Implementing a Three-Phase Four-Dimensional Blended Learning Model in Obstetrics and Gynecology Clinical Training: A Quasi-Experimental Study

A significant challenge in obstetrics and gynecology (OB/GYN) training is effective translation of theoretical knowledge into clinical competence. To address this gap, we developed and evaluated a structured "Three-Phase Four-Dimensional" (3P4D) blended learning model to enhance clinical skill acquisition among medical students during their obstetrics and gynecology clerkship.

A quasi-experimental design was adopted, as it allowed for rigorous comparison of educational interventions while accommodating the practical constraints of clinical rotation scheduling in a real-world teaching hospital. A total of 126 fifth-year clinical medical students undertaking their obstetrics and gynecology clerkship were enrolled. To ensure strict group size equality, we randomly assigned participants using block randomization with a fixed block size of 6. Within each block, a predetermined allocation ratio of 2:2:2 to the three groups was applied and randomly permuted via a computer-generated sequence, guaranteeing a final distribution of exactly 42 students per group: traditional lecture-based learning (LBL), online-intensive learning (OL), and the novel online-offline blended learning (OBL) group implementing the full 3P4D model. Outcome measures included Objective Structured Clinical Examination (OSCE), knowledge-based tests, procedural skill assessments, and a self-developed satisfaction questionnaire with established validity (content validity index>0.80; construct validity confirmed through exploratory factor analysis). Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Intergroup comparisons were performed using one-way ANOVA; where significant differences were detected, post-hoc pairwise comparisons were conducted using the Least Significant Difference (LSD) test.

The OBL group demonstrated significantly higher scores in OSCE (89.5±4.2 vs. 80.3±4.8 vs. 76.8±5.1, P<0.001), skill operation (90.2±4.0 vs. 81.0±5.5 vs. 78.5±6.0, P<0.001), and learner satisfaction (4.6±0.5 vs. 3.8±0.7 vs. 3.5±0.8, P<0.001) compared to OL and LBL groups, respectively. Knowledge scores showed no significant differences among the groups.

The 3P4D blended learning model effectively enhanced clinical skill acquisition and competency transformation among medical students during their OB/GYN clerkship, bridging the gap between theoretical knowledge and clinical practice.