The use of bedside case-based learning in the clinical practice of midwifery education in China | BMC Medical Education

Study design

This study was a quasi-experimental design using one group pre-test-post-test design.

Sample selection and setting

This study was conducted in an undergraduate direct-entry midwifery program at the Zhejiang Chinese Medical University nursing school in Zhejiang Province, China. A convenience sample of all midwifery students, having successfully completed foundational courses in Years 1 and 2; were provided with information about the study, a consent form, and invited to participate in the study. The study enrolled sixty-seven third-year students majoring in midwifery, which was the first-generation midwifery student at the Zhejiang Chinese Medical University nursing school.

Based on previous research and expert opinions, we chose a medium effect size (Cohen’s d = 0.5), targeting an 80% power and a 0.05 significance level. Using G*Power, we determined that 60 participants per group are needed. Allowing for a 10% dropout rate, we plan to recruit 66 students per group. These parameters were chosen to balance statistical power with practical resource constraints.

Application of bedside case-based learning model

At the beginning of the semester, students completed the pre-class surveys; the Self-Rating Scale of Self-Directed Learning (SRSSDL), and the Critical Thinking Disposition Inventory (CTDI)-Chinese version to provide baseline data. At the end of the semester, all students were required to complete the post-class surveys with the same scales to evaluate the effect of BCBL in improving students’ learning abilities. The BCBL process lasted for the whole semester with a class held each week.

The BCBL approach was as follows:

Before class, clinical instructors prepared the teaching materials and required readings for the course, identified the learning objectives and the typical clinical scenario case one day in advance of class, collaborated with the identified patient on the process, and obtained consent from the patient. And clinical scenarios were found in real clinical wards in the hospital based on the different teaching themes to present key information related to patient history, symptoms, and initial findings. Before each class, students engage with the provided content and complete the required readings. There are a total of 14 themes over the semester (Table 1).

Before beginning classroom activities, students are assigned to one of four parallel groups of seven to eight individuals. All clinical instructors received the same training on teaching content and how to deliver BCBL effectively in advance. The clinical instructors are midwives working at Hangzhou Women’s Hospital. Each class session begins with a brief overview of the topic and the class schedule.

Each clinical instructor presents a typical patient case with the same disorder using a slide deck. The clinical instructors then lead students to the bedside to directly acquire the patient’s medical history. Students then engage in small-group discussions under the supervision of the clinical instructor where they are encouraged to pose relevant clinical questions to patients and seek information using the Internet or the databases held by the hospital library. A student representative from each group presents a summary of the key findings to the class, the group’s responses to the questions raised, and clarification on any unanswered questions. Subsequently, the clinical instructors review the essential theoretical information and summarize it for the class. Students are required to complete and submit an assessment report at the end of each class. The assessment report includes the details of clinical case and the analysis of their own critical thinking.

Instruments

Self-assessments completed by students included the Self-Rating Scale of Self-Directed Learning (SRSSDL) and the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) to measure midwifery students’ self-directed learning ability, and critical thinking, at the beginning and end of the semester.

Williamson developed the self-rating scale of self-directed learning (SRSSDL) in 2007 [8]. The author authorized Shen Wangqin and Hu Yan [9] from Fudan University to translate it to Chinese in 2012. The SRSSDL consists of 60 items categorized into five broad areas, each consisting of 12 items. The categories included: awareness (understanding the factors that contribute to being self-directed learners); learning strategies (strategies recommended for being self-directed learners); learning activities (activities often used in self-directed learning); evaluation (attributes that help learners monitor their learning activities) and interpersonal skills (skills considered pre-requisite to becoming self-directed learners). The responses for each item are rated using a five-point Likert type scale (5 = Always, 1 = Never). The score ranges from 60 to 300 points, with a higher score indicating a higher ability for self-directed learning. The Chinese version of the SRSSDL has demonstrated good reliability and internal consistency (Cronbach’s α coefficient is 0.97).

Based on the California Critical Thinking Dispositions Inventory (CCTDI), Pang [10] adapted and updated the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV). The scale is a standardized 70-item, multiple-choice survey with seven dimensions: truth-seeking (10 items), open-mindedness (10 items), analyticity (10 items), systematicity (10 items), self-confidence (10 items), inquisitiveness (10 items), and cognitive maturity (10 items). The responses for each item are rated using a six-point Likert type scale (6 = Strongly Agree, 1 = Strongly Disagree). The total score ranges between 70 and 420 points with a higher score indicating higher critical thinking skills. The Chinese version of the CCTDI has demonstrated good reliability and internal consistency (Cronbach’s α coefficient is 0.90).

Ethics approval

This study was approved by the Research Ethics Committee at the Nursing School of Zhejiang Chinese Medical University and conducted according to the Helsinki Declaration.

Data analysis

The data were processed and analyzed using SPSS version 20.0 (Chicago, USA). Continuous variables are presented as mean ± standard deviation. Categorical variables are shown as the number of participants (percentage). A paired sample t-test was used to analyze the mean difference between pre- and post-test for the same students. P values < 0.05 were considered statistically significant.