Effect of Integrated Lecture-, Case-, and Problem-Based Learning on Critical Thinking and Clinical Competence in Gastrointestinal Surgery Trainees: A Randomized Controlled Trial

Enhancing clinical thinking and competence is central to gastrointestinal surgical training. This study is aimed at evaluating the effectiveness of an integrated instructional model combining lecture-based learning (LBL), problem-based learning (PBL), and case-based learning (CBL) in gastrointestinal surgical training.

This prospective randomized controlled trial was conducted at the Affiliated Hospital of North Sichuan Medical College, China, from September to November 2024. A total of 120 gastrointestinal surgical trainees, including final-year medical interns and first-year surgical residents, were randomly assigned (1:1:1) to the LBL, PBL + CBL, or integrated LBL + PBL + CBL groups using a computer-generated sequence, with allocation concealed by an independent assistant. After completing an 8-week standardized curriculum delivered by the same teaching team, the following outcomes were assessed: critical thinking ability using the Chinese version of the California critical thinking disposition inventory (CTDI-CV); theoretical knowledge through written and oral examinations; learning efficiency (study time and task completion rate) and satisfaction; and clinical competence assessed via the miniclinical evaluation exercise (Mini-CEX). Data were analyzed using IBM SPSS Statistics with one-way analysis of variance, and statistical significance was set at p < 0.05.

The integrated LBL + PBL + CBL groups achieved the highest CTDI-CV total scores, theoretical knowledge performance, and Mini-CEX scores compared with the other groups (p < 0.05). Despite reporting the shortest weekly study time, the integrated group attained the highest task completion rate and learner satisfaction score (p < 0.05).

The integrated LBL + PBL + CBL approach enhances efficiency and is well-suited for advancing clinical competence in surgical training.

Chinese Clinical Trial Registry (ChiCTR2000041569).