Effects of standardised patients (SP) combined with case-based learning (CBL) in Chinese clinical education: a systematic review and meta-analysis

Abstract

Objectives: Combining standardised patients (SP) with case-based learning (CBL) enriches the learning experience by immersing learners in diverse clinical scenarios. This meta-analysis study aims to assess the intervention effects of this teaching approach on Chinese medical students' and resident physicians' teaching satisfaction, theoretical knowledge achievements and clinical practice performance.

Design: A systematic review and meta-analysis through Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

Data sources: PubMed, Web of Science, Cochrane Library, Education Resources Information Center, China National Knowledge Infrastructure, Wanfang Database and the VIP Database from their inception up to 30 April 2025. ELIGIBILITY CRITERIA : Included studies were randomised controlled trials (RCTs) comparing SP+CBL (experimental group) with lecture-based learning (LBL) (control group) among Chinese medical students and resident physicians, with outcomes including teaching satisfaction, theoretical knowledge scores and clinical practice performance. Non-English/non-Chinese studies, non-RCTs, duplicate publications, studies with incomplete data or irrelevant topics were excluded.

Data extraction and synthesis: Two researchers (JS/XC) independently screened records. Disagreements were resolved by a third reviewer (ZZ). Study quality was assessed using the Cochrane Risk-of-Bias 2.0 tool (ROB 2.0). Meta-analysis used Stata V.17.0. A random effects (RE) model was prespecified due to anticipated heterogeneity, final model selection RE or fixed effects was based on I² statistics. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Evidence profiles were generated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Publication bias was assessed using funnel plots and Egger's test. Subgroup analyses compared theoretical/clinical outcomes between medical students and resident physicians to explore heterogeneity sources.

Results: A meta-analysis of 31 RCTs (n=2674), SP+CBL pedagogy outperformed traditional methods in three domains. Teaching satisfaction showed substantial improvement (OR 7.19, 95% CI 3.80 to 13.60, p<0.001; moderate GRADE evidence). Theoretical knowledge achievements increased significantly (MD 5.91, 95% CI 4.63 to 7.18, p<0.001; low GRADE evidence due to inconsistency). Clinical practice performance also improved significantly (MD=7.62, 95% CI 6.16 to 9.08, p<0.001; low GRADE evidence from inconsistency). All findings remained robust in sensitivity analyses. Further subgroup analyses revealed that the improvement in theoretical knowledge scores was more pronounced among medical students, while the enhancement in clinical performance was more significant among resident physicians.

Conclusions: Despite some high outcomes heterogeneity stemming from unavoidable methodological constraints in education, our meta-analysis and systematic review of eligible literature demonstrate that integrating SP and CBL facilitates students and resident physicians in acquiring theoretical knowledge and practical skills. It also boosts teaching satisfaction and positively impacts Chinese clinical education.

Inplasy registration number: INPLASY202560118.

Keywords: clinical competence; education & training (see medical education & training); education, medical.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the literature screening process and results. CNKI, China National Knowledge Infrastructure; ERIC, Education Resources Information Center. VIP, VIP Chinese Science and Technology Periodical Database‌.

Figure 2. Risk-of-Bias 2.0 assessment of the included studies.

Figure 3. Forest plot for the effect of SP+CBL and LBL on students’ and resident physicians’ teaching satisfaction. CBL, case-based learning; LBL, lecture-based learning; SP, standardised patients.

Figure 4. Forest plot for the effect of SP+CBL and LBL on Chinese medical students’ and resident physicians’ theoretical knowledge achievements. CBL, case-based learning; LBL, lecture-based learning; SP, standardised patients.

Figure 5. Forest plot for the effect of SP+CBL and LBL on Chinese medical students’ and resident physicians’ clinical practice performance. CBL, case-based learning; LBL, lecture-based learning; SP, standardised patients.

Figure 6. Funnel plot for the publication bias. (A) Theoretical knowledge achievements. (B) Clinical practice performance. MD, mean difference.