Integrated PBL-CBL-CTTM Teaching to Enhance Clinical Self-Efficacy in Endocrine Critical Illness Among Internal Medicine Residents: An RCT

NCT07801170 | Completed

• 2 other identifiers: KYXM-202508-021AHWJ2025BAp20022
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial evaluates whether an integrated online-offline multimodal teaching approach combining Problem-Based Learning (PBL), Case-Based Learning (CBL), and Case Three-Dimensional Teaching Method (CTTM) improves clinical self-efficacy and hands-on proficiency in managing endocrine and metabolic critical illness among internal medicine residents, compared to traditional lecture-based learning (LBL). Ninety internal medicine residents on their first endocrine rotation will be randomly assigned in a 1:1:1 ratio to three groups: (1) Control group receiving traditional LBL alone; (2) Experimental group 1 receiving PBL plus LBL; (3) Experimental group 2 receiving the integrated PBL-CBL-CTTM closed-loop teaching program. All groups receive a standardized 12-hour curriculum on endocrine and metabolic critical illness, including diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, and refractory hypoglycemia. The primary outcome is the clinical skills assessment score (0-50 points). Secondary outcomes include theoretical examination scores, General Self-Efficacy Scale (GSES) scores, a self-developed Endocrine High-Risk Management Self-Efficacy Source Questionnaire (four dimensions based on Bandura's self-efficacy theory), teaching satisfaction, and semi-structured focus group interviews. The study was conducted from September 2025 to August 2026 at the Fourth Affiliated Hospital of Anhui Medical University, Chaohu, China. This study aims to establish an evidence-based, replicable teaching model that addresses the gap between theoretical knowledge and clinical confidence in managing endocrine emergencies among residents.

Conditions

Medical Education; Endocrine System Diseases; Critical Illness

Keywords

Problem-Based Learning; Case-Based Learning; Clinical Self-Efficacy; Internal Medicine Residents; Randomized Controlled Trial

Outcome Measures

Primary Outcomes (1)

• Clinical skills assessment score

  Assessed by group-blinded evaluators using a standardized clinical skills checklist immediately after the 12-hour intervention. Total score range: 0-50 points. Higher scores indicate better clinical proficiency in managing endocrine and metabolic critical illness.

  Immediately post-intervention (upon completion of the 12-hour curriculum)

Secondary Outcomes (5)

• Theoretical examination score

  Immediately post-intervention

• General Self-Efficacy Scale (GSES) score

  Baseline (pre-intervention) and immediately post-intervention

• Endocrine High-Risk Management Self-Efficacy Source Questionnaire score

  Baseline (pre-intervention) and immediately post-intervention

• Teaching satisfaction scale score

  Immediately post-intervention

• Focus group interview themes

  Within 1 week post-intervention

Study Arms (3)

Control Group (LBL Alone)

ACTIVE COMPARATOR

Received only in-person one-way didactic lectures (lecture-based learning, LBL) with self-directed review after class. No online discussions, ward-based training, CTTM resources, or post-class debriefing. Total 12-hour standardized curriculum on endocrine and metabolic critical illness. n=30.

Behavioral: Lecture-based learning (LBL)

Experimental Group 1 (PBL+LBL)

EXPERIMENTAL

Received pre-class online problem-based learning (PBL) via DingTalk (open-ended critical case questions, independent literature search, online group discussion) plus standardized in-person lectures (LBL), with self-directed review after class. No ward-based CTTM training or post-class debriefing. Total 12-hour standardized curriculum. n=30.

Behavioral: PBL plus LBL

Experimental Group 2 (Integrated PBL-CBL-CTTM)

EXPERIMENTAL

Received integrated closed-loop teaching: pre-class PBL (identical to experimental group 1) plus standardized in-person lectures plus post-class ward-based case-based learning (CBL) with attending-supervised hands-on critical case training, case three-dimensional teaching method (CTTM) resources, and post-class debriefing. Total 12-hour standardized curriculum. n=30.

Behavioral: Integrated PBL-CBL-CTTM

Interventions

Lecture-based learning (LBL) BEHAVIORAL

In-person one-way didactic lectures with self-directed review after class. Total 12-hour standardized curriculum on endocrine and metabolic critical illness, including diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, and refractory hypoglycemia.

Control Group (LBL Alone)

PBL plus LBL BEHAVIORAL

Pre-class online problem-based learning (PBL) via DingTalk (open-ended critical case questions, independent literature search, online group discussion) plus standardized in-person lectures (LBL), with self-directed review after class. Total 12-hour standardized curriculum.

Experimental Group 1 (PBL+LBL)

Integrated PBL-CBL-CTTM BEHAVIORAL

Integrated closed-loop teaching: pre-class online PBL (identical to experimental group 1) plus standardized in-person lectures plus post-class ward-based case-based learning (CBL) with attending-supervised hands-on critical case training, case three-dimensional teaching method (CTTM) resources, and post-class debriefing. Total 12-hour standardized curriculum.

Experimental Group 2 (Integrated PBL-CBL-CTTM)

Eligibility Criteria

• Age: 22 Years - 35 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Full-time internal medicine residents undergoing their first endocrine rotation at the Fourth Affiliated Hospital of Anhui Medical University
• No prior endocrine remedial training or advanced study experience
• No independent management experience with endocrine and metabolic critical cases
• Ability to complete all 12 hours of standardized curriculum and all post-intervention assessments
• Voluntary participation with written informed consent

You may not qualify if:

• Prior completion of an endocrine rotation or specialized endocrine training
• Prior independent management experience in diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, thyroid storm, or refractory hypoglycemia
• Inability to complete the full 12-hour teaching schedule due to clinical duties, leave, or rotation transfer
• Concurrent participation in other teaching intervention research projects
• Decline to provide written informed consent or withdrawal before randomization

Sponsors & Collaborators

• Chaohu Hospital of Anhui Medical University: lead

Study Sites (1)

The Fourth Affiliated Hospital of Anhui Medical University

Chaohu, Anhui, 238000, China

Location

MeSH Terms

Conditions

Endocrine System Diseases; Critical Illness

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Outcome assessors (theoretical exam graders and clinical skills evaluators) were blinded to group allocation. Participants and teaching faculty could not be blinded due to the inherent differences among the three teaching modalities.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Chief Physician, Department of Endocrinology

Study Record Dates

• First Submitted: August 28, 2026
• First Posted: September 3, 2026
• Study Start: September 1, 2025
• Primary Completion: August 28, 2026
• Study Completion: August 28, 2026
• Last Updated: September 3, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)