Efficacy of problem-based learning combined with case-based learning versus lecture-based learning in orthopedic education: a systematic review and meta-analysis

Abstract

Objective: To systematically evaluate the effectiveness of the Problem-based learning (PBL) combined with Case-based learning (CBL) teaching method compared with the Lecture-based learning (LBL) method in orthopedic education and provide evidence for optimizing orthopedic teaching methods.

Methods: Literature was systematically searched in Chinese and English databases and screened using strict inclusion/exclusion criteria. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the literature. Meta-analyses were performed with RevMan 5.3 and Stata 16 software. We compared the application effects of the PBL-CBL teaching method versus the LBL teaching method in orthopedic education across multiple dimensions: theoretical knowledge mastery, practical skill proficiency, comprehensive competency development, and satisfaction with teaching methods.

Results: (1) 15 studies involving 980 participants were included. (2) Meta-analysis showed significant superiority of PBL-CBL over LBL in: ①Objective outcomes: theoretical knowledge (SMD = 1.46, P < 0.0001), practical skills (SMD = 1.53, P < 0.0001), physical examination (SMD = 1.64, P < 0.0001), case analysis (SMD = 1.30, P < 0.0001), and plaster immobilization (SMD = 2.42, P < 0.0001); ② Subjective outcomes: debridement proficiency (RR = 1.44, P = 0.001), aseptic awareness (SMD = 1.58, P = 0.003), and other comprehensive competencies (self-learning, learning interest, learning efficiency, clinical thinking, team collaboration, etc., P < 0.001 for all). Satisfaction with the teaching method was also significantly higher (RR = 1.34, P < 0.0001). (3) Heterogeneity was observed in the study (I² = 77-87%), which may be related to differences in teaching duration, case design, and assessment criteria. However, sensitivity analysis showed good stability of the results, indicating that the conclusions are informative.

Conclusion: Meta-analysis demonstrates that, in orthopedic education, the PBL-CBL teaching method offers significant advantages over LBL in enhancing students' theoretical knowledge, clinical skills, and comprehensive abilities. It also stimulates learning interest, improves teaching satisfaction, and facilitates the cultivation of orthopedic clinical talent. However, its generalizability requires further verification through research in different countries.

Keywords: Case-based learning; Lecture-based learning; Meta-analysis; Orthopedic education; Problem-based learning; Teaching efficacy.

Fig. 1

The PRISMA flow chart of the literature selection for the meta-analysis

Fig. 2

Risk of bias diagram

Fig. 3

Summary of risk of bias

Fig. 4

Forest plot of the effect of the PBL-CBL group versus LBL group on theoretical scores

Fig. 5

Funnel plot of the effect of the PBL-CBL group versus LBL group on theoretical scores

Fig. 6

Sensitivity analysis of the effect of PBL-CBL versus LBL on theoretical scores

Fig. 7

Trim and Fill analysis results for PBL-CBL versus LBL on theoretical scores

Fig. 8

Forest plot of the effect of the PBL-CBL group versus LBL group on practical skills scores

Fig. 9

Funnel plot of the effect of the PBL-CBL group versus LBL group on practical skills scores

Fig. 10

Sensitivity analysis of the effect of PBL-CBL versus LBL on practical skills scores

Fig. 11

Trim and Fill analysis results for PBL-CBL versus LBL on practical skills scores

Fig. 12

Forest plot of the effect of the PBL-CBL group versus LBL group on (A. physical examination scores; B. case analysis scores; C. plaster immobilization skills; D. debridement technique proficiency; E. aseptic awareness; F. self-learning ability)

Fig. 13

Forest plot of the effect of the PBL-CBL group versus LBL group on (A. learning interest; B. learning efficiency; C. clinical thinking ability; D. team collaboration ability; E. communication and expression abilities; F. CTDI-CV total score)

Fig. 14

Forest plot of the effect of the PBL-CBL group versus LBL group on satisfaction with teaching methods