strategy for fostering the critical thinking disposition among undergraduate students across a diverse range of disciplines and curricula [22–24]. Given that Medical Immunology is the overarching principle that links multiple medical subjects, this study discovered a case-based teaching model based on Nobel Prize stories in this course to cultivate students’ critical thinking disposition in the medical university. Our results revealed that employing a Nobel Prize-based teaching approach led to obvious improvements in the overall dispositions of critical thinking dispositions among medical students, particularly in the areas of truth-seeking, analyticity, systematicity, and maturity in judgment. These findings strongly suggest that incorporating Nobel Prize narratives into the classroom instruction of Medical Immunology holds considerable promise and demonstrates tangible effectiveness in cultivating the critical thinking dispositions of students.

Among the seven sub-scales of critical thinking dispositions, truth-seeking stands out as a vital characteristic of proficient critical thinkers, and measures to improve truth-seeking are also deemed important to ensure that students strive for the most accurate and reliable information available [25]. However, several studies have indicated that nursing students tend to score lowest on the truth-seeking subscale when measuring critical thinking dispositions [25–29]. In contrast to these findings, our study presents a promising outcome. With the implementation of Nobel Prize-based classroom reforms, we noted that the scores of truth-seeking surpassed 40 points, indicating a significantly positive disposition toward this dimension among our students. Truth-seeking represents the attitude of the individual toward seeking the best information or knowledge in a given context, courageously posing questions, and candidly conducting investigations, even if the findings do not meet his/her interests or preconceptions [25].

It was indeed noteworthy and encouraging to observe that maturity in judgment exhibited the highest subscale mean score, with a score above 40 indicating that participants had a favorable tendency in this dimension. In alignment with our study, Ma and colleagues implemented an unfolding case-based learning that markedly enhanced the cognitive maturity of undergraduate nursing students with a mean score over 40 [30]. As such, our innovative Nobel Prize-based teaching intervention appears to have successfully fostered this trait. A positive inclination toward maturity in judgment implies that students tend to regard problems as complex and multifaceted, eschewing oversimplified black-and-white perspectives [25]. Consequently, they demonstrate the ability to make a judicious judgment at the appropriate time, i.e., neither too hastily nor with unnecessary procrastination. This capacity engenders confidence in their reasoning process, thereby enhancing their aptitude for problem-solving and decision-making.

Analyticity and systematicity represent two cognitive facets of critical thinking that are notably influenced by cultural context [31]. Analyticity entails a keen attentiveness to forthcoming events and strategic employment of available evidence, alongside predicting possible consequences to resolve practical problems [6, 31]. Systematicity, on the other hand, involves the disciplined, targeted, and persistent pursuits of problem-solving strategies [25, 31]. After the implementation of classroom teaching reforms, the scores of these two dimensions on their subscales also increased, indicating the improvement of students’ analytical and systematic abilities. However, it is crucial to acknowledge that the scores between 30 and 39 of these two subscales still implied a neutral inclination of subjects. In addition, the mean score obtained for subscales including open-mindedness, confidence in reasoning, and inquisitiveness did not change significantly with the use of Noble Prize-based teaching compared to the traditional lecture. This could potentially be due to an inadequacy in the current teaching framework and curriculum design to comprehensively develop all dimensions of critical thinking, thus requiring further refinement and optimization.

Finally, the observed positive relationship between the total scores of CTDI-CV and the final grades emphasized the crucial role of critical thinking dispositions in academic achievement. Previous studies, including those conducted by Biggs [32] as well as Ren and colleagues [2], have consistently recognized critical thinking as a pivotal factor contributing to academic performance. Collectively, these findings provide valuable insights into the benefits of fostering critical thinking dispositions among college students. Meanwhile, medical educators should consider the cultivation of student’s critical thinking as one paramount teaching objective.

Our study provided a novel exemplar for cultivating critical thinking based on the Nobel Prize stories originated from Medical Immunology in a case-based teaching manner by the implementation of a pretest-posttest control group design. Besides, we have meticulously detailed the various steps undertaken to implement the teaching approach, illustrating for our readers the Nobel Prize material as a unifying theme throughout the curriculum. However, it is important to note that we conducted this study with a limited number of medical students over a single semester and a single university, which might constrain the broad application of the findings obtained. To enhance the generalizability of these results, we suggest further research to compare the differences in critical thinking dispositions between Nobel Prize lectures and other teaching methods in a larger cohort from other schools or majors. Furthermore, there is a need for longitudinal studies that track the evolution of students’ dispositions towards critical thinking throughout their college tenure. Such research would provide rewarding insights into the lasting impact of educational interventions on critical thinking among medical students.

Conclusions

In summary, our research indicated that utilizing Nobel Prize-centered instructional strategies significantly improved the critical thinking dispositions of college medical students, thus enhancing their academic performance to a certain degree. Given the requirement for critical self-examination in contemporary medical education, using case studies based on Nobel Prizes might play a central role in guiding clinical diagnosis, drug therapy, innovative thinking, and lifelong learning of medical students.

Author contributions

Na Li: Investigation, Writing-Original Draft, Writing-Reviewing and Editing, Visualization, and Data curation; Chonghao Zhang: Writing-Original Draft, Visualization, and Data curation; Jiaqi Cui: Visualization and Data curation; Qing Wang: Investigation and Methodology; Tiangang Li: Conceptualization, Investigation, Supervision, and Funding acquisition; Guiying Peng: Conceptualization, Investigation, Methodology, Supervision, Project administration, Writing-Reviewing and Editing, and Funding acquisition. All authors read and approved the final manuscript.

Funding

This work was supported by the Educational Research Foundation of Beijing University of Chinese Medicine (No. XJY22032 and No. XJYS21007), the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine (No. ZYYCXTD-C202001), and the Teaching Master workshops of Beijing University of Chinese Medicine (No. MSGZF-202207 and No. MSGZF-201803).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

All procedures involving the subjects of this work were approved by the Ethics Committee of BUCM. All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.