case study vs problem based learning

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Case-based Teaching and Problem-based Learning

Case-based teaching.

With case-based teaching, students develop skills in analytical thinking and reflective judgment by reading and discussing complex, real-life scenarios. The articles in this section explain how to use cases in teaching and provide case studies for the natural sciences, social sciences, and other disciplines.

Teaching with Case Studies (Stanford University)

This article from the Stanford Center for Teaching and Learning describes the rationale for using case studies, the process for choosing appropriate cases, and tips for how to implement them in college courses.

The Case Method (University of Illinois)

Tips for teachers on how to be successful using the Case Method in the college/university classroom. Includes information about the Case Method values, uses, and additional resource links.

National Center for Case Study Teaching in Science (National Science Teaching Association)

This site offers resources and examples specific to teaching in the sciences. This includes the “UB Case Study Collection,” an extensive list of ready-to-use cases in a variety of science disciplines. Each case features a PDF handout describing the case, as well as teaching notes.

The Michigan Sustainability Cases Initiative (CRLT Occasional Paper)

This paper describes the Michigan Sustainability Cases Initiative, including links to the full library of cases, and it offers advice both for writing cases and facilitating case discussions effectively.

The Case Method and the Interactive Classroom (Foran, 2001, NEA Higher Education Journal)

First-person account of how a sociology faculty member at University of California, Santa Barbara began using case studies in his teaching and how his methods have evolved over time as a professor.

Problem-based Learning

Problem-based learning (PBL) is both a teaching method and an approach to the curriculum. It consists of carefully designed problems that challenge students to use problem solving techniques, self-directed learning strategies, team participation skills, and disciplinary knowledge. The articles and links in this section describe the characteristics and objectives of PBL and the process for using PBL. There is also a list of printed and web resources.

Problem-Based Learning Network (Illinois Mathematics and Science Academy)

Site includes an interactive PBL Model, Professional Development links, and video vignettes to illustrate how to effectively use problem-based learning in the classroom. The goals of IMSA's PBLNetwork are to mentor educators in all disciplines, to explore problem-based learning strategies, and to connect PBL educators to one another.

Problem-Based Learning: An Introduction (Rhem, 1998, National Teaching and Learning Forum)

This piece summarizes the benefits of using problem-based learning, its historical origins, and the faculty/student roles in PBL. Overall, this is an easy to read introduction to problem-based learning.

Problem-Based Learning (Stanford University, 2001)

This issue of Speaking of Teaching identifies the central features of PBL, provides some guidelines for planning a PBL course, and discusses the impact of PBL on student learning and motivation.

Problem-Based Learning Clearinghouse (University of Delaware)

Collection of peer reviewed problems and articles to assist educators in using problem-based learning. Teaching notes and supplemental materials accompany each problem, providing insights and strategies that are innovative and classroom-tested. Free registration is required to view and download the Clearinghouse’s resources.

See also: The International Journal of Problem-Based Learning

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Problem-Based Learning and Case-Based Learning

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• First Online: 17 December 2022
• pp 1235–1253
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• Joerg Zumbach 5 &
• Claudia Prescher 6  

Part of the book series: Springer International Handbooks of Education ((SIHE))

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Problem-based learning (PBL) is a learner-centered small-group learning approach that supports active learning. This chapter provides core definitions of PBL and other forms of case-based learning. To be precise, several aspects of designing PBL are described, such as problem design, process structure, small-group learning, tutoring, and others. Research and evaluation of PBL compared to traditional approaches are summarized mostly based on meta-analyses.

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Problem-Based Learning: Conception, Practice, and Future

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Zumbach, J., Prescher, C. (2023). Problem-Based Learning and Case-Based Learning. In: Zumbach, J., Bernstein, D.A., Narciss, S., Marsico, G. (eds) International Handbook of Psychology Learning and Teaching. Springer International Handbooks of Education. Springer, Cham. https://doi.org/10.1007/978-3-030-28745-0_58

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Comparing Problem-Based Learning with Case-Based Learning: Effects of a Major Curricular Shift at Two Institutions

Srinivasan, Malathi MD; Wilkes, Michael MD, PhD; Stevenson, Frazier MD; Nguyen, Thuan MS, MD; Slavin, Stuart MD

Dr. Srinivasan is assistant professor of medicine, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Wilkes is professor of medicine and vice dean, Education, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Stevenson is associate professor of medicine, University of California, Davis, School of Medicine, Sacramento, California.

Ms. Nguyen is a statistics PhD candidate, University of California, Davis, School of Medicine, Davis, California.

Dr. Slavin is associate dean for curriculum, Saint Louis University School of Medicine, St. Louis, Missouri.

Correspondence should be addressed to Dr. Srinivasan, UC Davis Department of Medicine, 4150 V. Street, Suite 2400, Sacramento, CA 95817; telephone: (916) 734-7005; e-mail: ( [email protected] ).

Purpose 

Problem-based learning (PBL) is now used at many medical schools to promote lifelong learning, open inquiry, teamwork, and critical thinking. PBL has not been compared with other forms of discussion-based small-group learning. Case-based learning (CBL) uses a guided inquiry method and provides more structure during small-group sessions. In this study, we compared faculty and medical students’ perceptions of traditional PBL with CBL after a curricular shift at two institutions.

Method 

Over periods of three years, the medical schools at the University of California, Los Angeles (UCLA) and the University of California, Davis (UCD) changed first-, second-, and third-year Doctoring courses from PBL to CBL formats. Ten months after the shift (2001 at UCLA and 2004 at UCD), students and faculty who had participated in both curricula completed a 24-item questionnaire about their PBL and CBL perceptions and the perceived advantages of each format

Results 

A total of 286 students (86%–97%) and 31 faculty (92%–100%) completed questionnaires. CBL was preferred by students (255; 89%) and faculty (26; 84%) across schools and learner levels.

The few students preferring PBL (11%) felt it encouraged self-directed learning (26%) and valued its greater opportunities for participation (32%). From logistic regression, students preferred CBL because of fewer unfocused tangents (59%, odds ration [OR] 4.10, P = .01), less busy-work (80%, OR 3.97, P = .01), and more opportunities for clinical skills application (52%, OR 25.6, P = .002).

Conclusions 

Learners and faculty at two major academic medical centers overwhelmingly preferred CBL (guided inquiry) over PBL (open inquiry). Given the dense medical curriculum and need for efficient use of student and faculty time, CBL offers an alternative model to traditional PBL small-group teaching. This study could not assess which method produces better practicing physicians.

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Promising Practices in Undergraduate Science, Technology, Engineering, and Mathematics Education: Summary of Two Workshops (2011)

Chapter: 4 scenario-, problem-, and case-based teaching and learning, 4 scenario-, problem-, and case-based teaching and learning.

The primary purpose of the October workshop was to thoughtfully examine the evidence behind a select set of promising practices that came to light during the June workshop. Susan Singer opened the October workshop by linking its agenda to key themes of the June workshop (see Chapter 3 ). Although these practices are not perfect and do not represent the universe of evidence-based innovations, she said, they are recognized by experts as promising, and each is supported by some evidence.

The promising practices discussed include scenario-, problem-, and case-based teaching and learning (this chapter); assessments to guide teaching and learning ( Chapter 5 ); efforts to restructure the learning environment ( Chapter 6 ); and faculty professional development ( Chapter 7 ). Singer explained that the presentations were based on papers prepared following a template the steering committee developed after the June workshop. 1 The authors were asked to describe the context in which the promising practice was implemented, identify examples of how the practice was used, and provide evidence to support the claim that the practice was promising, including evidence of its impact or efficacy.

FIGURE 4-1 Problem-based learning.

SOURCE: Gijbels (2008). Reprinted with permission. Problem

PROBLEM-BASED LEARNING

David Gijbels (University of Antwerp) described the cycle of problem-based learning (see Figure 4-1 ). After the instructors present a problem to the class, students meet in small groups to discuss what they know about it and what they need to learn. During a short period of independent self-study, students gather the needed resources to solve the problem. They then reconvene their small groups to re-assess their collective understanding of the problem. When they solve the problem, the instructor provides a different problem and the cycle begins anew.

Noting that problem-based learning has many possible definitions and permutations, Gijbels nonetheless stressed the importance of identifying a core set of principles that characterize this type of learning. Having a core definition enables researchers to compare problem-based learning with other types of learning environments. In his research, Gijbels uses a model developed by Howard Barrows (1996) that identifies six characteristics of problem-based learning:

Student-centered learning.

Small groups.

Tutor as a facilitator or guide.

Problems first.

The problem is the tool to achieve knowledge and problem-solving skills.

Self-directed learning.

Gijbels then described a meta-analysis conducted to examine the effects of problem-based learning on students’ knowledge and their application of knowledge, and to identify factors that mediated those effects (Dochy et al., 2003). The meta-analysis focused on empirical studies that compared problem-based learning with lecture-based education in postsecondary classrooms in Europe, and almost all of the studies that met the criteria focused on medical education. 2 Through the analysis, Gijbels and his colleagues found the following:

Students’ content knowledge was slightly lower in problem-based learning courses than in traditional lecture courses.

Although students in problem-based learning environments demonstrated less knowledge in the short term, they retained more knowledge over the long term.

Students in problem-based learning settings were better able to apply their knowledge than students in traditional courses.

These findings prompted Gijbels and his colleagues to undertake a deeper analysis of the assessment of problem-based learning (Gijbels et al., 2005). That analysis focused on three levels of knowledge that were assessed in the selected studies: (1) knowledge of concepts, (2) understanding of principles that link concepts, and (3) the application of knowledge. Gijbels noted that of the 56 studies in the analysis, 31 focused on concepts, 17 focused on principles, and 8 focused on the application of knowledge. The analysis revealed the following:

Students in problem-based learning environments and traditional lecture-based learning environments exhibited no differences in the understanding of concepts.

Students in problem-based learning environments had a deeper understanding of principles that link concepts together.

Students in problem-based learning environments demonstrated a slightly better ability to apply their knowledge than students in lecture-based classes.

Gijbels concluded by stating that problem-based learning has not completely fulfilled its potential. He suggested that students might become better problem solvers if faculty members assessed them more on problem solving. Noting that students often do not develop a sense of shared cognition when working in teams in problem-based learning environments, he also stressed the importance of attending to group developmental processes when implementing problem-based learning.

CASE-BASED TEACHING

Mary Lundeberg (Michigan State University) defined some key elements of case-based teaching. In the paper she wrote for the workshop (Lundeberg, 2008, p. 1), she said:

Cases involve an authentic portrayal of a person(s) in a complex situation(s) constructed for particular pedagogical purposes. Two features are essential: interactions involving explanations, and challenges to student thinking. Interactions involving explanations could occur among student teams, the instructor and a class; among distant colleagues; or students constructing interpretations in a multimedia environment. Cases may challenge students’ thinking in many ways, e.g., applying concepts to a real life situation; connecting concepts [and/or] interdisciplinary ideas; examining a situation from multiple perspectives; reflecting on how one approaches or solves a problem; making decisions; designing projects; considering ethical dimensions of situations. Brief vignettes, quick examples, or unedited documents are not cases.

She presented four examples to illustrate the wide range of cases that might be used in undergraduate science, technology, engineering, and mathematics (STEM) education: 3

The Deforestation of the Amazon: A Case Study in Understanding Ecosystems and Their Value, a problem-based case used in a biology seminar for nonmajors.

Cross-Dressing or Crossing-Over: Sex Testing of Women Athletes, a historical case used in large lecture courses with clicker technology (handheld wireless devices through which students register their responses to multiple-choice questions that are projected on a screen).

Case It!, in-depth problem-based multimedia cases used in biology labs.

Project-based scenarios used in engineering.

Citing the National Research Council (2002), Lundeberg identified three types of research questions often investigated in studies of educational activities—those that focus on description, cause, and process. She explained that there is much more descriptive research (i.e., faculty and student perceptions of what is happening) than research showing causal effects or describing the process of learning.

Lundeberg described the research that she and her colleagues have conducted on case-based learning. The descriptive aspects of their research involved surveys of 101 faculty members in 23 states and Canada who were using cases from the National Center on Case Study Teaching and Science (see http://library.buffalo.edu/libraries/projects/cases/case.html ). On the surveys, faculty members reported that cases make students more engaged and active learners and help them to develop multiple perspectives, gain deeper conceptual understanding, engage in critical thinking, enhance their communications skills, and develop positive peer relationships (Lundeberg, 2008). Lundeberg also reported that faculty members cited the increased time needed to prepare lessons and assess students as obstacles to implementing case-based learning.

To identify the systematic effects of case-based learning, Lundeberg and her colleagues conducted a year-long study of the use of cases in large undergraduate biology classes equipped with clickers. The study combined a design involving random assignment to experimental and control groups with an A-B-A-B design in which 12 participating faculty members alternated the use of cases and lectures systematically across two semesters. They found that “students (n = 4,366) who responded to cases using ‘clicker’ technology performed significantly better than their peers on five of the eight biology topics (cells, Mendelian genetics, cellular division, scientific method, and cancer), and in five of the eight areas in which they were asked to transfer information (cells, cellular division, scientific method, microevolution and DNA)” (Lundeberg, 2008, p. 8).

Students in the clicker classes also performed significantly better on tests of data interpretation than students in lecture classes. However, students who used cases with clicker technology showed no difference or lower effects on standardized tests measuring accumulated medical knowledge, on one topic in biology (characteristics of life), and on standardized tests of critical thinking.

Lundeberg argued that cases are effective for several reasons. First, stories are a powerful mechanism for organizing and storing information. In addition, the real-life context engages students. Cases also challenge students’ thinking and require them to integrate knowledge, reflect on their ideas, and articulate them. Lundeberg noted that role-playing during case-based education engages students and enables them to consider multiple perspectives.

In closing, Lundeberg reiterated that cases have an impact on understanding, scientific thinking, and engagement. She cited the need for more multiyear, mixed-methods studies on the effectiveness of case-based teaching, particularly classroom experiments that do not confound instructor or student effects. She also identified several gaps in the knowledge base at the undergraduate level: Which students benefit from cases? What content is most suitable? What benefits do different types of cases afford? What kinds of interaction between students and faculty matter? Do cases promote scientific literacy?

USE OF COMPLEX PROBLEMS IN TEACHING PHYSICS

Tom Foster (Southern Illinois University) discussed the use of complex problems in teaching physics. He explained that complex problems are rooted in cooperative group problem solving, which is characterized by the following traits (Foster, 2008):

positive interdependence among group members;

individual accountability;

monitoring of interpersonal skills;

frequent processing of group interactions and functioning; and

aspects of the task or learning activity that require ongoing conversation, dialogue, exchange, and support.

Foster emphasized the importance of designing the appropriate task in using this teaching method. He noted that if the problems are simple enough to be solved moderately well alone, students will not abandon their independence to work in a group. Students also will not abandon their independence if the problems are too complex for the group to initially succeed in solving them.

Context-rich problems are one example of an appropriate task for group problem solving. Foster creates such problems by converting traditional end-of-chapter problems into complex problems that students solve cooperatively, placing students in the problem by using the word “you.” Foster and his colleagues prefer not to include pictures in the problem, as a way of encouraging the group to decide whether and how to illustrate it. According to Foster, context-rich problems also provide many other decision points to foster ongoing interaction among group members. For example, problems might include extra information, omit information, or leave variables unnamed. These problems also “hide the physics” by avoiding technical terms and focusing on real-world settings. By hiding the physics, the problems demonstrate that the world is rich in physics and require students to determine which fundamental physical principles to apply (Foster, 2008).

In physics, context-rich problems are closed-ended, meaning that there is essentially one correct answer that is dictated by the rules of mathematics and physics. Even though they are closed-ended, the problems still require creativity to define and apply the correct principles and equations. Citing Schwartz, Bransford, and Sears (2005), Foster said that this balance between effectiveness and innovation is vital to the transfer of knowledge from one situation to another.

Foster noted that context-rich problems are an excellent way to challenge students’ misconceptions about problem solving. For example, students often believe that the aim of solving a physics problem is to reduce it to a mathematical exercise, and that it is always necessary to use all the information in a problem. Faculty members can address these misconceptions by structuring the problems differently, as described in previous paragraphs.

In Foster’s experience, it is easy to make context-rich problems too difficult. He and his colleagues have developed a set of 21 “difficulty traits” that fall into the broad categories of approach, analysis of the problem, and mathematical solution. Faculty members can use the traits as a checklist to design context-rich problems and to assess and adjust their level of difficulty.

Turning to the evidence, Foster explained that he uses traditional instruments, such as the Force Concept Inventory and conceptual surveys on electricity and magnetism, to measure students’ concept development. He has found that students who solve context-rich problems in cooperative group settings score as well on these measures as their peers who are taught using other interactive methods. To assess problem solving, Foster uses a rubric developed at the University of Minnesota that includes five dimensions: (1) description of the problem, (2) physics approach (i.e., whether students used the correct physics), (3) specific application of the physics, (4) mathematical procedures, and (5) logical progression. Foster reported that students’ problem-solving abilities improve through the use of context-rich problems, but he cautioned that the method does not result in quantum leaps in problem-solving abilities. Foster called his evidence on students’ attitudes and behaviors about context-rich problems anecdotal but positive.

He closed by identifying future directions for this method of physics instruction. Citing the need to create more context-rich problems in physics, he mentioned problems that begin with an answer and require the formulation of a question (such as on the television show “Jeopardy!”) as well as problems in which students identify and correct errors. He also stressed the importance of developing context-rich problems outside physics to assess the transfer of knowledge from one domain to another.

Remarking on the differences in terminology across disciplines, Karen Cummings (Southern Connecticut State University) observed that these differences pose a challenge for researchers. She asked Gijbels how he distinguished between knowledge of concepts and application of knowledge in his study. Gijbels agreed and explained that for his review of the literature he examined actual assessment questions to determine what type of knowledge they were assessing. Lundeberg added that it was a challenge for the faculty members in her study to develop assessments that measure higher order thinking, because it is easier for them to write questions that focus on definitions and conceptual knowledge.

Martha Narro (University of Arizona) asked Gijbels to clarify some of the findings that he discussed in his presentation. He explained that, across studies that assessed student learning of concepts, there was no significant difference between students in problem-based and traditional settings. Across studies that assessed student learning of principles and application of conceptual knowledge, however, students in problem-based environments performed better. He also pointed out that the findings varied depending on the context (specifically, whether the students were in their first or last year of medical school) and the curriculum, and that he was reporting on the overall trends in the data.

Responding to another question, Lundeberg and Foster discussed the issue of relevance when constructing scenarios, problems, and cases. They agreed that there is very little research on what it means to be relevant. Lundeberg related several examples of cases that faculty members designed to be relevant but that did not resonate with students. In her experience, allowing students to design their own cases is a powerful way to make the cases relevant. Foster added that many college students are still developing their identities, which makes the notion of relevance more challenging. An audience member, referring to a paper by Mayberry (1998) about pedagogies that encourage students to develop their own sense of science, cautioned faculty members to be careful about coming across as knowing more than students about what is relevant.

Following another question, the speakers engaged in a discussion about the importance of longitudinal research to understand the longer term impact of these pedagogical strategies. Lundeberg mentioned some examples of longitudinal studies of innovative instructional strategies that show mixed results. Foster added that it is difficult to measure long-term knowledge or to trace it back to its origins. As an example, he said that although students might not demonstrate understanding of a concept after a certain

course, the exposure they gained to that concept might facilitate later learning. In that situation, the initial course had an effect that is impossible to measure. The panelists noted that longitudinal research is important, difficult to conduct, difficult to fund, and relatively rare.

Numerous teaching, learning, assessment, and institutional innovations in undergraduate science, technology, engineering, and mathematics (STEM) education have emerged in the past decade. Because virtually all of these innovations have been developed independently of one another, their goals and purposes vary widely. Some focus on making science accessible and meaningful to the vast majority of students who will not pursue STEM majors or careers; others aim to increase the diversity of students who enroll and succeed in STEM courses and programs; still other efforts focus on reforming the overall curriculum in specific disciplines. In addition to this variation in focus, these innovations have been implemented at scales that range from individual classrooms to entire departments or institutions.

By 2008, partly because of this wide variability, it was apparent that little was known about the feasibility of replicating individual innovations or about their potential for broader impact beyond the specific contexts in which they were created. The research base on innovations in undergraduate STEM education was expanding rapidly, but the process of synthesizing that knowledge base had not yet begun. If future investments were to be informed by the past, then the field clearly needed a retrospective look at the ways in which earlier innovations had influenced undergraduate STEM education.

To address this need, the National Research Council (NRC) convened two public workshops to examine the impact and effectiveness of selected STEM undergraduate education innovations. This volume summarizes the workshops, which addressed such topics as the link between learning goals and evidence; promising practices at the individual faculty and institutional levels; classroom-based promising practices; and professional development for graduate students, new faculty, and veteran faculty. The workshops concluded with a broader examination of the barriers and opportunities associated with systemic change.

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27 Problem-based Learning and Case-based Learning

Teaching strategies: problem-based learning and case-based learning, problem-based learning.

Problem-based learning, or PBL, in its purest form, presents a fully-formed “real-world” problem to students at the outset of a course. Students then experiment and explore to solve the problem, with the instructor acting as a “guide” in the process, offering correction, focus, and assistance to guide inquiry. 

During class time, the students are presented with a problem or issue that needs to be solved using the information they are learning about.  As a group, they decide what they already know about the subject, determine what they need to know to solve the problem, apply suggested solutions to the problem, and analyze the results.

The four basic questions of problem-based learning are:

• What do you know (about the topic/problem/issue)?
• What do you need to know to solve the problem?
• How do you get that information?
• How do you apply the information to solve the problem?

Case-based learning

Case-based learning and problem-based learning are instructional strategies that use the analysis of authentic, “real-life” scenarios or challenges as a means of demonstrating and/or building skills, competencies, and disciplinary intuition. Case-based learning tends to use cases as part of an integrated pedagogical strategy along with lectures, readings, and other instructional activities; once students have been presented with a theoretical framework they review a case and try to apply the principles to the case at hand, bridging theory and practice.

Quick Start Guide – PBL 101

Employing this strategy can be rewarding but takes careful planning to give your students the tools they need to solve the problem – we have created a planning document that walks you through the steps to creating a comprehensive lesson based on PBL, which can be found here: Problem-based instruction planning template .

Quick Start Guide – Case-based Learning 101

Employing this strategy can encourage critical thinking in students as they comprehensively analyze a case while connecting it to the content.  To help you develop the most robust case-based lesson possible, ATS has created a planning document that walks you through the steps to creating a case-based lesson:

Case-based instruction planning template

This section outlines how you might begin to think about adopting the aforementioned teaching strategies and the tools you might consider employing.

Problem-Based Learning

Project-based learning, also called PBL, uses extended projects such as problems, questions, or challenges to help students gain knowledge or explore information.

• Online collaborative tools  are useful for Problem-based learning.
•   One Drive  allows students to share documents in the cloud.
• Mindmapping tools can help students brainstorm and create logic chains to solve the problem.

• For those in education, the  PELP framework is a useful tool to evaluate cases.  Instructional Design Services has developed a  PELP Framework Case Selection Guide  and  PELP Framework Activity Guide (for students)
• Games and simulations are a way to get students to think through case scenarios and to create logic chains.
• Case-based learning and problem-based learning do not need to be exclusive.  Cases and scenarios can often be the basis for the problem in problem-based learning.
• Case studies from the  National Center for Case Study Teaching in Science
• A Journal of Teaching Cases in Public Administration and Public Policy,  University of Washington
• Real-life cases can often be found in newspapers, journals, and social media sites.  College of Business faculty have access to real-life scenarios from the Wall Street Journal.  Instructional Design Services has created a WSJ Instruction Template  to walk you through using the Wall Street Journal in your lesson.

In the Library

Allen, D. E., Donham, R. S., & Bernhardt, S. A. (2011). Problem-based learning. New Directions For Teaching & Learning , 2011 (128), 21-29. doi:10.1002/tl.465

Amador, J., Miles, L., & Peters, C.B. (2006). The Practice of Problem-Based Learning: A Guide to Implementing PBL in the College Classroom . Boston, MA: Anker Publishing Company.

Crowther, B. (2002). Problem-based learning: Case studies. International Journal of Electrical Engineering Education, 39 (1), 87.

Dolmans, D., De Grave, W., Wolfhagen, I., & Van der Vleuten, C.P. (2005). Problem-based learning: future challenges for educational practice and research. Medical Education, 39 (7), 732-741.

Hale, S. (2006). Politics and the real world: A case study in developing case-based learning. European Political Science, 5 (1), 84-96. doi:10.1057/palgrave.eps.2210060

Klenk, M., Aha, D. W., & Molineaux, M. (2011). The case for case-based transfer learning. AI Magazine , 32 (1), 54.

Yew, E., Chng, E., & Schmidt, H. (2011). Is learning in problem-based learning cumulative? Advances In Health Sciences Education: Theory And Practice, 16 (4), 449-464. doi:10.1007/s10459-010-9267-y 1 MrJanzen1984. (Creator). (2016, August 02).Problem Based Learning vs Project-Based Learning [digital image]. https://commons.wikimedia.org/wiki/File:Problem_Based_Learning_vs_Project_Based_Learning.png#file

Maverick Learning and Educational Applied Research Nexus Copyright © 2021 by Minnesota State University, Mankato is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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• Resources and Guides

Case Method Teaching and Learning

What is the case method? How can the case method be used to engage learners? What are some strategies for getting started? This guide helps instructors answer these questions by providing an overview of the case method while highlighting learner-centered and digitally-enhanced approaches to teaching with the case method. The guide also offers tips to instructors as they get started with the case method and additional references and resources.

On this page:

What is case method teaching.

• Case Method at Columbia

Why use the Case Method?

Case method teaching approaches, how do i get started.

• Additional Resources

The CTL is here to help!

For support with implementing a case method approach in your course, email [email protected] to schedule your 1-1 consultation .

Cite this resource: Columbia Center for Teaching and Learning (2019). Case Method Teaching and Learning. Columbia University. Retrieved from [today’s date] from https://ctl.columbia.edu/resources-and-technology/resources/case-method/  

Case method 1 teaching is an active form of instruction that focuses on a case and involves students learning by doing 2 3 . Cases are real or invented stories 4  that include “an educational message” or recount events, problems, dilemmas, theoretical or conceptual issue that requires analysis and/or decision-making.

Case-based teaching simulates real world situations and asks students to actively grapple with complex problems 5 6 This method of instruction is used across disciplines to promote learning, and is common in law, business, medicine, among other fields. See Table 1 below for a few types of cases and the learning they promote.

Table 1: Types of cases and the learning they promote.

For a more complete list, see Case Types & Teaching Methods: A Classification Scheme from the National Center for Case Study Teaching in Science.

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Case Method Teaching and Learning at Columbia

The case method is actively used in classrooms across Columbia, at the Morningside campus in the School of International and Public Affairs (SIPA), the School of Business, Arts and Sciences, among others, and at Columbia University Irving Medical campus.

Faculty Spotlight:

Professor Mary Ann Price on Using Case Study Method to Place Pre-Med Students in Real-Life Scenarios

Read more  

Professor De Pinho on Using the Case Method in the Mailman Core

Case method teaching has been found to improve student learning, to increase students’ perception of learning gains, and to meet learning objectives 8 9 . Faculty have noted the instructional benefits of cases including greater student engagement in their learning 10 , deeper student understanding of concepts, stronger critical thinking skills, and an ability to make connections across content areas and view an issue from multiple perspectives 11 . 

Through case-based learning, students are the ones asking questions about the case, doing the problem-solving, interacting with and learning from their peers, “unpacking” the case, analyzing the case, and summarizing the case. They learn how to work with limited information and ambiguity, think in professional or disciplinary ways, and ask themselves “what would I do if I were in this specific situation?”

The case method bridges theory to practice, and promotes the development of skills including: communication, active listening, critical thinking, decision-making, and metacognitive skills 12 , as students apply course content knowledge, reflect on what they know and their approach to analyzing, and make sense of a case. 

Though the case method has historical roots as an instructor-centered approach that uses the Socratic dialogue and cold-calling, it is possible to take a more learner-centered approach in which students take on roles and tasks traditionally left to the instructor. 

Cases are often used as “vehicles for classroom discussion” 13 . Students should be encouraged to take ownership of their learning from a case. Discussion-based approaches engage students in thinking and communicating about a case. Instructors can set up a case activity in which students are the ones doing the work of “asking questions, summarizing content, generating hypotheses, proposing theories, or offering critical analyses” 14 . 

The role of the instructor is to share a case or ask students to share or create a case to use in class, set expectations, provide instructions, and assign students roles in the discussion. Student roles in a case discussion can include: 

• discussion “starters” get the conversation started with a question or posing the questions that their peers came up with; 
• facilitators listen actively, validate the contributions of peers, ask follow-up questions, draw connections, refocus the conversation as needed; 
• recorders take-notes of the main points of the discussion, record on the board, upload to CourseWorks, or type and project on the screen; and 
• discussion “wrappers” lead a summary of the main points of the discussion. 

Prior to the case discussion, instructors can model case analysis and the types of questions students should ask, co-create discussion guidelines with students, and ask for students to submit discussion questions. During the discussion, the instructor can keep time, intervene as necessary (however the students should be doing the talking), and pause the discussion for a debrief and to ask students to reflect on what and how they learned from the case activity. 

Note: case discussions can be enhanced using technology. Live discussions can occur via video-conferencing (e.g., using Zoom ) or asynchronous discussions can occur using the Discussions tool in CourseWorks (Canvas) .

Table 2 includes a few interactive case method approaches. Regardless of the approach selected, it is important to create a learning environment in which students feel comfortable participating in a case activity and learning from one another. See below for tips on supporting student in how to learn from a case in the “getting started” section and how to create a supportive learning environment in the Guide for Inclusive Teaching at Columbia . 

Table 2. Strategies for Engaging Students in Case-Based Learning

Approaches to case teaching should be informed by course learning objectives, and can be adapted for small, large, hybrid, and online classes. Instructional technology can be used in various ways to deliver, facilitate, and assess the case method. For instance, an online module can be created in CourseWorks (Canvas) to structure the delivery of the case, allow students to work at their own pace, engage all learners, even those reluctant to speak up in class, and assess understanding of a case and student learning. Modules can include text, embedded media (e.g., using Panopto or Mediathread ) curated by the instructor, online discussion, and assessments. Students can be asked to read a case and/or watch a short video, respond to quiz questions and receive immediate feedback, post questions to a discussion, and share resources. 

For more information about options for incorporating educational technology to your course, please contact your Learning Designer .

To ensure that students are learning from the case approach, ask them to pause and reflect on what and how they learned from the case. Time to reflect  builds your students’ metacognition, and when these reflections are collected they provides you with insights about the effectiveness of your approach in promoting student learning.

Well designed case-based learning experiences: 1) motivate student involvement, 2) have students doing the work, 3) help students develop knowledge and skills, and 4) have students learning from each other.  

Designing a case-based learning experience should center around the learning objectives for a course. The following points focus on intentional design. 

Identify learning objectives, determine scope, and anticipate challenges. 

• Why use the case method in your course? How will it promote student learning differently than other approaches? 
• What are the learning objectives that need to be met by the case method? What knowledge should students apply and skills should they practice? 
• What is the scope of the case? (a brief activity in a single class session to a semester-long case-based course; if new to case method, start small with a single case). 
• What challenges do you anticipate (e.g., student preparation and prior experiences with case learning, discomfort with discussion, peer-to-peer learning, managing discussion) and how will you plan for these in your design? 
• If you are asking students to use transferable skills for the case method (e.g., teamwork, digital literacy) make them explicit. 

Determine how you will know if the learning objectives were met and develop a plan for evaluating the effectiveness of the case method to inform future case teaching. 

• What assessments and criteria will you use to evaluate student work or participation in case discussion? 
• How will you evaluate the effectiveness of the case method? What feedback will you collect from students? 
• How might you leverage technology for assessment purposes? For example, could you quiz students about the case online before class, accept assignment submissions online, use audience response systems (e.g., PollEverywhere) for formative assessment during class? 

Select an existing case, create your own, or encourage students to bring course-relevant cases, and prepare for its delivery

• Where will the case method fit into the course learning sequence? 
• Is the case at the appropriate level of complexity? Is it inclusive, culturally relevant, and relatable to students? 
• What materials and preparation will be needed to present the case to students? (e.g., readings, audiovisual materials, set up a module in CourseWorks). 

Plan for the case discussion and an active role for students

• What will your role be in facilitating case-based learning? How will you model case analysis for your students? (e.g., present a short case and demo your approach and the process of case learning) (Davis, 2009). 
• What discussion guidelines will you use that include your students’ input? 
• How will you encourage students to ask and answer questions, summarize their work, take notes, and debrief the case? 
• If students will be working in groups, how will groups form? What size will the groups be? What instructions will they be given? How will you ensure that everyone participates? What will they need to submit? Can technology be leveraged for any of these areas? 
• Have you considered students of varied cognitive and physical abilities and how they might participate in the activities/discussions, including those that involve technology? 

Student preparation and expectations

• How will you communicate about the case method approach to your students? When will you articulate the purpose of case-based learning and expectations of student engagement? What information about case-based learning and expectations will be included in the syllabus?
• What preparation and/or assignment(s) will students complete in order to learn from the case? (e.g., read the case prior to class, watch a case video prior to class, post to a CourseWorks discussion, submit a brief memo, complete a short writing assignment to check students’ understanding of a case, take on a specific role, prepare to present a critique during in-class discussion).

Andersen, E. and Schiano, B. (2014). Teaching with Cases: A Practical Guide . Harvard Business Press. 

Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. Journal of Microbiology & Biology Education , 16 (1), 21–28. https://doi.org/10.1128/jmbe.v16i1.846

Davis, B.G. (2009). Chapter 24: Case Studies. In Tools for Teaching. Second Edition. Jossey-Bass. 

Garvin, D.A. (2003). Making the Case: Professional Education for the world of practice. Harvard Magazine. September-October 2003, Volume 106, Number 1, 56-107.

Golich, V.L. (2000). The ABCs of Case Teaching. International Studies Perspectives. 1, 11-29. 

Golich, V.L.; Boyer, M; Franko, P.; and Lamy, S. (2000). The ABCs of Case Teaching. Pew Case Studies in International Affairs. Institute for the Study of Diplomacy. 

Heath, J. (2015). Teaching & Writing Cases: A Practical Guide. The Case Center, UK. 

Herreid, C.F. (2011). Case Study Teaching. New Directions for Teaching and Learning. No. 128, Winder 2011, 31 – 40. 

Herreid, C.F. (2007). Start with a Story: The Case Study Method of Teaching College Science . National Science Teachers Association. Available as an ebook through Columbia Libraries. 

Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. Journal of College Science Teaching. Oct 2006, 36(2). https://search.proquest.com/docview/200323718?pq-origsite=gscholar  

Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. Journal on Excellence in College Teaching. 27(2), 131-153. 

Lundberg, K.O. (Ed.). (2011). Our Digital Future: Boardrooms and Newsrooms. Knight Case Studies Initiative. 

Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207. https://doi.org/10.1016/j.nedt.2010.06.002

Schiano, B. and Andersen, E. (2017). Teaching with Cases Online . Harvard Business Publishing. 

Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). The effectiveness of case-based learning in health professional education: A BEME systematic review . Medical Teacher. 2012; 34(6): e421-44. 

Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. Journal of College Science Teaching; Sept/Oct 2007; 37(1). 

Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass.

Additional resources 

Teaching with Cases , Harvard Kennedy School of Government. 

Features “what is a teaching case?” video that defines a teaching case, and provides documents to help students prepare for case learning, Common case teaching challenges and solutions, tips for teaching with cases. 

Promoting excellence and innovation in case method teaching: Teaching by the Case Method , Christensen Center for Teaching & Learning. Harvard Business School. 

National Center for Case Study Teaching in Science . University of Buffalo. 

A collection of peer-reviewed STEM cases to teach scientific concepts and content, promote process skills and critical thinking. The Center welcomes case submissions. Case classification scheme of case types and teaching methods:

• Different types of cases: analysis case, dilemma/decision case, directed case, interrupted case, clicker case, a flipped case, a laboratory case. 
• Different types of teaching methods: problem-based learning, discussion, debate, intimate debate, public hearing, trial, jigsaw, role-play. 

Columbia Resources

Resources available to support your use of case method: The University hosts a number of case collections including: the Case Consortium (a collection of free cases in the fields of journalism, public policy, public health, and other disciplines that include teaching and learning resources; SIPA’s Picker Case Collection (audiovisual case studies on public sector innovation, filmed around the world and involving SIPA student teams in producing the cases); and Columbia Business School CaseWorks , which develops teaching cases and materials for use in Columbia Business School classrooms.

Center for Teaching and Learning

The Center for Teaching and Learning (CTL) offers a variety of programs and services for instructors at Columbia. The CTL can provide customized support as you plan to use the case method approach through implementation. Schedule a one-on-one consultation. 

Office of the Provost

The Hybrid Learning Course Redesign grant program from the Office of the Provost provides support for faculty who are developing innovative and technology-enhanced pedagogy and learning strategies in the classroom. In addition to funding, faculty awardees receive support from CTL staff as they redesign, deliver, and evaluate their hybrid courses.

The Start Small! Mini-Grant provides support to faculty who are interested in experimenting with one new pedagogical strategy or tool. Faculty awardees receive funds and CTL support for a one-semester period.

Explore our teaching resources.

• Blended Learning
• Contemplative Pedagogy
• Inclusive Teaching Guide
• FAQ for Teaching Assistants
• Metacognition

CTL resources and technology for you.

• Overview of all CTL Resources and Technology
• The origins of this method can be traced to Harvard University where in 1870 the Law School began using cases to teach students how to think like lawyers using real court decisions. This was followed by the Business School in 1920 (Garvin, 2003). These professional schools recognized that lecture mode of instruction was insufficient to teach critical professional skills, and that active learning would better prepare learners for their professional lives. ↩
• Golich, V.L. (2000). The ABCs of Case Teaching. International Studies Perspectives. 1, 11-29. ↩
• Herreid, C.F. (2007). Start with a Story: The Case Study Method of Teaching College Science . National Science Teachers Association. Available as an ebook through Columbia Libraries. ↩
• Davis, B.G. (2009). Chapter 24: Case Studies. In Tools for Teaching. Second Edition. Jossey-Bass. ↩
• Andersen, E. and Schiano, B. (2014). Teaching with Cases: A Practical Guide . Harvard Business Press. ↩
• Lundberg, K.O. (Ed.). (2011). Our Digital Future: Boardrooms and Newsrooms. Knight Case Studies Initiative. ↩
• Heath, J. (2015). Teaching & Writing Cases: A Practical Guide. The Case Center, UK. ↩
• Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. Journal of Microbiology & Biology Education , 16 (1), 21–28. https://doi.org/10.1128/jmbe.v16i1.846 ↩
• Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. Journal on Excellence in College Teaching. 27(2), 131-153. ↩
• Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). The effectiveness of case-based learning in health professional education: A BEME systematic review . Medical Teacher. 2012; 34(6): e421-44. ↩
• Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. Journal of College Science Teaching; Sept/Oct 2007; 37(1). ↩
• Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207. https://doi.org/10.1016/j.nedt.2010.06.002 ↩
• Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass. ↩
• Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. Journal of College Science Teaching. Oct 2006, 36(2). https://search.proquest.com/docview/200323718?pq-origsite=gscholar ↩

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• Case, scenario, problem, inquiry-based learning
• Teaching guidance
• Teaching practices
• Active learning

Facilitate students to apply disciplinary knowledge, critical thinking and problem-solving skills in safe, real-life contexts.

Case, scenario, problem and inquiry-based learning are active learning strategies suitable for a face-to-face, online or hybrid environment. These approaches require students to apply their disciplinary knowledge, critical thinking and problem-solving skills in a safe, real-world context.

Case-based learning (CBL) presents students with a case or dilemma situated in an authentic context, which they are required to solve. Students are provided with background, situation and supporting data. They can work individually or as a group. The course coordinator takes on a facilitator’s role to guide learning rather than dictate answers.

Scenario-based learning (SBL) uses interactive scenarios based on the principles of situated learning theory (Lave & Wenger, 1991). It works by simulating real-world practice, provide safe opportunities to engage in situations that may be otherwise difficult for students to experience in their studies.

Problem-based learning (PBL) supports learning through an enquiry-guided method for students to solve a real-life problem. Students use ‘triggers’ derived from the problem to define their own learning outcome/objectives. There is a specific, guided methodology for implementing PBL.

Inquiry-based learning (IBL) encourages students to explore material, ask questions, and share ideas in small groups with guided learning. It uses a constructivist approach with the goal for students to make meaning, guided by the Course Coordinators.

Best practice

Technology considerations, case studies, references and further reading, case-based learning (cbl).

A case study is generally based on real situations (names and facts often changed to ensure anonymity). Many case studies include supporting data and documentation and require students to answer an open-ended question or develop a solution(s). The facilitator has an active role in shaping questions that will guide students in their learning.

Most effective cases:

• are developed in line with defined learning objectives
• have an educational purpose
• are authentic and relevant
• draw on common/typical scenarios
• consider dilemmas to promote decision-making
• add supporting data where necessary, and
• have relatable characters, and some include the voice of characters (e.g. patients) to add drama and realism.

In facilitating case-based learning:

• Give students ample time to read and think about the case. You can provide the case before class.
• Introduce the case briefly and provide some guidelines for how to approach it.
• Create groups (ideally 3–6 students) and monitor them to ensure everyone is involved.
• Have groups present their solutions/reasoning.
• Ask questions for clarification and to move discussions to another level.
• Synthesise issues raised. Be sure to bring the various strands of the discussion back together at the end. Ask groups to summarise their findings and compare group responses. Help the whole class interpret and understand the implications of their solutions.

(Adapted from Case Studies , Eberly Center for Teaching Excellence & Educational Innovation, Carnegie Mellon University)

Scenario-based learning (SBL)

Scenarios put students in a simulated context to provide rich learning experiences.

When designing a scenario:

• Identify the learning outcomes . It is important to identify what you want students to achieve on completing the scenario and then work backwards from the learning outcomes to create the situation that will lead to this learning. 
• Decide on your format . Is your scenario delivered in face-to-face or online environments? What media (photographs, audio, video) and other resources will you need? If you use an online scenario, will you provide other supporting activities, such as wikis, discussion forums, etc.?
• Choose a topic . Remember that non-routine tasks lend themselves to scenario-based learning. Consider using ‘critical incidents’ and challenging situations that have occurred in your subject area.
• Identify the trigger event or situation . This will be the starting point of your scenario. As you create the scenario, identify decision points and key areas for feedback and student reflection. Creating a storyboard is an effective way to do this.
• Peer review your scenario . Ask colleagues to work through the scenario to ensure that it flows in the way you expect and achieves the outcomes you intended.

Problem-based learning (PBL)

Problem-based learning can be used to engage in active learning that challenges higher-order thinking in collaboration with peers.

There are various ways to plan, design and implement PBL in your classroom. The following resources may suit your context:

• Wood (2007) identified a structure for incorporating PBL into the curriculum and emphasises that PBL will only be successful if the problems developed are of high quality.
• Ganareo and Lyons (2015) outline key steps to design, implement and assess PBL to help develop twenty-first-century skills such as teamwork, digital literacy and problem-solving.
• The ‘Seven Jump’ method (Gijselaers, 1995) used at Maastricht describes the key steps students go through to resolve a problem during PBL tutorial sessions.

Inquiry-based learning (IBL)

Inquiry-based learning (IBL) encourages students to explore a specific topic, ask questions, and share ideas.

Heick identified four phases of Inquiry-Based Learning :

• Interaction : dive into engaging, relevant, and credible media forms to identify a ‘need’ or opportunity for inquiry.
• Clarification : summarising, paraphrasing, and categorising learning with teacher or expert support.
• Questioning : asking questions to drive continued, self-directed inquiry.
• Design : designing an accessible, relevant, and curiosity-driven action or product to culminate and justify inquiry.

When planning case, scenario, problem and inquiry-based learning, you need to consider the context of the learners and select technologies that support the steps you have planned.

• Small group discussion in person or online (e.g. discussion boards , Zoom breakout rooms ).
• Identify relevant questions, (e.g. in person or through PadletUQ ).
• Research (e.g. journal articles, databases, search engines, Library Catalogue)
• Face-to-face or online brainstorming (e.g. discussion boards , PadletUQ,   Zoom breakout rooms , or mind map).
• Spreadsheet software (e.g. Microsoft Excel, Google Sheets) for graphing and presenting data.
• Presentation software (e.g. Microsoft PowerPoint, Adobe Express , Prezi) for presenting investigation results.
• Collaborate (e.g. Zoom  if presenting online, or Microsoft Teams ).

View centrally-supported active learning tools

View more case studies (UQ Assessment Ideas Factory)

4 Phases of Inquiry-based Learning , Teachthought

Active & Inquiry-based Learning , Victoria University Melbourne Australia

Azer, S. A. (2007). Twelve tips for creating trigger images for problem-based learning cases. Medical Teacher, 29 (2-3), 93-97. doi:10.1080/01421590701291444

Case-based Teaching and Problem-based Learning (University of Michigan, Centre for Research on Learning & Teaching)

Case Studies , Eberly Center for Teaching Excellence & Educational Innovation, Carnegie Mellon University

Clark, R., (2009). Accelerating expertise with scenario-based learning. Learning Blueprint . Merrifield, VA: American Society for Teaching and Development.

Davis, B. (1993). Tools for Teaching . San Francisco: Jossey-Bass.

Davis, C. & Wilcock, E. (2003). Teaching Materials Using Case Studies.

Enquiry-based learning (Griffith University)

Errington, E.P., (2003). Developing scenario-based learning: Practical insights for tertiary educators . Palmerston North, N.Z .: Dunmore Press. 9-20.

Ganareo, V., & Lyons, R. (2015). Problem-Based Learning: Six Steps to Design, Implement, and Assess .

Gijselaers, W. (1995). Perspectives on problem-based learning. In W. Gijselaers, D. Tempelaar, P. Keizer, J. Blommaert, E. Benard, & H. Kasper (Eds.), Educational Innovation in Economics and Business Administration (pp. 39-52). Netherlands: Springer.

Gossman, P., Stewart, T., Jaspers, M., & Chapman, B. (2007). Integrating web-delivered problem-based learning scenarios to the curriculum. Active Learning In Higher Education , 8(2), 139-153.

Journal of University Teaching and Learning Practice, 8 (1), 0-17. Retrieved from http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1149&context=jutlp

Kindley, R. W. (2002). Scenario-based e-learning: a step beyond traditional e-learning. ASTD Magazine . Retrieved from http://www.astd.org/

Problem-Based Learning at Maastricht University

Retrieved from https://www.facultyfocus.com/articles/course-design-ideas/problem-based-learning-six-steps-to-design-implement-and-assess/

Ribeiro, L. R. C. (2011). The Pros and Cons of Problem-Based Learning from the Teacher's Standpoint.

Savery, John R. (2006) Overview of Problem-based Learning: Definitions and Distinctions, Interdisciplinary Journal of Problem-based Learning 1 (1)

Schwartz, P., Mennin, S., & Webb, G. (2001). Problem-Based Learning: Case Studies, Experience and Practice (Eds.). London, UK: Kogan Page Limited.

Using Case Studies to Teach , Centre for Excellence and Innovation in Teaching, Boston University

Weimer, M. (2009). Problem-Based Learning: Benefits and Risks . Retrieved from http://www.facultyfocus.com/articles/effective-teaching-strategies/problem-based-learning-benefits-and-risks/

Wood, D. F. (2003). Problem-based learning. BMJ, 326, 328-330. doi: 10.1136/bmj.326.7384.328

• Project-based learning
• Reflective learning
• Collaborative learning
• Experiential learning
• In-class active learning activities

   Resources

• Active learning tools
• UQ Assessment Ideas Factory

ITaLI offers personalised support services across various areas including case, scenario, problem, inquiry-based learning.

• Our Mission

New Research Makes a Powerful Case for PBL

Two new gold-standard studies provide compelling evidence that project-based learning is an effective strategy for all students—including historically marginalized ones.

When Gil Leal took AP Environmental Science in his junior year of high school, he was surprised by how different it was from his other AP classes. Instead of spending the bulk of the time sitting through lectures, taking notes, and studying abstract texts, his class visited a strawberry farm in the valley nearby.

It wasn’t just for a tour. Leal and his peers were tasked with thinking about the many challenges that modern farms confront, from water shortages to pest infestations and erosion. More surprising to Leal: Students were asked to design their own solutions, incorporating what they had learned about things like soil composition, ecosystem dynamics, and irrigation systems.

Now an environmental science major at UCLA—and a first-generation college student—Leal sees the visit as a pivotal moment that led to his decision to pursue science in college. He had never visited a farm before, and was used to a traditional sit-and-listen learning model.

“In other classes, it was lecture, readings, test,” said Leal, “but in AP Environmental Science we worked on projects with other students, discussed our ideas, considered different perspectives—and I learned so much more this way.”

Leal’s AP class, taught by Brandie Borges, is part of a new generation of classes that transform traditional teacher-led instruction into a more student-centered, project-based approach—requiring students to work together as they tackle complex, real-world problems that emphasize uncertainty, iterative thinking, and innovation. Proponents of project-based learning (PBL) argue that it fosters a sense of purpose in young learners, pushes them to think critically, and prepares them for modern careers that prize skills like collaboration, problem-solving, and creativity.

Critics say that the pedagogy places too much responsibility on novice learners, and ignores the evidence about the effectiveness of direct instruction by teachers. By de-emphasizing knowledge transfer from experts to beginners, the critics suggest, PBL undermines content knowledge and subject fluency.

While project-based learning and direct instruction aren't incompatible, evidence that might settle the deeper controversy over PBL's effectiveness has been sparse. Only a handful of studies over the last decades have established a causal relationship between structured project-based learning and student outcomes—in either direction.

But two major new gold-standard studies—both funded by Lucas Education Research , a sister division of Edutopia—conducted by researchers from the University of Southern California and Michigan State University, provide compelling evidence that project-based learning is an effective strategy for all students, outperforming traditional curricula not only for high achieving students, but across grade levels and racial and socioeconomic groups.

Reimagining Advanced Placement Courses

The two studies involved over 6,000 students in 114 schools across the nation, with more than 50 percent of students coming from low-income households.

In the AP study , which included Gil Leal’s class along with over 3,600 students in both AP Environmental Science and AP U.S. Government and Politics courses from five districts serving a diverse student body, researchers looked at a broad range of project-based activities in the sciences and humanities.

In one example, students in Amber Graeber’s AP Government class took part in a simulation of an electoral caucus. Meanwhile, instead of simply reading about Supreme Court cases, students in Erin Fisher’s class studied historic cases and then took on real-world roles, arguing the cases in mock court, acting as reporters, and designing campaign ads and stump speeches to make their case.

Researchers found that nearly half of students in project-based classrooms passed their AP tests, outperforming students in traditional classrooms by 8 percentage points. Students from low-income households saw similar gains compared to their wealthier peers, making a strong case that well-structured PBL can be a more equitable approach than teacher-centered ones. Importantly, the improvements in teaching efficacy were both significant and durable: When teachers in the study taught the same curriculum for a second year, PBL students outperformed students in traditional classrooms by 10 percentage points.

The study results nudged at entrenched ideas about how to best teach students from different backgrounds. “There’s a belief among some educators and some policymakers that students from underserved backgrounds… aren’t ready to have student-centered instruction where they’re driving their own learning,” said USC researcher Anna Saavedra, the lead researcher on the AP study. “And so there’s this idea, and the results of this study really challenged that notion.”

Nationally, the researchers concluded, 30 percent of students from low-income households take AP tests, but that number jumped to 38 percent for students in PBL classrooms—there are more low-income students taking AP tests using project-based learning, and more are passing as well.

It may seem counterintuitive that a student-centered approach is effective in an environment that’s so focused on high-stakes testing, but the results suggest otherwise.

“Students felt like the work was more authentic,” said Saavedra, suggesting a possible explanation for the improvements. “There were more connections to their real lives. For example, in the AP Environmental Science course, they were learning about their ecological footprint and thinking: How do my behaviors affect the health of my community and of the larger world?”

Authentic Learning

But project-based learning isn’t just for high school kids. In Billie Freeland’s third-grade class, PBL not only builds students’ interest in science but also helps them make more connections with the world around them, generating a deep understanding of—and appreciation for—science, she says.

“Third-grade students work on the ‘Toy Unit,’” said Freeland. “But don’t let the name fool you.... Third graders learn the concepts of gravity, friction, force, and direction by designing toys from simple objects such as water bottles, straws, and recycled milk cartons. The unit ends with them designing their own toys that use magnetic or electrical force,” she told researchers, while emphasizing that the projects are aligned with Next Generation Science Standards (NGSS).

Freeland’s class was one of dozens involved in the large-scale study examining the effectiveness of PBL in elementary science classes . In the study, researchers from Michigan State University and the University of Michigan studied 2,371 third-grade students in 46 schools who were randomly assigned to a business-as-usual control group or a treatment group. The schools selected for the study were diverse: 62 percent of the schools’ student bodies qualified for free or reduced-price lunch, and 58 percent were students of color.

Like the high school students in the AP study, elementary students in PBL classrooms outperformed their peers, this time by 8 percentage points on a test of science learning. The pattern held across socioeconomic class and across all reading ability levels: In the project-based learning group, all boats rose on the tide—and both struggling readers and highly proficient readers outperformed their counterparts in traditional classrooms.

“The beauty of all of this, which is really quite lovely, is that we have PBL in science, a progression of it, from elementary through high school,” said Barbara Schneider, a professor of education at Michigan State University who worked on the study. “Our findings are consistent all across elementary and secondary school, which is really quite remarkable. And in both cases, we’re looking at substantial increases in science achievement.”

The Takeaway: In two gold-standard, randomized, controlled trials of thousands of students in diverse school systems across the U.S., project-based learning significantly outperformed traditional curricula, raising academic performance across grade levels, socioeconomic subgroups, and reading ability. To learn more about the AP courses and the research, watch the videos Reinventing AP Courses With Rigorous Project-Based Learning  and  A Project-Based Approach to Teaching Elementary Science .

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• v.31(3); 2021 Jun

Effective Learning Behavior in Problem-Based Learning: a Scoping Review

Azril shahreez abdul ghani.

1 Department of Basic Medical Sciences, Kulliyah of Medicine, Bandar Indera Mahkota Campus, International Islamic University Malaysia, Kuantan, 25200 Pahang Malaysia

2 Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150 Kelantan Malaysia

Ahmad Fuad Abdul Rahim

Muhamad saiful bahri yusoff, siti nurma hanim hadie.

3 Department of Anatomy, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan Malaysia

Problem-based learning (PBL) emphasizes learning behavior that leads to critical thinking, problem-solving, communication, and collaborative skills in preparing students for a professional medical career. However, learning behavior that develops these skills has not been systematically described. This review aimed to unearth the elements of effective learning behavior in a PBL context, using the protocol by Arksey and O’Malley. The protocol identified the research question, selected relevant studies, charted and collected data, and collated, summarized, and reported results. We discovered three categories of elements—intrinsic empowerment, entrustment, and functional skills—proven effective in the achievement of learning outcomes in PBL.

Introduction

Problem-based learning (PBL) is an educational approach that utilizes the principles of collaborative learning in small groups, first introduced by McMaster Medical University [ 1 ]. The shift of the higher education curriculum from traditional, lecture-based approaches to an integrated, student-centered approach was triggered by concern over the content-driven nature of medical knowledge with minimal clinical application [ 2 ]. The PBL pedagogy uses a systematic approach, starting with an authentic, real-life problem scenario as a context in which learning is not separated from practice as students collaborate and learn [ 3 ]. The tutor acts as a facilitator who guides the students’ learning, while students are required to solve the problems by discussing them with group members [ 4 ]. The essential aspect of the PBL process is the ability of the students to recognize their current knowledge, determine the gaps in their knowledge and experience, and acquire new knowledge to bridge the gaps [ 5 ]. PBL is a holistic approach that gives students an active role in their learning.

Since its inception, PBL has been used in many undergraduate and postgraduate degree programs, such as medicine [ 6 , 7 ], nursing [ 8 ], social work education [ 9 ], law [ 10 ], architecture [ 11 ], economics [ 12 ], business [ 13 ], science [ 14 ], and engineering [ 15 ]. It has also been applied in elementary and secondary education [ 16 – 18 ]. Despite its many applications, its implementation is based on a single universal workflow framework that contains three elements: problem as the initiator for learning, tutor as a facilitator in the group versions, and group work as a stimulus for collaborative interaction [ 19 ]. However, there are various versions of PBL workflow, such as the seven-step technique based on the Maastricht “seven jumps” process. The tutor’s role is to ensure the achievement of learning objectives and to assess students’ performance [ 20 , 21 ].

The PBL process revolves around four types of learning principles: constructive, self-directed, collaborative, and contextual [ 19 ]. Through the constructive learning process, the students are encouraged to think about what is already known and integrate their prior knowledge with their new understanding. This process helps the student understand the content, form a new opinion, and acquire new knowledge [ 22 ]. The PBL process encourages students to become self-directed learners who plan, monitor, and evaluate their own learning, enabling them to become lifelong learners [ 23 ]. The contextualized collaborative learning process also promotes interaction among students, who share similar responsibilities to achieve common goals relevant to the learning context [ 24 ]. By exchanging ideas and providing feedback during the learning session, the students can attain a greater understanding of the subject matter [ 25 ].

Dolmans et al. [ 19 ] pointed out two issues related to the implementation of PBL: dominant facilitators and dysfunctional PBL groups. These problems inhibit students’ self-directed learning and reduce their satisfaction level with the PBL session. A case study by Eryilmaz [ 26 ] that evaluated engineering students’ and tutors’ experience of PBL discovered that PBL increased the students’ self-confidence and improved essential skills such as problem-solving, communications, critical thinking, and collaboration. Although most of the participants in the study found PBL satisfactory, many complained about the tutor’s poor guidance and lack of preparation. Additionally, it was noted that 64% of the first-year students were unable to adapt to the PBL system because they had been accustomed to conventional learning settings and that 43% of students were not adequately prepared for the sessions and thus were minimally involved in the discussion.

In a case study by Cónsul-giribet [ 27 ], newly graduated nursing professionals reported a lack of perceived theoretical basic science knowledge at the end of their program, despite learning through PBL. The nurses perceived that this lack of knowledge might affect their expertise, identity, and professional image.

Likewise, a study by McKendree [ 28 ] reported the outcomes of a workshop that explored the strengths and weaknesses of PBL in an allied health sciences curriculum in the UK. The workshop found that problems related to PBL were mainly caused by students, the majority of whom came from conventional educational backgrounds either during high school or their first degree. They felt anxious when they were involved in PBL, concerned about “not knowing when to stop” in exploring the learning needs. Apart from a lack of basic science knowledge, the knowledge acquired during PBL sessions remains unorganized [ 29 ]. Hence, tutors must guide students in overcoming this situation by instilling appropriate insights and essential skills for the achievement of the learning outcomes [ 30 ]. It was also evident that the combination of intention and motivation to learn and desirable learning behavior determined the quality of learning outcomes [ 31 , 32 ]. However, effective learning behaviors that help develop these skills have not been systematically described. Thus, this scoping review aimed to unearth the elements of effective learning behavior in the PBL context.

Scoping Review Protocol

This scoping review was performed using a protocol by Arksey and O’Malley [ 33 ]. The protocol comprises five phases: (i) identification of research questions, (ii) identification of relevant articles, (iii) selection of relevant studies, (iv) data collection and charting, and (v) collating, summarizing, and reporting the results.

Identification of Research Questions

This scoping review was designed to unearth the elements of effective learning behavior that can be generated from learning through PBL instruction. The review aimed to answer one research question: “What are the effective learning behavior elements related to PBL?” For the purpose of the review, an operational definition of effective learning behavior was constructed, whereby it was defined as any learning behavior that is related to PBL instruction and has been shown to successfully attain the desired learning outcomes (i.e., cognitive, skill, or affective)—either quantitatively or qualitatively—in any intervention conducted in higher education institutions.

The positive outcome variables include student viewpoint or perception, student learning experience and performance, lecturer viewpoint and expert judgment, and other indirect variables that may be important indicators of successful PBL learning (i.e., attendance to PBL session, participation in PBL activity, number of interactions in PBL activity, and improvement in communication skills in PBL).

Identification of Relevant Articles

An extensive literature search was conducted on articles published in English between 2015 and 2019. Three databases—Google Scholar, Scopus, and PubMed—were used for the literature search. Seven search terms with the Boolean combination were used, whereby the keywords were identified from the Medical Subject Headings (MeSH) and Education Resources Information Center (ERIC) databases. The search terms were tested and refined with multiple test searches. The final search terms with the Boolean operation were as follows: “problem-based learning” AND (“learning behavior” OR “learning behaviour”) AND (student OR “medical students” OR undergraduate OR “medical education”).

Selection of Relevant Articles

The articles from the three databases were exported manually into Microsoft Excel. The duplicates were removed, and the remaining articles were reviewed based on the inclusion and exclusion criteria. These criteria were tested on titles and abstracts to ensure their robustness in capturing the articles related to learning behavior in PBL. The shortlisted articles were reviewed by two independent researchers, and a consensus was reached either to accept or reject each article based on the set criteria. When a disagreement occurred between the two reviewers, the particular article was re-evaluated independently by the third and fourth researchers (M.S.B.Y and A.F.A.R), who have vast experience in conducting qualitative research. The sets of criteria for selecting abstracts and final articles were developed. The inclusion and exclusion criteria are listed in Table ​ Table1 1 .

Inclusion and exclusion criteria

Data Charting

The selected final articles were reviewed, and several important data were extracted to provide an objective summary of the review. The extracted data were charted in a table, including the (i) title of the article, (ii) author(s), (iii) year of publication, (iv) aim or purpose of the study, (v) study design and method, (iv) intervention performed, and (v) study population and sample size.

Collating, Summarizing, and Reporting the Results

A content analysis was performed to identify the elements of effective learning behaviors in the literature by A.S.A.G and S.N.H.H, who have experience in conducting qualitative studies. The initial step of content analysis was to read the selected articles thoroughly to gain a general understanding of the articles and extract the elements of learning behavior which are available in the articles. Next, the elements of learning behavior that fulfil the inclusion criteria were extracted. The selected elements that were related to each other through their content or context were grouped into subtheme categories. Subsequently, the combinations of several subthemes expressing similar underlying meanings were grouped into themes. Each of the themes and subthemes was given a name, which was operationally defined based on the underlying elements. The selected themes and subthemes were presented to the independent researchers in the team (M.S.B.Y and A.F.A.R), and a consensus was reached either to accept or reformulate each of the themes and subthemes. The flow of the scoping review methods for this study is illustrated in Fig.  1 .

The flow of literature search and article selection

Literature Search

Based on the keyword search, 1750 articles were obtained. Duplicate articles that were not original articles found in different databases and resources were removed. Based on the inclusion and exclusion criteria of title selection, the eligibility of 1750 abstracts was evaluated. The articles that did not fulfil the criteria were removed, leaving 328 articles for abstract screening. A total of 284 articles were screened according to the eligibility criteria for abstract selection. Based on these criteria, 284 articles were selected and screened according to the eligibility criteria for full article selection. Fourteen articles were selected for the final review. The information about these articles is summarized in Table ​ Table2 2 .

Studies characteristics

Study Characteristics

The final 14 articles were published between 2015 and 2019. The majority of the studies were conducted in Western Asian countries ( n  = 4), followed by China ( n  = 3), European countries ( n  = 2), Thailand ( n  = 2), Indonesia ( n  = 1), Singapore ( n  = 1), and South Africa ( n  = 1). Apart from traditional PBL, some studies incorporated other pedagogic modalities into their PBL sessions, such as online learning, blended learning, and gamification. The majority of the studies targeted a single-profession learner group, and one study was performed on mixed interprofessional health education learners.

Results of Thematic Analysis

The thematic analysis yielded three main themes of effective learning behavior: intrinsic empowerment, entrustment, and functional skills. Intrinsic empowerment overlies four proposed subthemes: proactivity, organization, diligence, and resourcefulness. For entrustment, there were four underlying subthemes: students as assessors, students as teachers, feedback-giving, and feedback-receiving. The functional skills theme contains four subthemes: time management, digital proficiency, data management, and collaboration.

Theme 1: Intrinsic Empowerment

Intrinsic empowerment enforces student learning behavior that can facilitate the achievement of learning outcomes. By empowering the development of these behaviors, students can become lifelong learners [ 34 ]. The first element of intrinsic empowerment is proactive behavior. In PBL, the students must be proactive in analyzing problems [ 35 , 36 ] and their learning needs [ 35 , 37 ], and this can be done by integrating prior knowledge and previous experience through a brainstorming session [ 35 , 38 ]. The students must be proactive in seeking guidance to ensure they stay focused and confident [ 39 , 40 ]. Finding ways to integrate content from different disciplines [ 35 , 41 ], formulate new explanations based on known facts [ 34 , 35 , 41 ], and incorporate hands-on activity [ 35 , 39 , 42 ] during a PBL session are also proactive behaviors.

The second element identified is “being organized” which reflects the ability of students to systematically manage their roles [ 43 ], ideas, and learning needs [ 34 ]. The students also need to understand the task for each learning role in PBL, such as chairperson or leader, scribe, recorder, and reflector. This role needs to be assigned appropriately to ensure that all members take part in the discussion [ 43 ]. Similarly, when discussing ideas or learning needs, the students need to follow the steps in the PBL process and organize and prioritize the information to ensure that the issues are discussed systematically and all aspects of the problems are covered accordingly [ 34 , 37 ]. This team organization and systematic thought process is an effective way for students to focus, plan, and finalize their learning tasks.

The third element of intrinsic empowerment is “being diligent.” Students must consistently conduct self-revision [ 40 ] and keep track of their learning plan to ensure the achievement of their learning goal [ 4 , 40 ]. The students must also be responsible for completing any given task and ensuring good understanding prior to their presentation [ 40 ]. Appropriate actions need to be undertaken to find solutions to unsolved problems [ 40 , 44 ]. This effort will help them think critically and apply their knowledge for problem-solving.

The fourth element identified is “being resourceful.” Students should be able to acquire knowledge from different resources, which include external resources (i.e., lecture notes, textbooks, journal articles, audiovisual instructions, the Internet) [ 38 , 40 , 45 ] and internal resources (i.e., students’ prior knowledge or experience) [ 35 , 39 ]. The resources must be evidence-based, and thus should be carefully selected by evaluating their cross-references and appraising them critically [ 37 ]. Students should also be able to understand and summarize the learned materials and explain them using their own words [ 4 , 34 ]. The subthemes of the intrinsic empowerment theme are summarized in Table ​ Table3 3 .

 Intrinsic empowerment subtheme with the learning behavior elements

Theme 2: Entrustment

Entrustment emphasizes the various roles of students in PBL that can promote effective learning. The first entrusted role identified is “student as an assessor.” This means that students evaluate their own performance in PBL [ 46 ]. The evaluation of their own performance must be based on the achievement of the learning outcomes and reflect actual understanding of the content as well as the ability to apply the learned information in problem-solving [ 46 ].

The second element identified in this review is “student as a teacher.” To ensure successful peer teaching in PBL, students need to comprehensively understand the content of the learning materials and summarize the content in an organized manner. The students should be able to explain the gist of the discussed information using their own words [ 4 , 34 ] and utilize teaching methods to cater to differences in learning styles (i.e., visual, auditory, and kinesthetic) [ 41 ]. These strategies help capture their group members’ attention and evoke interactive discussions among them.

The third element of entrustment is to “give feedback.” Students should try giving constructive feedback on individual and group performance in PBL. Feedback on individual performance must reflect the quality of the content and task presented in the PBL. Feedback on group performance should reflect the ways in which the group members communicate and complete the group task [ 47 ]. To ensure continuous constructive feedback, students should be able to generate feedback questions beforehand and immediately deliver them during the PBL sessions [ 44 , 47 ]. In addition, the feedback must include specific measures for improvement to help their peers to take appropriate action for the future [ 47 ].

The fourth element of entrustment is “receive feedback.” Students should listen carefully to the feedback given and ask questions to clarify the feedback [ 47 ]. They need to be attentive and learn to deal with negative feedback [ 47 ]. Also, if the student does not receive feedback, they should request it either from peers or teachers and ask specific questions, such as what aspects to improve and how to improve [ 47 ]. The data on the subthemes of the entrustment theme are summarized in Table ​ Table4 4 .

Entrustment subtheme with the learning behavior elements

Theme 3: Functional Skills

Functional skills refer to essential skills that can help students learn independently and competently. The first element identified is time management skills. In PBL, students must know how to prioritize learning tasks according to the needs and urgency of the tasks [ 40 ]. To ensure that students can self-pace their learning, a deadline should be set for each learning task within a manageable and achievable learning schedule [ 40 ].

Furthermore, students should have digital proficiency, the ability to utilize digital devices to support learning [ 38 , 40 , 44 ]. The student needs to know how to operate basic software (e.g., Words and PowerPoints) and the basic digital tools (i.e., social media, cloud storage, simulation, and online community learning platforms) to support their learning [ 39 , 40 ]. These skills are important for peer learning activities, which may require information sharing, information retrieval, online peer discussion, and online peer feedback [ 38 , 44 ].

The third functional skill identified is data management, the ability to collect key information in the PBL trigger and analyze that information to support the solution in a problem-solving activity [ 39 ]. Students need to work either individually or in a group to collect the key information from a different trigger or case format such as text lines, an interview, an investigation, or statistical results [ 39 ]. Subsequently, students also need to analyze the information and draw conclusions based on their analysis [ 39 ].

The fourth element of functional skill is collaboration. Students need to participate equally in the PBL discussion [ 41 , 46 ]. Through discussion, confusion and queries can be addressed and resolved by listening, respecting others’ viewpoints, and responding professionally [ 35 , 39 , 43 , 44 ]. In addition, the students need to learn from each other and reflect on their performance [ 48 ]. Table ​ Table5 5 summarizes the data on the subthemes of the functional skills theme.

Functional skills subtheme with the learning behavior elements

This scoping review outlines three themes of effective learning behavior elements in the PBL context: intrinsic empowerment, entrustment, and functional skills. Hence, it is evident from this review that successful PBL instruction demands students’ commitment to empower themselves with value-driven behaviors, skills, and roles.

In this review, intrinsic empowerment is viewed as enforcement of students’ internal strength in performing positive learning behaviors related to PBL. This theme requires the student to proactively engage in the learning process, organize their learning activities systematically, persevere in learning, and be intelligently resourceful. One of the elements of intrinsic empowerment is the identification and analysis of problems related to complex scenarios. This element is aligned with a study by Meyer [ 49 ], who observed students’ engagement in problem identification and clarification prior to problem-solving activities in a PBL session related to multiple engineering design. Rubenstein and colleagues [ 50 ] discovered in a semi-structured interview the importance of undergoing a problem identification process before proposing a solution during learning. It was reported that the problem identification process in PBL may enhance the attainment of learning outcomes, specifically in the domain of concept understanding [ 51 ].

The ability of the students to acquire and manage learning resources is essential for building their understanding of the learned materials and enriching discussion among team members during PBL. This is aligned with a study by Jeong and Hmelo-Silver [ 52 ], who studied the use of learning resources by students in PBL. The study concluded that in a resource-rich environment, the students need to learn how to access and understand the resources to ensure effective learning. Secondly, they need to process the content of the resources, integrate various resources, and apply them in problem-solving activities. Finally, they need to use the resources in collaborative learning activities, such as sharing and relating to peer resources.

Wong [ 53 ] documented that excellent students spent considerably more time managing academic resources than low achievers. The ability of the student to identify and utilize their internal learning resources, such as prior knowledge and experience, is also important. A study by Lee et al. [ 54 ] has shown that participants with high domain-specific prior knowledge displayed a more systematic approach and high accuracy in visual and motor reactions in solving problems compared to novice learners.

During the discussion phase in PBL, organizing ideas—e.g., arranging relevant information gathered from the learning resources into relevant categories—is essential for communicating the idea clearly [ 34 ]. This finding is in line with a typology study conducted by Larue [ 55 ] on second-year nursing students’ learning strategies during a group discussion. The study discovered that although the content presented by the student is adequate, they unable to make further progress in the group discussion until they are instructed by the tutor on how to organize the information given into a category [ 55 ].

Hence, the empowerment of student intrinsic behavior may enhance students’ learning in PBL by allowing them to make a decision in their learning objectives and instilling confidence in them to achieve goals. A study conducted by Kirk et al. [ 56 ] proved that highly empowered students obtain better grades, increase learning participation, and target higher educational aspirations.

Entrustment is the learning role given to students to be engaging and identify gaps in their learning. This theme requires the student to engage in self-assessment, prepare to teach others, give constructive feedback, and value the feedback received. One of the elements of entrustment is the ability to self-assess. In a study conducted by Mohd et al. [ 57 ] looking at the factors in PBL that can strengthen the capability of IT students, they discovered that one of the critical factors that contribute to these skills is the ability of the student to perform self-assessment in PBL. As mentioned by Daud, Kassim, and Daud [ 58 ], the self-assessment may be more reliable if the assessment is performed based on the objectives set beforehand and if the criteria of the assessment are understood by the learner. This is important to avoid the fact that the result of the self-assessment is influenced by the students’ perception of themselves rather than reflecting their true performance. However, having an assessment based on the learning objective only focuses on the immediate learning requirements in the PBL. To foster lifelong learning skills, it should also be balanced with the long-term focus of assessment, such as utilizing the assessment to foster the application of knowledge in solving real-life situations. This is aligned with the review by Boud and Falchikov [ 59 ] suggesting that students need to become assessors within the concept of participation in practice, that is, the kind that is within the context of real life and work.

The second subtheme of entrustment is “students as a teacher” in PBL. In our review, the student needs to be well prepared with the teaching materials. A cross-sectional study conducted by Charoensakulchai and colleagues discovered that student preparation is considered among the important factors in PBL success, alongside other factors such as “objective and contents,” “student assessment,” and “attitude towards group work” [ 60 ]. This is also aligned with a study conducted by Sukrajh [ 61 ] using focus group discussion on fifth-year medical students to explore their perception of preparedness before conducting peer teaching activity. In this study, the student in the focus group expressed that the preparation made them more confident in teaching others because preparing stimulated them to activate and revise prior knowledge, discover their knowledge gaps, construct new knowledge, reflect on their learning, improve their memory, inspire them to search several resources, and motivate them to learn the topics.

The next element of “student as a teacher” is using various learning styles to teach other members in the group. A study conducted by Almomani [ 62 ] showed that the most preferred learning pattern by the high school student is the visual pattern, followed by auditory pattern and then kinesthetic. However, in the university setting, Hamdani [ 63 ] discovered that students prefer a combination of the three learning styles. Anbarasi [ 64 ] also explained that incorporating teaching methods based on the student’s preferred learning style further promotes active learning among the students and significantly improved the long-term retrieval of knowledge. However, among the three learning styles group, he discovered that the kinesthetic group with the kinesthetic teaching method showed a significantly higher post-test score compared to the traditional group with the didactic teaching method, and he concluded that this is because of the involvement of more active learning activity in the kinesthetic group.

The ability of students to give constructive feedback on individual tasks is an important element in promoting student contribution in PBL because feedback from peers or teachers is needed to reassure themselves that they are on the right track in the learning process. Kamp et al. [ 65 ] performed a study on the effectiveness of midterm peer feedback on student individual cognitive, collaborative, and motivational contributions in PBL. The experimental group that received midterm peer feedback combined with goal-setting with face-to-face discussion showed an increased amount of individual contributions in PBL. Another element of effective feedback is that the feedback is given immediately after the observed behavior. Parikh and colleagues survey student feedback in PBL environments among 103 final-year medical students in five Ontario schools, including the University of Toronto, McMaster University, Queens University, the University of Ottawa, and the University of Western Ontario. They discovered that there was a dramatic difference between McMaster University and other universities in the immediacy of feedback they practiced. Seventy percent of students at McMaster reported receiving immediate feedback in PBL, compared to less than 40 percent of students from the other universities, in which most of them received feedback within one week or several weeks after the PBL had been conducted [ 66 ]. Another study, conducted among students of the International Medical University of Kuala Lumpur examining the student expectation on feedback, discovered that immediate feedback is effective if the feedback is in written form, simple but focused on the area of improvement, and delivered by a content expert. If the feedback is delivered by a content non-expert and using a model answer, it must be supplemented with teacher dialogue sessions to clarify the feedback received [ 67 ].

Requesting feedback from peers and teachers is an important element of the PBL learning environment, enabling students to discover their learning gaps and ways to fill them. This is aligned with a study conducted by de Jong and colleagues [ 68 ], who discovered that high-performing students are more motivated to seek feedback than low-performing students. The main reason for this is because high-performing students seek feedback as a tool to learn from, whereas low-performing students do so as an academic requirement. This resulted in high-performing students collecting more feedback. A study by Bose and Gijselaers [ 69 ] examined the factors that promote feedback-seeking behavior in medical residency. They discovered that feedback-seeking behavior can be promoted by providing residents with high-quality feedback to motivate them to ask for feedback for improvement.

By assigning an active role to students as teachers, assessors, and feedback providers, teachers give them the ownership and responsibility to craft their learning. The learner will then learn the skills to monitor and reflect on their learning to achieve academic success. Furthermore, an active role encourages students to be evaluative experts in their own learning, and promoting deep learning [ 70 ].

Functional skills refer to essential abilities for competently performing a task in PBL. This theme requires the student to organize and plan time for specific learning tasks, be digitally literate, use data effectively to support problem-solving, and work together efficiently to achieve agreed objectives. One of the elements in this theme is to have a schedule of learning tasks with deadlines. In a study conducted by Tadjer and colleagues [ 71 ], they discovered that setting deadlines with a restricted time period in a group activity improved students’ cognitive abilities and soft skills. Although the deadline may initially cause anxiety, coping with it encourages students to become more creative and energetic in performing various learning strategies [ 72 , 73 ]. Ballard et al. [ 74 ] reported that students tend to work harder to complete learning tasks if they face multiple deadlines.

The students also need to be digitally literate—i.e., able to demonstrate the use of technological devices and tools in PBL. Taradi et al. [ 75 ] discovered that incorporating technology in learning—blending web technology with PBL—removes time and place barriers in the creation of a collaborative environment. It was found that students who participated in web discussions achieved a significantly higher mean grade on a physiology final examination than those who used traditional methods. Also, the incorporation of an online platform in PBL can facilitate students to develop investigation and inquiry skills with high-level cognitive thought processes, which is crucial to successful problem-solving [ 76 ].

In PBL, students need to work collaboratively with their peers to solve problems. A study by Hidayati et al. [ 77 ] demonstrated that effective collaborative skills improve cognitive learning outcomes and problem-solving ability among students who undergo PBL integrated with digital mind maps. To ensure successful collaborative learning in PBL, professional communication among students is pertinent. Research by Zheng and Huang [ 78 ] has proven that co-regulation (i.e., warm and responsive communication that provides support to peers) improved collaborative effort and group performance among undergraduate and master’s students majoring in education and psychology. This is also in line with a study by Maraj and colleagues [ 79 ], which showed the strong team interaction within the PBL group leads to a high level of team efficacy and academic self-efficacy. Moreover, strengthening communication competence, such as by developing negotiation skills among partners during discussion sessions, improves student scores [ 80 ].

PBL also includes opportunities for students to learn from each other (i.e., peer learning). A study by Maraj et al. [ 79 ] discovered that the majority of the students in their study perceived improvement in their understanding of the learned subject when they learned from each other. Another study by Lyonga [ 81 ] documented the successful formation of cohesive group learning, where students could express and share their ideas with their friends and help each other. It was suggested that each student should be paired with a more knowledgeable student who has mastered certain learning components to promote purposeful structured learning within the group.

From this scoping review, it is clear that functional skills equip the students with abilities and knowledge needed for successful PBL. Studies have shown that strong time management skills, digital literacy, data management, and collaborative skills lead to positive academic achievement [ 77 , 82 , 83 ].

Limitation of the Study

This scoping review is aimed to capture the recent effective learning behavior in problem-based learning; therefore, the literature before 2015 was not included. Without denying the importance of publication before 2015, we are relying on Okoli and Schabram [ 84 ] who highlighted the impossibility of retrieving all the published articles when conducting a literature search. Based on this ground, we decided to focus on the time frame between 2015 and 2019, which is aligned with the concepts of study maturity (i.e., the more mature the field, the higher the published articles and therefore more topics were investigated) by Kraus et al. [ 85 ]. In fact, it was noted that within this time frame, a significant number of articles have been found as relevant to PBL with the recent discovery of effective learning behavior. Nevertheless, our time frame did not include the timing of the coronavirus disease 19 (COVID-19) pandemic outbreak, which began at the end of 2019. Hence, we might miss some important elements of learning behavior that are required for the successful implementation of PBL during the COVID-19 pandemic.

Surprisingly, the results obtained from this study are also applicable for the PBL sessions administration during the COVID-19 pandemic situation as one of the functional skills identified is digital proficiency. This skill is indeed important for the successful implementation of online PBL session.

This review identified the essential learning behaviors required for effective PBL in higher education and clustered them into three main themes: (i) intrinsic empowerment, (ii) entrustment, and (iii) functional skills. These learning behaviors must coexist to ensure the achievement of desired learning outcomes. In fact, the findings of this study indicated two important implications for future practice. Firstly, the identified learning behaviors can be incorporated as functional elements in the PBL framework and implementation. Secondly, the learning behaviors change and adaption can be considered to be a new domain of formative assessment related to PBL. It is noteworthy to highlight that these learning behaviors could help in fostering the development of lifelong skills for future workplace challenges. Nevertheless, considerably more work should be carried out to design a solid guideline on how to systematically adopt the learning behaviors in PBL sessions, especially during this COVID-19 pandemic situation.

This study was supported by Postgraduate Incentive Grant-PhD (GIPS-PhD, grant number: 311/PPSP/4404803).

Declarations

The study has received an ethical approval from the Human Research Ethics Committee of Universiti Sains Malaysia.

No informed consent required for the scoping review.

The authors declare no competing interests.

Publisher's Note

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• Published: 04 August 2024

Developing a BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment and Summary) model combined with the OBE (Outcome Based Education) concept to improve the teaching outcomes of higher education

• Zhiwei Xu 1 ,
• Liping Ge 1 ,
• Guiqin Song 1 ,
• Jie Liu 1 ,
• Lijuan Hou 1 ,
• Xiaoyun Zhang 1 ,
• Xiaotong Chang 1 ,
• Lan Yin 3 &
• Xiaoming Li   ORCID: orcid.org/0000-0003-3899-7021 2  

Humanities and Social Sciences Communications volume  11 , Article number:  1001 ( 2024 ) Cite this article

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The teaching objectives of traditional approaches in higher education emphasize mostly students’ mastery of knowledge and have insufficient directionality to social needs. In this study, we developed a BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment and Summary) teaching model combined with the OBE (Outcome Based Education) concept to enhance the teaching outcomes. Firstly, based on the graduation requirements and professional training objectives of students, we divided the course objectives into three dimensions (knowledge, ability and quality), and further specified into index points. Then, the teaching content of each chapter was set to correspond with the index points. Finally, the BOPPPS teaching model was used to meet each requirement. Clinical biochemistry testing course was used as a model to assess the effects of the teaching reform. After the class, the teaching effect was analyzed based on the questionnaire surveys from the students and their scores of both the chapter and final examinations. The results showed that compared with the traditional approach, the BOPPPS teaching model combined with the OBE concept has demonstrated a notable enhancement in student engagement, and significant improvement of their mastery of knowledge, application skills, and problem-solving abilities. The examination scores of the BOPPPS group were markedly higher than those of the traditional group. Moreover, the difference between the two groups diverse assessment scores was much bigger than that between the two group examination scores. Our study indicates that the BOPPPS teaching model combined with the OBE concept is a highly effective teaching model for enhancing the learning effectiveness of students.

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Introduction.

Traditional higher education’s unidirectional knowledge transfer and unitary assessment methods inadequately address social needs, resulting in compromised teaching effectiveness. Therefore, how to redesign the curriculum training objectives, update the curriculum content system, and innovate teaching and assessment models to cultivate talents with good practical, innovative, and comprehensive abilities is an urgent problem to be studied and solved.

OBE, known as result-oriented education or goal-oriented education, originated from the Western higher education reform trend in the 1980s and has made remarkable contributions to education systems worldwide (Shaheen, 2019 ). Since OBE is oriented towards expected outcome goals, the teachers need to clarify what is most important to students before organizing, implementing, and evaluating teaching (Yen, 2016 ; Singh and Ramya, 2011 ). That is, teachers should clarify the abilities that students should possess upon graduation, and determine educational goals according to the required abilities in the profession to ensure that students can adapt to their job positions in a timely manner after graduation (Akçayır and Akçayır, 2018 ; Zhang, 2020 ). On this basis, appropriate teaching activities are designed to ensure the achievement of expected goals, the core of which is to emphasize that teaching should be reasonably designed and optimized around the expected learning outcomes, ensuring that students meet graduation requirements and acquire the comprehensive skills that should be possessed during employment (Dai et al., 2017 ; Rajaee et al., 2013 ). In summary, the OBE concept is based on the future effectiveness of students, emphasizing what students have learned rather than what teachers have taught, which can effectively improve the problem of students’ insufficient comprehensive abilities in traditional learning and provide new ideas for current education and teaching (Sajdak and Kościelniak, 2014 ; Tan et al., 2018 ).

However, altering teaching concepts is not enough. Specific teaching models and methods need to be reformed. The BOPPPS model, which originated in Canada and was initially created based on the need for teacher qualification certification, emphasizes student-centered participatory teaching and meets the requirements of the times (Instructional Skills Workshop Network, 2023 ). Since the BOPPPS teaching model advocates a student-centered approach, teachers are required to utilize diversified teaching methods, optimize teaching design, and increase classroom interactivity. This model has provided teachers with a highly organized teaching framework to ensure high-quality and efficient teaching, which mainly includes Bridge-in, Objectives, Pre-assessment, Participatory-Learning, Post-assessment, and Summary. The initial letter of each part is combined into BOPPPS as the abbreviation of this teaching model. The meanings and characteristics of each part are as follows: B (Bridge-in): the introduction and guidance of the class, introducing the teaching content, attracting students’ attention and stimulating their interest; O (Objectives): the teaching objectives and expected teaching outcomes, clarifying the teaching objectives and enabling students to understand what can be done by learning the knowledge; P (Pre-assessment): the pre-class testing process, which helps teachers understand students’ mastery degree of relevant knowledge, laying the foundation for subsequent teaching; P (Participatory-Learning): the core module of the BOPPPS model and the main part of classroom teaching, allowing students to participate in classroom activities and guiding them to learn independently; P (Post-assessment): the assessment to understand students’ learning effectiveness, whether teaching objectives have been achieved, what the students have learned, and provide feedback on the learning effectiveness; S (Summary): Summarizing this lesson and introducing the content of the next lesson, collecting feedback, praising, and guiding students to summarize and reflect on what they have learned. The BOPPPS model has been employed in the teaching of many subjects, such as physiology education (Liu et al., 2022 ), oral histopathology (Wang et al., 2021 ), dental materials education (Yang et al., 2019 ), healthcare and management education (Ma et al., 2021 ). And the model has been proven to be highly effective for improving the learning effectiveness of the students.

In this study, the OBE concept and BOPPPS teaching model were combined to improve teaching outcomes of higher education. First, the course outcome goals were divided into three dimensions – knowledge, ability and quality, which were further specified into index points. Then, the teaching content of each chapter was set to correspond to the index points. Finally, the BOPPPS teaching model was used to achieve each requirement. Clinical biochemistry testing course, the core course of medical laboratory technology subject, was used as a model to assess the effects of the teaching reform. This course covers a wide range of knowledge and complex content, and plays an important role in medical theory and practice. Seven classes of undergraduate juniors majoring in medical laboratory technology were randomly divided into two groups. The BOPPPS group containing three classes utilized the BOPPPS teaching model combined with the OBE concept. The traditional group containing the remaining four classes used the traditional teaching approach. After the class, the teaching effect was analyzed based on the questionnaire surveys from the students and their scores on both chapter and final examinations.

Design of the BOPPPS teaching model combined with OBE concept

Based on the OBE concept and the implementation process of BOPPPS teaching model, this study constructed the idea of “student-oriented, result-oriented, and continuous improvement”, and designed the BOPPPS teaching model combined with OBE concept (Fig. 1 ).

Cultivation goals and corresponding graduation requirements were determined based on social and industry development demands. Then, index points were specified to meet the requirement. According to the points, the curriculum and its teaching requirements were set, and corresponding teaching activities were launched by BOPPOS teaching model. Finally, evaluations were conducted to feed back the teaching effect and provide reference for teaching improvement.

Implementation steps of the BOPPPS teaching model combined with OBE concept

The OBE education concept emphasizes the achievement orientation. We divided the outcome objectives into knowledge objectives, ability objectives and quality objectives, and further subdivided them into index points corresponding to graduation requirements based on the specific training goals and graduation requirements of students in different majors. The teaching content was optimized based on these index points, ensuring that the course teaching outcomes support graduation requirements. This study utilized the six-phase BOPPPS teaching model to attain the targeted index points (Fig. 2 ).

From the perspectives of both teachers and students, we carried out teaching activities through the six specific steps of the BOPPPS teaching model (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, and Summary) to achieve learning outcomes.

The effective course bridge-in can guide students well to have strong interest and motivation, and help students focus on or connect to the course content, improving the completion of the index points from the source. In this stage, the teachers focused on explaining the importance of this course learning around the index points, telling stories and current events closely related to the core teaching content or the previous related teaching content, organically linking the students’ existing foundation with the content they would learn, and put forward questions related to the teaching topic to guide students into the core content of the teaching link. For example, in the chapter of “the biochemistry test of hepatobiliary diseases” of clinical biochemistry testing course, bilirubin metabolism and the occurrence mechanism of jaundice are the key and difficult contents. Before class, teachers preloaded typical teaching cases and clinical images of jaundiced patients on the “Xuexitong” platform, posing questions to engage students in the course material. For examples, what clinical manifestations do you find through observation; what are the biochemical mechanisms leading to these clinical manifestations; what disease may a patient suffer from?

Based on the graduation requirements and professional training objectives of students, we divided the objectives into three dimensions, further refined them into ability index points. All teaching and learning activities were conducted and developed around the index points and their corresponding learning objectives. The teacher informed students of the learning objectives in the “Notification” column of the “Xuexitong” platform in advance. The students could use the resources of the platform for purposeful independent learning. For example, before class teaching of “Selection and evaluation of clinical biochemistry test methodology” of clinical biochemistry testing course, the students were informed in advance that through this class they would learn to design a technical route for the performance evaluation of a clinical biochemical test method. The establishment of learning objectives would enable students to have a clear understanding of the content of this class, and enhance their motivation to learn, thus more effectively urging students to actively participate in learning and meet the requirements of the index points.

Pre-assessment

Pre-assessment was used to understand the gap between real situation of the students and the index points requirements through questionnaires, exams, homework, questions, discussions, and other forms after the learning objectives were established. The teacher posted a time-limited questionnaire or test through the “Xuexitong” platform, which covered the basic knowledge related to this class. After finishing the statistics on the students’ task completion, the teacher got to know the students’ knowledge mastery and the effect of their independent learning before class, so as to achieve reference for subsequent teaching design, such as adjusting the depth and pace of lecture content.

Participatory learning

Participatory learning is a very important part, which facilitates teacher-student interaction to achieve interactive learning of the course’s core content. In this link, both student group discussion and interactive communication under simulated situations were arranged to enhance the classroom atmosphere of participatory learning and achieve the real effect of participatory learning between teachers and students. This link could be divided into three sub-parts as follows, including determination of learning tasks, exploration of activities, exchange and display of results:

Determination of learning tasks

Under the guidance of the index points, the teacher clarified what knowledge and skills students should master in this class according to the curriculum standards and teaching objectives, and made it clear to the students what outcomes they should obtain through this class. Then, learning tasks were determined around the outcome goals, and the students were given the space to think and develop independently. For example, since typical cases of diabetes, liver disease, kidney disease, hyperthyroidism, acute myocardial infarction, familial hypercholesterolemia would be selected during the teaching in the clinical biochemistry testing course, the cases and some related questions were published in advance of the “Xuexitong” platform. The inquiries focused on identifying potential diseases, diagnostic foundations, appropriate biochemical tests, and the theoretical underpinnings of test design. The students were asked to consult relevant information and material in advance, perceive the learning tasks in advance in the context created by the teacher, and engage in independent learning to prepare for subsequent class learning.

Exploration of activities

The teacher used the random grouping function in the “Xuexitong” platform to divide students into groups, making each group with 5–7 persons. In the process of activity exploration, students chose the appropriate path according to their respective tasks, independently consulted relevant information and material to complete the corresponding learning tasks, and then deliberated, analyzed and discussed with group members on the specific task content.

Results exchange and display

The OBE Concept emphasizes the importance of providing students with opportunities as many as possible to display their learning results, which can in turn motivate them to learn. A representative was selected randomly to give a presentation about task completion status, and other groups gave their opinions or suggestions, so that they could complement one another. Moreover, the teacher gave the comments and supplements, and summarized all the presentations in the end to provide feedback on the completion of the index points. In this way, all students actively took part in the learning process.

Post-assessment

An assessment was conducted near the end of the class. The targeted assessment was used to check students’ learning status and to understand whether students’ learning in this class had achieved the index points. The assessment was designed to effectively measure whether index points were achieved, so as to give feedback on teaching and learning. Accordingly, the teaching could be timely and correctly adjusted, thereby getting enhanced effectiveness. After the completion of classroom teaching, assignments were published through the “Xuexitong” platform so that the teaching could further inspect students’ understanding and mastery of this section based on the completion status of the exams and assignments.

The teacher reviewed all the course content of this section, helping students comprehensively understand and systematize the learned content around the index points, and promoting reflection on their own learning effectiveness. The teacher could also use the summary section to emphasize again the key points of this lesson or to set the stage for the next lesson. Summaries are usually brief, but essential. For example, to summarize the lesson “Bilirubin metabolism and the mechanism of jaundice” in the clinical biochemistry testing course, firstly, we outlined the four components of bilirubin metabolism: Mononuclear phagocyte system generation; Transport in blood; Uptake, transformation and excretion by hepatocytes; Changes in the intestinal tract and enterohepatic circulation. Then, the pathogenesis of the three types of jaundice was briefly reviewed in the context of the bilirubin normal metabolism diagram. Additionally, the content of the next lesson was previewed: the laboratory differential diagnosis of the three types of jaundice and the determination of bilirubin. Summaries give students a sense of the systematicness, logicality, and completeness of the course.

Above all, to achieve the index points, the BOPPPS teaching model combined with the OBE concept begins with attracting students’ interest in learning. Teaching objectives are announced before class to achieve outcome orientation, and a pre-assessment is performed to understand students’ knowledge and ability reserves. Then, based on the results of this assessment, interactive and participatory teaching activities are designed, and students’ mastery is assessed through assessments after the completion of teaching activities. Finally, a teaching summary is launched, which is also the introduction to the next class.

The use of diverse assessment methods to measure students’ learning effectiveness

The OBE education concept advocates the use of multiple evaluation methods to assess students’ learning outcomes, breaking through the traditional way of paper-and-pencil answer-based tests, introducing a diverse assessment model for the entire teaching process, and emphasizing the evaluation of students’ overall quality. The evaluation dimensions mainly included examinations and, evaluations from the teachers and other students in the group. The students not only received feedback from teachers and classmates but also had a clear understanding on the mastery of their own knowledge and skills and how they performed during the cooperation with classmates. Learning effectiveness was improved through teacher and classmates’ comments as well as personal self-evaluation and reflection. The diverse assessment approach is more reasonable for learning performance evaluation and more conducive to student growth.

As shown above, we designed a BOPPPS teaching model combined with the OBE concept, and outlined its implementation steps and assessment methods of students’ learning effectiveness. Herein, clinical biochemistry testing course was used as a model to assess the effects of the teaching reform. We analyzed whether the BOPPPS teaching model combined with the OBE concept could play a positive role in promoting students’ performance and shaping their own ability, so as to promote the continuous improvement of this teaching model, with a view to providing teaching reference for the medical laboratory technology-related professional courses. Based on the graduation requirements and professional training objectives of students, we divided the course objectives into three dimensions, further refined them into 10 index points. Finally, the validity of the model was verified using diverse assessment, questionnaires, and interviews. The chapter “Biochemical tests of endocrine diseases” was used as an example for showing the implementation process.

Ethics statement

This study was approved by the Ethical Review Committee of Hebei North University (No. hbnuky-2022-066). All participants voluntarily participated in this study and completed an informed consent form. Information with the potential to identify individuals was anonymized.

Experimental design

Experimental subjects.

Seven undergraduate classes from the Medical Laboratory Technology program at Hebei North University participated in this study. Each class contained 36 or 37 students. Among them, three classes were randomly selected as BOPPPS group, for which the BOPPPS teaching model combined with the OBE concept was implemented. The other four classes were set up as traditional group, for which the traditional teaching model was implemented. The students in different classes had no significant difference in terms of age and gender. Especially, At the beginning of the study, all the students have been assessed for their learning abilities and critical thinking skills, which were assessed based on students’ GPA (Ghanizadeh, 2017 ; Kim and Shin, 2021 ; Nur’azizah et al., 2021 ) during last two years and statistical analysis. The results showed that there was no significant difference in critical thinking skills and learning abilities of students in the traditional group and those of students in BOPPS group. The traditional teaching model adopted a teacher centered teaching method, emphasizing the teaching of teachers and the listening of students. At the beginning, the students were randomly divided into groups. The student number of each group was the same as that of BOPPPS group. The teaching process included three parts as follows: (1) teacher lecture (55 min), during which teachers systematically explained new knowledge, concepts, principles and skills. (2) practice and Q&A (25 min), during which the students engaged in case studies and discussion in groups, and the teacher answered students’ questions. (3) summary and preview assignment (10 min), during which the teacher summarized the lesson, emphasized key points, and finally assigning preview tasks for the next class.

The teaching team were provided with unified training on the teaching model to ensure that every teacher utilized the same teaching methods and strategies, and that the students in each group received consistent teaching methods.

Analysis of outcome targets and index points

According to result-oriented requirements of the OBE concept, in this study the outcome objectives of the course “Clinical Biochemistry Testing” were divided into knowledge objectives, competence objectives and quality objectives, and further subdivided into 10 index points corresponding with the training objectives and graduation requirements of medical laboratory technology students, which were shown in Table 1 .

Corresponding relationship between the teaching content and index points

Each chapter of the clinical biochemistry testing course corresponds to the corresponding index points to form a matrix of teaching activities to ensure that the course teaching outcomes support graduation requirements, as shown in Table 2 .

Teaching of the example chapter

Endocrine system is an important regulatory system in the body. Secreted hormones enter the blood circulation and regulate the normal physiological activities of many organs and cells through body fluids. The content of this chapter is highly theoretical, numerous and complex. Before class, according to the teaching model, the teacher published learning objectives, learning tasks and learning resources through the “Xuexitong” platform the day before class teaching. The teacher adjusted the classroom teaching content appropriately according to the results of pre-assessment at the beginning of the class. Then, the students learned by means of question guidance, group discussion and representative presentation, and the teacher comprehensively controlled the teaching and learning effect and rhythm through the teaching model. After class, the teacher posted the summary of learning effect and homework online, and collected students’ learning feedback. According to the feedback, the learning difficulty and rhythm of the following chapters were adjusted, and finally the diverse evaluations were carried out. The teaching process of this chapter in the class of 90 min is shown in Fig. 3 .

In the class, the first step is to conduct a pre-assessment to understand the students’ preview situation, and adjust the teaching content appropriately. Next, cases were led in and questions were put forward to attract students’ attention and guide them into a learning state. Then, the students were engaged in a series of participatory learnings, including group discussions and representative statements after the teacher explained knowledge points through animated demonstrations and clinical real test reports, and further thinking and discussions based on the summary and questions of the teacher. And then, a post-assessment was conducted to evaluate the learning effectiveness of students. Finally, the teacher summarized the key content of this lesson.

Analysis of teaching effect

Questionnaire for survey.

A survey was conducted to exhibit the effectiveness of the BOPPPS teaching model combined with the OBE concept and traditional teaching methods. The questionnaire was formulated based on the expected outcomes. Table 3 showed the questionnaire survey form. For each question, responses of the students were given out of five options, including “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree”. The questionnaire covered three aspects as follows: 1) student outcomes; 2) course outcomes; 3) teaching methodology. Student outcomes mainly manifested the students’ skills and the ability to utilize them in future professional life. Course outcomes represented the students’ opinions about some aspects of the course, mainly including its precision, workload, attraction, and help. The last part of the questionnaire was about the teaching methodology, which is also very important because it directly affects student learning. The teaching methodology and the teacher should exhibit some necessary characteristics (Ezechil, 2017 ), such as presenting knowledge and information clearly, treating the students with respect and fairly, enthusiastic about teaching the course, encouraging the students to learn, and providing supports and help timely when needed.

Student score analysis

In order to further quantitatively compare the teaching effect of the BOPPPS teaching model combined with the OBE concept and traditional teaching methods, we conducted systematic analyses into scores of the BOPPPS group and traditional group at end of both the chapter (staged scores) and the semester (final scores). We have considered two aspects for both the stage scores and final scores. One aspect is the examination scores. The other aspect is diverse assessment scores, among which examination, evaluation from teachers and classmates accounted for 50%, 30%, and 20% respectively. The scores of the BOPPPS group and traditional group were expressed as mean value ± standard deviation. Statistical calculations were conducted with SPSS (Chicago, IL, USA) 21.0 Windows software, and T-test was used to analyze the differences of the scores between the two groups. A p -value less than 0.05 was regarded as a significant difference. Moreover, we compared the proportion of students in different score intervals (90–100, 80–90, 70–80, 60–70 and under 60) in the two groups.

Interview record analysis

In order to understand views and learning experience of the teachers and students who participated in the experiment about the BOPPPS teaching model combined with OBE concept, we conducted oral interviews with them, which were launched after the final exam and before the students received their scores. The interviews were held by teaching supervision group of the college who had no dependent relationship with the teachers and students of this course. Ten students were randomly selected from each class in the traditional group and BOPPPS group by a simple random sampling method. The conversation with students mainly included students’ acceptance and adaptation to the teaching mode, their learning effectiveness and difficulties encountered, opinions and suggestions on the teachers, cooperation in the group, and their feelings towards the classroom environment. All the teachers were interviewed. The conversation with the teachers mainly included the overall feeling of the teachers towards the BOPPPS teaching mode and whether they have adapted and liked this teaching mode; their experience in the BOPPPS teaching mode, including course design, teaching methods, and the use of teaching resources; changes in teacher-student interaction and classroom atmosphere under the BOPPPS teaching mode; the mastery of knowledge by students in the traditional and BOPPPS teaching mode; the advantages and disadvantages of BOPPPS teaching mode compared to traditional teaching mode. Finally, the teaching supervision group checked each feedback, extracted key information and viewpoints, and summarized the feedback and suggestions.

Questionnaire survey

Each student of both BOPPPS group and traditional group was asked to fill out the questionnaire form and record their responses to every item in the questionnaire. All of the filled questionnaire forms were collected. Figure 4a showed the responses of the BOPPPS group while Fig. 4b shows the survey result of the traditional group. Quantitative analysis results of the student responses based on that “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” were set as 1, 2, 3, 4, and 5, respectively, were shown in Fig. 4c . It could be found that compared with the students in traditional group, more students in BOPPPS group thought that they developed analytical approach, elevated problem-solving skills and produced new ideas, and that the developed skills were helpful for their future career. In addition, compared to the traditional group, higher proportion of students in BOPPPS group believed that technical approaches were adopted, and that application of knowledge to practical work was learned. From the responses to the second part of questionnaire, course outcomes, it could be seen that in contrast to the traditional group, more students in BOPPPS group agreed that the skills were helpful for their future professional development. Moreover, higher proportion of students exhibited a keen interest in the course, and thought that the course materials were updated and relevant. The last portion was related to the teaching methodology. Compared with the students in traditional group, more students in BOPPPS group agreed that knowledge and information were presented clearly, and that learning and participation were well encouraged. 95.42% of the students in BOPPPS group agreed that the course was well taught, including 62.39% of those who strongly agreed, while 84.25% of the students in traditional group agreed that the course was well taught, including only 36.3% of those who strongly agreed.

Student responses of BOPPPS group ( a ) and traditional group ( b ) to each question of the questionnaire survey, which were given out of five options, including “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” for each question; Quantitative analysis results of the student responses ( c ) based on that “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” were set as 1, 2, 3, 4, and 5, respectively; Statistical mean of the student responses to the six questions in each section of the questionnaire survey ( d ) based on that “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” were set as 1, 2, 3, 4, and 5, respectively. (* denotes P  < 0.05 compared to traditional group).

Statistical mean of the student responses to the six questions in each section of the questionnaire survey based on that “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” were set as 1, 2, 3, 4, and 5, respectively, was depicted in Fig. 4d . It was shown clearly that for the part of student outcomes, the BOPPPS group had a generally higher level of agreement than the traditional group did. For the part of course outcomes, the level of agreement for the BOPPPS group was also significantly higher than that for the traditional group although two groups of students with almost the same proportion agreed that the workload of the course was manageable. For the last part of questionnaire survey, the BOPPPS group also had a significantly higher level of agreement than the traditional group did. The data further confirmed the potency of the BOPPPS teaching model combined with the OBE concept in education.

Furthermore, we conducted reliability analysis to evaluate reliability of the questionnaire. The higher the Cronbach α coefficient is, the higher the reliability is. If the coefficient were above 0.7, reliability of the questionnaire would be acceptable while if the coefficient were below 0.6, reliability of the questionnaire would be too low, and its items would need to be redesigned (Hair et al., 2011 ). The reliability analysis result of the questionnaire in this study was shown in Table 4 , from which it could be seen that the Cronbach reliability coefficient was greater than 0.9, indicating that the reliability of the data should be very high.

In addition, we conducted validity analysis using Kaiser-Meyer-Olkin (KMO) and Bartlett’s Test of Sphericity (BTS) to evaluate if the questionnaire could effectively measure the required content and express the accuracy of the results. The results showed that the KMO value of our questionnaire was 0.965 and that the P value of BTS was 0.000 (Table 4 ), which indicated that our questionnaire had good structural validity (Kline, 2015 ).

Staged score

After the teaching of the chapter, student staged scores of the BOPPPS group and traditional group were analyzed. Figure 5a shows that the examination scores of the BOPPPS group (88.7 ± 5.8) were significantly higher than those of the traditional group (78.9 ± 5.8). Moreover, diverse assessment scores of the BOPPPS group (90.4 ± 5.3) were also notably higher than those of the traditional group (77.7 ± 5.1). The difference between the two group diverse assessment scores was much bigger than that between the two group examination scores. Specially, we analyzed the score interval of the BOPPPS group and traditional group, the results of which were shown in Fig. 5b . The percentage of 90–100 score interval students in the BOPPPS group was much bigger than that in the traditional group (examination: 49.5% vs. 8.9%; diverse assessment: 68.8% vs. 2.1%), while the percentage of students, whose scores were under 80, in the BOPPPS group was much smaller than that in the traditional group (examination: 7.3% vs. 52.1%; diverse assessment: 9.2% vs. 65.8%). Especially, there was no student under 60 score in the BOPPPS group while there were some in the traditional group (examination: 0.7%; diverse assessment: 1.4%).

Examination score and diverse assessment score among which examination accounted for 50%, evaluation from teachers accounted for 30%, and evaluation from classmates accounted for 20% ( a ), and percentage of the students in different score interval ( b ). (* denotes P  < 0.05 compared to traditional group).

Final score

At the end of the semester, the final scores of both BOPPPS group and traditional group were analyzed. Firstly, the final examination scores of the two groups were compared, as shown in Fig. 6a . We can see that the final examination scores of the BOPPPS group were significantly higher than those of the traditional group (90.7 ± 5.7 vs. 80.3 ± 5.4). Besides, the diverse assessment scores of the BOPPPS group were also significantly higher than those of the traditional group (91.7 ± 5.5 vs. 78.0 ± 5.9). Obviously, the difference in the diverse assessment scores between the two groups was much bigger than the difference in examination scores between the two groups. Furthermore, the score interval of the BOPPPS group and traditional group was summarized, the results of which were shown in Fig. 6b . We can see that the percentage of 90–100 score interval students in the BOPPPS group was much bigger than that in the traditional group (examination: 51.4% vs. 6.2%; diverse assessment: 74.3% vs. 3.4%). As expected, the percentage of students with scores under 80 in the BOPPPS group was much smaller than that in the traditional group (examination: 5.5% vs. 41.1%; diverse assessment: 7.3% vs. 63.0%). Moreover, there were no students under 60 score in the BOPPPS group while there were some in the traditional group (examination: 0.7%; diverse assessment: 0.7%).

The final examination score and diverse assessment score among which examination accounted for 50%, evaluation from teachers accounted for 30%, and evaluation from classmates accounted for 20% ( a ), and percentage of the students in different score interval ( b ). (* denotes P  < 0.05 compared to traditional group).

Interviews with the teachers

The teachers stated that compared to the traditional teaching, the BOPPPS teaching model provided a more clear teaching framework, making classroom teaching more organized and helping them better organize and plan teaching content. The BOPPPS teaching model made the classroom more lively and interesting, and students show higher enthusiasm. The teachers generally believed that through interactive activities such as group discussions and representative presentations, students’ interest in learning could be enhanced, and their ability to analyze and solve problems could be exercised. In the BOPPPS teaching model, multimedia and online resources could be more fully and effectively utilized, enriching teaching content and methods. The teachers thought that in the BOPPPS teaching mode, teacher-student interaction was more in-depth, the classroom atmosphere was more active, students were more willing to speak and ask questions, and the communication and interaction between teachers and students increased the fun and attractiveness of the classroom, as well as improved students’ understanding and memory of knowledge. Moreover, the teachers reported that compared to the traditional teaching, the BOPPPS teaching model could make students have a stronger grasp and improved understanding and application abilities of knowledge because they have more opportunities to participate in the exploration and understanding process of knowledge.

Interviews with the students

The students in the BOPPPS group said that they liked such a learning atmosphere, which could improve their interest in learning, and cultivate their teamwork ability and innovative thinking. The achievement-oriented approach enabled them to know clearly “what to learn, how to learn, and to what extent they need to learn”. Moreover, they could always check their achievement of learning objectives in class and get timely feedback information. Communication and discussion among classmates were found to not only increase knowledge but also foster mutual understanding and positive emotions. Although a small number of students expressed that they were initially not accustomed to this teaching mode, they felt that their knowledge and ability had been significantly improved and gained a lot, and now they gradually become fond of this teaching mode, and even expect more courses to adopt this teaching mode in future.

Traditional group students felt that the classroom was dull and lacked interaction, but they became accustomed to the traditional teaching mode and were able to learn according to the teacher’s guidance. However, they thought that their critical thinking and innovative abilities had not be significantly enhanced. The students generally believed that the teachers were serious and responsible, but they hoped that the teachers could increase the interactivity and fun of the classroom. They felt that cooperation among students was not enough.

The knowledge system of teaching content needs to be dynamically updated according to the frontiers and tendencies of the discipline and the requirements of social development, and introduce the new achievements of academic and scientific development of the discipline into the curriculum to meet the professional requirements of modern technology. The BOPPPS teaching model emphasizes student-centered learning and embodies specific implementation process, which has played an important role in improving the attractiveness of classroom teaching. However, there are still problems in its implementation, such as insufficient targeting of activity goals towards social demands, unclear teaching objectives, etc., resulting in limited teaching effectiveness, and the students could not be well recognized by employers after graduation (Wu et al., 2022 ; Shen et al., 2024 ). OBE emphasizes result-oriented education or goal-oriented education and has made significant contributions to education systems worldwide. However, OBE did not show how to implement the teaching process (Yang et al., 2023 ; Huang et al., 2023 ). We can see that the two teaching models are complementary. Although they have been extensively practiced respectively, few studies on the combined use of them have been found. In this study, we designed the BOPPPS teaching model based on the OBE concept. Under this model, the emphasis is very much on clarifying objectives, embodying specific implementation process, and evaluating learning progress and completion. Especially, we proposed specific index points according to results-oriented requirements of the OBE concept and the professional training objectives. Teaching content was constructed according to the index points, and the theoretical, practical, high-level and innovative nature of the curriculum were specifically reflected according to the employment destination and graduation requirements of students. We transformed the curriculum teaching from one-way knowledge teaching to two-way discussion between teachers and students through the BOPPPS teaching mode, keeping the teaching content up-to-date with the times. Moreover, comprehensive and reasonable evaluations including both phased assessments and summative assessments at the end of the course were suggested, such as phased exams, final exams, student evaluations, teacher evaluations, questionnaire surveys, student interviews, teacher interviews, etc.

During the teaching implementation process, we reasonably arranged teaching content, and chose teaching methods and means based on the index points to ensure high-quality teaching. The teaching methods were more diverse, and information and digital teaching tools were more complete. We have recorded 35 teaching videos, each of which lasts 10–15 min and focuses on one knowledge point for students to learn online. Through teacher guidance, students developed learning plans based on learning tasks and objectives, using textbooks, electronic courseware, exercise library and case library, to clarify learning objectives and master course content well. The six links of the BOPPPS teaching model were gradually integrated and organically combined to create a closed teaching loop. The purpose of creating such a teaching loop was to enable students to form a continuous “ubiquitous learning”, which could extend our classroom beyond the original classroom, make the teaching process interactive and immersive, and effectively solve the problem of low participation of extracurricular student in learning, greatly improving students’ learning enthusiasm and enhancing their sense of gain (Dai et al., 2022 ; Hu et al., 2022 ; Zhang et al., 2020 ). In addition, through three-dimensional and systematic learning before, during, and after class, knowledge learned by students was consolidated, and their habit of discovering problems and exploring independently was gradually developed, forming a virtuous cycle of high-level learning, which is greatly beneficial for the learning and development of subsequent courses and the improvement of their own quality (Chen et al., 2022 ; Z. Li et al., 2023b ).

Because of the results-oriented OBE concept education, students achieved a clearer understanding of the employment situation and graduation needs. Targeted learning exercises have improved practical skills and clinical thinking abilities of the students, and their overall quality has significantly improved. The teaching staff of the internship and training hospital reported that the knowledge structure of these students was more reasonable and their overall quality was high. The student evaluation excellence rate for the teaching team reached 100%, and the average score of the team members reached higher than 95 on a 100-point scale. At the same time, both theory and practice were emphasized. The teaching models that emphasized practical application have been unanimously recognized by students and colleagues (Chung et al., 2015 ; S. Li et al., 2023a ; Li et al., 2015 ).

During the teaching implementation process, we realized that the BOPPPS teaching model combined with the OBE concept should be flexibly applied, following the basic framework of BOPPPS, but not rigidly adhering to the fifteen minutes and six small modules. Normally, the BOPPPS teaching mode divides a class into six small modules, each of which lasts for fifteen minutes. These small modules serve as a connecting link to form a closed-loop teaching mode. But in the actual teaching process, there are many unpredictable factors, and the time of each process will inevitably be longer or shorter. Fifteen minutes is only an ideal situation, so in practice, teachers should plan the class reasonably based on the actual situation. At the same time, the six small modules in teaching do not necessarily need to be carried out in the original order one by one. The modules can be appropriately merged and reorganized according to the teaching content, such as combining bridge-in with objectives for teaching, or organically combining objectives with pre-assessment.

Conclusions

This study developed a BOPPPS teaching model combined with the OBE concept for higher education. First, the course outcome goals were divided into three dimensions – knowledge, ability and quality, and further specified into index points. Then, the teaching content of each chapter was set to correspond with the index points. Finally, the BOPPPS teaching model was used to meet each requirement. The effectiveness of this teaching model was assessed in the clinical biochemistry course. According to the training objectives and graduation requirements of the medical laboratory technology major, the results-oriented objectives of clinical biochemistry testing course were divided into three dimensions and subdivided into 10 index points. The content of each chapter corresponded to the index points one by one, ensuring that each index point was supported during teaching, enabling students to always focus on the expected results in learning, and letting them know what to learn, how to learn, and to what extent they have learned. Under the teaching model, the students could self-reflect on the achievement of their learning and ability development goals better, and be promoted better to internalize the clinical biochemistry testing knowledge. The results showed that the teaching quality was significantly enhanced by the teaching reform. Overall, compared to the traditional teaching method, the BOPPPS teaching model combined with OBE concept possesses clearer objectives, could stimulate students’ learning motivation better, and stimulate their learning interest and enthusiasm better. Moreover, evaluation methods used in the teaching model are reasonable and diverse, and could assess the comprehensive abilities required by today’s society. So, the BOPPPS teaching model combined with OBE concept could provide an effective strategy for teaching reform and improvement of higher education.

Data availability

The baseline data, questionnaire survey results, stage scores, and final scores of students collected and analyzed during the current study are available in the Harvard Dataverse repository: https://doi.org/10.7910/DVN/RJZQCD .

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Acknowledgements

The authors acknowledge financial support from the Planning Subject for the 14th Five Year Plan of Hebei Province Education Sciences (No. 2303088), the Higher Education Teaching Reform Research and Practice Project of Hebei Province (No. 2019GJJG334), the Fok Ying Tung Education Foundation (No. 141039), the Fund of Key Laboratory of Advanced Materials of Ministry of Education (No. AdvMat-2023-10), the International Joint Research Center of Aerospace Biotechnology and Medical Engineering, Ministry of Science and Technology of China, and the 111 Project (No. B13003).

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Zhiwei Xu, Liping Ge, Guiqin Song, Jie Liu, Lijuan Hou, Xiaoyun Zhang & Xiaotong Chang

Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China

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Key Laboratory of Advanced Materials of Ministry of Education, Tsinghua University, Beijing, China

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Zhiwei Xu: Conceptualization, methodology, investigation, writing - original draft preparation, writing—review and editing, funding acquisition, and resources; Liping Ge: Data curation, formal analysis, and investigation; Wei He: Data curation, writing—original draft preparation, and writing—review and editing; Guiqin Song: Methodology, formal analysis, and investigation; Jie Liu: Data curation, formal analysis, and investigation; Lijuan Hou: Data curation and investigation; Xiaoyun Zhang: Data curation and investigation; Xiaotong Chang: Data curation and investigation; Lan Yin: Conceptualization and writing - review and editing; Xiaoming Li: Conceptualization, methodology, writing—original draft preparation, writing—review and editing, funding acquisition, resources, and supervision.

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Xu, Z., Ge, L., He, W. et al. Developing a BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment and Summary) model combined with the OBE (Outcome Based Education) concept to improve the teaching outcomes of higher education. Humanit Soc Sci Commun 11 , 1001 (2024). https://doi.org/10.1057/s41599-024-03519-y

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Project-Based Learning Strategies

Table of contents.

Active-Learning

The A ctive-Learning  definition is “students doing things while thinking about what they are doing.” The range of what students “do” includes a diverse range of activities to construct their knowledge and understanding (i.e., develop higher-order thinking). Although not always explicitly required, student reflections about what they are learning and how they are learning are essential elements. The goal is to link the activity with learning. Active-learning is a broader educational strategy, within which many other project-based learning tactics reside.  

Inductive-Learning

Inductive learning  is the process of learning by example and observation. Students induce a general rule, concept, or principle from a set of observed examples. Deductive learning presents the idea first and demonstrates how it works—but this process simply isn’t possible, or as effective, for the diversity of simultaneous explorations that occur with project-based learning. PBL exposes students to how a concept or principles happens in practice (through case-studies, system-thinking analysis, just-in-time teaching) so they can better understand the universal principles that build towards a rule or lesson. The flexibility of in-course activities in PBL allows for inductive learning to occur through specific examples, events, experiences crafted to the particular stage of development.

Backward Design 

The open-ended nature of day-to-day activities within a student-led PBL format can be uncomfortable for some instructors if used to control the process by which the lessons are presented and learned.   Backward course design  (or backward mapping) is essential for project-based learning because it provides a planning framework that works back from the module’s overall objectives, course, or project and creates a series of lessons built to help achieve these goals. PBL is a goal-focused approach with distinct phases which allows instructors to align short-term activities with long-term goals, content production, and student performance. Progress in PBL classes may not happen linearly with predictable results, but instructors can provide a framework for this advancement through lessons, problems, and goal-oriented assignments. Students work towards these deadlines, thus, crafting the process of teaching to support the goals of student learning.

Experiential Activities  

PBL courses frequently integrate a series of  experiential-learning  opportunities throughout the process. The purpose of these experiences is to expand opportunities for students to discover, empathize, and understand the problem in different ways. In these activities, students are exposed to, or create, a direct “experience” related to the course topic or project question (e.g., “What makes a shoe fit well?” or “How difficult is it to carry water long distances?”). This experience begins a process of reflection, discussion, analysis, and evaluation of the skills to guide further activities. Ideally, these experiences include exposure to circumstances,  and people , not typically included in traditional classroom environments. The authenticity and significance of PBL problems cemented during this process. 

Haptic Engagement 

Many experiential activities involve a  haptic, hands-on approach  to learning. Some learners look for ways to include the sense of touch in their educational process: drawing, building, fiddling with something, manipulating elements to complete a task. In project-based learning, these preferences are well-suited to aspects of the discovery and ideation process. Imagine how to learn about food safety practices through cooking or product design performance by testing it for failures. 

Retrieval Practice 

The idea behind  retrieval practice  is to develop ways to turn passively-absorbed information into more embedded knowledge and understanding. Instead of re-reading books and notes, retrieval depends on one’s ability to “hack” their ability to recall information. This step occurs through visual note-taking, peer-to-peer teaching, or with hands-on experiences. As an example, imagine lifting two seemingly identical rods made of different densities; this one simple experience (“that’s heavier than the other one”) will immediately trigger an understanding of density and materiality. Explaining this lesson to others or drawing it would enhance the experience.

Metacognition & Problem-Solving Strategies

For questions with right/wrong answers, solving a problem is embedded within the job (e.g., orders of operation, application of principles, etc.). Still, many of the problems used in the PBL model intentionally defy straightforward solutions. When problems are complex, multi-faceted, and vexing, a non-linear problem-solving method becomes necessary. PBL courses need to teach strategies for  solving  problems, ideally using best practices of metacognition (thinking about thinking). Specific tactics are essential to demonstrate: Students should be encouraged to articulate which principles and concepts are unclear and explain how their previous successful attempts at problem-solving might be useful. When students share their strategies by demonstrating their solutions aloud or graphically, they gain confidence in their efforts and foster a community mindset. Instructors should model problem-solving strategies rather than offering answers and ask directing questions to help students overcome obstacles.

Just-in-Time Teaching

One of the challenges of teaching an open-ended educational practice is the potential variability in timing for when introducing specific lessons. Imagine a scenario in which student groups reach an impasse in their work because they lacked knowledge about a particular subject or the skills to manage one of their learning tools.  Just-in-Time teaching  tries to anticipate these impasses by creating a series of exercises that allow the instructor to survey and assess the students’ abilities and knowledge. This learning activity often takes the form of open-ended warm-up questions or surveys about the course material before class begins—the instructor can adjust the course activities to address any shortcomings or misunderstandings meaningfully. The learning happens just-in-time to apply it towards the PBL project. For example, an instructor asks students in a course about sustainable practices in landscape architecture to explain water retention principles. Then, they realize that most students don’t understand the relationship between soil types and drainage, so an in-class demonstration of the concept is created and shown at the start of class.

Guided Discovery 

A cornerstone of all project-based learning models is the exceptional relationship between curiosity, critical thinking, and problem-solving. These strengthen connections through  guided discovery problems . These are carefully constructed puzzles, challenges, or discrete questions that push students to learn  how  to solve the issues and build a framework of knowledge from these inquiries—before explaining the content to them. This type of discovery learning method based on the profound and straightforward notion that students are more likely to remember concepts and principles when they initially discover them. These “learning-by-doing” exercises are combining with experiential learning and haptic engagement exercises. Ideally, introducing these lessons in a collaborative setting in which individuals experience the learning, reflect upon it, and convey the lessons they’ve learned to their teammates. As an example, asking at a beginning astronomy course for students to speculate on how to explain the phases of the moon using physical models and a light source—they discover that the Earth’s shadow doesn’t cause the moon’s phases. 

Coached Ideation 

At certain stages in the project-based learning/design thinking process, groups apply their knowledge of course content towards a project as they generate ideas. When the problems are complex, and the design process is collaborative, instructors must guide to facilitate these activities. A coached ideation process gives smaller groups of students a particular issue to address as it applies to the overall project (e.g., identifying options for non-conductive metals, prioritizing options for food distribution, etc.). The point isn’t to solve the broader problem of PBL, but perhaps a crucial stage in one of the branch problems. These exercises should be short, somewhat informal, and ungraded interactions where students present ideas, explore, and evaluate collaboratively. Instructors should encourage all students to interact (modeling inclusive classroom tactics) and provide just-in-time learning to clear misconceptions, suggest case studies, or provide technical expertise for concepts not apparent to student teams. The most important aspect of this process is that the work remains student-led. Doing so helps to emphasize student “voice and choice” while strengthening their engagement in the process. In a team-based learning process, this role of a “coach” may fall upon peer coaches or other team members.  

Visualizing Systems Thinking

The complexity and interdisciplinary nature of the problems used in PBL courses require participants to understand systems thinking. Systems thinking is the process of trying to understanding how constituent parts interrelate and influence each other within a whole system. Systems thinking looks for a holistic approach to the research, analysis, and design activities (e.g., how air, water, plants, and animals interact in an ecosystem). Systems thinking and visualizing the various means (e.g., causal loop diagrams (CLD), qualitative/quantitative (QQ) diagrams, Behavior Over Time (BOT) models, simulators), serves as a universal language that connects inter-disciplinary teams. Systems thinking deals with the variables, links, effects, and constraints that affect behaviors in complex systems—it is an ideal evaluative tool for the agile project-based learning approach. Although the visualization techniques and modeling can be advanced, the process need not be; consider  these drawtoast examples  of people have visually mapped “How To Make Toast.” 

Case-Study Method

Case-studies are real-world examples of situations, solutions, or failures that can provide valuable information during a project-based learning approach. Many professions rely upon case methods for continuing education because it is particularly useful in linking new learning to existing conditions. It is a valuable tactic in PBL courses in three primary ways:

• First, the PBL method relies extensively upon information gathering to define the problem, suggest potential solutions, and to understand the scope of on-going efforts either as a literature search or precedent study.
• Second, introduce specific case-studies as a way of provoking questions and challenging solutions. When students confront dilemmas from previous cases, they can assume the role decision-maker and weigh their potential choices against the real-world consequences.
• Finally, the case’s real-life nature brings relevance and authenticity to the project—the data sets and theories connect to an actual event with consequences.

Shared Solutions / Send-A-Problem

During the problem-solving phases of project-based learning, it becomes tricky to solicit multiple potential solutions to the same problem simultaneously. Some groups or individuals may dominate the conversation, and others become disengaged if no one pursues their solution. An excellent strategy to avoid these conflicts while still maintaining the cooperative problem-solving effort is to use a  Send-A-Problem  method (a variation of the Coached Problem-solving method). In this method, forming multiple student groups (2-4 each).

• Give each group a different discrete problem; the problems should be complicated and nuanced enough that no single right answer is possible.
• Teams discuss the issue, record their solution, and pass their resolution off to another group. Each group contributes a new or revised solution to the original.
• Eventually, after the problem has made its way through the class, a final resolution is selected (often a hybrid model of many suggestions). This process nurtures collaborative problem-solving and communication skills—groups have to learn to listen and consider other perspectives before offering their solution. It encourages creativity without demanding originality—set solutions are within the context of ideas that others have developed.
• In-person and online forums are equally useful for this process.

Learning Artifacts & Portfolios

Learning artifacts/objects are tangible demonstrations of student learning. They are essential elements of a project-based learning course. The public presentations of learning artifacts often mark the transitions between the various stages of a project-based learning approach. As the stages progress from discovery to ideation, evaluation, and implementation, the artifacts change. The goal is to have students produce a series of expressions that showcases the process:

• Some elements demonstrate critical thinking, initial ideation and problem-solving, others to show a progression through design/problem-solving development.
• Eventually, all the artifacts can be linked together in a compelling story—ideally with demonstrations of work across format with a refined sense of resolution. The production of a portfolio at the end of the process is a critical learning tool. It promotes student self-reflection on learning and becomes evidence of the competencies required in the course’s learning objectives.
• The link between the visual representation of complex ideas is an essential professional communication skill to promote.
• Finally, portfolios are artifacts that extend the project’s life through publications, research funding, and as case-studies for other similar projects.

Cooperative & Team-Based Learning 

Collaboration is one of the essential components to successful project-based learning courses—but it is a soft skill that deserves specific instructional attention that it needs. PBL depends on the students’ ability to work as a team to produce a shared work. When students learn to work in a supportive, inclusive, and cooperative environment, they thrive. Teaching productive collaborative learning tactics involves a series of exercises presented to students that allows them to understand more about form teams, assess team members’ assets, refine roles and contributions to the project, and foster supportive intra-team communication. There are specific ways to model positive cooperation in the course: informal learning groups, think/pair/share exercises, peer instruction, jigsaw, etc. The PBL process has regular intervals built into the process for a routine sharing of ideas and formative evaluation of team-working efficacy. A more formalized model is the team-based learning (TBL) format. This small-group learning experience emphasizes student preparation out of class and application of knowledge in class. Students are organized strategically into diverse teams of 5-7 students that work together throughout the course. 

Role-Playing & Evaluation

A critical aspect of the project-based learning method is the ability to generate empathy and insight as an integral part of the initial information collection/discovery/research phase. One way of trying to instill an understanding of the process is to use a  role-playing  method. Simply put, ask a student (or groups of students) to assume the perspective of a particular character or user group. To do so, they’ll need to supplement their imagination with actual data, cultural competence training, and other research information about how the issues affect human interaction. Once the research is complete, the instructor facilitates an event (role-playing exercise) in which groups interact with questions and answers—during this event, raise concerns and present potential solutions, etc. as a way of evaluating progress. Specific feedback is essential for growth (“I don’t think that will work because…” vs. “I don’t like it”). Depending on the discipline or scenario, some vibrant online role-playing forums and simulations may lend additional feedback. 

• Open access
• Published: 09 August 2024

Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates

• Dachuan Fan 1   na1 ,
• Chao Wang 2   na1 ,
• Xiumei Qin 1   na1 ,
• Shiyu Qiu 1   na1 ,
• Yatang Wang 1 &
• Jinxiao Hou   ORCID: orcid.org/0000-0001-6736-1714 3  

BMC Medical Education volume  24 , Article number:  860 ( 2024 ) Cite this article

Metrics details

This study aimed to assess the effectiveness of the BOPPPS model (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) in otolaryngology education for five-year undergraduate students.

A non-randomized controlled trial was conducted with 167 five-year undergraduate students from Anhui Medical University, who were allocated to an experimental group and a control group. The experimental group received instruction using the BOPPPS model, while the control group underwent traditional teaching methods. The evaluation of the teaching effectiveness was performed through an anonymous questionnaire based on the course evaluation questionnaire. Students’ perspectives and self-evaluations were quantified using a five-point Likert scale. Furthermore, students’ comprehension of the course content was measured through a comprehensive final examination at the end of the semester.

Students in the experimental group reported significantly higher scores in various competencies compared to the control group: planning work (4.27 ± 0.676 vs. 4.03 ± 0.581, P  < 0.05), problem-solving skills (4.31 ± 0.624 vs. 4.03 ± 0.559, P  < 0.01), teamwork abilities (4.19 ± 0.704 vs. 3.87 ± 0.758, P  < 0.05), and analytical skills (4.31 ± 0.719 vs. 4.05 ± 0.622, P  < 0.05). They also reported higher motivation for learning (4.48 ± 0.618 vs. 4.09 ± 0.582, P  < 0.01). Additionally, students in the experimental group felt more confident tackling unfamiliar problems (4.21 ± 0.743 vs. 3.95 ± 0.636, P  < 0.05), had a clearer understanding of teachers’ expectations (4.31 ± 0.552 vs. 4.08 ± 0.555, P  < 0.05), and perceived more effort from teachers to understand their difficulties (4.42 ± 0.577 vs. 4.13 ± 0.59, P  < 0.01). They emphasized comprehension over memorization (3.65 ± 1.176 vs. 3.18 ± 1.065, P  < 0.05) and received more helpful feedback (4.40 ± 0.574 vs. 4.08 ± 0.585, P  < 0.01). Lecturers were rated better at explaining concepts (4.42 ± 0.539 vs. 4.08 ± 0.619, P  < 0.01) and making subjects interesting (4.50 ± 0.546 vs. 4.08 ± 0.632, P  < 0.01). Overall, the experimental group expressed higher course satisfaction (4.56 ± 0.542 vs. 4.34 ± 0.641, P  < 0.05). In terms of examination performance, the experimental group scored higher on the final examination (87.7 ± 6.7 vs. 84.0 ± 7.7, P  < 0.01) and in noun-interpretation (27.0 ± 1.6 vs. 26.1 ± 2.4, P  < 0.01).

The BOPPPS model emerged as an effective and innovative teaching method, particularly in enhancing students’ competencies in otolaryngology education. Based on the findings of this study, educators and institutions were encouraged to consider incorporating the BOPPPS model into their curricula to enhance the learning experiences and outcomes of students.

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Introduction

Otolaryngology is a distinctive clinical discipline characterized by its unique professional attributes that focus on the diagnosis and treatment of disorders affecting the ears, nose, throat, head and neck regions. Otolaryngologists frequently encounter various clinical manifestations associated with systemic diseases, requiring advanced clinical reasoning and complex problem-solving abilities [ 1 ]. Undergraduate otolaryngology education encompasses a wide range of knowledge areas and emphasizes the integration of theory and practice to train a highly qualified cadre of doctors [ 2 ]. The challenge of this specialized education lies in providing effective teaching modalities that ensure competency in the diagnosis and management of otolaryngologic disorders within a standardized framework [ 2 , 3 , 4 ].

In medical curricula, the traditional teaching prevalent in the current evidence relies on lecture-based instruction and emphasizes the delivery of syllabi and concepts [ 4 ]. However, the term “traditional” is not clearly defined and may vary depending on the individual teacher. In this format, students first receive reading materials, including textbooks and the course syllabus, and then passively absorb knowledge through face-to-face classroom sessions, while teachers impart theoretical knowledge, answer questions, and repeat any knowledge points that students had not been fully understood in the class, via PowerPoint slides and handouts [ 5 , 6 ]. This model often results in unsatisfactory learning outcomes as medical students acquire knowledge passively from instructors with little interaction, resulting in decreased motivation to study and innovate. Moreover, otolaryngology experience and training in medical schools have been gradually declining at undergraduate medical education worldwide [ 7 , 8 ]. As a consequence, undergraduate students and primary care practitioners often exhibit low competency in managing ear, nose, and throat problems, such as difficulty in accurately diagnosing common conditions, limited proficiency in performing basic examinations, and insufficient knowledge of appropriate treatment protocols [ 4 , 9 , 10 , 11 , 12 ]. Thus, it is crucial to restructure the current educational approach from conventional didactic learning, aiming to enhance students’ competencies by incorporating focused teaching and skills training [ 3 ].

The BOPPPS (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) model was a six-stage framework which was originally developed by the Center for Teaching and Academic Development, University of British Columbia, Canada [ 13 ]. It offered a comprehensive and coherent teaching process and theoretical foundation to achieve learning objectives [ 5 ]. Moreover, it clearly organized the teaching process and creates a closed-loop teaching unit with an integrated system that emphasizes the effectiveness of learning outcomes and the diversity of teaching methods [ 5 ]. Several studies have demonstrated that the BOPPPS model is more effective than traditional instruction in enhancing students’ skills and knowledge, as well as improving their self-learning ability, academic performance, and learning satisfaction across various disciplines, such as ophthalmology, thoracic surgery and gynecology [ 5 , 14 , 15 , 16 , 17 , 18 ]. However, the application of the BOPPPS model in otolaryngology education has not been fully explored.

In fact, we first applied the single BOPPPS teaching to integration cases in the spring of 2021 for the students of Class 2017, and then in 2022 for Class 2018. Unlike traditional teaching, the BOPPPS model encouraged active engagement from students through participatory learning activities, fostering deeper understanding, critical thinking, and application of knowledge. Moreover, while traditional teaching may focus primarily on content delivery, the BOPPPS model emphasized the integration of theoretical concepts with practical clinical scenarios, thereby promoting a more holistic approach to learning [ 6 , 18 ]. In this study, we conducted a preliminary evaluation of the effectiveness of the BOPPPS model for otolaryngology education among five-year undergraduates.

Participants and recruitment

This study was a non-randomized controlled trial conducted at Anhui Medical University between April 1, 2023, and May 30, 2023. We recruited 167 students majoring in clinical medicine from Anhui Medical University who were undergraduate students studying otolaryngology in their eighth semester. Informed consent was obtained from each participant prior to enrolment in the study. Each participant voluntarily agreed to take part in this study. The students were from almost all regions of China and approximately half of them were residents of Anhui province. They all received systematic pre-college education under the same guideline and using the same textbooks after passing the requirements of the entrance examination. The students were divided into 4 sections to be taught separately. Each section was usually taught by one teacher throughout the entire Otolaryngology course. All teachers had at least 10 years’ experience of teaching and met the standard requirements of teaching after group rehearsal of the course contents. We assigned them to two groups: an experimental group that used the BOPPPS model and a control group that used the traditional instructional approach.

Study design and setting

The study conducted over two months, focusing on the effectiveness of the BOPPPS model in teaching otolaryngology. The experimental group applied the BOPPPS model, while the control group received traditional lecture-based instruction. Both groups covered a total of 49 topics related to otolaryngology, with chronic sinusitis being one example. The course comprised 27 sessions with 45 min per session. The study included 169 five-year undergraduate students from Anhui Medical University, with 49 students in the experimental group and 118 students in the control group. Students were allocated to these groups based on their class schedules and availability. The same curriculum was used as the teaching content for both groups of students. The teaching processes were completed within the same duration for the experimental group and the control group. The control group received mainly traditional teaching [ 19 ]. In the traditional lecture-based format, teachers delivered theoretical knowledge through PowerPoint slides, handouts, and lectures. Students passively received information and took notes. The traditional teaching sessions involved the following steps: Reading Material : Students first received the reading material, including textbooks and the course syllabus. Classroom Instruction : Teachers used overhead projectors and PowerPoint slides to deliver the content face-to-face, with minimal student interaction. Teaching Materials : Students had access to teaching materials and reference book. Question and Answer : Teachers answered students’ questions and repeated any points that were not fully understood.

The experimental group applied the BOPPPS model for teaching, using the topic on chronic sinusitis as an example. The BOPPPS model is composed of six parts [ 6 , 20 ]: Bridge-in : Before class, the teacher introduces two problems of chronic sinusitis from online searching platforms ( https://pubmed.ncbi.nlm.nih.gov ) to motivate students’ interest in learning clinical diseases characterized by “rhinorrhea” and “headache”. The teacher also provides a clinical case with a framework for understanding the course’s main content by asking students to recall the anatomy and physiology of the paranasal sinuses and the common symptoms of chronic sinusitis. Objective : According to the course syllabus of Anhui Medical University, the teacher clearly states the diagnosis and treatment of chronic sinusitis as the focus of the course. Pre-assessment : The teacher administers a quiz or a poll to assess the students’ prior knowledge and understanding of chronic sinusitis. The teacher also asks students to share their questions or difficulties about the topic. Participatory learning : The teacher divides the students into small groups and assigns each group a clinical case related to chronic sinusitis. The students are instructed to discuss the case in their groups and answer questions based on the pre-assessment such as: what are the possible causes and risk factors of chronic sinusitis? what are the diagnostic tests and criteria for chronic sinusitis? what are the treatment options and goals for chronic sinusitis? how would you educate the patient about prevention and self-care? The teacher facilitates the discussion by providing feedback, guidance and additional information as needed. Post-assessment : The teacher conducts another quiz or a poll to evaluate the students’ learning outcomes and progress after the participatory learning. The teacher also urges students to reflect on their learning experience and identify their strengths and weaknesses. The teacher adjusts the subsequent content to improve teaching efficiency based on the post-assessment. Summary : The teacher summarizes the main points and key concepts of chronic sinusitis. The teacher also reviews the learning objectives and emphasizes the clinical implications and applications of chronic sinusitis. The teacher encourages students to expand their learning beyond the course and seek further learning resources if interested, such as by consulting expert consensus and clinical guidelines (e.g., European Position Paper on Rhinosinusitis and Nasal Polyps, 2020). To ensure clarity and concision, the teaching flowchart is depicted in Fig.  1 .

Flowchart of BOPPPS and traditional instructional teaching using chronic sinusitis as an example. Bridge-in : following the problem introduction or a clinical case, delve into the interest motivation by exploring the symptoms of chronic sinusitis, such as “rhinorrhea” and “headache,” commonly searched online, sparking our curiosity about this condition. Objective : diagnosis and treatment of chronic sinusitis based on the course syllabus. Pre-assessment : a quiz/poll; sharing any questions or areas of difficulty regarding the topic. Participatory learning : students are divided into small groups to analyze clinical cases of chronic sinusitis, discussing causes, diagnostics, treatments, and patient education. Post-assessment : quiz/poll, student reflection on learning experience, and subsequent content adjustment for improved teaching efficiency. Summary : the teacher summarizes key points of chronic sinusitis, reviews learning objectives, underscores clinical implications, and encourages students to explore additional resources for further learning

Assessment of teaching outcomes

To evaluate the efficacy of the BOPPPS instructional model, we administered an anonymous questionnaire to the students. The questionnaire was adapted from the course evaluation questionnaire [ 21 ]. The students from both groups filled out the questionnaire after completing the course. We quantified the students’ perspectives and self-evaluations using a five-point Likert-type scale ranging from a score of one for strong disagreement to a score of five for strong agreement.

We also tested the students’ understanding of the course content by administering a comprehensive final examination at the end of the semester. The written examination (with a total score of 100 points) assessed the theoretical knowledge of Otolaryngology. The examination questions consisted of three parts: medical-terms interpretation (28 points), single-choice questions (42 points) and short-answer questions (30 points). They were randomly selected from the examination question bank, which encompassed the students’ skills in Otolaryngology.

Statistical analysis

Statistical analyses were conducted using SPSS 26.0 (SPSS, Inc., Chicago, IL). 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.

Demographic characteristics of the participants

Table  1 depicted the main demographic features of the two groups of undergraduate students. The experimental group consisted of 49 students (30 males, 19 females) with a mean age of 21.29 years. The control group comprised 118 students (87 males, 31 female) with a mean age of 21.70 years. The two groups were comparable in their general characteristics, such as sex, age, and origin of the students ( P  > 0.05). No significant differences were observed between the two groups regarding sex, age, and family background ( P  > 0.05).

Comparison of student perspectives

In Table  2 , we compared students’ perspectives in the control group to those of the experimental group. Students in both groups considered the otolaryngology course to be too heavy (3.56 ± 1.050 vs. 3.39 ± 0.894), overly theoretical and abstract (3.75 ± 1.139 vs. 3.36 ± 1.00) and needed a good memory (4.25 ± 0.700 vs. 4.13 ± 0.461). There was no significant difference in learning pressure (3.40 ± 1.125 vs. 3.20 ± 0.962, P  > 0.05), course comprehension (3.42 ± 1.164 vs. 3.30 ± 1.013, P  > 0.05), and time spent (3.73 ± 1.086 vs. 3.53 ± 0.910, P  > 0.05) between the two groups. More students in the experimental group agreed that BOPPPS model significantly enhanced their ability to plan their own work (4.27 ± 0.676 vs. 4.03 ± 0.581, P  < 0.05), developed their problem-solving skills (4.31 ± 0.624 vs. 4.03 ± 0.559, P  < 0.01), helped them work as a team member (4.19 ± 0.704 vs.3.87 ± 0.758, P  < 0.05), sharpen their analytical skills (4.31 ± 0.719 vs. 4.05 ± 0.622, P  < 0.05), and improved their motivation for learning (4.48 ± 0.618 vs. 4.09 ± 0.582, P  < 0.01) than the control group. Through the experimental group course, students felt more confident about tackling unfamiliar problems than through the control group course (4.21 ± 0.743 vs. 3.95 ± 0.636, P  < 0.05). Compared to those in the control group, students in the experimental group demonstrated a significantly clearer understanding of the teaching staff’s expectations from the start (4.31 ± 0.552 vs. 4.08 ± 0.555, P  < 0.05). Furthermore, the experimental group perceived a greater effort from the staff to understand their difficulties (4.42 ± 0.577 vs. 4.13 ± 0.59, P  < 0.01), a stronger emphasis on comprehension rather than memorization (3.65 ± 1.176 vs. 3.18 ± 1.065, P  < 0.05), and received more helpful feedback from the teaching staff (4.40 ± 0.574 vs.4.08 ± 0.585, P  < 0.01). Additionally, students in the experimental group found the lecturers to be significantly better at explaining concepts (4.42 ± 0.539 vs.4.08 ± 0.619, P  < 0.01) and perceived a higher level of effort in making the subjects interesting (4.50 ± 0.546 vs. 4.08 ± 0.632, P  < 0.01) than those in the control group. Overall, the experimental group was significantly more satisfied with the course than the control group (4.56 ± 0.542 vs. 4.34 ± 0.641, P  < 0.05).

Evaluation of academic performance

The experimental group achieved significantly higher final examination scores compared to the control group (87.7 ± 6.7 vs. 84.0 ± 7.7), and the difference was statistically significant ( P  = 0.004). The experimental group also obtained significantly higher scores in noun-interpretation than the control group (27.0 ± 1.6 vs. 26.1 ± 2.4, P  = 0.005). However, there was no statistically significant difference in single-choice scores between the two groups (31.8 ± 6.1 vs. 30.0 ± 4.9, P  = 0.076), as well as in short-answer scores (28.2 ± 3.3 vs. 28.0 ± 3.4, P  = 0.690) (Fig.  2 ).

Comparison of examination scores between experimental and control groups

The evolution of medical education has been driven by advancements in medical knowledge and pedagogy, as well as the need to address the complexities of chronic disease management and adapt to demographic, economic, and organizational changes in the healthcare system [ 22 , 23 ]. In the past few decades, medical education has shifted from a disease-oriented approach to a problem-based approach, and finally to a competency-based approach [ 24 , 25 ]. This transformation signified a crucial shift towards a more holistic and integrated model of otolaryngologic medical education [ 26 , 27 , 28 ]. It recognized the dynamic and complex nature of the field and the changing healthcare environment, where the demands on future otolaryngologists extended far beyond mere anatomical knowledge.

This study was the first application of the BOPPPS model in otolaryngologic education for the fourth year undergraduates in terms of students’ perspectives and examination scores. The findings revealed several positive outcomes. Firstly, the BOPPPS model significantly developed students’ problem-solving skills, improved teamwork, sharpened analytical skills, and increased students’ motivation for learning by engaging students in challenging clinical scenarios and encouraging them to analyse complex situations. Those skills are crucial and essential to make quick and accurate decisions for optimal patient treatment. Several studies demonstrated that the BOPPPS model enhanced clinical practice abilities and increased student satisfaction, and that it better inspired enthusiasm and enhanced comprehensive abilities in clinical teaching practice, which was consistent with our findings [ 6 , 18 ]. Secondly, the model promoted effective communication and cooperation by engaging students in participatory activities and group discussions. This approach enhanced critical thinking abilities during problem-solving exercises, enabling students to assess medical information, interpret diagnostic findings, and explore diverse treatment alternatives. Thirdly, it cultivated a supportive and engaging learning environment, leading to increased confidence and a deeper understanding of the subject matter for students. By prioritizing comprehension over memorization and providing personalized guidance, the model optimized students’ learning strategies. These results were confirmed by a recent meta-analysis, which highlights the significant impact of the BOPPPS model across multiple disciplines in Chinese medical education [ 5 ]. The most crucial outcome was the significantly higher final examination scores achieved by the experimental group. These scores were not only important for evaluating the students’ academic achievement, but also for measuring educational quality in the field [ 6 , 18 ]. The application of the BOPPPS model with or without innovative teaching in medical education demonstrated its effectiveness, fulfilling the requirements of competency-based teaching, equipping future otolaryngologists with the necessary skills to make quick and accurate decisions in patient treatment, and meeting the needs of modern medical education [ 14 , 16 , 29 , 30 ].

Competency-based education was an outcomes-centered approach that focused on mastering specific skills and knowledge required in a field of study, rather than memorizing facts and information [ 31 , 32 , 33 ]. In our study, the BOPPPS model, a six-stage framework, was used to design and deliver effective and engaging instruction for otolaryngology education. Our results demonstrated significant improvements in analytical skills, problem-solving abilities, and motivation, thereby supporting the effectiveness of the BOPPPS model in achieving competency-based educational outcomes. Each stage has a specific purpose and function in the teaching process [ 20 , 34 ].

Bridge-in: This stage aims to capture the students’ attention and interest by linking their prior knowledge and experience to the new topic or concept. This stage can help students activate their existing competencies and connect them to the new learning objectives, as well as motivate them to learn more.

Objective: This stage defines the clear and measurable learning outcomes that the students are expected to achieve by the end of the lesson. This stage can help students concentrate on mastering specific competencies required in their field of study, as well as provide them with clear criteria and expectations for assessment.

Pre-assessment: This stage evaluates the students’ current level of knowledge and skills related to the topic, as well as their learning needs and preferences. This stage can help teachers identify the students’ strengths and weaknesses, as well as tailor their instruction accordingly. This stage can also help students self-assess their competencies and set their own learning goals.

Participatory learning: This stage engages the students in active and collaborative learning activities that help them acquire and apply the new knowledge and skills. This stage can help students develop and enhance their competencies through problem-solving exercises, case studies, simulations, role-plays, and other interactive methods. This stage can also help students practice their critical thinking, communication, teamwork, and other soft skills that are essential for their field of study.

Post-assessment: This stage evaluates the students’ learning outcomes and progress by measuring their achievement of the learning objectives. This stage can help teachers provide feedback and guidance to the students on their performance and improvement. This stage can also help students demonstrate their competencies and reflect on their learning process.

Summary: This stage reviews and reinforces the main points and key concepts of the lesson, as well as provides feedback and guidance for further learning. This stage can help students consolidate their competencies and transfer them to other contexts, as well as identify their areas for further development.

Implications for practice

As a result, the BOPPPS model could provide a structured and systematic way to assess and enhance students’ competencies, as well as encourage active participation and collaboration among students [ 6 , 18 , 35 ]. By using the BOPPPS model, teachers could create a meaningful and memorable learning experience for their students, preparing them for real-world challenges in their field of study. By focusing on practical application, personalized feedback, and collaborative learning, the model fostered a transformative learning experience that empowered students to become competent and well-rounded professionals in their chosen field [ 5 , 17 ]. The model’s application provided a comprehensive and in-depth approach to develop students’ abilities, ensuring they were well-prepared for their future careers.

The results of this study suggested that educators and institutions should explore integrating the BOPPPS model into their curricula to optimize the learning experience for aspiring otolaryngologists. The findings also supported the wider adoption of competency-based pedagogy, emphasizing the potential of BOPPPS to enhance students’ perceptions, academic performance, and overall learning experiences in otolaryngology education and beyond, aligning with other studies [ 5 , 17 , 28 , 35 ]. The findings underscored the significance of learner-centered and practice-oriented approaches in medical education, providing useful insights for curriculum design and instructional strategies [ 35 ]. As educators and institutions seeked to optimize learning outcomes and prepared competent healthcare professionals, the BOPPPS model served as a promising and effective tool for shaping the future of otolaryngology medical education [ 6 , 18 ].

All students from the five-year undergraduate program acknowledged the course’s heavy workload and its theoretical and abstract nature. They also recognized the importance of having a good memory for effectively navigating the course material. There were no significant differences between the two groups in terms of learning pressure, course comprehension, and the amount of time spent on the course. These findings indicated that while the BOPPPS model positively influenced some aspects of students’ learning experiences and academic performance, it did not drastically alter their overall perceptions of the course’s demands and challenges. The course’s heavy workload and abstract content may remain inherent challenges of otolaryngology education, regardless of the teaching methodology employed. To further enhance the learning experience, future studies could investigate ways to reduce the perceived heavy workload and abstract nature of the course while continuing to utilize the strengths of the BOPPPS model [ 30 , 36 , 37 ]. Implementing additional interactive and hands-on learning opportunities, incorporating practical case studies, and providing tailored support for memory retention could be potential strategies to adopt. Moving forward, educators and institutions can build upon the strengths of the BOPPPS model while exploring additional strategies to optimize students’ learning experiences in otolaryngology.

Limitations and future research suggestions

While this study offered valuable insights, it was important to recognize certain limitations in its design and scope. Firstly, the research focused on a specific group of fourth year undergraduates, potentially limiting the generalizability of the findings to students at different stages of their medical education. Expanding the study to include a more diverse cohort from various educational levels would provide a more comprehensive understanding of the model’s efficacy. Additionally, the study’s single-institution setting and relatively short duration might restrict the applicability of the results to other medical schools. Conducting future research involving multiple institutional settings, larger sample sizes and a longitudinal investigation extending over multiple years would enhance the external validity and enable a broader assessment of the BOPPPS model’s impact. In this study, the survey was designed to capture general aspects of the learning experience applicable to any teaching method, though we recognize the need for refined questions to better address the nuances of each methodology. While students from different classes had their teaching sessions conducted simultaneously to minimize information sharing, the possibility cannot be entirely eliminated. Furthermore, a crossover design was not feasible due to logistical constraints and the structured curriculum, but future research should incorporate this approach for a more direct comparison and to capture the long-term effects of the BOPPPS model on students’ academic performance and perceptions.

In this study, BOPPPS model increased student satisfaction and improved learning outcomes in otolaryngologic medical education by fostering active learning, problem-solving skills, teamwork, analytical thinking, and motivation. This comprehensive approach showed great promise in effectively cultivating future otolaryngologists. Educators and medical institutions should consider adopting similar innovative teaching methodologies to enhance the learning experiences and academic achievements of medical students.

Data availability

Data is provided within the manuscript or supplementary information files.

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This work was supported by the Natural Science Foundation of Anhui Provincial Education Department (KJ2021A0315).

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Dachuan Fan, Chao Wang, Xiumei Qin and Shiyu Qiu contributed equally to this work.

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Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui Province, China

Dachuan Fan, Xiumei Qin, Shiyu Qiu, Yan Xu & Yatang Wang

Department of Economics and Trade, School of Economics and Management, Hefei University, No. 99 Jinxiu Avenue, Hefei, 230601, Anhui Province, China

Department of Hematology, the Second Affiliated Hospital of Anhui Medical University, NO. 678, Furong Road, Hefei, 230601, Anhui Province, China

Jinxiao Hou

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DC-F designed the study and drafted the manuscript. C-W designed the course evaluation questionnaire. XM-Q, SY-Q, Y-X, and YT-W collected data and assessed examination scores for eligibility. JX-H performed the statistical analysis and supervised the study. All authors critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

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Fan, D., Wang, C., Qin, X. et al. Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates. BMC Med Educ 24 , 860 (2024). https://doi.org/10.1186/s12909-024-05868-3

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Project-based learning: definition, benefits and ideas

Learning and Development

Table of contents

Project-based learning is a teaching method in which students apply an active inquiry approach to real-world challenges and problems.

Organizing and implementing the project-based learning method of teaching includes a commitment on the part of all those involved to carry out activities in which the investigation of authentic real-world problems, the development of solutions and discussion are key. 

To provide you with an approach to this type of teaching, in this article we will take you by the hand through the subject. We will start by explaining what project-based learning is , then we will show you its benefits and end by sharing with you a series of ideas related to the subject.  

What is project-based learning?

Project-based learning or PBL is a teaching method in which the curriculum takes the student as the center of reference to develop learning through research, questions and the resolution of non-fictional situations in the real world.

The teacher’s role is one of accompaniment and does not instruct the students, but rather it is the students who face a learning process that must be open, participatory and focused on critical thinking, communication, collaboration and creativity.

PBL is such an attractive process as to encourage students to engage in it and develop their own approaches by delving deeper into answers and solutions to present a final resolute result. 

With the final presentation of the prototypes, students show the problems solved, the research processes and methods used, as well as the results obtained. 

From all this, they can receive feedback and undergo a review of the plans and the projects as if it were one in real life. 

9 benefits of project-based learning

Implementing a curriculum focused on project-based learning brings a number of benefits that we detail below:

Strengthens long-term retention of what is learned 

The direct research process to find solutions, measures and tools, as well as the practical involvement in the resolution of the project, make the learning more established and last longer in the student’s memory.  

On the other hand, the fact of being personally involved makes the concentration on learning to be more intense and the final performance also yields better results.

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It generates intrinsic motivation and engagement 

The student’s participation in this type of teaching is voluntary and is usually a response to a self-motivation to learn in a different way. 

Believing that this is the learning that best fits their expectations of study, leads the student to a greater commitment to the project. 

Improves technological skills

The irruption of ICTs in education has meant a wonderful discovery of the power of technology when it comes to improving learning processes. 

Among the tools to consult and use, the technological ones are especially relevant, helping the student to carry out research with a much wider range of sources consulted -always under the premise of respect for digital privacy – and with a saving of search times also to be taken into account. 

Enhances project management competence

Students are submitted to the resolutions by themselves -or in a team- of a project based on real problems. 

The achievement of the project is obtained by going through the whole management process from the beginning to the end. 

Project-based learning can be focused on large, long projects or on smaller projects. Also, as we have anticipated, it can correspond to a solo project or to collaborative projects with other students with whom to form a team. 

Encourages active and continuous learning

Tackling a possibly unfamiliar starting project involves a thorough investigation of topics and resources that perfectly symbolizes active learning . 

Students search for the resources and means that will help them create the prototype of the final project to be presented. 

Once students have discovered the benefits of research and documentation, their receptiveness to participate naturally in continuous learning processes is self-evident.

Develops communication skills

The learner must be able to communicate with others the needs, solutions or results they are obtaining as their work progresses.

Whether we focus on communication with other team members, when the project so requires, or if we talk about a solo project, in all cases the ability to communicate the aspects mentioned in the previous paragraph are key to a successful achievement. 

If communication fails, does not exist or is erroneous, the factors associated with it, such as the correct understanding of the project, can be compromised. 

In addition to presenting their impressions and views, learners must be able to listen to the opinions of others. 

Boosts collaborative and teamwork skills

Collaborative and teamwork skills are directly related to communication and engagement, and help the learner develop relationships that are key to their academic and personal growth.

These collaborative skills end up extending and creating a development of peers, professional networks and members of the industry. 

Reinforces creativity

Students enrolled in project-based learning programs are more predisposed to think innovatively and creatively. 

This is logical when you consider that they have total freedom to explore different approaches and methods, as well as being an excellent opportunity to express their personality and talent through their work. 

Enhances critical thinking and problem solving skills 

This benefit makes sense, since the student is confronted with the pragmatic resolution of problems that are not solved in textbooks. 

We are not talking about a traditional study, in this case thinking beyond the established and collected is the key to move the project forward. 

10 ideas for project-based learning

There is a multitude of options that fit in the project-based learning, so we will use a battery of 10 ideas so that from them you can think of a better development of those mentioned or so that having these references you can think of your own. 

• Design of a community garden. 
• Create prototypes of accessories for existing machinery. 
• Innovate recipes based on new cooking techniques.
• Design food programs for people with specific health problems.  
• Simulate trials on specific causes. 
• Create sustainable city plans. 
• Research new technological applications based on renewable energies. 
• Create interactive digital maps of specific regions. 
• Research specific artistic movements and create their own works inspired by these movements.
• Create reports with different statistics to identify patterns of behavior after analyzing the data. After that, develop strategies for prevention or problem solving. 

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Exploring student perceptions of problem-based learning and clinical field experiences: a phenomenological study.

Ashley Michelle Boles , Liberty University Follow

School of Education

Doctor of Philosophy in Education (PhD)

Mary Strickland

problem-based learning, medical education, higher-order thinking and processing, critical thinking, clinical reasoning, problem-solving, clinical field experiences

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Education | Medicine and Health Sciences

Recommended Citation

Boles, Ashley Michelle, "Exploring Student Perceptions of Problem-Based Learning and Clinical Field Experiences: A Phenomenological Study" (2024). Doctoral Dissertations and Projects . 5866. https://digitalcommons.liberty.edu/doctoral/5866

The purpose of this phenomenological study is to understand the experiences of participating in a physical therapy course primarily taught using problem-based learning teaching methods for Doctor of Physical Therapy students at a university in the mid-western United States. This study aimed to understand student perception of PBL and its effects on clinical field experiences (CFEs), specifically related to higher-order processing skills. The theory guiding this study was the social constructivism theory as it explains how knowledge acquisition and learning occurs through social interactions during problem-based learning activities. The central research question this study attempted to answer was: What were the experiences of DPT students who participate in a PBL education? This study design was a qualitative, hermeneutic phenomenological study. Convenience sampling was done from a pool of DPT students at a university in the midwestern United States. Data collection methods included journal prompts, individual interviews, and focus groups. Data analysis was based on van Manen’s data analysis methods. Findings reveal DPT students preferred PBL over traditional teaching methods and felt the use of PBL improved their higher-order thinking and processing skills. Participants felt that PBL teaching methods were conducive to their learning as the method allowed for real-time feedback and a perception of better content retention. DPT students also felt that using PBL teaching methods improved their ability to prioritize and funnel information to organize information in a way conducive to developing a solution to the problem. Participants felt that the problem-solving, critical thinking, and clinical reasoning they developed during the therapeutic exercise course did carry over into their ability to apply these higher-order thinking and processing skills during CFEs.

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Please note you do not have access to teaching notes, offline vs online problem-based learning: a case study of student engagement and learning outcomes.

Interactive Technology and Smart Education

ISSN : 1741-5659

Article publication date: 10 January 2022

Issue publication date: 2 February 2023

Furthermore, the purpose of this study is to compare the student engagement and the learning outcomes in offline and online PBL in the aforementioned course. The COVID-19 pandemic has caused disruption in various sectors, including education. Since it was first announced in mid-March 2020 in Indonesia, teaching and learning activities have been carried out online. In this study, a comparison of the offline (Spring 2019, prior to the pandemic) and online (Spring 2021, during the pandemic) problem-based learning (PBL) method in the sustainable chemical industry course is investigated.

Design/methodology/approach

A quantitative analysis was conducted by measuring the students’ engagement, course-learning outcomes (CLOs) and student learning outcomes (SLOs). Difference tests of engagement score, CLOs and SLOs were investigated by using the t -test or Mann–Whitney U -test. Furthermore, the perceived students’ stressors were measured.

It is found that the students’ engagement in offline and online PBL gives similar scores with no significant difference. This is possible because of the PBL structure that demands students to be actively engaged in gaining knowledge, collaboratively working in teams and interacting with other students and lecturers. Although similarly engaged, the CLOs and SLOs of online PBL are significantly lower than offline PBL, except for SLO related to oral and written communication skills and affective aspect. The decrease in CLOs and SLOs could be influenced by students’ academic, psychological and health-related stressors during the COVID-19 pandemic time.

Originality/value

This study provides a recommendation to apply online PBL during the COVID-19 pandemic time and beyond, although some efforts to improve CLOs and SLOs are needed.

• Distance learning
• Higher education
• Teaching methods
• Learning methods

Acknowledgements

This study is supported by a research grant from Parahyangan Catholic University’s Centre of Research and Community Service (No. III/LPPM/2021–07/143-PDM). The authors would also like to thank Dr Johanna R. Octavia for her input and discussion during the manuscript preparation.

Kristianto, H. and Gandajaya, L. (2023), "Offline vs online problem-based learning: a case study of student engagement and learning outcomes", Interactive Technology and Smart Education , Vol. 20 No. 1, pp. 106-121. https://doi.org/10.1108/ITSE-09-2021-0166

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• Published: 08 August 2024

Drug repositioning based on residual attention network and free multiscale adversarial training

• Guanghui Li 1 ,
• Shuwen Li 1 ,
• Cheng Liang 2 ,
• Qiu Xiao 3 &
• Jiawei Luo 4  

BMC Bioinformatics volume  25 , Article number:  261 ( 2024 ) Cite this article

35 Accesses

Metrics details

Conducting traditional wet experiments to guide drug development is an expensive, time-consuming and risky process. Analyzing drug function and repositioning plays a key role in identifying new therapeutic potential of approved drugs and discovering therapeutic approaches for untreated diseases. Exploring drug-disease associations has far-reaching implications for identifying disease pathogenesis and treatment. However, reliable detection of drug-disease relationships via traditional methods is costly and slow. Therefore, investigations into computational methods for predicting drug-disease associations are currently needed.

This paper presents a novel drug-disease association prediction method, RAFGAE. First, RAFGAE integrates known associations between diseases and drugs into a bipartite network. Second, RAFGAE designs the Re_GAT framework, which includes multilayer graph attention networks (GATs) and two residual networks. The multilayer GATs are utilized for learning the node embeddings, which is achieved by aggregating information from multihop neighbors. The two residual networks are used to alleviate the deep network oversmoothing problem, and an attention mechanism is introduced to combine the node embeddings from different attention layers. Third, two graph autoencoders (GAEs) with collaborative training are constructed to simulate label propagation to predict potential associations. On this basis, free multiscale adversarial training (FMAT) is introduced. FMAT enhances node feature quality through small gradient adversarial perturbation iterations, improving the prediction performance. Finally, tenfold cross-validations on two benchmark datasets show that RAFGAE outperforms current methods. In addition, case studies have confirmed that RAFGAE can detect novel drug-disease associations.

Conclusions

The comprehensive experimental results validate the utility and accuracy of RAFGAE. We believe that this method may serve as an excellent predictor for identifying unobserved disease-drug associations.

Peer Review reports

Drugs play important roles in treating diseases and promoting the health of organisms [ 1 ]. However, traditional drug development is an extremely lengthy and expensive process [ 2 ]. Recent studies have estimated that the average development cost to approve a new drug is $2.6 billion and the average development time is 10 years [ 3 ]. Drug repositioning, which involves discovering new therapeutic outcomes for previously approved drugs, is considered an important alternative to traditional drug development [ 4 , 5 , 6 , 7 , 8 ]. This approach shortens drug development and research cycles to 7 years, reduces costs to $295 million, and is more reliable than novel drug development [ 9 ]. Therefore, using known drugs for new disease treatments is gaining popularity [ 10 , 11 ]. Traditional methods of discovering abnormal clinical manifestations through manual screening of clinical drug databases requires extensive experimentation. With the continuous accumulation of a wide variety of biological data, numerous computational methods based on data mining techniques have gained traction [ 12 ].

Matrix factorization aims to approximate the initial matrix by decomposing it into the product of two low-rank matrices, which are represented by hidden factor vectors in the k -dimension. The inner product of the drug and disease vectors represents the association between them. Previous studies have shown that matrix decomposition methods are effective computational methods for drug-disease association prediction [ 13 , 14 , 15 , 16 , 17 ]. For example, the similarity constrained matrix factorization method for the drug-disease association prediction (SCMFDD) method, proposed by Zhang et al., maps the associations between diseases and drugs into two low-ranking spaces and reveals the basic features. Then, drug similarity and disease similarity are introduced as increasing constraints [ 18 ]. Furthermore, Yang et al. proposed the multisimilarities bilinear matrix factorization (MSBMF) approach, which connects multiple disease and drug similarity matrices and extracts the effective latent features in the similarity matrix to infer associations between diseases and drugs [ 19 ]. In addition, Zhang et al. proposed a new drug repositioning method by using Bayesian inductive matrix completion (DRIMC), which uses the complement of Bayesian inductive matrices. This method integrates multiple similarities into a fused similarity matrix, where similarity information is described by similarity values between a drug or disease and its k -nearest neighbors. Finally, the disease-drug association is predicted via induction matrix completion [ 20 ].

Networks can represent the complex relationships among entities, and the methods used to construct biological networks can effectively utilize information from multiple biological entities to represent the degree of association between them [ 21 ]. The network-based method has produced good results in drug repositioning [ 22 , 23 , 24 ]. For instance, Zhao et al. first constructed a heterogeneous information network by combining drug-disease, protein-disease and drug-protein bioinformatics networks with disease and drug biology information. Then, the combined features of the nodes were learned from a biological and topological perspective via different representations. Moreover, random forest classifiers can be used to predict unknown associations [ 25 ]. Zhang et al. proposed a multiscale neighborhood topology learning method for drug repositioning (MTRD) to learn and integrate multiscale neighborhood topologies. This method involves the construction of different drug-disease heterogeneous networks to discover new drug-disease associations [ 26 ]. In addition, Luo et al. proposed a method named MBiRW that uses similarity matrices and known associations to construct heterogeneous networks and predicts unknown associations via the double random walk algorithm [ 27 ].

Although matrix factorization methods achieve good performance, they are weak in the interpretability of associations between diseases and drugs, whereas network methods are biased in representing higher-order networks. To solve these problems, several pioneering studies have focused on developing deep learning-based drug repositioning models [ 28 , 29 , 30 , 31 , 32 , 33 ]. For example, Zeng et al. first integrated multiple disease-drug biological networks and designed a multimodal deep autoencoder named deep learning-based drug repositioning (deepDR) for learning higher order neighborhood information of drug-disease associations [ 34 ]. Subsequently, Yu et al. constructed a graph convolutional network (GCN) architecture with attention mechanisms, i.e., the label-aware GCN (LAGCN). First, this method uses known drug-disease associations, disease-disease similarities and drug-drug similarities to construct heterogeneous networks and applies GCNs to the network. Next, the embeddings from multiple GCN layers are integrated via layer attention mechanisms. Finally, drug-disease pairs are scored on the basis of the integrated embeddings [ 35 ]. Feng et al. proposed Protein And Drug Molecule interaction prEdiction (PADME), a novel method to combine molecular GCNs for compound featurization with protein descriptors for drug-target interaction prediction [ 36 ]. Moreover, Meng et al. proposed a drug repositioning approach based on weighted bilinear neural collaborative filtering (DRWBNCF) on the basis of neighborhood interaction and collaborative filtering. Instead of using all neighbors, this method uses only the nearest neighbors, thus filtering out noise and yielding more precise results [ 37 ]. Recently, Gu et al. proposed a method named relations-enhanced drug-disease association (REDDA) for learning node features of heterogeneous networks and topological subnetworks. This method employs heterogeneous networks as the backbone and combines the backbone with three attention mechanisms [ 38 ]. Deep learning-based methods mainly construct heterogeneous networks by using supplementary information about diseases and drugs and learn the features of diseases and drugs by applying deep learning algorithms to these networks.

However, these deep learning-based approaches tend to have oversmoothing problems caused by the homogenization of node embeddings and are highly dependent on the input quality. In this paper, we present a novel method of drug repositioning named RAFGAE. This method combines residual networks, graph attention networks (GATs), graph autoencoders (GAEs) and adversarial training to predict unknown associations between diseases and drugs. First, we use disease semantic similarity, drug structural similarity and disease-drug associations to construct the initial input features. GATs are used to facilitate the learning of disease and drug embeddings in each layer and combine the embedding of different layers via attention mechanisms. Moreover, the initial residual and adaptive residual connections are adopted to alleviate the oversmoothing problem. Then, two GAEs are constructed on the basis of the disease space and drug space, and the information in these spaces can be integrated through synergistic training. Finally, the scores of the two GAEs are linearly combined by a balancing parameter to calculate the final prediction scores. On this basis, adversarial training is introduced to reduce invalid information and data noise, improving the input quality. The main contributions of RAFGAE can be summarized as follows:

RAFGAE is a complete deep learning approach that can effectively predict the associations between diseases and drugs.

RAFGAE designs the Re_GAT framework, which includes multilayer GATs and two residual networks. Multilayer GATs are utilized to learn the node embeddings by aggregating information from multihop neighbors, and two residual networks are used to alleviate the deep network oversmoothing problem. Then, an attention mechanism is introduced to combine the node embeddings of different attention layers.

RAFGAE performs adversarial training that may eliminate abnormal values, missing values and noise, increasing the input quality and prediction accuracy when extracting associations between diseases and drugs.

Our comprehensive experimental results demonstrate that the proposed RAFGAE method significantly outperforms five state-of-the-art methods on the benchmark dataset.

Results and discussion

Algorithm performance comparison.

To verify the performance of RAFGAE, we compare it with five recently proposed methods.

DRWBNCF [ 37 ], a method for drug repositioning on the basis of neighborhood interaction and collaborative filtering, uses only the nearest neighbors, rather than all neighbors, to filter out noisy information. A new weighted bilinear GCN encoder is then proposed.

LAGCN [ 35 ], a layer attention GCN method for drug repositioning, encodes a heterogeneous network combining known drug-disease associations, disease similarity and drug similarity information. To integrate all useful information, a layer attention mechanism is introduced into multiple GCN layers.

In bounded nuclear norm regularization (BNNR) [ 39 ], a heterogeneous network is constructed. This network combines known drug-disease associations, disease similarity and drug similarity information. The method tolerates noise by adding a regularization term to balance the rank properties and approximation error.

The neural inductive matrix completion with GCN (NIMCGCN) method [ 40 ], a method for the prediction of miRNA-disease associations) first employs GCN to learn the features of diseases and miRNAs from the disease and miRNA similarity networks. Then, neural induction matrix completion is applied for association matrix completion.

SCMFDD [ 18 ] (a similarity constraint matrix completion method for the prediction of drug-disease associations) projects known drug-disease association information into two low-rank spaces, revealing potential disease and drug embeddings, and then introduces drug featured-based and disease semantic similarities as constraints for drugs and diseases in the low-rank spaces.

The above methods also involve similarity-based graph neural network models. The parameters in these methods are set to either the optimal values via a grid search (for DRWBNCF, λ is selected from {0.1, 0.2, ..., 0.9}; for BNNR, α and β are chosen from {0.01, 0.1, 1, 10}; and for SCMFDD, k is selected from{5%, 10%, ..., 50%}) or the values recommended by the authors (for LAGCN, α = 4000, β =0.6, and γ = 0.4; and for NIMCGCN, α = 0.4, l = 3, and t = 2). Furthermore, to ensure a meaningful and relevant comparison, each of the comparison methods is initially evaluated via the same 10-fold cross-validation approach and on the same benchmarking sets as those for our proposed method, RAFGAE. This approach allows us to conduct a comprehensive and rigorous assessment of the performance of all the methods.

The area under the curve (AUC) values in Fig. 1 and Table 1 show a comparison of the model performance. On the F-dataset, RAFGAE achieves the highest AUC score of 0.9343, which is 7.28%, 4.50%, 3.13%, 4.31%, and 4.01% higher than those of SCMFDD, LAGCN, BNNR, NIMGCN, and DRWBNCF, respectively. Similarly, on the C-dataset, RAFGAE achieves the highest AUC score of 0.9346. By comparing the model proposed in this paper with other models, it is evident that introducing residual connections and adversarial training can enhance the predictive performance of our model. Overall, the above experiments show that RAFGAE is an excellent predictor of disease-drug relationships.

ROC curves and PR curves of RAFGAE and other models on the F-dataset

Ablation study

To quantitatively evaluate the importance of the two modules (the Re_GAT framework and the FMAT module) to RAFGAE, ablation experiments are conducted. The details of these variants of RAFGAE are listed below:

RAFGAE: The comprehensive RAFGAE framework consists of three main components: the Re_GAT framework, the FMAT module, and the GAE module.

GAE: The RAFGAE variant that includes only the GAE module.

FGAE: The RAFGAE variant that includes the FMAT and GAE modules but excludes the Re_GAT framework.

RAGAE: The RAFGAE variant that includes Re_GAT framework and the GAE module but excludes the FMAT module.

According to Fig.  2 and Table  2 , it is clear that RAFGAE achieved the highest AUC and area under the precision–recall (AUPR) curve values on both the F-dataset and the C-dataset. The RAGAE and FGAE results show the impacts of global neighborhood node information aggregation and adversarial feature enhancement on the RAFGAE performance, respectively. In addition, the GAE results demonstrate that combining the Re_GAT framework and the FMAT module can improve the predictive performance of the RAFGAE model. In comparing FGAE and RAGAE to GAE, the performance results imply that both the Re_GAT framework and the FMAT module can improve the model performance. The poor performance of GAE suggests that the use of multilayer attention networks to aggregate global information and the incorporation of residual architectures to address the potential oversmoothing problem can enhance the accuracy of drug-disease association prediction. Furthermore, the results indicate that the inclusion of the adversarial training module improves the input quality, thereby satisfying the requirements of deep neural networks for high-quality input features. These results demonstrate that the RAFGAE structure is reasonable.

Results of RAFGAE and its variants in the ablation study on the F-dataset

Performance evaluation

To assess the effectiveness of RAFGAE in predicting known associations, tenfold cross validation (CV) is applied. In tenfold CV, the dataset is divided into ten folds. Nine folds are used as the training set, and the remaining fold is used to validate the performance of RAFGAE. This process is repeated 10 times, with each fold used as the testing fold once. Several important indicators are used to evaluate the performance of RAFGAE. The receiver operating characteristic (ROC) curve, which is based on the false-positive rate (FPR) and the true positive rate (TPR), is utilized. As the benchmark datasets used in this experiment are imbalanced, we also use the PR curve and calculate the area under the PR curve (AUPR) as two additional indicators. To further evaluate the overall performance of the prediction model from multiple perspectives, the F1 score and the Mathews correlation coefficient (MCC) are calculated.

The ROC and PR curves for the F-dataset are shown in Fig.  3 . RAFGAE achieves mean AUC and AUPR values of 0.9343 and 0.5270, respectively. The detailed results, including the F1-score and MCC, are presented in Table  3 . The results based on the C-dataset are shown in Table  4 . As shown in Tables 1 and 2 , the newly proposed RAFGAE model obtains good performance on the above two datasets, proving the effectiveness and robustness of this model.

RAFGAE ROC and PR curves via tenfold CV on the F-dataset

Parameter adjustment

Since the hyperparameter settings can influence the performance of RAFGAE, we used tenfold CV on the F-dataset to analyze the impact of different parameter settings. In the Re_GAT framework, the weight α of the initial residual connection and the weight β of the adaptive residual connection can directly affect the result of feature fusion. To fully integrate adjacent node information and mitigate the oversmoothing problem, we adjust the α and β values within the following range: α ϵ {0.1 ~ 0.9} and β ϵ {0.1 ~ 0.9}. As shown in Fig.  4 , when α  = 0.3 and β  = 0.7, the AUC reaches its maximum value.

Effect of the α and β parameters on the AUC of RAFGAE

In addition, the features of diseases and drugs are extracted via GATs. The Re_GAT framework computes and aggregates different multilayer features via the GAT. We discuss the impact of GATs with different numbers of layers on association prediction. Figure  5 presents the results of the ROC curve analysis on the basis of tenfold CV.

Effect of the number of GAT layers on the AUC of RAFGAE

To optimize the initial parameters, we use the Adam optimizer [ 41 ]. As in previous studies [ 42 , 43 ], we set the dropout and weight decay parameters to 0.5 and 10 –5 , respectively. We also evaluate the model performance by changing the dimensions of the GAE hidden layers. With the other parameters unchanged, the AUC value of RAFGAE generally increases as the embedding dimension of the GAE hidden layer increase and tends to stabilize when the dimension reaches 256. Finally, we set the embedding dimension of the hidden layer to 256. These results are shown in Fig.  6 .

Effect of the hidden vector dimension on the AUC of RAFGAE

Case studies

To evaluate the practical ability of RAFGAE to predict unknown indications of approved drugs as well as new therapies for existing diseases, we train the RAFGAE model using all known associations as training data, and predict potential associations for known diseases or drugs. The predicted ranking of unknown indications of approved drugs and unknown therapies for existing diseases is validated on the public database, namely, the Comparative Toxicogenomics Database (CTD) [ 44 ].

To assess the ability of RAFGAE to discover new indications, we select two representative medicinal products. Table 5 shows the confirmation information for the top 10 candidate diseases and the known drug-disease associations. Among them, doxorubicin is a cytotoxic anthracycline antibiotic that is widely used to treat various cancers, including Kaposi sarcoma and metastatic cancer related to AIDS. Of the top 10 positive predictions, there were 7 tumor-related diseases that have been verified via reliable databases. Levodopa is a precursor of dopamine and is commonly used in the treatment of Parkinson's syndrome and Parkinson's syndrome-related disorders because of its ability to cross the blood–brain barrier. As shown in Table  5 , reliable sources have identified 7 of the top 10 associated diseases. This evidence suggests that RAFGAE can be trained on and can learn from existing biological information and can identify association markers that are not captured in the training set.

To validate the practical ability of RAFGAE to discover novel therapies, we select breast neoplasms and small-cell lung cancer as experimental cases. On the basis of the RAFGAE prediction results, the 10 drugs with the highest prediction scores are validated via the CTD. Table 6 shows similar results for the top 10 positive predictions. Breast neoplasms are among the most common malignancies in women and the leading cause of cancer-related disease in women. As shown in Table  6 , 9 of the top 10 drugs were verified via reliable sources. The high incidence rate and high mortality of small cell lung cancer worldwide make this complex tumor a difficult medical problem. In summary, 6 drugs have been confirmed by evidence from authoritative sources among the top 10 predicted drugs ranked by prediction score. In summary, case studies have shown that RAFGAE can identify the associations between diseases and drugs that are unknown in training datasets but that have been validated in real-world studies. Moreover, RAFGAE can make reliable predictions regarding unconfirmed potential associations between diseases and drugs. Therefore, RAFGAE has a noteworthy ability to uncover novel therapies/indications for existing diseases/drugs.

In this paper, a deep-learning methodology named RAFGAE is developed for elucidating drug-disease associations. The key innovation of RAFGAE is that it combines the Re_GAT framework and the FMAT algorithm, facilitating the learning of neighbor node information and enhancing the initial node features in the disease-drug bipartite network. Then, two GAEs with collaborative training are applied to integrate the disease and drug spaces for association prediction. Notably, unlike some previous predictors that consider only low-order neighbor information, the Re_GAT framework can account for both high-order and low-order neighbor information by using multilayer GATs. Moreover, residual networks are introduced to mitigate model data oversmoothing, enabling the full employment of graph structure information hidden in the bipartite network. To enhance the initial features of nodes and make the model more robust, the FMAT algorithm is employed. This algorithm adds gradient-based adversarial perturbation to the input characteristics. In addition, we construct two GAEs with collaborative training for label propagation, enabling the full integration of the drug and disease space information for association prediction and improving the robustness of the RAFGAE model.

With tenfold CV, the RAFGAE model achieves an AUC score of 0.9343, which is better than the AUC scores of five state-of-the-art predictors. Furthermore, the case study results show that RAFGAE can reposition several representative drugs for human diseases and can be applied as a reasonable and effective tool for predicting the relationships between diseases and drugs.

We propose a computational drug repurposing method. This method can effectively identify candidate drugs with potential for treating different diseases and has the potential to uncover new indications for approved drugs that were previously unexplored. RAFGAE can guide wet laboratory experiments, accelerating drug development, reducing costs, and expanding treatment options. The method combines multilayer neural networks with residual connections to capture global information and alleviate oversmoothing problems. We also employ adversarial perturbations to improve the input quality. This novel combination of techniques provides a new perspective for future research and can also serve as a valuable reference for similar studies, such as predicting the associations between ncRNAs and diseases, microbiome-disease associations, and screening ncRNA drug targets.

However, RAFGAE has certain limitations. In this study, the negative and positive samples of the benchmark dataset are unbalanced, and we use all the negative samples as negative samples for training the proposed model. However, these unknown samples considered negative samples may be potential correlations, which greatly impacts the prediction accuracy of the model. In the future, we will select negative samples to further improve the model accuracy. In terms of biological data, we simply apply the interaction network between drugs and diseases without establishing a more informative biological regulatory network, which may further improve performance. In future research, we will introduce other biological entities, such as proteins, pathways, and genes. In scenarios where drugs share the same or similar indications but lack structural similarity, the transmission of structural similarity information through a multilayer neural network can give rise to an "information leakage" problem, leading to a distorted view of the algorithm's performance in realistic drug repurposing settings. In our future research, we plan to address the problem of information leakage further by incorporating multiple drug similarities, such as target protein domain similarity, GO target protein annotation similarity, side effect similarity, and GIP similarity. This broader range of drug similarities can provide a more comprehensive features for drug repurposing. Similarly, incorporating disease similarities, such as disease ontology similarity, can help improve the accuracy and reliability of repositioning predictions by leveraging additional disease-related information.

Data preparation

We employ two benchmark datasets established by investigators. The first dataset is the F-dataset, which corresponds to Gottlieb's gold standard dataset [ 45 ]. The F-dataset contains 1933 known associations between diseases and drugs, including 313 diseases collected from the OMIM database [ 46 ] and 593 drugs obtained from the DrugBank database [ 47 ]. The second dataset is the C-dataset [ 24 ], which includes 2532 known associations between 409 diseases collected from the OMIM database and 663 drugs obtained from the DrugBank database. Table 7 summarizes the benchmark datasets in our proposal.

In this study, we calculated the drug structure similarity matrix X dr via the simplified molecular input line entry system (SMILES) chemical structure [ 48 ], which is represented as the Tanimoto index of chemical fingerprints of the drug pair via the Chemical Development Kit [ 49 ]. The disease semantic similarity matrix X di is computed from the semantic similarity of the disease phenotypes via information from the medical descriptions of the disease pairs [ 50 ].

After collecting the required data from different sources, we propose a prediction model with three individual modules to predict potential candidate diseases for drugs of interest. We first design the Re_GAT framework, which captures global structural information from a bipartite network. For the second module, we employ GAEs that use known associations between diseases and drugs to simulate label propagation to guide and predict unknown associations. On the basis of the above, we utilize the FMAT module for adversarial training to improve the input quality and increase the prediction accuracy. Figure  7 shows the overall workflow of RAFGAE.

Flow chart of the RAFGAE calculation method

Re_GAT framework

Graph attention networks use a self-attention hidden layer to assign different attention scores to different neighbors, thus extracting the features of neighboring nodes more effectively.

The initial input to the Re_GAT framework can be described as follows:

where N represents the node count, F represents the dimension of the feature and h i ϵ R F represents the initial feature matrix of all the nodes. GATs calculate attention scores on the basis of the importance of neighbors and then aggregate neighbor features on the basis of the attention score.

The attention score is calculated as follows:

To adjust for the influence of different nodes, we use the softmax function for attention score normalization score:

By combining Formulas ( 3 ) and ( 4 ), the calculation formula for the attention score can be expressed as:

where a ij is the attention score, W is a learnable linear transformation matrix, a vector denotes the weight vector, σ () represents the LeakyReLU activation function, and ║ denotes the connection operation. After normalization, the following formula can be used to calculate the final output feature:

In this study, the drug-disease association matrix is given by matrix A , where the columns represent diseases and the rows represent drugs. The matrix A ( j , k ) = 1 if drug j is associated with disease k and 0 otherwise. Matrix A and its transposition matrix A T define the bipartite network G :

We create the initial input embedding H (0) as follows:

When combined with the bipartite network adjacency matrix G above, the graph attention network is defined as:

where H ( l ) represents the node embedding of the l -th layer, where l  = 1, …, L , and GATs () represents a single attention layer, whereas the entire Re_GAT framework consists of multiple attention layers.

This study proposes a Re_GAT framework through two main strategies for forward propagation: (I) initial residual connection and adaptive residual connection; and (II) attention mechanism layer aggregation.

To facilitate the learning of feature information from higher-order neighbors, multiple attention layers are typically used, easily homogenizing the data and thus leading to oversmoothing problems. To alleviate the oversmoothing problem of deep CNNs, residual connections, also known as skip connections was first proposed for ResNet. Inspired by ResNet [ 51 ], recent studies have attempted to apply various residual connections to GATs to alleviate the oversmoothing problem. Several studies have shown that residual connections are necessary for deep GATs [ 52 ], not only to alleviate the oversmoothing problem, but also to give GATs a more stable gradient.

We sum the H ( l ) weights with H (0) and H ( l− 1) according to the scale coefficients α and β , respectively. We use the initial skip connection and the adaptive skip connection to mitigate the oversmoothing problem and accelerate the convergence of the GATs. The GAT formula of our model can be rewritten as:

where α and β are hyperparameters.

Inspired by LAGCN [ 35 ], the embedding of each layer captures structural information from different orders of the heterogeneous network. For instance, the initial layer obtains direct connection information, whereas the higher-order layers collect information about multihop neighbors through iterative update embedding. To fuse all useful information from multiple GAT layers, we use the attention mechanism. Since the Re_GAT framework calculates the embedding of different layers and the embeddings contain different information, we define the resulting GAT layer embedding as:

where Hdr l ϵ R Ndr × kl is the embedding of the drug in layer l and Hdi l ϵ R Ndi × kl is the embedding of the disease in layer l . We use attention mechanism layer aggregation to integrate multiple embedding matrices, and the final fused embedding matrix is as follows:

where, Hdr i and Hdi i are the l -layer embeddings of drugs and diseases, respectively, a i and b i are the attention factors that can be calculated via Formulas ( 2 ), ( 3 ) and ( 4 ), and L is the number of layers.

Constructing the feature similarity graph

A previous study showed that a similarity graph constructed using drug and disease features can be used to propagate labels [ 53 ]. We use the features C dr and C di to construct feature similarity graphs for diseases and drugs, respectively. These features are used for label propagation in the disease and drug spaces. The feature similarity graphs are constructed as follows. First, the Euclidean distance between nodes is calculated and ranked. Second, for each node i , its 10 nearest neighbors are selected. Finally, the adjacency matrix is defined as M , and the set of neighbors of node i is defined as N ( i ). The matrix M satisfies M ij  = 1 when j belongs to N ( i ); otherwise, M ij  = 0.

The self-loop adjacency matrix for the similarity graph S is constructed as follows:

where ⊙ is the Hadamard product. This method can be used to obtain both the drug similarity graph S dr and the disease similarity graph S di .

• Graph autoencoder

Previous studies have shown that the graph autoencoder may simulate label propagation by iteratively propagating label information on the graph [ 54 , 55 , 56 ]. The association matrix A can be considered initial label information. The initial label information and the similarity graph S calculated via the above method are input to the GAE. The encoder layer produces a hidden layer Z , whereas the decoder outputs the score F . The encoder of the GAE can be defined as:

where Φ denotes the weight matrix. Here, we use two GAEs to propagate label information on the drug and disease graphs. We can obtain the drug hidden layer Z dr and the disease hidden layer Z di , which are expressed as follows:

where S dr and S di denote the drug similarity graph and the disease similarity graph, respectively, and A denotes the association matrix.

The decoder of the GAE is applied to decode the hidden layer representation, which is defined as follows:

Therefore, the score matrices F dr and F di can be obtained by decoding Z dr and Z di , respectively.

Since F dr and F di are both low rank matrices [ 57 ], they need to satisfy the rank-sum inequality:

By performing a linear combination of F dr and F di , the final integrated score is obtained as follows:

where α ϵ (0,1) represents the balanced weight between the drug space and the disease space.

The GAE reconstruction error is the loss of cross-entropy between the final prediction and the true value:

As the information from the disease space and the drug space influences the predicted outcome, we use a cotraining approach to train the above two GAEs. The cotraining training loss L co is defined as:

The combined loss function can be rewritten as:

where L rdr and L rdi denote the reconstruction errors of the two GAEs in the drug space and the disease space, respectively.

Free multiscale adversarial training

In this section, we investigate how to effectively improve the input quality through data augmentation [ 58 ]. When neural networks are trained, the quality of the data is far more important than the quantity. By searching for and stamping out small perturbations that cause the classifier to fail, one may hope that adversarial training could benefit standard accuracy. Adversarial training is a well-studied method that increases the robustness and interpretability of neural networks. When the data distribution is sparse and discrete, the beneficial effect of adversarial perturbations on generalizability is prominent [ 59 ]. Inspired by this, we introduce free multiscale adversarial training (FMAT) to augment the node features [ 60 ].

Adversarial training first generates adversarial perturbations, which are then integrated into the training node features. Given a learning model f θ with parameters θ , we denote the perturbed feature as H adv  =  H  +  δ . Adversarial learning follows the min–max formulation:

where A represents the real value, D represents the data distribution, L represents the objective loss function, ε represents the perturbation budget, and ║║ p represents an l p -norm distance measure.

The saddle-point optimization problem can be solved via projected gradient descent (PGD), which implements inner maximization, and stochastic gradient descent (SGD), which implements outer minimization. The parameter δ is updated after each step:

where ∏ ║δ║≤ε is projected onto the ε -sphere under the l ∞ -norm . The initial layer of the Re_GAT framework can be rewritten as:

To effectively exploit the generalizability of adversarial perturbations and improve their diversity and quality, Chen et al. emphasized the importance of adapting to different types of data enhancements [ 61 ]. To achieve this, we introduce a 'free' training approach [ 62 ].

The calculation of δ is inefficient because the N -step update requires N forward and backward channels. This update runs N times completely forward and backward to obtain the worst perturbation δ N . However, the model weight θ is updated once to use only δ N . Model training is N times slower because of this process. In contrast, the 'free' training outputs the model weights θ on the same backward channel while calculating the δ gradient, allowing model weight updates to be calculated in parallel with perturbation updates.

'Free' training has the same robustness and accuracy as standard adversarial training does. However, the training costs are the same as those of clean training. The 'free' strategy accumulates a gradient of \(\nabla_{\theta } L\) in each iteration and updates the model weight θ through this gradient. During training process, the model runs the inner circle T times, each time calculating the gradient of θ t -1 and δ t by taking a step along the average gradient at H ( l )  +  δ 0 , …, H ( l )  +  δ T- 1 . Formally, the optimization step is

Availability of data and materials

We acquired the C-dataset of disease-drug associations, from the Comparative Toxicogenomics Database [ 44 ] ( http://ctdbase.org/ ). We screened the F-dataset of disease-drug interactions from the OMIM database [ 46 ] ( https://www.omim.org/ ) and DrugBank database [ 47 ] ( https://www.drugbank.ca/ ). These two datasets and the source code are available at: https://github.com/ghli16/RAFGAE .

Abbreviations

• Graph attention network

True positive rate

False-positive rate

Receiver operating characteristic

Area under ROC curve

Cross validation

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This work is supported by the National Natural Science Foundation of China (Grant Nos. 62362034, 61862025, 62372279, and 62002116), the Natural Science Foundation of Jiangxi Province (Grant Nos. 20232ACB202010, 20212BAB202009, 20181BAB211016), and the Natural Science Foundation of Shandong Province (Grant No. ZR2023MF119).

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GL and JL conceived and designed the study. GL and SL implemented the experiments and drafted the manuscript. CL and QX analyzed the results. All the authors have read and approved the final manuscript.

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Li, G., Li, S., Liang, C. et al. Drug repositioning based on residual attention network and free multiscale adversarial training. BMC Bioinformatics 25 , 261 (2024). https://doi.org/10.1186/s12859-024-05893-5

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