Abstract
BACKGROUND: In situ hybridization for Epstein-Barr virus-encoded small RNAs (EBERs-ISH) is a cornerstone of clinical pathology, essential for the diagnosis of EBV-associated diseases. However, traditional lecture-based learning (LBL) in EBERs-ISH instruction often emphasizes unidirectional knowledge transfer, which frequently results in diminished student engagement and inadequate practical troubleshooting skills. While problem-based learning (PBL) has demonstrated efficacy in enhancing clinical competencies within medical education, its application in EBERs-ISH training remains underexplored. This study aimed to evaluate the impact of PBL on the practical proficiency of pathology students regarding EBERs-ISH techniques. METHODS: This study involved postgraduate students majoring in Pathophysiology at The First Affiliated Hospital, College of Medicine, Zhejiang University. Participants were allocated into two cohorts: a control group (n = 32) receiving LBL and an experimental group (n = 29) engaging in a PBL curriculum. Both cohorts underwent a foundational training session on EBERs-ISH techniques. Subsequently, the experimental group participated in PBL modules structured around three distinct clinical scenarios. Upon completion of the instructional period, student proficiency was evaluated through theoretical and practical EBERs-ISH examinations. Statistical analysis was performed using non-parametric and chi-square tests, with statistical significance set at p < 0.05. RESULTS: Analysis of performance outcomes revealed that the PBL group achieved a significantly higher proportion of “excellent” scores compared to the LBL group (p < 0.013). However, no significant differences were observed in the proportions of “good” or “fail” scores between the two cohorts. In the practical EBERs-ISH assessment, the PBL group’s mean total score (81.9 ± 6.8) was substantially higher than that of the LBL group (65.9 ± 7.9; p < 0.001). Specifically, significant inter-group differences were identified in scores for sectioning quality (p < 0.001), artifact presence (p = 0.003), and staining quality (p < 0.001). Furthermore, Receiver Operating Characteristic (ROC) curve analysis confirmed that these assessment criteria effectively discriminated between the skill levels of the two groups. CONCLUSIONS: PBL significantly enhances student proficiency in both the theoretical and practical aspects of EBERs-ISH when compared to traditional LBL. These findings indicate that PBL is a highly effective pedagogical strategy with considerable potential for broader application in clinical pathology technology education. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-026-08864-x.