Innovative multimodal educational strategies: assessing the impact of integrative teaching methods on standardized neurology resident training

Abstract

Objective

This study explores the application effects of a novel teaching model that combines micro-learning, bedside teaching, and case-based learning (CBL) in the standardized training of neurology residents.

Methods

From January 2022 to December 2024, a total of 103 neurology residents undergoing standardized training at the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. A quantitative research design was employed, and participants were randomly divided into an experimental group and a control group. The experimental group (51 participants) utilized a novel teaching model that integrated micro-learning, bedside teaching, and CBL, while the control group (52 participants) employed Lecture-Based Learning (LBL) methods. The study focused on several indicators, including theoretical assessment scores from standardized training, student satisfaction and interest in the teaching content, clinical competency evaluations, and self-assessments by instructors.

Results

The novel teaching model combining micro-learning, bedside teaching, and CBL significantly outperformed traditional teaching methods in improving residents’ theoretical assessment scores (83.02 ± 7.33 vs. 76.04 ± 7.19) and clinical competency evaluations, particularly in comprehensive ability assessments (85.55 ± 5.24 vs. 75.10 ± 7.86). Students also reported a marked increase in satisfaction with the teaching content and learning interest (P < 0.01). Furthermore, instructors expressed a high level of recognition for the new course model in their post-class self-evaluations (P < 0.01).

Conclusion

The findings of this study indicate that the integration of micro-learning, bedside teaching, and CBL can provide a more effective teaching model for the training of neurology residents, offering strong support for future reforms and developments in medical education.

Graphical Abstract

Introdution

Since the official launch of standardized residency training in China in 2014 [1], neurology has played a crucial role as an important medical discipline in the training of residents. However, the current state of neurology education still faces numerous challenges. On one hand, the complexity and diversity of neurological diseases demand rigorous logical thinking and extensive practical experience for clinical diagnosis and treatment. Traditional teaching methods(Lecture-Based Learning (LBL)) often emphasize the transmission of textbook knowledge, resulting in a lack of effective training in students’ clinical reasoning and practical skills [2].As the incidence of neurological disorders continues to rise [3], clinicians must possess enhanced judgment and decision-making abilities to address various clinical scenarios. The clinical manifestations, pathophysiology, and anatomical structures associated with neurological diseases are inherently complex, posing significant challenges to understanding [4, 5]. Therefore, effectively integrating this knowledge into training to enhance residents’ comprehensive abilities has become an important topic in educational research [6].

Moreover, current neurology education often lacks sufficient time allocation for case discussions and clinical skills training, leading to a lack of confidence among students when confronted with real cases [7].Recent studies indicate that while many residents have a solid grasp of foundational knowledge, their ability to apply this knowledge in clinical practice remains inadequate, particularly in areas such as patient assessment, diagnostic decision-making, and treatment planning [8].Consequently, there is an urgent need for reform in the educational model of neurology to better meet clinical demands and improve residents’ ability to navigate complex situations. Previous literature has reported that the unique characteristics of neurology necessitate a teaching model that combines various instructional methods [9], however, there is currently a lack of exploration into the application of multiple teaching modalities in neurology.

Bedside teaching allows students to observe patients’ clinical presentations firsthand while providing opportunities to practice clinical skills in real-time. The case-based learning (CBL) model promotes critical thinking and problem-solving skills through the analysis of specific clinical scenarios [10]. Micro-lessons, delivered through short videos, systematically provide background knowledge and theoretical frameworks, enabling learners to review foundational knowledge and relevant anatomical structures prior to class. This approach, particularly in presenting anatomical structures and pathophysiological mechanisms in a vivid and interactive manner, facilitates more effective participation in subsequent case discussions [11].Research shows that innovative teaching models such as micro-lessons and bedside teaching not only stimulate students’ interest in learning but also help them integrate theory with practice, enhancing their clinical skills and cognitive abilities [12, 13].Furthermore, the flexibility and accessibility of micro-lessons empower students to learn at different times and locations, further strengthening their self-directed learning capabilities.

This study aims to systematically evaluate the specific advantages of combining CBL with micro-lessons and bedside teaching in the standardized training of neurology residents, exploring how this innovative multi-modal teaching approach can more effectively assist students in mastering the complexities of neurology and enhancing their clinical capabilities and practical skills.

Methods

Participants

This study involved 103 residents from the neurology department at the First Affiliated Hospital of Zhengzhou University from 2022 to 2024.All participants were second-year medical residents enrolled in a standardized training program, comprising practicing graduates and postgraduate students with established clinical competencies. Informed consent was obtained from all participants before the study commenced to ensure ethical compliance throughout the process.

Participants were randomly assigned to two groups using a random number table method. The experimental group (CBL + ML + BT group n = 51) received a teaching model that integrated case-based learning (CBL) with micro-lessons and bedside teaching, while the control group (LBL group n = 52) continued with traditional teacher-centered lectures. The random grouping process was conducted by independent researchers to ensure fairness and scientific validity. A comparative analysis of the demographic characteristics of the two groups, including gender and age, as well as the pre-test scores, revealed no statistically significant differences(p>0.05)(Table 1).

Table 1.

Comparison of participant demographic information and pre-course tests

	CBL + ML + BT(n = 51)	LBL(n = 52)	t/χ2/Z	P
Gender(male)	19(52)	17(51)	0.338	0.502
Age	25.60 ± 2.11	25.23 ± 2.10	-0.907	0.750
Score	79.84 ± 6.68	78.94 ± 6.53	-0.692	0.671

MF: Micro Film; CBL: Case-based learning, LBL: traditional lecture-based teaching

Study design

Experimental Group

This group received no traditional lectures. They underwent a structured educational intervention comprising three core components(twice a week, for 2 h each time): (1) Prior to the course, there preparatory materials, including the latest consensus or guidelines regarding disease advancements, and a 5–10 min micro-lessons provided an introduction to relevant diseases, anatomical structures for the trainees to preview; (2) During the class, 30-minute bedside teaching rotations involving direct clinical practice of history-taking, physical examination techniques first and assess clinical symptoms and signs; (3)90-minute case-based learning (CBL) sessions conducted in small-group formats (5–6 residents per group), exploring typical clinical presentations, pathophysiological mechanisms, differential diagnoses, and treatment options. After each case discussion, teachers provided summaries and feedback to reinforce students’ learning outcomes.

Control group

This group continued with Lecture-Based Learning methods, primarily relying on lectures and classroom explanations, focusing on knowledge transmission and memorization. The content covered was the same as that of the experimental group, but it lacked targeted bedside teaching, case analysis, and interactive discussions.(Twice a week, each session lasts for a total of 2 h. It consists of two 50-minute classes with a 20-minute break in between).

Both the experimental group and the control group consisted of clinical rotation trainees, and all of them participated in normal clinical work.

Intervention duration

14 weeks (aligned with the annual training cycle).

Evaluation method

This study assessed the learning outcomes of the two groups of residents through the following indicators:

Theory assessment

A standardized theoretical examination (50 multiple-choice questions, MCQs, Bloom’s Levels 1–4) was conducted at the end of the training, utilizing a closed-book format to evaluate residents’ mastery of neurology-related theoretical knowledge, including understanding of disease mechanisms, diagnostic criteria, and treatment plans.

Comprehensive ability evaluation

At the end of the training, residents were assessed through a standardized examination format that evaluated their ability to collect patient histories, perform physical examinations, document cases, and analyze clinical scenarios, as well as their clinical reasoning and rapid response skills (Bloom’s Levels 4–6). This comprehensive evaluation also assessed communication and teamwork abilities using multi-dimensional scoring scales.

Satisfaction survey

A self-designed questionnaire was administered to gauge satisfaction with the teaching model, the practicality of the teaching content, and the effectiveness of teacher guidance, using a five-point scale (1 - very dissatisfied; 5 - very satisfied) [14].

Interest inventory

Students’ interest in learning neurology was collected through a questionnaire, assessing the appeal and engagement of the course, using a seven-point scale (1 - not interested at all; 7 - very interested).

Teachers Self-Evaluation

Instructors evaluated the course content and teaching effectiveness using a questionnaire, employing a five-point scale (1 - very dissatisfied; 5 - very satisfied) [15].The total score of the two evaluation indicators is 10 points.

Statistical analysis

Data collected were analyzed using SPSS statistical software. To compare the performance of the two groups across various observation indicators, normally distributed continuous data (e.g., assessment scores, satisfaction ratings, and interest ratings) were expressed as mean ± standard deviation (mean ± s). Differences between the two groups were analyzed using independent samples t-tests or rank-sum tests. A significance level of p < 0.05 was set to determine whether the differences between the experimental and control groups were statistically significant. Graphical representations were created using GraphPad Prism 8.0.

Results

Clinical theory assessment

The experimental group achieved an average score of 83.02 ± 7.33, while the control group had an average score of 76.04 ± 7.19. The t-test results indicated a statistically significant difference between the two groups (t = -4.873, p < 0.001) (Table 2). This suggests that residents taught using the CBL combined with micro-lessons and bedside teaching outperformed those taught through traditional methods in their mastery of clinical theoretical knowledge, reflecting the effectiveness of case discussions and micro-learning. (Fig. 1A)

Table 2.

Courses performance of CBL + ML + TB and LBL group

	CBL + ML + TB(n = 51)	LBL(n = 52)	t/χ2/Z	P
Theoretical Knowledge	83.02 ± 7.33	76.04 ± 7.19	-4.873	<0.001
Interest Inventory	5.59 ± 0.85	3.60 ± 1.01	-6.063	<0.001
Comprehensive evaluation	85.55 ± 5.24	75.10 ± 7.86	-7.608	<0.001
Satisfaction	4.22 ± 0.61	2.96 ± 0.62	-7.435	<0.001
Instructors Self-evaluation	7.45 ± 1.29	5.27 ± 0.78	-4.781	<0.001

MF: Micro Film; CBL: Case-based learning, LBL: traditional lecture-based teaching

Fig. 1.

A comparative analysis of the new integrative teaching methods and the traditional teaching mode

Comparison of theoretical achievement and comprehensive ability(A); Comparison of learning interest, satisfaction and self-evaluation of teachers(B).(*indicates P<0.05,** indicates P<0.001)

Abbreviations: CBL,Case-Based Learning (CBL); ML,Micro-learning; BT,Bedside Teaching; LBL,Lecture-Based Learning

Comprehensive ability evaluation

In the comprehensive ability assessments, including case analysis, the experimental group scored an average of 86.25 ± 6.52, compared to 75.10 ± 7.86 in the control group. The t-test results also showed a significant difference between the two groups (t = -7.608, p < 0.001) (Table 2). This indicates that the experimental group exhibited superior clinical reasoning and case analysis abilities, suggesting that the new multimodal teaching approach helps enhance residents’ overall performance, particularly in communication and teamwork skills, likely due to their more active and participatory learning style. (Fig. 1A)

Satisfaction survey

In the satisfaction survey, the experimental group reported a satisfaction score of 4.22 ± 0.61, while the control group scored 2.96 ± 0.62. The t-test revealed a significant difference (t = -10.303, p < 0.001) (Table 2). These results indicate that the residents in the experimental group had a significantly higher level of satisfaction with the innovative multimodal teaching model compared to the control group, suggesting that this new teaching method better meets the learning needs of neurology residents. (Fig. 1B)

Interest inventory

Regarding the interest ratings, the experimental group received a score of 5.59 ± 0.85, whereas the control group scored 3.60 ± 1.01. The t-test results similarly showed a significant difference between the two groups (p < 0.001) (Table 2). This finding demonstrates that the new multimodal teaching approach significantly enhances students’ interest and engagement in learning, potentially fostering greater enthusiasm and commitment to the field of neurology among residents. (Fig. 1B)

Teachers Self-Evaluation

Instructors evaluated the course content and student reactions after the sessions, resulting in a score of 7.45 ± 1.29 for the experimental group and 5.27 ± 0.78 for the traditional teaching group. The difference between the two groups was significant (p < 0.001) (Table 2), indicating that teachers found the multimodal teaching approach to be more effective in delivering content and engaging students compared to traditional methods.( Fig. 1B).

Disscussion

Neurology is a highly complex and challenging discipline within the medical field, encompassing numerous diseases and various pathophysiological mechanisms, The nervous system has a complex structure and function, comprising various components, including the brain, spinal cord, and peripheral nerves. As learners strive to understand these anatomical features, they often encounter significant challenges [16].This challenge is particularly evident in certain neurological disorders, such as Parkinson’s disease and epilepsy, where clinical manifestations can be highly characteristic. Observing real cases provides a more intuitive understanding than reading rigid textbook descriptions, which enhances residents’ comprehension and memory, fostering a holistic understanding of these diseases. Therefore, studying and practicing in this field requires residents not only to master extensive professional knowledge but also to possess strong spatial and three-dimensional thinking abilities to appropriately localize and characterize various neurological disorders [17].This is where the advantages of case-based learning (CBL) combined with bedside teaching come into play—through real clinical cases, students can delve into the anatomical background, pathophysiological mechanisms, and clinical presentations of specific diseases, while micro-videos reinforce their understanding and retention of these complex concepts [6].

This study validated the effectiveness of the CBL combined with micro-lessons and bedside teaching model in training neurology residents through comparative analysis, revealing significant advantages. The experimental group outperformed the control group in clinical theory assessments and comprehensive ability evaluations. This indicates that the micro-lesson format allows learners to grasp knowledge quickly while also stimulating their interest and critical thinking [18], Learning from real bedside cases enables residents to deepen their understanding of theoretical knowledge in a genuine clinical environment [7], The CBL model encourages active participation and critical thinking among students, facilitating progress through problem discussions and reflecting the interactive and participatory nature of the learning process [19], This approach effectively enhances their motivation and learning outcomes.

The study found that the innovative multimodal teaching model enabled residents to engage in continuous self-reflection and adjustment during the learning process [6]. Traditional teaching methods often lack feedback and communication, whereas CBL encourages residents to interact and collaborate through group discussions and role-playing, thereby deepening their understanding and retention of knowledge [20]. This not only aids in mastering theoretical knowledge but also promotes the application of clinical skills [21]. The CBL model encourages residents to take on more active roles in their education, enhancing their initiative and engagement in learning, which in turn improves their comprehensive ability evaluation scores [22].

Additionally, the introduction of the micro-lesson model provides residents with a flexible learning approach. In the rapidly evolving field of neurology, knowledge is updated frequently, and micro-lessons can convey core concepts in a short time, allowing residents to deepen their understanding of specific knowledge points anytime and anywhere [23].Furthermore, for complex anatomical structures or intricate conduction pathways that are difficult to understand in neurology, creating micro-video animations or 3D visualizations can significantly aid students in comprehension and retention while increasing their interest in learning [24]. The study results indicate that residents rated the micro-lesson model very positively, believing that it effectively supplements the shortcomings of traditional teaching, particularly in reinforcing the learning and understanding of specific knowledge points in a short period.

It is noteworthy that this study also found a significant improvement in clinical skills and communication abilities among residents participating in the CBL combined with bedside teaching. This phenomenon is closely related to the increased communication between students and patients during bedside teaching, as well as the enhancement of clinical skills through bedside examinations and procedures [25], Numerous studies have shown that teamwork and effective communication are essential components of modern medical education [26].Through team discussions and collaborative decision- making, residents are able to practice and learn in a simulated real-world environment, which greatly benefits their future clinical practice. Additionally, the bedside teaching process continuously reinforces students’ clinical communication and examination skills. This model also positively impacts residents’ clinical reasoning, patient education, and teamwork skills [27].

Data indicate that residents experienced a significant increase in overall satisfaction with the course and their learning interest, particularly in terms of engagement and a sense of achievement. This suggests that the combination of micro-lessons, bedside teaching, and CBL not only successfully imparts knowledge but also plays a crucial role in cultivating residents’ interest in learning and positive attitudes. Previous studies have confirmed that integrated teaching models, such as flipped classrooms, timely teaching, and problem-based learning, represent the future of neurology education [9].Enhancing teaching satisfaction and interest significantly influences physicians’ learning motivation and future career development, encouraging them to maintain a continuous learning attitude in their professional growth [28].

Moreover, the results of this study show that the self-evaluations of teachers using the micro-video, bedside teaching, and CBL model were significantly higher than those of teachers employing traditional teaching methods. This advantage can be attributed to several factors. First, the micro-lesson format allows educators to deliver concise and focused content, while also enabling the 3D visualization of anatomical structures and imaging, achieving efficient learning outcomes in a short time [29].The bedside teaching process facilitates the integration of theory and practice, allowing students to easily understand clinical situations. Teachers can also observe students’ performance in real time and provide feedback, aligning closely with specific learning objectives, thereby enhancing students’ comprehension and engagement [30]. Educators often feel more capable and confident when using teaching methods that align with students’ needs and preferences. Second, the integration of CBL promotes active learning and encourages critical thinking, enriching the learning experience for students and enabling teachers to adopt more student-centered teaching approaches [31].Furthermore, the collaborative nature of CBL fosters feedback and discussion, which can enhance teachers’ self-reflective practices. Engaging in discussions about real cases encourages educators to continuously evaluate and refine their teaching strategies, contributing to professional development and increased job satisfaction. Although the new teaching methods require teachers to invest considerable time in preparing lesson plans, the positive feedback received has not negatively impacted the self-satisfaction ratings of students and teachers [32].Therefore, the combination of micro-lessons, bedside teaching, and CBL clearly creates a more favorable teaching and learning environment than traditional methods, resulting in higher self-evaluation scores for teachers. This underscores the importance of innovative medical education strategies to promote the mutual growth of educators and learners [9].

Despite the positive effects of the combined teaching models of micro-learning, bedside teaching, and CBL in the training of neurology residents, However, there may be some obstacles when implemented in different training environments. Firstly, Successful adoption requires faculty proficiency in multimodal teaching methods. Institutions may need workshops to train educators in CBL facilitation and micro-lesson design. Moreover, Micro-lessons rely on digital platforms (e.g., learning management systems), which may be inaccessible in low-resource settings. Offline alternatives (e.g., preloaded tablets) could address this gap.Transitioning from traditional lectures to active learning may face resistance from both faculty and trainees accustomed to passive learning. Pilot programs and incremental implementation are recommended.

This research still has some limitations. First, the sample size of this study was relatively small and limited to a single medical center, which may affect the generalizability of the results. Future research should consider expanding the sample size and conducting comparisons across multiple institutions to verify the reproducibility and applicability of the findings. Second, the study did not adequately account for individual differences and learning styles among residents during implementation. Different educational backgrounds and learning approaches may influence learning outcomes. Therefore, future research should explore how to implement differentiated instruction based on individual differences to enhance learning effectiveness.

Conclusion

This study advances neurology education by systematically integrating micro-learning, bedside teaching, and CBL—a combination not yet extensively explored in prior literature. The significant improvements in theoretical knowledge and clinical competency as well as the higher interest and satisfaction shown by trainees and teachers, underscore that this multimodal approach directly mitigates limitations of traditional LBL, such as passive knowledge acquisition and fragmented skill development. These results provide actionable insights for institutions aiming to align neurology training with competency-based frameworks, offering strong support for future reforms and developments in medical education.

Author contributions

PH and NS designed the study. PH wrote the main manuscript, analyzed the data, and prepared the tables and figures. PH, WM,TM, RW, NS, XLand FY collected the data. PH made modifications to the figures. WM led the research group and critically revised the article. All authors reviewed the manuscript and approved the submitted version.

Funding

This study was supported by the Henan Provincial Key Scientific Research Project of Higher Education Institutions (23A320022) and the 2022 “Four New” Teaching Reform Research and Practice Projects of Zhengzhou University (2022zzusx021).

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

This study was submitted to and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Approval No. 2025-KY-0407-001), in accordance with the Declaration of Helsinki (1964). We obtained written informed consent from all participants involved in this study, including patients, students, and faculty members. All participants were clearly informed of the research purpose, research methods, randomization grouping plan, data anonymization processing, and the right to withdraw voluntarily.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Potential conflicts of interest

Nothing to report.