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Impacts of blended learning with BOPPPS model on Chinese medical undergraduate students: a comprehensive systematic review and meta-analysis of 44 studies
BMC Medical Education volume 24, Article number: 914 (2024)
Abstract
Background
With the development of Internet information technology, especially the impact of the sudden outbreak of the novel coronavirus disease 2019 epidemic, along with the call for “classes suspended but learning continues,” a large number of medical educators have learned and experienced online teaching. They have understood the shortcomings of traditional teaching methods. Not only the blended BOPPPS teaching mode combines the advantages of the BOPPPS teaching mode but also the online teaching platform breaks through the limitation of time and space. However, a general consensus on the effectiveness of the blended BOPPPS teaching strategy in China is lacking, and few studies use quantitative synthesis to evaluate the effectiveness of this teaching strategy. Hence, this study aimed to assess the overall effectiveness of online and offline blended BOPPPS teaching strategies in higher medical education in China compared with the lecture-based learning (LBL) teaching model.
Methods
Studies that blended learning with the BOPPPS model in China from January 2000 to October 2023 were searched in the Chinese and English-language online databases. We analyzed the objective and subjective scores of students and performed subgroup analysis for specialties and online teaching platforms. The data were analyzed using the Stata version 14.0 software. The quality assessment was performed using the Jadad scoring scale.
Results
Forty-four studies were included in this meta-analysis. Compared with the LBL mode, the blended the BOPPPS teaching mode was more effective in terms of the overall capacity [standardized mean difference (SMD) = 1.193, 95% confidence interval (CI): 0.813–1.572], mastery of medical theory knowledge (SMD = 1.090, 95% CI: 0.730–1.450), and practical skills (SMD = 1.246, 95% CI: 0.799–1.693). The analyzed questionnaire surveys indicated the positive effects of the blended BOPPPS teaching mode on classroom satisfaction, autonomous learning ability, learning interest, teamwork ability, interpersonal skills, ability to analyze and solve problems, group interaction, learning engagement, and learning strategies.
Conclusions
The study underscored that the blended BOPPPS teaching mode could effectively improve the comprehensive quality of students. The subjective scores also indicated that students generally preferred this novel teaching mode.
Introduction
The quality of medical education is influenced by the method of education to some extent. Different educational approaches yield significant differences in teaching effectiveness. The BOPPPS teaching model originated from the Canadian teacher skill training, which was put forward by Douglas Kerrin in 1978 [1]. It is a new teaching model oriented by educational goals and centered on students, which is divided into six essential steps: bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary. In the era of rapid development of network information technology, especially influenced by the impact of the sudden outbreak of the novel coronavirus disease 2019 (COVID-19) epidemic and the imperative of the call of “classes suspended but learning continues,” a large number of medical educators have learned and experienced online teaching. They have understood the disadvantages of traditional teaching methods, and promoted the development of blended teaching. Online and offline blended teaching is a learning method that relies on online high-quality resources, combines online learning with offline traditional learning, and has the advantages of the two approaches to achieve the purpose of deep learning [2].
For decades, traditional lecture-based learning (LBL) has been widely used in China [3]. In this approach, teachers deliver knowledge on the platform, and students passively receive it at their desks [4]. However, this teaching method has common shortcomings. On the one hand, this teaching method provides teacher-based indoctrination teaching, which can easily make students slack off, distracting their attention and failing to ignite their enthusiasm and initiative. On the other hand, passive listening to teachers makes students dependent and lose their ability to think independently [5]. The blended BOPPPS teaching mode not only combines the advantages of the BOPPPS teaching mode, which is, a systematic, step-by-step and actionable teaching model, but it also facilitates teachers in improving their teaching process and focuses on students’ ability to participate, interact and provide feedback. According to these six steps, teachers can evaluate and modify any steps, making it extremely convenient to implement [6]. Moreover, the online teaching platform breaks through the limitations of time and space. It also effectively combines the three steps of students’ pre-class preparation, in-class participation, and post-class follow-up, thereby compensating for the limitations of the traditional teaching methods. Additionally, most college students at present are born in the Internet era and hence are willing to accept the blended teaching mode [7]. Therefore, in the post-epidemic era, a hybrid approach combining the advantages of online and offline teaching is in significant demand [8].
In China, academic research in the China National Knowledge Infrastructure (CNKI) database indicates a growing focus on “blended learning” since 1997, with a significant increase in attention since 2009. By the end of 2016, the number of studies on blended learning exceeded 400 [9]. In the last 3 years, the blended teaching model has experienced a rapid expansion, driven by the impact of the COVID-19 pandemic. A large number of studies have been performed on the effectiveness of the blended BOPPPS teaching model. Most of these have pointed out that, compared with traditional lecturers, the online and offline blended BOPPPS teaching model can significantly improve teachers’ instructional outcomes and students’ overall capabilities [10,11,12]. Despite being a relatively new teaching mode, it has gained extensive adoption and has garnered valuable insights through widespread implementation in Chinese universities.
However, a comprehensive assessment of the impact of the online and offline blended BOPPPS teaching strategy in China is currently lacking. Meilan Wang. et al.’s research shows that the mixed teaching mode can effectively improve students’ learning performance [13], but Li Li. et al.’s research shows that the mixed BOPPPS teaching mode has certain disadvantages. For example, it may not be effective in improving practical skills [14]. In addition, few studies use quantitative synthesis to evaluate the effectiveness of this teaching strategy. Therefore, this meta-analysis aimed to evaluate the overall effectiveness of online and offline blended BOPPPS teaching strategies in higher medical education in China compared with the LBL teaching model.
Materials and methods
Study design
This systematic review was reported following the preferred reporting items in the Cochrane Handbook for systematic reviews and meta-analysis guidelines [15]. It required no ethics approval because no human trials were performed. The main purpose of this systematic review was to assess the effectiveness of the online and offline blended BOPPPS teaching model.
Literature search
We searched PubMed, Web of Science, and Chinese online databases, such as CNKI, WanFang, VIP, and Chinese BioMedical Literature. The following keywords were used: (“BOPPPS” OR “BOPPPS mode” OR “BOPPPS teaching mode”) AND (“Blended learning” OR “Blended mode teaching” OR “Blended practice teaching” OR “Blended teaching method” OR “Rain Classes” OR “Xuexi Tong” OR “Yunban Ke”). The search period was from January 2000 to October 2023.
Inclusion criteria
The studies were selected and included according to the PICOS principles in the field of evidence-based medicine. (a) Participants: Chinese medical undergraduate students. (b) Intervention: blended learning with the BOPPPS model, which incorporates online teaching, such as using “Xuexi Tong,” “Yunban Ke,” “Rain Classes,” or other network platforms, into a BOPPPS teaching model based on our understanding of the learning characteristics of Chinese students. (c) Intervention: blended learning with the BOPPPS model, which incorporates online teaching, such as using “Xuexi Tong,” “Yunban Ke,” “Rain Classes,” or other network platforms, into a BOPPPS teaching model based on our understanding of the learning characteristics of Chinese students. (d) Comparison: The LBL teaching method, which is a traditional teaching mode in which teachers deliver lectures and students listen to lectures. (e) Outcomes: knowledge score used to assess the students’ mastery of theoretical knowledge; practical skills assessments used to evaluate students’ practical problem-solving ability; total score, comprising theoretical knowledge, practical skills, and daily performance, used to estimate the overall level; and questionnaire surveys used to assess students’ subjective feelings about classroom atmosphere and teaching quality. At least one of the aforementioned scores could be available. (f) Studies: randomized controlled trial.
Exclusion criteria
The exclusion criteria were as follows: (a) nonmedical undergraduate students; (b) nonrandomized controlled trials; (c) use of a teaching model other than blended learning with the BOPPPS model, such as the teaching mode of micro-class before class only and online teaching mode only; (d) control group not a pure LBL teaching model; and (e) duplicate literature.
Data extraction
Two reviewers independently completed the search and read the title, abstract, and full text of the literature to extract relevant information and data. If the search results or extracted information was inconsistent, the experts were consulted for a solution. The following information was extracted from each study: (a) author, (b) publication year, (c) sample size, (d) specialties of the students, (e) online teaching platforms, and (g) outcome measures.
Quality assessment
The revised Jadad score scale [16] (Oxford scoring system) was used to assess the quality of studies, classified as low-quality studies by score (≤ 3 points) and high-quality studies (4–7 points). The differences were resolved through discussion to reach a consensus.
Statistical analysis
The data were analyzed using the Stata version 14.0 software. The effect sizes of scores were expressed as standardized mean difference (SMD) and 95% confidence intervals (CIs). The qualitative data were expressed as odds ratios (OR) and 95% CI. The results were pooled using a fixed-effects model when heterogeneity was ≤ 50% and a random-effects model when heterogeneity was > 50% [17, 18]. The sensitive analysis was used to investigate the impact of individual studies on the overall effect size. The subgroup analysis of students’ specialties and online teaching platforms was conducted. The publication bias was evaluated using Egger’s test [19]. P value < 0.05 indicated a statistically significant. When there is publication bias in the study, we analyze it by trim-and-fill method, and the results before and after analysis are unchanged, which means that even if there is publication bias, the final results will not be affected.
Results
Study selection
The study selection procedure is depicted in Fig. 1. We conducted an online search and found a total of 1571 articles. After removing 1193 articles unrelated to medical subjects and 210 duplicates, we were left with 168 articles. Then, we re-examined the full text of the studies for detailed evaluation. Of the remaining 46 studies, 2 had no standard deviation. Finally, the remaining 44 studies were included in our meta-analysis to analyze further the application effect of the online and offline blended BOPPPS teaching model in Chinese medical students [8, 13, 14, 20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60].
Study characteristics
The characteristics of 44 included studies published between 2017 and 2023 are listed in Table 1. In this study, the sample size was 20–518 students for the intervention group and 20–532 for the control group. The total sample size was 7004 (3487 for the experimental group and 3517 for the control group). The participants included in this study were from 11 different specialties [15 nursing, 13 clinical medicine, 4 traditional Chinese medicine (TCM), 1 rehabilitation therapy technique, 1traditional Chinese pharmacology, 2 oral medicine, 1 health management, 2 pediatrics, 1 pharmaceutical engineering, 1 anesthesiology, and 3 other specialties]. The outcome measures were categorized into objective and subjective evaluations, including total score, knowledge score, practice score, satisfaction, autonomous learning ability, learning interest, teamwork ability, interpersonal skills, problem-solving ability, group interaction, learning engagement, and learning strategies.
Study quality
The Jadad scores of the 44 studies included were not high overall; 5 studies achieved scores of 4–5, which were of high quality. The remaining 39 studies were of low quality with scores of 1–3.
Influence of blended learning with the BOPPPS model on objective evaluation
A total of 13 studies with 2030 students provided total scores. Further, 39 studies with 6106 students were analyzed for knowledge scores, and 14 studies with 1565 students were used to evaluate the relationship between the new teaching model and practice scores. The hybrid BOPPPS teaching mode was related to higher total scores (SMD = 1.193; 95% CI = 0.813–1.572; I2 = 93.5%; P < 0.001;) knowledge scores (SMD = 1.090; 95%CI = 0.730–1.450; I2 = 97.5%; P < 0.001;) and practice scores (SMD = 1.246; 95% CI = 0.799–1.693; I2 = 94.2%; P < 0.001;) (Table 2 and Fig. 2).
A further subgroup analysis was used to stratify students by specialties and online teaching, better assessing the association between the new teaching model and high scores. High scores were correlated with the new teaching model across all specialties in terms of the total score assessment, knowledge score assessment, and practical score assessment. The application of different online teaching platforms could basically improve students’ total scores, knowledge scores, and practical scores. However, no significant difference was observed in the knowledge scores of students majoring in TCM. The use of Rain Classes teaching did not improve students’ total scores, and the use of Xuexi Tong was not significant in the evaluation of students’ practice scores (Table 3).
The sensitivity analysis of results with high heterogeneity showed that the deletion of any one study had no significant effect on overall effect size (Fig. 3).
Influence of blended learning with the BOPPPS model on subjective evaluation
A total of 6 studies with 532 students provided satisfaction, 16 studies with 2169 students were analyzed for autonomous learning ability, 4 studies with 482 students were analyzed for learning interest, 7 studies with 1034 students were analyzed for teamwork ability, 9 studies with 1327 students were analyzed for interpersonal skill, 6 studies with 587 students were analyzed for problem-solving ability, 3 studies with 221 students were analyzed for group interaction ability, 2 studies with 387 students were analyzed for learning engagement, and 3 studies with 540 students were used to evaluate the relationship between the new teaching model and learning strategies. The mixed BOPPPS teaching mode was related to high satisfaction (OR = 1.381; 95% CI = 1.261–1.512; I2 = 68.5%; P = 0.007), autonomous learning ability (SMD = 0.825; 95% CI = 0.610–1.041; I2 = 81.9%; P < 0.001), learning interest (SMD = 0.735; 95% CI = 0.350–1.119; I2 = 74.1%; P = 0.009), team work ability SMD = 0.846; 95% CI = 0.504–1.188; I2 = 84.5%; P < 0.001;), interpersonal skills (SMD = 0.851; 95% CI = 0.378–1.324; I2 = 93.7%; P < 0.001), problem-solving ability (SMD = 0.786.; 95% CI = 0.353–1.220; I2 = 84.2%; P < 0.001;), group interaction (SMD = 0.804; 95% CI = 0.530–1.079; I2 = 0.0%; P = 0.590), learning engagement (SMD = 0.747; 95% CI = 0.494–1.000; I2 = 25.1%; P = 0.248), and learning strategies (SMD = 0.524; 95% CI = 0.375–0.674; I2 = 0.0%; P = 0.972) (Table 4).
A further subgroup analysis was used to stratify students by specialties and online teaching platform in projects where the number of studies included was five or more to assess better the association between the new teaching model and high scores. The results indicated that the new teaching model was related to high scores across all specialties in evaluating satisfaction, autonomous learning ability, and teamwork ability. Furthermore, the use of various network teaching platforms enhanced the effectiveness of the blended BOPPPS teaching approach, which also correlated with high scores. However, no significant difference was found in interpersonal skills assessment of students majoring in other specialties. The use of Xuexi Tong did not improve students’ interpersonal skills, and the use of Rain Classes teaching was not significant in evaluating students’ problem-solving ability (Table 5).
The sensitivity analysis of results with high heterogeneity showed that the deletion of any one study had no significant effect on the overall effect size (Fig. 4).
Publication bias
We assessed the publication bias of the research on the online and offline hybrid BOPPPS teaching model in Chinese medical undergraduate teaching. The result showed no significant publication bias except in assessing total scores, practice scores, satisfaction, teamwork ability, and interpersonal skills. All combined SMD/OR values remained significant even after applying the trim-and-fill method when assessing total scores, practice scores, satisfaction, teamwork ability, and interpersonal skills (Tables 6 and 7).
Discussion
This meta-analysis was novel in comprehensively examining the effectiveness of blended BOPPPS teaching strategies in medical education in China. It analyzed 44 studies on the teaching effect of the online and offline blended BOPPPS teaching model for medical undergraduates in our country. We found that the blended BOPPPS teaching model was a novel and effective teaching model that improved students’ overall quality of education. The subjective scores also showed that students generally preferred this new teaching mode.
BOPPPS is one of the most popular teaching models in universities in North America. It is a systematic teaching model that follows step-by-step teaching and emphasizes the participation and feedback of students. This model has been recommended for use in more than 33 countries and promoted by more than 100 universities and training institutions globally [61]. In China, the hybrid BOPPPS teaching mode combines traditional teaching and online teaching organically, learning from each other’s strengths, aiming at effectively expanding teaching time and space and improving teaching quality [62]. It is conducive to teaching students according to their aptitude, identifying disparities in students’ learning, and offering personalized and targeted suggestions to engage students, promote learning, and address the challenges they encounter in their educational journey [63]. The six components of the online and offline blended BOPPPS teaching mode are closely interconnected, underscoring the significance of students’ principal position in the teaching process and effectively enhancing students’ participation in classroom teaching. Bridge-in constitutes the first step in the complete teaching cycle. Teachers carefully design questions and select classic cases, hot topics, and social phenomena related to the curriculum as pre-class introduction resources through the online teaching platform [64]. In the pre-test phase, teachers can generate 10–20 exercises aligned with teaching objectives online for small tests, provide timely feedback on learning results, and assess each student’s grasp of key concepts, with timely adjustments to improve the efficiency and quality of teaching [65]. The next step, participatory learning, represents the pivotal component of the BOPPPS teaching model. This phase focuses on unleashing students’ subjective initiative, placing students at the core, and emphasizing their active involvement. Teachers can stimulate students’ enthusiasm and interest in learning by organizing in-class discussions or online discussions by posting comments on an online platform to engage in discussions and receive online responses. Teachers can also pinpoint key points and challenging areas from the curriculum and carry out targeted teaching practices. For key knowledge, the approach of group reporting, explanations, and questions is used, while applied knowledge is taught through role-playing, involving both students and teachers. In combination with the presentation of the results of each group, the teacher affirms the innovations presented by each group, addresses the objections of other students, highlights the merits of the supplement, and identifies the shortcomings of each group [66]. Relevant research shows that pictures and texts enhance students’ enthusiasm for participatory and interactive learning and facilitate backup and storage through video-sharing learning or interactive exchange [67]. The post-test link is designed to assess students’ learning achievements; this involves self-testing through textbook exercises and platform supplementary contact to test their grasp of the teaching content in the unit. Students complete the assigned tasks and realize knowledge transfer [68]. In summary, the final component of the teaching cycle is the feedback and sublimation of the entire teaching process. The summarization of the content learned spans both in-class and post-class phases. In-class summarization involves organizing and consolidating the knowledge acquired, whereas post-class summarization occurs when students finish their homework or practice and they engage in deep reflection on the knowledge, representing an additional layer of summarization [69]. These six stages collectively form a coherent, systematic, and actionable teaching design model, providing a robust framework for achieving effective teaching outcomes.
Our results revealed that the objective and subjective assessment scores of the mixed BOPPPS teaching group were higher than those of the traditional teaching group. Everal factors accounted for these results. First, compared with the traditional learning mode, the blended BOPPPS teaching mode allowed students to engage in pre-class preparation and post-class review, thus improving their academic performance. Second, this teaching mode was relatively novel, which could significantly improve students’ interest and initiative in subject-based learning. Third, the teaching model provided students with a clear learning goal, which might make students study more purposefully and thus get higher grades. We found that applying the mixed BOPPPS teaching mode improved students’ practical ability, which was in line with the student-centered teaching concept of the BOPPPS teaching mode. Through participative learning, students had more practical opportunities and improved practical skills. At the same time, the questionnaire scores also showed that the teaching model was widely welcomed by students, with good feedback regarding both classroom satisfaction and other subjective evaluations such as autonomous learning ability. This also reflected that the blended teaching mode had a significant advantage in creating a good classroom atmosphere and improved teaching quality. Although various methods were used to maintain interactivity in learning during online courses, some students still provided feedback that the classroom interaction was poor [70]. Our study showed that using the online and offline hybrid BOPPPS teaching model contributed to the interaction between students and students, and between students and teachers. For this distinction, we believed that the mixed teaching mode had the dual advantages of both online and offline teaching and effectively made up for the lack of interaction in online teaching. However, in objective evaluation, no significant difference was found in the knowledge scores of students majoring in TCM. We suspect that this was because fewer TCM articles were included, as the original articles all showed that students in the BOPPPS group scored higher and the results were significant. The use of Rain Classes teaching did not improve students’ total scores, and the use of Xuexi Tong was not significant in evaluating students’ practice scores. We believe that the results could be changed if more articles could be included, as the original shows significant differences. In subjective evaluation, no significant difference was observed in interpersonal skills assessment of students majoring in other specialties. This may be due to the fact that we incorporate oral communication skills into interpersonal skills, which may not be the same. The use of Xuexi Tong did not improve students’ interpersonal skills, and the use of Rain Classes teaching was not significant in evaluating students’ problem-solving ability. This may be due to the small number of literature and the difference between the two teaching platforms. To sum up, these results might be explained by many factors. First, the results might not be significant due to the small number of studies included in some aspects of the analysis. Second, the heterogeneity of the literature might also contribute to the variation in results. Thirdly, some of the indicators included may not be equivalent. Finally, differences in learning platform might play a role. The Rain Classes was jointly developed by the online school and the online education office of Tsinghua University, allowing teachers to deliver MOOC videos, quizzes, and other materials through online platforms for students to access before class. Teachers and students can also interact with each other on the network platform. Rain Classes scientifically covers every teaching phase before, during, and after class, enhancing the clarity of teaching and learning. Xuexi Tong serves as the integrated terminal for products offered by a company Superstar, providing access to various educational resources, curriculum materials, social tools, and public communities. Compared with Xuexi Tong, Rain Classes main focuses on supporting the flipped classroom approach, various resources such as novels that are not available. These two educational platforms are constantly growing in response to the continuous development of network information technology in China. Also, the outbreak of COVID-19 has accelerated the adoption and use of online education platforms, significantly enhancing their implementation in colleges and universities. In summary, these two different software may bring different outcomes in teaching effectiveness. Although we believe that different teaching platforms produce different teaching effects, in this paper, only a few articles were included due to our multi-level subgroup analysis. Therefore, we suspect that the lack of significant results is largely due to the low number of articles included.
However, some obvious heterogeneity was detected among the majority of studies. Several possible sources of high heterogeneity in some results were as follows. First, the teaching quality provided by the teachers was a crucial factor in cultivating students. Teachers from different schools and regions may have different levels of teaching expertise, leading to substantial differences in teaching effectiveness. Although all of the studies included in this study were mostly conducted in higher medical schools or their affiliated hospitals, only a small number of studies discussed of the teacher’s teaching proficiency. In addition, the teachers’ understanding of the blended BOPPPS model and teaching practice was different. Although teachers were familiar with blended learning with the BOPPPS teaching mode and made extensive attempts, only a small number of teachers received systematic teaching training. Second, the students’ desires to learn and abilities were different. Some students attempting to get a scholarship might have a strong learning aspiration and ability. Therefore, we believed that students’ learning ability was also a source of heterogeneity.
However, our study had several unavoidable limitations. Besides the heterogeneity discussed earlier, the results of the quality evaluation of included studies were also one of the limitations of this meta-analysis. The reason for the low literature score was that the Jadad scores were suitable for clinical randomized clinical trials and teaching trials. The blind methods could not be designed, and hence the study scores were generally lower. The small sample size of some studies might have led to inaccurate results, which was another limitation of this study. Moreover, because of the characteristics of the teaching process, most of the studies included might be randomized at the time of grouping; however, students knew their grouping as the teaching progressed, leading to information bias. Finally, many students will encounter difficulties in adapting to new learning methods, which may affect the final results [56].
Conclusions
This meta-analysis demonstrated that the blended online and offline BOPPPS teaching model was more effective than LBL in improving students’ medical theory knowledge and practical operational skills in mainland China. The questionnaire surveys revealed the positive impacts of the blended teaching model on classroom satisfaction, autonomous learning ability, learning interest, teamwork skills, interpersonal abilities, problem-solving ability, group interaction, learning engagement, and learning strategies. The results of this study fully reflect the advantages of the hybrid BOPPPS teaching compared with the traditional teaching. This allows us to understand that the online and offline blended BOPPPS teaching model is really effective, it can stimulate students’ potential, improve students’ performance and is worth popularizing in medical colleges and universities.
Availability of data and materials
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
References
Instructional Skills Workshop Network. ISW Handbook. Available at: https://www.iswnetwork.ca/resources/isw-and-fdw-handbooks/. Accessed 3 Jan 2018.
Zhang Q, Wang A. Research on new blended teaching mode based on “flipped classroom.” Mod Educ Technol. 2014;24(04):27–32. (In Chinese).
Chen L, Tang XJ, Chen XK, et al. Effect of the BOPPPS model combined with case-based learning versus lecture-based learning on ophthalmology education for five-year paediatric undergraduates in Southwest China. BMC Med Educ. 2022;22(1):437.
Hu K, Ma RJ, Ma C, et al. Comparison of the BOPPPS model and traditional instructional approaches in thoracic surgery education. BMC Med Educ. 2022;22(1):447.
Zeng W, Zhu J, Alcidin P. Advantages and disadvantages of LBL, PBL and TBL teaching methods and their application in clinical medicine teaching. Med Health. 2016(4):21–2. (In Chinese).
Ma X, Zeng D, Wang J, et al. Effectiveness of bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary teaching strategy in Chinese medical education: a systematic review and meta-analysis. Front Med. 2022;9:975229. (2296-858X (Print)).
Gong S, Zhang Z, Zheng G, et al. Application of BOPPPS course design based on blended teaching in infantile epidemiology teaching. Health Vocat Educ. 2022;40(08):79–81. (In Chinese).
Liu XY, Lu C, Zhu H, et al. Assessment of the effectiveness of BOPPPS-based hybrid teaching model in physiology education. BMC Med Educ. 2022;22(1):217.
Gu L, Chen D. An analysis of the current situation and trend of domestic blended learning research-based on the top 50 journals published in CNKI from 2004 to 2016. J Kaifeng Vocat Coll Cult Art. 2017;37(10):114–5+243. (In Chinese).
Zhang F, Lin S, Huang Q. Application of BOPPPS teaching mode based on the superstar learning platform in the course of identification technology of traditional Chinese medicine. Strait Pharm J. 2020;32(8):84–8. (In Chinese).
Wen J. Research and practice of hybrid teaching mode based on intelligent teaching platform. Modern Manuf Technol Equip. 2021;57(9):204–6. (In Chinese).
Chen X, Pan P, Shen X, et al. Discussion on the teaching practice of pathogenic biology and immunology based on BOPPPS teaching mode. Sci Technol Ecnony Market. 2021;4:135–6,8. (In Chinese).
Wang M, Ma C, Lin X, et al. Exploration and practice of BOPPPS teaching mode in basic nursing mixed teaching. Course Educ Res. 2021;5:170–1,4. (In Chinese).
Li L, Zhang Y, Fu X, et al. Application of mobile classroom based on BOPPPS model in the teaching of diagnostics. China High Med Educ. 2021;9:117–8. (In Chinese).
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339 https://doi.org/10.1136/bmj.b2535.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–48.
Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.
Zhang C, Xin J, Li K, et al. Exploration on the mixed teaching of natural medicinal chemistry based on SPOC. Basic Med Educ. 2020;22(11):792–5. (In Chinese).
Xu Y, Jin M, Liu Z, et al. Research on the combined teaching mode of basic theory of traditional Chinese medicine based on BOPPPS and Xuexi Tong. Lishizhen Med Mater Med Res. 2019;30(6):1481–2. (In Chinese).
Wang Z. Applicationresearch of blended learningbased on BOPPPS teaching mode in “Basics of Traditional Chinese Medicine Nursing”. Shandong University of Traditional Chinese Medicine; 2021. (In Chinese).
Wang J, Zheng Y, Wang L, et al. Research on the application of BOPPPS online and offline blended teaching mode in prescriptions. Theory Pract Innov Entrep. 2022;5(11):167–9. (In Chinese).
Si X, Ye Z, Wang Q, et al. Application of BOPPPS teaching model in blended teaching approach of histology and embryology in nursing specialty. Chin J Histochem Cytochem. 2021;30(5):493–7,502. (In Chinese).
Ma Y, Cai M, Cao J, et al. Exploration and practice of online and offline blended teaching of pharmaceutical chemistry based on BOPPPS model. Health Vocat Educ. 2022;40(21):61–4. (In Chinese).
Ma X, Ma X, Li L, et al. Effect of blended learning with BOPPPS model on Chinese student outcomes and perceptions in an introduction course of health services management. Adv Physiol Educ. 2021;45(2):409–17.
Liu Y, Song T, Xu R, et al. The application of the online BOPPPS teaching method and the traditional offline teaching in the teaching of nursing specialty. China Modern Doct. 2021;59(1):146–8,52. (In Chinese).
Li X, Liang Y, Xu Y, et al. Application of MOOC-based flip class + BOPPPS blended teaching in the cultivation of clinical decision-making ability of hematology undergraduates. China Higher Med Educ. 2021;11:68–9. (In Chinese).
Huang Z, Zhang F, You J, et al. Study on the application of the blended teaching mode based on BOPPPS in the teaching of sterilism. Health Vocat Educ. 2021;39(15):43–6. (In Chinese).
Du X, Li L, Chen S, et al. Practice of blended teaching mode of skin and venereal disease nursing based on BOPPPS and Xuexi Tong. Dermatol Venereol. 2022;44(3):273–5. (In Chinese).
Chen L, Peng G, Wang D, et al. Application of blended BOPPPS teaching model in the teaching of internal nursing. Chin J Med Educ Res. 2019;18(9):936–41. (In Chinese).
Zheng X, Luo X, Lai Y, et al. Application and exploration of OBE+BOPPPS teaching modein Orthodontics teaching under the background of “New Medicine”. China Med Educ Technol. 2022;36(3):351–5. (In Chinese).
Zhao G, Guo F, Wu H, et al. Application of BOPPPSmodel based0n rain classroom platform in “eyperimental diagnostics.” J Clin Hematol. 2019;32(12):976–8. (In Chinese).
Zhang Y, Liu X, Qu X, et al. Design and practice of BOPPPS teaching mode based on “Yuke Tang” in pediatric orthopaedics teaching. Chongqing Med. 2022;51(9):1600–2. (In Chinese).
Shen B, Wang Z, Zhang M, et al. Exploration of clinical pharmacology teaching based on BOPPPS model and WeChat platform. Chin J Med Educ Res. 2020;19(10):1172–5. (In Chinese).
Liu Y, Du Y, Ma J. Application of BOPPPS model combined with mobile APP in clinical teaching of spinal surgery. Chin J Med Educ. 2020;40(12):1006–10. (In Chinese).
Liu X, Zhao Y, Cai W, et al. Study on application effect of “Yuke Tang” teaching based on BOPPPS model in teaching reform of health assessment course. Health Vocat Educ. 2020;38(16):47–9. (In Chinese).
Liu D, Zhang M, Mei Q, et al. Practice and thinking of participatory teaching of medical genetics informatization. China High Med Educ. 2020;1:119–20. (In Chinese).
Li J, Xu J, Wang C, et al. The application of teaching model of BOPPPS combined with rain classroom in clinical practice in internal medicine. J Qiqihar Med Univ. 2021;42(14):1263–5. (In Chinese).
Jia J, Shi X, Li Y, et al. Application of innovative BOPPPS teaching model in clinical pathology teaching. Basic Med Educ. 2022;24(6):390–3. (In Chinese).
Gao P, Tang F. Application of flipped classroom teaching under BOPPPS Model in rehabilitation therapy. Med Educ Res Pract. 2021;29(6):893–7,919. (In Chinese).
Zhang Y, Lai Z, Lin J, et al. Teaching practice of pedatric BOPPPS based on the online course platform. China Med Educ Technol. 2017;31(5):561–4. (In Chinese).
Yang X, Meng T. Application of BOPPPS combined with blackboard during the practice of obstetric intercourse. China Contin Med Educ. 2019;11(2):29–32. (In Chinese).
Xue J, Jin R, Huai P, et al. Application of BOPPPS model based on e-teaching platform in the course of community nursing. J Nurs Sci. 2018;33(1):12–5. (In Chinese).
Chen P, Huang M, Lin Y, et al. Application of mixed BOPPPS combined with case analysis teaching in nursing practice teaching in the department of endocrinology. Chin J Med Educ Res. 2022;21(4):508–12. (In Chinese).
Zhang P, Sha G, Cao X, et al. Research on the application of division classroom based on superstar learning platform in BOPPPS teaching mode of pediatric nursing. World Latest Med Inform. 2021;21(105):601–2,5. (In Chinese).
Zhang L, Wei J, Sun S, et al. The application of blended teaching mode based on virtual simulation platform in histology experiment. Health Vocat Educ. 2023;41(06):62–5. (In Chinese).
Zhang L, Liu J, Liu C. Teaching reform and practice of research on the application of “fundamentals of nursing” course based on “rain classroom” and BOPPPS model. Educ Modern. 2019;6(61):91–3. (In Chinese).
Xu Y, You S, Mohedes S, et al. Application of BOPPPS teaching model based on flip class in basic nursing teaching. J Xinjiang Med Univ. 2022;45(09):1071–4. (In Chinese).
Liu Y, Zhao Y, Xu J, et al. Application of mixed teaching under BOPPPS mode in occlusal science. China Contin Med Educ. 2022;14(24):11–4. (In Chinese).
Hao S, Yuan Y, Chen D, et al. Application of the BOPPPS mode based on superstar platform in the fundamentals of nursing of traditional Chinese medicine. Educ Chin Med. 2023;42(3):1–12. (In Chinese).
Cui J, Wen Y, Wei S, et al. Application of rain classroom combined with BOPPPS model in pathology teaching. J Guangxi Univ Chin Med. 2022;25(6):78–81. (In Chinese).
Chu F, Zeng W, Jiang F. Application of BOPPPS combined with medical simulation in the probation teaching of nephrology department. Chin J Sci Technol Database Educ Sci. 2022;6:165–7. (In Chinese).
Cheng C, Zhu N, Li M, et al. Application of raining class combing with CBL method based on BOPPPS model in experimental teaching of physical diagnosis. Chin J Gen Pract. 2022;20(11):1941–3+77. (In Chinese).
Cai Z, Liu D, Zhang J, et al. Application of BOPPPS model based on rain class in pain teaching of undergraduates. China Contin Med Educ. 2022;14(18):135–8. (In Chinese).
Peng S, Yan Z, Luo L, et al. Practice of BOPPPS teaching method based on superstar Xuexitong in histology and embryology. Chin Med Modern Dist Educ China. 2023;21(17):41–3. (In Chinese).
Qunzhou, Yang X. The application effect of hybrid teaching based on BOPPPS model in basic nursing science. Nurs Pract Res. 2023;20(13):1936–40. (In Chinese).
Xu Z, Che X, Yang X, et al. Application of the hybrid BOPPPS teaching model in clinical internships in gynecology. BMC Med Educ. 2023;23(1):465.
Yu L, Luo X. Exploration on application of BOPPPS based on mixed teaching mode between online and offline in pharmacy courses of traditional Chinese medicine. Health Vocat Educ. 2023;41(11):51–4. (In Chinese).
Zhao B, Li L, Song Q, et al. Application of the BOPPPS teaching mode based on “Rain Classroom” in the clinical teaching of operating room nursing. Nurs Pract Res. 2023;20(13):1932–6. (In Chinese).
Yang N. Application research of BOPPPS teaching mode in online + offline teaching. J Elegance Classic. 2021;16:154–7. (In Chinese).
Zhang Z, Song C, Zhang G, et al. Design and practice of pediatric mixed teaching based on BOPPPS teaching mode. Guide Sci Educ. 2021;455(23):91–3. (In Chinese).
Wang Y, Su Y, Wang F, et al. Application of BOPPPS blended teaching model in community nursing course. Chin Gen Pract Nurs. 2022;20(12):1721–4. (In Chinese).
Sun K, Li Z, Zhu J, et al. Design and practice of blended teaching mode based on rain classroom and BOPPPS in the basic teaching of clinical laboratory in higher vocational education. China Modern Educ Equip. 2022;393(17):62–4. (In Chinese).
Liu N. Research on blended teaching based on BOPPPS model. Ind Inf Technol Educ. 2021;104(08):37–41. (In Chinese).
Zhang H. Design and application of blended teaching mode based on BOPPPS–taking community nursing as an example. Healthmust-Readmag. 2020;36:185. (In Chinese).
Jiajingzhang, Wang C, Liu M, et al. Reform practice and effect evaluation of blended courses in smart classroom. Chin Med Modern Dist Educ China. 2022;20(13):157–9. (In Chinese).
Liang J, Yi P. The onling teaching and practice of nursing English in BOPPPS education model. J Chengdu Univ Trad Chin Med. 2021;23(2):1721–4. (In Chinese).
Yu D, Wu J, Sun H, et al. Discussion on online and offline mixed teaching practice of traditional Chinese medicine identification based on BOPPPS teaching mode. China Med Herald. 2020;17(28):75–8. (In Chinese).
Varachotisate P, Siritaweechai N, Kositanurit W, et al. Student academic performance in non-lecture physiology topics following the abrupt change from traditional on-site teaching to online teaching during COVID-19 pandemic. Med Educ Online. 2023;28(1):2149292.
Acknowledgements
We thank all colleagues who participated in this study.
We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.
Funding
This study was funded by the teaching project of the Youth Talent Cultivation Fund of Dalian Medical University. (QNJY2209).
Postgraduate education teaching reform research project of Liaoning Province. (LNYJG2023222).
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XinChen designed the study, obtained funding and oversaw the project. Xiaofeng Li, Li Ma, Qiujuan Li, Xiance Sun and Xin Chen collected the data. Shuze Li and Wei Wei analyzed data and wrote the manuscript. All authors reviewed the manuscript.
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Li, S., Wei, W., Li, X. et al. Impacts of blended learning with BOPPPS model on Chinese medical undergraduate students: a comprehensive systematic review and meta-analysis of 44 studies. BMC Med Educ 24, 914 (2024). https://doi.org/10.1186/s12909-024-05917-x
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DOI: https://doi.org/10.1186/s12909-024-05917-x