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. 2026 Apr 7;26:814. doi: 10.1186/s12909-026-09114-w

The role of three-dimensional knowledge target teaching combined with immersive clinical experience in otology teaching practice

Yongjun Zhu 1,#, Hao Zhou 2,#, Jianming Yang 1,#, Dachuan Fan 1,✉
PMCID: PMC13217954  PMID: 41947104

Abstract

Objective

This study aimed to evaluate the impact of three-dimensional knowledge-targeted teaching combined with immersive clinical experiences on otology education.

Methods

A prospective study was conducted on 100 undergraduate interns in their eighth semester of otolaryngology training at Anhui Medical University from June 2023 to November 2024. They were randomly assigned to either a control group (n = 50), which received conventional teaching, or an observation group (n = 50), which received a teaching model combining three-dimensional knowledge-targeted instruction integrated with immersive clinical experience (ICE). ICE involved supervised role-playing, progressive hands-on skill training, real-time instructor feedback, case discussions, and reflective journaling. Primary outcomes included teaching quality scores, clinical practice ability assessed by the Mini-CEX scale, and teaching satisfaction.

Results

In the post-intervention assessment, the observation group scored significantly higher than the control group both in teaching quality (all five dimensions; all P < 0.01) and in Mini-CEX-evaluated clinical abilities, including humanistic care (7.25 ± 0.33 vs. 5.45 ± 0.20), clinical judgment (7.56 ± 0.31 vs. 6.10 ± 0.31), medical interview (7.45 ± 0.66 vs. 6.20 ± 0.11), organizational efficiency (7.45 ± 0.69 vs. 6.45 ± 0.35), communication skills (7.45 ± 0.22 vs. 6.40 ± 0.20), physical examination (7.40 ± 0.41 vs. 6.30 ± 0.21), and overall performance (7.45 ± 0.62 vs. 6.56 ± 0.23) (all P < 0.01). Teaching satisfaction was also higher in the observation group than in the control group (90.00% vs. 72.00%; P = 0.021).

Conclusion

Integrating three-dimensional knowledge-targeted teaching with immersive clinical experience enhances students’ performance in clinical practice and overall satisfaction. This innovative teaching model suggests a potential benefit of comprehensive student development, improves teaching satisfaction, and strengthens the foundation for advancing otology education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-09114-w.

Keywords: Three-dimensional knowledge-targeted teaching, Immersive clinical experience, Ear Science Teaching Practice, Medical Education, Educational Innovation

Introduction

The rapid advancement of China’s healthcare sector underscores the crucial role of healthcare professionals in delivering quality services. Hospital internships serve as a key learning stage for students transitioning from academic environments to clinical practice, making it essential to cultivate versatile technical skills that align with the evolving demands of modern medicine. This is particularly significant in clinical education, where developing a comprehensive skill set is vital [1–3]. The ear, as a critical organ for sensory perception, significantly impacts the quality of life by facilitating hearing and maintaining balance and coordination. Thus, otolaryngology, focused on ear health, is integral to overall well-being.

Otology, a subfield of otolaryngology, specializes in diagnosing and treating ear-related diseases, which involve complex anatomical and physiological functions [4]. Its education encompasses basic anatomy, physiology, and practical skills like auditory and balance tests, as well as electro-otoscopy, which are essential for effective clinical communication and diagnosis. [5–6] Otology also requires understanding common ear diseases, such as secretory otitis media, suppurative otitis media and complications (e.g., labyrinthitis and meningitis), Meniere’s disease, and otosclerosis. Integrating theory with hands-on experience enhances students’ diagnostic and treatment capabilities. [7–8] As medical technology advances, educational strategies in clinical settings are vital for producing skilled otologists proficient in specialized techniques and safe practices, thereby elevating professional standards and disseminating knowledge. [9–10] Teaching otology is essential for medical education and societal health needs; continuous innovation in methods improves instruction quality and effectiveness, fostering highly qualified otologists. [11–12]

The concept of three-dimensional knowledge-goal teaching, which incorporates three interconnected educational dimensions—knowledge and skills, processes and methods, and affective attitudes and values—has become integral to educational theory. [13–14] This holistic approach enhances students’ professional competence and overall quality, making it particularly suitable for fields that blend theoretical learning with practical application. It enables students to acquire essential knowledge and skills while fostering a positive professional attitude, establishing a solid foundation for their future careers.

Immersive clinical experience (ICE) is a teaching method meticulously designed to fully engage learners by simulating real-world clinical environments. It enables students to enhance empathy, clinical skills, and decision-making through interaction with highly realistic scenarios. In otology education, ICE has proven effective in helping students better understand otology concepts, refine clinical skills, and improve future performance in practice. This model, which integrates theoretical understanding with practical application, is a vital component of contemporary medical education. [15–16] In this study, we investigated the effect of combining three-dimensional knowledge-goal teaching with immersive clinical experience in otology education, with the goal of improving student learning outcomes and clinical proficiency.

Methods

Participants and recruitment

The study enrolled 100 undergraduate interns studying otolaryngology in their eighth semester between June 2023 to November 2024. These participants had recently completed the theoretical components of their undergraduate medical degree and were undertaking mandatory supervised clinical internship rotations. These participants were randomly divided into two groups (control group and observation group), each comprising 50 individuals, utilizing a simple randomization procedure based on a computer-generated random number table prepared in advance by an independent teacher not involved in the study. Allocation was concealed until after baseline assessments were completed. The comparison of the general characteristics between the two groups revealed no significant differences (P > 0.05), as detailed in Table 1. Similarly, theoretical examination scores in school did not differ significantly between the two groups (P > 0.05).

Table 1.

Comparison of general information of the two groups of students

Variable Control Group (n = 50) Observation Group (n = 50) χ2/t P
Gender 0.164 0.685
 Male 28 (56.00) 30 (60.00) - -
 Female 22 (44.00) 20 (40.00) - -
Age (years) 23.63 ± 2.25 23.65 ± 2.41 0.047 0.963
Theoretical examination scores 75.68 ± 4.67 75.89 ± 4.81 0.243 0.809
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Inclusion criteria

(1) All participants were otolaryngology internship students from Anhui Medical University; and (2) written informed consent was obtained, with all agreeing to cooperate and sign the consent form.

Exclusion criteria

(1) Participants who withdrew from the program midway; and (2) those whose academic performance did not meet the required standards.

Study design and setting

The clinical internship cases were selected from the specialized case database of the Department of Otorhinolaryngology, compiled specifically for postgraduate residents and interns to support learning. The control group received instruction from qualified instructors as part of routine clinical teaching activities. Teaching adhered to the internship syllabus, with instructors demonstrating and explaining relevant knowledge and procedures. Students observed clinical operations and learned under instructor guidance, who employed a teaching-by-example approach.

Initially, students were provided with an in-depth explanation of the department’s layout, the functions of each area, departmental rules and regulations, and precautions to ensure informed patient consent. The teaching program’s objectives, content, and focus were clarified.

Subsequently, students accompanied instructors during clinical practice, where instructors explained and demonstrated operational procedures in real-life scenarios. This approach ensured integration of theory with practical application.

Lastly, theoretical knowledge was reinforced through centralized lectures utilizing PowerPoint presentations (PPTs), aligned with internship goals and the Otology department’s requirements. Assessments evaluated students’ understanding and progress. The observation group employed a three-dimensional knowledge-goal teaching approach, integrated with immersive clinical experience.

Formation of a teaching team

Under the leadership of the Otolaryngology Teaching and Research Department, a specialized teaching team was established to manage the department’s teaching activities. Qualified instructors were selected to ensure effective coordination of teaching and resource allocation.

Knowledge objectives

Students were expected to.

  1. Understand the anatomical structure of the outer, middle, and inner ear.

  2. Master the innervation of the ear, particularly nerve pathways related to hearing and vestibular function.

  3. Comprehend sound propagation, the hearing process, and the conversion of sound into neural signals.

  4. Recognize common ear diseases, understand their etiology, pathological changes, and clinical manifestations.

  5. Master otological examinations, including otoscopic examination, hearing tests (e.g., tuning fork and pure tone audiometry), and the basic principles of ear imaging (e.g., CT, MRI) and their application in otological diagnosis.

Competency objectives

Students should demonstrate the ability to.

  1. Independently perform otoscopic examinations, demonstrating proficiency in using otoscopes.

  2. Observe and document the external auditory canal and tympanic membrane.

  3. Identify common abnormalities.

  4. Assess hearing.

  5. Master basic otological surgical procedures, including suturing techniques, preoperative preparation, anesthesia, and postoperative care.

Emotional and attitudinal objectives

To stimulate student interest in otology.

  1. The program included sharing the latest research findings, clinical cases, and success stories.

  2. Students were guided to understand the historical development of otology.

  3. They participated in related lectures, seminars, and internships.

  4. Emphasis was placed on teaching effective patient communication, ensuring students demonstrated empathy, addressed patients’ emotional needs, and maintained professional attitudes in healthcare settings.

  5. The program aimed to instill respect for professional ethics and the roles and responsibilities of healthcare workers.

Integration of immersive clinical experience

Interns were grouped with selected patient cases, supervised by instructors. Students played roles of doctors, patients, and family members to develop empathy and understanding of patient needs through role-playing. Basic skills such as ear examination, hearing assessment, and ear cleaning were taught progressively. Regular case discussions analyzed diagnosis and treatment processes, allowing students to contribute insights and learn different treatment approaches. During practice sessions, the lead instructor provided real-time feedback to correct errors. Students were encouraged to reflect on their experiences by writing journals. Skills were assessed through simulated operations or clinical practice to evaluate students’ proficiency.

Observation indicators

Teaching quality score

The quality of learning for pre- and post-training interns is evaluated across five dimensions: basic operation, specialty knowledge, paperwork recording ability, cooperation ability, and device management. Each dimension is scored out of 10 points, yielding a total score of 50. A higher total score correlates with better teaching quality. Assessors of the teaching quality scores were aware of the group assignments, as they were members of the department’s specialized teaching team. The pre-intervention assessment was conducted on the first day of the rotation to establish a baseline. This assessment was specific to the Otology field and focused on foundational knowledge (e.g., ear anatomy and basic diagnostic theories) that students had acquired from previous general medical courses. It did not evaluate the general teaching quality of the university, but rather the students’ readiness for the specialized otology internship.

Clinical practice ability

The Mini-CEX scale is used to assess the clinical practice ability of interns before and after the activity. Higher scores reflect stronger clinical practice abilities. Consistent with the teaching quality evaluation, the assessors of the Mini-CEX were not blinded to the students’ group allocations due to the practical constraints of the teaching environment.

Teaching satisfaction

Interns are evaluated on four aspects: management mode, operation skills, and teaching content and effect. Each aspect is rated using a percentage system:

Unsatisfactory (less than 70%).

Basically satisfied (71–90%).

Very satisfied (above 91%).

The satisfaction questionnaire was a locally developed tool specifically designed for this curriculum. While its validity was reviewed by a panel of three experts to ensure relevance, it has not undergone formal psychometric testing for reliability and construct validity. To ensure clarity and concision, the teaching flowchart is depicted in Fig. 1.

Fig. 1.

Fig. 1

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Flowchart of the three-dimensional knowledge-goal teaching approach integrated with immersive clinical experience (ICE) versus routine clinical teaching. Control Group: Following initial orientation on department layout and regulations, students undergo routine clinical practice via a teaching-by-example approach with instructor demonstrations, supplemented by centralized PPT lectures aligned with the internship syllabus. Observation Group: Led by a specialized teaching team, this group follows a three-dimensional objective framework: Knowledge, Competency, and Emotional/Attitudinal. These goals are realized through ICE, utilizing a case database, role-playing, and real-time feedback. Observation Indicators: Post-intervention, both groups are evaluated based on Teaching Quality Scores (5 dimensions), Clinical Practice Ability (Mini-CEX scale), and Teaching Satisfaction

Statistical analysis

Statistical analyses were conducted using SPSS 23.0. The quantitative data were presented as means±standard deviations and subjected to analysis using the t-test. Meanwhile, categorical data were analysed by the chi-square test. P < 0.05 indicated.

that the difference was statistically significant.

Results

Teaching quality ratings

No statistically significant differences were observed between the teaching quality ratings before the intervention (P > 0.05). However, a notable improvement in the teaching quality was reported by interns in the observation group following the intervention (P < 0.01). These findings are further detailed in Table 2 and illustrated through Figs. 2 and 3.

Table 2.

Comparison of teaching quality

Variable Control Group Observation Group t value P value
Sample Size (n) 50 50 - -
Basic Skills
 Pre-Intervention 5.36 ± 0.20 5.40 ± 0.33 0.733 0.465
 Post-Intervention 7.10 ± 0.30 9.02 ± 0.20 37.654 < 0.01
Specialized Knowledge
 Pre-Intervention 6.40 ± 0.11 6.45 ± 0.66 0.528 0.598
 Post-Intervention 7.45 ± 0.35 8.52 ± 0.41 14.035 < 0.01
Documentation Skills
 Pre-Intervention 6.40 ± 0.23 6.45 ± 0.15 1.288 0.201
 Post-Intervention 7.30 ± 0.10 8.89 ± 0.35 30.887 < 0.01
Cooperation Ability
 Pre-Intervention 6.25 ± 0.52 6.26 ± 0.41 0.107 0.915
 Post-Intervention 7.30 ± 0.22 8.75 ± 0.13 40.123 < 0.01
Equipment Management
 Pre-Intervention 6.12 ± 0.11 6.15 ± 0.42 0.489 0.626
 Post-Intervention 7.45 ± 0.23 8.88 ± 0.10 40.318 < 0.01
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Fig. 2.

Fig. 2

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Comparison of teaching quality scores between the two groups before the intervention. No significant differences were observed between groups (all P > 0.05)

Fig. 3.

Fig. 3

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Comparison of teaching quality scores between the two groups after the intervention. 1 to 5 refers to basic operations, specialty knowledge, clerical record keeping skills, cooperation skills, and device management

Clinical practice skills

Clinical practice competency scores were higher in the observation group than in the control group (Table 3; Fig. 4; P<0.01).

Table 3.

Comparison of clinical practice competencies

Variable Control Group Observation Group t value P value
Sample size (n) 50 50 - -
Humanistic care 5.45 ± 0.20 7.25 ± 0.33 32.985 < 0.01
Clinical judgment 6.10 ± 0.31 7.56 ± 0.31 23.548 < 0.01
Medical interview 6.20 ± 0.11 7.45 ± 0.66 13.210 < 0.01
Organizational efficiency 6.45 ± 0.35 7.45 ± 0.69 14.035 < 0.01
Communication skills 6.40 ± 0.20 7.45 ± 0.22 24.972 < 0.01
Physical examination 6.30 ± 0.21 7.40 ± 0.41 16.885 < 0.01
Overall Performance 6.56 ± 0.23 7.45 ± 0.62 9.517 < 0.01
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Fig. 4.

Fig. 4

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Comparison of clinical practice competencies between the two groups. Note: 1–7: Humanistic Care, Clinical Judgment, Medical Interview, Organizational Efficiency, Communication Skills, Physical Examination, Overall Performance

Teaching satisfaction

Comparison of satisfaction between the two groups, 90.00% in the observation group was higher than72.00% in the control group (Table 4; Fig. 5; P = 0.021).

Table 4.

Comparison of teaching satisfaction

Control Group (n = 50) Observation Group (n = 50) χ2 value P value
Very satisfied (n, %) 25 (50.00) 35 (70.00)
Basically satisfied(n, %) 11 (22.00) 10 (20.00) - -
Unsatisfactory(n, %) 14 (28.00) 5 (10.00) - -
Satisfaction(n, %) 36 (72.00) 45 (90.00) 5.263 0.021
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Fig. 5.

Fig. 5

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Comparison of satisfaction between the two groups

Discussion

Clinical teaching is a crucial component of medical education, serving as an intermediary step in the transition from basic theory to clinical practice. It plays a key role in developing high-quality medical professionals. Through clinical teaching, students can apply theoretical knowledge acquired in the classroom to clinical practice, thereby deepening their understanding and mastery of the material. [17–18] Otology, the study of hearing and balance, examines the anatomy, physiology, and disease processes associated with these functions, and is closely linked to other foundational disciplines. Through instruction, students can acquire the theoretical knowledge and skills related to the etiology, pathology, clinical manifestations, diagnosis, and prevention of common otological disorders, while also developing sound clinical reasoning and methodologies. [19–20] Otolaryngology encompasses the subspecialties of ear, nose, and throat, with complex physiological functions vital for survival, such as communication, respiration, and swallowing. The field not only requires a broad range of clinical skills but also involves clinical examination methods like hearing tests, balance function tests, and otoscopy, motivating students to perform these procedures independently [21]. Teaching otology not only helps students master the essential theoretical knowledge and clinical skills but also fosters interdisciplinary collaboration and supports the advancement of medical education. By continually refining teaching methods and techniques, otology education will continue to provide a strong foundation for developing highly skilled medical professionals [22].

Clinical teaching plays a vital role in students’ transition from theoretical learning to practical application and is generally considered a key step in cultivating clinical competence. While the traditional bedside teaching model is effective, it has certain limitations. Therefore, exploring evidence-based teaching methods is crucial for enhancing students’ clinical abilities and overall qualities through positive learning attitudes and diverse teaching approaches, laying a solid foundation for their future medical careers.

Three-dimensional knowledge-objective teaching is a comprehensive educational framework that emphasizes the holistic development of knowledge, skills, and attitudes. It holds significant value in medical education, particularly in clinical teaching, where students not only acquire theoretical knowledge but also apply it in practice, understanding its real-world relevance. Through hands-on practice and clinical training, students master essential professional skills, improve their clinical abilities, cultivate professional ethics, teamwork, and patient care, while also fostering the development of humanistic qualities.

Immersive clinical experience teaching offers a safe and effective learning environment through authentic clinical settings, enabling students to deepen their understanding, enhance their skills, and prepare for their future careers. This method not only improves learning outcomes but also promotes the development of their overall qualities [23].

The results of this study showed that the teaching quality of interns in the observation group improved after the intervention, and their clinical practice ability score was higher than that of the control group. These findings suggest that combining three-dimensional knowledge-objective teaching with immersive clinical experience teaching can effectively enhance the quality of otology teaching and improve students’ clinical practice abilities.

Three-dimensional knowledge-objective teaching emphasizes the systematic nature of knowledge, the practicality of skills, and the professionalism of attitudes. By setting clear learning objectives, this approach provides students with a defined direction in both theoretical and practical learning, enabling them to master knowledge and skills more effectively. When combined with immersive clinical practice, it offers a teaching method that improves the ontological skills and knowledge of medical students or residents through simulation and hands-on operation [24, 25].

This teaching method prioritizes hands-on learning, allowing students to gain experience in real or simulated clinical environments. As a result, students can enhance their clinical judgment and operational skills, and gain a deeper understanding of medical knowledge in real-world situations. By analyzing real or simulated otology cases, students improve their diagnostic reasoning, ability to apply knowledge comprehensively, clinical judgment, and decision-making skills. Through hands-on practice, students deepen their understanding of ear diseases and treatments, forming a complete knowledge base.

The immersive clinical experience enables students to conduct ear examinations, hearing evaluations, and simple surgeries in real clinical environments, thereby enhancing their clinical skills. Instructors provide timely feedback, help students identify problems, make corrections, and improve learning outcomes. This comprehensive approach significantly enhances the quality of otology teaching.

When comparing the satisfaction levels of the two groups, 90.00% of the observation group expressed satisfaction, compared to 72.00% in the control group, suggesting that the combination of three-dimensional knowledge-objective teaching and immersive clinical experience teaching can effectively increase teaching satisfaction. This teaching model sets clear goals for knowledge, skills, and attitudes, helping students understand learning expectations and enhancing the relevance and purpose of their education. Immersive clinical practice simulates real-world clinical environments, encourages active student participation, and boosts motivation and enjoyment in learning. Through practice, students can better understand and apply knowledge, improving both the practicality and effectiveness of their learning, which ultimately enhances satisfaction and reinforces the integration of theory and practice in otology education [26, 27].

Clinical teaching serves as a critical bridge between theory and practice in medical education, and its quality directly determines whether medical students can successfully transition from knowledge recipients to clinical decision-makers. Otology, with its complex micro-anatomy, intricate physiological functions, and demanding clinical procedural skills, represents a particularly challenging domain within medical education. While the traditional “apprenticeship” model of bedside teaching can impart fundamental skills, it often falls short in systematically integrating knowledge, stimulating higher-order clinical thinking, and cultivating humanistic care competencies. This study’s integration of Three-Dimensional Knowledge-Objective Teaching with Immersive Clinical Experience constitutes an active exploration of a high-quality teaching model for the new era.

Our findings demonstrate that the observation group was accompanied by higher scores than the control group across all metrics of Teaching Quality and Clinical Practical Ability. This robustly validates the effectiveness of this composite teaching model. Its success is not incidental but stems from a scientifically coherent and mutually reinforcing pedagogical logic:

First, at the theoretical construction level, Three-Dimensional Knowledge-Objective Teaching provides a systematic “cognitive scaffold.” It dismantles the barriers that often separate knowledge, skills, and emotional attitudes in traditional teaching, establishing a multidimensional learning objective system.

In the Knowledge and Skills dimension, students not only memorize otological anatomical terms but also, through goal-oriented guidance, understand the three-dimensional structure and functional relationships from the outer to the inner ear, enabling them to flexibly apply anatomical knowledge to explain pathological phenomena and interpret examination results.

In the Process and Methods dimension, the teaching objectives directly address “how to learn” and “how to think.” Students are required to follow the clinical pathway—“history taking, physical examination, auxiliary tests, differential diagnosis, treatment planning”—as a practicing otologist would, thereby systematically constructing a clinical reasoning framework.

In the Emotional Attitude and Values dimension, explicit affective goals translate medical ethics education from abstract rhetoric into concrete clinical behavioral standards. For instance, experiencing communication difficulties while role-playing a patient with hearing loss can profoundly stimulate students’ empathy and professional commitment.

Second, at the practical transformation level, Immersive Clinical Experience creates a high-efficiency “skill transfer field.” Theoretical knowledge is internalized into genuine competency only through practical application. The immersive experience, characterized by high-fidelity simulation, role immersion, and real-time feedback, creates an ideal environment for this transformation.

The high-simulation environment reduces the cost of error and increases training intensity. Students can repeatedly practice otoscopic examination and hearing assessment simulations in a risk-free setting, thereby overcoming initial clinical anxiety and unfamiliarity, and building stable procedural muscle memory and self-confidence.

Role-playing and case discussions are crucial for developing “clinical wisdom.” When students assume the roles of patients or family members, they gain a deeper understanding of the psychosocial factors behind diseases. Defending their diagnoses in case discussions rigorously exercises their critical thinking and ability to utilize evidence, far surpassing the benefits of passive observation.

Real-time feedback and reflective practice form a closed learning loop. Instruction from teachers within the immersive environment is “targeted,” allowing for immediate correction of erroneous techniques. Requiring students to maintain reflective journals prompts metacognition, transforming fragmented experiences into structured understanding and achieving a qualitative leap from “having an experience” to “learning from experience.”

Furthermore, the significant improvement in teaching satisfaction observed in this study highlights the model’s substantial advantage in stimulating students’ intrinsic motivation for learning. This satisfaction aligns with motivational theory—when students perceive the relevance of the content (clear three-dimensional objectives), experience autonomy in the learning process (active participation in roles and discussions), and feel a sense of competence (mastering complex skills successfully through immersive training), their intrinsic learning motivation is greatly enhanced. Learning ceases to be an externally imposed task and becomes an engaging exploration filled with challenges and a sense of accomplishment.

Moreover, viewed through the lens of broader trends in medical education, this teaching model actively responds to the global shift towards Competency-Based Medical Education (CBME). It moves beyond imparting isolated facts to fostering the comprehensive competencies essential for a qualified otologist, integrating medical knowledge, technical skills, communication, collaboration, and professionalism. This aligns closely with the core competency dimensions advocated by modern medical assessment tools like the Mini-CEX.

Limitations

This study has several limitations. First, it was a single-center and non-blinded trial conducted at one tertiary teaching hospital, with a relatively modest sample size. Second, outcomes were evaluated immediately post-intervention without long-term follow-up, precluding assessment of the sustainability of improvements in clinical skills, knowledge retention, or transfer to independent practice; additionally, the locally developed teaching satisfaction questionnaire, while face-validated by experts, lacks formal psychometric testing, which may introduce measurement bias. Third, the innovative approach involved more structured, intensive, and interactive activities (role-playing, real-time feedback, case discussions, supervised hands-on practice) than conventional teaching, resulting in greater time-on-task and engagement that may have partly contributed to the superior short-term outcomes.

Conclusion

In conclusion, within the scope of this single-center study, the integration of three-dimensional knowledge-goal teaching with immersive clinical experience was associated with improved short-term teaching quality scores, clinical practice performance on the Mini-CEX scale, and higher student satisfaction among undergraduate otology interns in this single-center study. These findings suggest that this combined approach has the potential to contribute to more effective otology teaching by providing structured objective guidance and contextual immersion. However, due to the limited sample size and the lack of long-term longitudinal data, these results should be interpreted with caution. Further multi-center studies with longer-term follow-up are warranted to confirm the generalizability and sustainability of this model on clinical competency development.

Supplementary Information

Supplementary Material 1. (16.9KB, docx)

Acknowledgements

None.

Authors’ contributions

YJ-Z designed the study and drafted the manuscript. H-Z collected data and assessed examination scores for eligibility. JM-Y and DC-F performed the statistical analysis and supervised the study. All authors critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Funding

This work was supported by the New Era Education Quality Project of Anhui Provincial Education Department (2025zyxwjxalk205).

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted following the guidelines of the Helsinki Declaration, and approved by the local Ethics Committee of the Second Affiliated Hospital of Anhui Medical University. Each participant voluntarily took part in this study. Informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yongjun Zhu, Hao Zhou and Jianming Yang contributed equally to this work.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1. (16.9KB, docx)

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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