Psychological effects of project-based learning in participants receiving clinical oncology teaching

Abstract Background: This study will assess the effects of the project-based learning (PBL) for participants undergoing clinical oncology teaching (COT). Methods: A systematic and comprehensive literature records will be identified from the electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched from their inceptions up to the present. Any relevant randomized controlled trials on the effects of PBL in participants receiving COT will be considered for inclusion. Study quality will be assessed using the Cochrane risk of bias tool. RevMan 5.3 software will be utilized for statistical analysis. Results: This study will assess the effects of PBL in participants receiving COT through assessing the primary outcomes of psychological disorders, student satisfaction, and student feedback, and secondary outcomes of examination scores, excellence rates, course examination pass rates, and clinical knowledge or skills. Conclusion: The findings of this study will summarize the latest evidence on the effects of PBL in participants receiving in COT. PROSPERO registration number: PROSPERO CRD42019150433.


Study registration
This study has been funded through a protocol registry in the PROSPERO with CRD42019150433. It follows the Cochrane Handbook for Systematic Reviews of Interventions and the preferred reporting items for systematic reviews and metaanalysis protocol statement guidelines. [33] 2.2. Eligibility criteria for included studies 2.2.1. Study types. We will include randomized controlled trials (RCTs) that assess the effects of PBL in participants receiving COT. However, we will exclude non-RCTs.

Participant types.
All college or university students who receive COT will be included with no restrictions of country, race, and sex.  In the control group, all participants can receive any teaching methods, except the PBL.

Outcome types.
The primary outcomes are psychological disorders, as measured by any psychological assessment scales; student satisfaction, as measured by any relevant surveys or scores; and student feedback, as assessed by any student feedback Questionnaires.
The secondary outcomes consist of examination scores, excellence rates, course examination pass rates, and clinical knowledge or skills, as measured using any instruments.

Search strategy
We will systematically and comprehensively search the following electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search all electronic databases without limitations of language and publication status from their inceptions up to the present. The following search terms will be used: problembased learning, PBL, internal medicine, cancer, education, randomized controlled trials, blind, concealment, control, and comparator. Any relevant studies on the effects of PBL in COT will be included. We will present detailed search strategy of PUBMED in Table 1. We will adapt similar search strategy for other electronic databases. We will also search for conference proceedings, and reference lists of related reviews.
2.4. Data collection 2.4.1. Study selection. Two independent authors will identify and review relevant studies based on the previous defined eligible criteria. Any disagreements regarding the study selection between 2 authors will be solved by a third author involved. First, they will check titles and abstracts for all searched literatures and all irrelevant and duplicated studies will be excluded. Then, we will read full-texts of all remaining studies to further judge if they meet all inclusion criteria. We will record all excluded studies with reasons. We will show the process of study selection in the flowchart.

Data extraction.
Two independent authors will carry out data extraction using standard designed data extraction sheet. A third author will be invited to solve any disagreements occurred between 2 authors. The extracted information is as follows: title, first author, time of publication, location, course name, study setting, participant characteristics, sample, study methods, intervention details, controls, outcomes, and other associated information. If any insufficient or missing information occurs, we will contact original authors to request it.

Risk of bias assessment
Two authors will independently evaluate the risk of bias assessment for each included study using the Cochrane Risk of Bias Tool. We will assess it on 7 levels, and each one is divided as low, unclear, and high risk of bias. If some different opinions exist between 2 authors, a third author will help to settle down them by discussion.

Statistical analysis
We will use RevMan 5.3 software for statistical analysis. We will calculate continuous data with mean difference or standardized mean difference and 95% confidence intervals (CIs), and will express dichotomous data as risk ratio and 95% CIs based on the availability of data from included studies. We will use I 2 test to check heterogeneity among included studies. I 2 50% means low heterogeneity, while I 2 > 50% means high heterogeneity. If low heterogeneity is identified among studies, we will use a fixedeffect model to pool the data. Meanwhile, we will plan to conduct meta-analysis if more than 2 studies on the same interventions and outcomes are included. On the other hand, if high heterogeneity is found, we will use a random-effect model to synthesize the data. At the same time, we will perform subgroup analysis and meta-regression test to check any possible factors that may result in such high heterogeneity among included studies.

Additional analysis
We will perform subgroup analysis based on the different interventions, study quality, and outcomes. In addition, we will also carry out sensitivity analysis to check the stability and robustness of pooled outcomes by removing studies with high risk of bias.

Reporting bias
If it is possible, we will also check the reporting bias using the funnel plot [34] when more than 10 eligible RCTs enter in this study.

Ethics and dissemination
This study will not need ethic approval, because all data is collected from the published studies. Its results are expected to be published at a peer-reviewed journal. Table 1 Search strategy for PUBMED database.

Number
Search terms

Discussion
The PBL is one of the most common educational innovations developed against the dissatisfaction with the traditional education method. Recently, it has been widely utilized for the participants receiving COT. Up to now, a variety of studies have explored the effects of PBL compared with other education methods with inconclusive or inconsistent results. Furthermore, no systematic review has been addressed to investigate this issue. Thus, this study will assess the effect of PBL on the participants receiving COT. The results of this study will provide helpful evidence for clinical teaching education and future studies.