Abstract
BACKGROUND: Competency-based medical education requires innovative teaching models, yet limited evidence exists on the combined effectiveness of blended and case-based learning. This study aimed to evaluate a progressive blended case-based teaching model's effectiveness in enhancing the clinical competencies of medical students. METHODS: From September 2022 to January 2023, 258 5th-year clinical medical students were prospectively enrolled and randomly assigned to either a "3-tier progressive" case-based teaching group (experimental, n = 123) or a traditional lecture-based group (control, n = 135) for an integrated urology module. The experimental group utilized the "Rain Classroom" tool to implement a blended approach involving pre-class, in-class, and post-class activities. The control group received traditional lectures. Mixed-methods analysis assessed impacts on competencies, focusing on final evaluation scores. Informed consent was obtained. RESULTS: A total of 258 students participated in the study (123 in the experimental group and 135 in the control group). Before the intervention, no significant differences were found between the experimental and control groups in diagnostic course scores (P = .523), indicating comparable baseline academic levels. After the intervention, the experimental group scored significantly higher on the post-test than the control group (85.6 ± 5.0 vs 81.3 ± 5.2, P < .001). For self-perceived competencies, the experimental group reported significantly higher mean scores in 6 of the 8 core domains, including clinical skills and medical service ability, information collection and processing ability, medical knowledge and lifelong learning attitude, interpersonal and communication skills, teamwork and leadership ability, health promotion and disease prevention (all P < .001), while no significant differences were found in research skills or professionalism and ethical practice. Additionally, frequency-based analysis of the Likert scale responses revealed a higher overall proportion of students in the experimental group recognizing positive impacts of the teaching model on their competency development. CONCLUSION: The "progressive blended" case-based teaching method stimulates students' learning initiative, significantly enhances the quality of medical talent development, and facilitates continuous improvement in the clinical competencies of medical students.