Yu Zizhong, Zhao Zhao, Chen Xinyue, Shi Jiayi, Liang Yiting, Zhang Xicheng, Qu Mengjiao, Huang Meiyue, Li Panpan, Li Dan, Li Man, He Jinbo
Department of Otolaryngology-Head and Neck Surgery, Taihe Hospital, Shiyan, Hubei, China.
Department of Vascular Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
BMJ Open. 2025 Sep 3;15(9):e095705. doi: 10.1136/bmjopen-2024-095705.
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.
A systematic review and meta-analysis through Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.
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.
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 I 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.
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.
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.
INPLASY202560118.
将标准化病人（SP）与基于案例的学习（CBL）相结合，通过让学习者沉浸于多样的临床场景来丰富学习体验。本荟萃分析研究旨在评估这种教学方法对中国医学生和住院医师教学满意度、理论知识成绩及临床实践表现的干预效果。
通过《系统评价和荟萃分析的首选报告项目2020声明》进行系统评价和荟萃分析。
PubMed、科学网、考克兰图书馆、教育资源信息中心、中国知网、万方数据库和维普数据库，检索时间从建库至2025年4月30日。纳入标准：纳入的研究为随机对照试验（RCT），在中国医学生和住院医师中比较SP+CBL（实验组）与基于讲座的学习（LBL，对照组），结局包括教学满意度、理论知识得分和临床实践表现。排除非英文/非中文研究、非RCT、重复发表的研究、数据不完整或主题不相关的研究。
两名研究者（JS/XC）独立筛选记录。分歧由第三位审阅者（ZZ）解决。使用考克兰偏倚风险2.0工具（ROB 2.0）评估研究质量。荟萃分析使用Stata V.17.0。由于预期存在异质性，预先指定采用随机效应（RE）模型，最终模型选择RE或固定效应基于I统计量。计算比值比（OR）和平均差（MD）以及95%置信区间（CI）。使用推荐分级、评估、制定与评价（GRADE）方法生成证据概况。使用漏斗图和埃格检验评估发表偏倚。亚组分析比较医学生和住院医师之间的理论/临床结局以探索异质性来源。
对31项RCT（n=2674）进行的荟萃分析显示，SP+CBL教学法在三个领域优于传统方法。教学满意度有显著提高（OR 7.19，95%CI 3.80至13.60，p<0.001；中等GRADE证据）。理论知识成绩显著提高（MD 5.91，95%CI 4.63至7.18，p<0.001；因存在不一致性为低GRADE证据）。临床实践表现也显著改善（MD=7.62，95%CI 6.16至9.08，p<0.001；因存在不一致性为低GRADE证据）。所有结果在敏感性分析中均保持稳健。进一步的亚组分析显示，医学生的理论知识得分提高更为明显，而住院医师的临床实践表现提高更为显著。
尽管由于教育中不可避免的方法学限制存在一些较高的结局异质性，但我们对符合条件的文献进行的荟萃分析和系统评价表明，整合SP和CBL有助于医学生和住院医师获取理论知识和实践技能。它还提高了教学满意度，并对中国临床教育产生积极影响。
INPLASY注册号：INPLASY202560118。
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