Due to the continuous accumulation and development of science and technology, especially since the beginning of the twenty-first century, clinical work in hospitals has become increasingly complex. To ensure that medical students can adapt to clinical work quickly and train high-quality medical talent for the benefit of society, the traditional instillation and unitary teaching model faces difficulties with respect to solving clinical practical problems. The traditional model of medical education in China offers the advantages of a large amount of classroom information, low environmental requirements, systematic teaching knowledge and so on, which can basically meet the teaching needs of theoretical courses . However, this teaching model can easily lead to a disconnection between theory and practice, decrease students’ learning initiative and enthusiasm, and fail to analyse complex diseases in clinical practice comprehensively; accordingly, it cannot meet the requirements of higher medical education. In recent years, rates of spinal surgery in China have increased rapidly, and the teaching of spinal surgery has ushered in new challenges. During the undergraduate study of medical students, the most difficult aspect of surgery is orthopaedics, especially spinal surgery, whose knowledge points are relatively trivial, involving not only spinal deformity and infection but also involve trauma, bone tumours, and so on. These concepts are not merely abstract and complex but are also closely related to anatomy, pathology, imaging, biomechanics and other disciplines, so these contents are difficult to understand and remember. Simultaneously, many fields of spinal surgery are developing rapidly, and the knowledge contained in the available teaching materials is out of date, which makes it more difficult for teachers to teach. Therefore, transitioning away from traditional teaching methods in conjunction with the latest progress in international research, can allow the teaching of relevant theoretical knowledge to be connected to practice, improve students’ logical thinking ability, and induce students to engage in critical thinking. These failures of the current teaching process must urgently be addressed to explore the boundaries and limitations of contemporary medical knowledge and overcome the traditional barriers .
The PBL teaching mode is a learner-centred teaching method. Through the use of heuristics, independent learning and interactive discussions, students become fully motivated to transition from the passive acceptance of knowledge to active participation in the teacher’s lessons. Compared with the lecture-based teaching model, students who participate in the PBL teaching mode have sufficient time to use textbooks, the internet and software to find answers to their questions, think independently and discuss relevant topics in group settings. This approach develops students’ ability to think about problems, analyse them and solve them independently . In the process of free discussion, different students may have many different understandings of the same problem, which provides a platform for students to expand their thinking. Creative thinking and logical reasoning skills are developed through continuous thinking, and oral expression skills and team spirit are developed through communication among classmates . Most importantly, PBL teaching enables students to understand how to analyse, organize and apply the relevant knowledge, master the correct learning methods, and improve their comprehensive ability . Throughout our teaching process, we found that students were more interested in learning how to use the 3D visualization software than in understanding the boring professional medical concepts covered by textbooks, so in our study, the students in the experimental group were generally more motivated to engage in the learning process than the control group. Teachers should encourage students to speak boldly, cultivate students’ subject consciousness and stimulate their interest in participating in discussions. The test results show that with regard to the knowledge of mechanical memory, the scores of students in the experimental group were lower than those of students in the control group; however, with respect to the clinical case analysis questions that require the comprehensive use of relevant knowledge, the scores of students in the experimental group were significantly better than those of students in the control group, thus highlighting the advantages of the combination of 3DV with the PBL teaching method with regard to cultivating students’ comprehensive ability.
Anatomy teaching is the focus of the clinical teaching associated with spinal surgery. Because the structure of the spine is complex and because this surgery is involved to the spinal cord, spinal nerve, blood vessels and other important tissues, students’ spatial imagination is required for them to learn. Previous trainee teaching has used textbook illustrations, imaging images and other two-dimensional pictures to explain the relevant know, but despite these many materials, students do not develop intuitive, three-dimensional feelings in this context, resulting in difficulties in understanding. In view of the more complex physiological and pathological characteristics of the spine, such as the relationship between the spinal nerve and segments of the vertebral body, the teaching effect is not as strong as expected with regard to certain important and difficult points, such as the characteristics and classification of cervical fracture. Many students report that the content of spinal surgery is abstract and cannot be fully understood when learning, and the knowledge that they do remember will be forgotten soon after class, leading to difficulties in actual operations.
The author uses three-dimensional visualization technology to present clear and three-dimensional images to students, with different parts being represented by different colours. Through rotation, scaling, transparency and other operations, the spinal model can be viewed in layers alongside CT images, which not only clearly allows the students to observe the anatomical features of the cone but also stimulates their desire to engage in otherwise boring spinal CT imaging learning and deeply strengthens their imaging knowledge. Unlike the teaching models and tools used previously, the transparent processing function can effectively solve the occlusion problem, and it is more convenient by allowing students to observe fine anatomical structures and complex nerve directions, especially for beginners. Students can operate freely as long as they bring their own computers, and there are virtually no associated costs. This approach is a perfect substitute for traditional two-dimensional image teaching . In our study, the control group performed better with regard to objective questions, indicating that the lecture teaching model cannot be rejected entirely, since it still has a certain degree of value in the clinical teaching of spinal surgery. This finding leads us to consider whether we should combine the traditional teaching model with the PBL teaching model as supplemented with 3D visualization technology for different types of tests and different levels of students with the aim of maximizing educational outcomes. However, whether and how the two can be combined and whether students are receptive to this combination remains unclear, which may be a direction for future research. This study also faces certain shortcomings, such as possible confirmation bias in students’ completion of the questionnaires after they became aware that they would be participating in a new educational model. This teaching experiment was implemented only in the context of spinal surgery and requires further validation if it is to be applied to the teaching of all surgical disciplines.
We combine 3D visualization technology with the PBL teaching model to overcome the limitations of traditional teaching models and teaching tools and to explore the practical application of this combination to the clinical probation teaching of spinal surgery. With regard to the examination scores, the scores of students in the experimental group on subjective questions were better than those of students in the control group (P < 0.05), and the professional knowledge and classroom satisfaction reported by students in the experimental group in the questionnaire survey were better than those reported by students in the control group (P < 0.05). In summary, our experiments confirmed that the combination of PBL with 3DV technology is beneficial and allows students to engage in clinical thinking, learn professional knowledge and improve their interest in learning.