Integrating iHEC into standardized residency training for chronic disease management: a structural equation analysis...

To evaluate the association between an Intelligent Hypertension Excellence Centers (iHEC)-integrated teaching model and multidimensional educational outcomes in standardized residency training, and to explore whether self-directed learning (SDL) mediates the association between digital health-enhanced training and educational performance.

A retrospective sequential cohort study was conducted among 245 resident physicians who completed a standardized 4-week hypertension rotation in the Department of Geriatric Cardiology between September 2022 and August 2024. Residents were assigned to a conventional ward-based teaching cohort (n = 118) or an iHEC-integrated teaching cohort (n = 127) according to rotation period. Both cohorts received identical curriculum requirements, faculty supervision, and assessment procedures. Educational outcomes included objective structured clinical examination (OSCE) performance, knowledge acquisition, SDL readiness, critical thinking disposition, and educational satisfaction. Structural equation modeling (SEM) with bias-corrected bootstrapping was performed to evaluate direct and indirect associations.

Baseline characteristics and educational assessments were comparable between cohorts. After adjustment for baseline performance, specialty, and calendar time, the iHEC cohort demonstrated higher post-rotation OSCE scores [adjusted mean difference (AMD) 6.85, 95% CI 5.12-8.58, p < 0.001], knowledge scores (AMD 5.42, 95% CI 3.84-7.00, p < 0.001), SDL scores (AMD 9.86, 95% CI 7.21-12.51, p < 0.001), and critical thinking scores (AMD 12.45, 95% CI 9.15-15.75, p < 0.001). The respecified SEM demonstrated good model fit (CFI = 0.962, TLI = 0.951, RMSEA = 0.052, SRMR = 0.038). The iHEC teaching model was positively associated with SDL (β = 0.68, p < 0.001) and educational performance (direct effect β = 0.36, p < 0.001). SDL showed a significant indirect association with educational performance (β = 0.38, 95% bootstrap CI 0.21-0.55), accounting for 51.4% of the total association.

The iHEC hypertension teaching model was associated with improved resident educational outcomes, with enhanced self-directed learning representing a potential explanatory pathway underlying these observed associations; prospective multicenter studies are needed to further evaluate causal relationships, long-term retention, and implementation feasibility.