The Application of the Online and Offline Interactive Teaching Method in Clinical Anesthesiology Teaching

Objective. To explore whether better teaching effect can be achieved by applying the online and offline interactive teaching method to clinical anesthesiology teaching.Methods. Sixty-three students in grade three majoring in anesthesiology of Wenzhou Medical University were selected as research objects and randomly divided into 2 groups. .e experimental group (32 students) adopted the online and offline interactive teaching method. .e control group (31 students) adopted the traditional teaching method. .e teaching effect was evaluated by the theoretical test results of the two groups and the survey of students in the experimental group. Results. .e score of the theoretical test of students in the experimental group (79.31± 4.54) was higher than that of students in the control group (75.61± 4.88), and the difference achieved statistical significance (p< 0.05). 81.3% of the students think that the interactive teaching method enhances the interest of learning. 90.6% (29/32) of the students in the experimental group hold positive attitude towards the fact that the overall learning effect can be improved by the online and offline interactive teaching method. Conclusions..e online and offline interactive teachingmethod can not only improve students’ theoretical test results but also help to improve students’ learning participation. Students have given a high score for the evaluation of the online and offline interactive teaching method; good teaching effect has been achieved.


Introduction
Clinical anesthesiology is one of the core courses of anesthesiology. It is a highly compatible modern medical discipline, which mainly covers the knowledge of adjusting life function, intensive care treatment, and pain treatment. It also integrates the knowledge of many disciplines, such as internal medicine, surgery, physiology, pharmacology, etc. [1]. erefore, it puts forward higher requirements for professional students, requiring students to have strong learning ability and practical ability. At the same time, teachers are also required to have rich clinical knowledge and the ability to answer questions [2]. e teachers of clinical anesthesiology in our university are all served by senior doctors in affiliated hospitals. Due to the limitation of clinical working time, the course time of teachers is relatively tight, and the total number of class hours of this course is limited. In the past, the teaching method was mainly based on teaching.
is "spoon-feeding, full-house irrigation" teaching method [3,4] ignores students' learning autonomy, flexibility, and creativity. And teachers are busy preaching knowledge in class, so it is difficult to explain a problem thoroughly, let alone expand the relevant knowledge. is arbitrary teaching method is not conducive to the mastery of students' knowledge and the improvement of related abilities.
erefore, how to stimulate students' initiative, improve their participation before, during, and after class, and improve their ability to improve, analyze, and solve problems related to clinical anesthesiology has become a major challenge in clinical anesthesiology teaching.
In recent years, an online and offline interactive teaching method came into being under the background of the Internet, which has made attempts and breakthroughs in the combination of theory and practice, the diversification of educational subjects, the transformation of time and space of education, dynamic teaching mode, and so on [5][6][7]. Generally speaking, in the traditional offline classroom teaching, the model of teacher-student relationship is relatively fixed, the dominant position of teachers is solidified because of identity, and the dominant position of students has been hidden or obviously ignored because of habits. e dialogue relationship between teachers and students lacks real equality. At present, teaching is gradually realizing the transformation from traditional teacher-led teaching mode to learner-centered autonomous learning mode. In this situation, online classes connect students, teachers, and other parties (such as parents, etc.) together through the network and can share teaching resources in the platform in real time and efficiently, such as classroom videos, microclasses, micro-lectures, online interaction, tutoring, testing, and other tasks [8,9]. However, online teaching needs to rely on information technology literacy and platform resource development, space differences lead to psychological barriers in teaching, time endurance, and interactive experience, and other aspects also have their inherent limitations. e establishment of online and offline interactive teaching ecology can effectively make up for the shortcomings of traditional teaching and online teaching, the new dialogue relationship between teachers and students, which is not limited by time and space, can be established, and the authority of teachers in the binary opposition mode will be dispelled [10]. Students' autonomy is enhanced, and personalized problem needs are guaranteed. In addition, in the Internet environment, teachers and students, as well as students and students, can communicate through online interaction or message prompts and other interactive functions to form a good atmosphere of communication and discussion, so that the problem can be solved in a relaxed group discussion. Students no longer passively accept the teaching content, but become the main body of the dialogue, and can actively acquire knowledge through their own activities. erefore, we try to apply the online and offline interactive teaching method to the classroom teaching of clinical anesthesiology, make full use of their respective advantages to arrange the teaching content, and make the two complement each other, in order to establish a flexible and practical teaching system of clinical anesthesiology under limited time and conditions, to achieve the teaching goal to the maximum extent and achieve good teaching results.

Research Object.
Sixty-three undergraduate students majoring in anesthesiology in Wenzhou Medical University were selected as the research subjects. All the research subjects had informed consent to the study.

Research Methods.
In this study, we adopted a randomized controlled trial method.
irty-two students in class 1 of anesthesiology specialty were set as experimental group, and thirty-one students in class 2 of anesthesiology specialty were set as control group.
ere were no interactions among the subjects in experimental group and control group. e ratio of male to female in the experimental group was 15 : 17, while that in the control group was 15 : 16, with no significant difference (df � 1, p � 0.904). e age of the students in the experimental group was (21.56 ± 0.16) years, while the age of the students in the control group was (21.61 ± 0.15) years, with no significant difference (t � 0.22, p � 0.8209). We compared the college entrance scores of the two groups of students, with the students in class 1 (567.3 ± 6.81) and class 2 (563.9 ± 7.76), with no significant difference (t � 0.13, p � 0.897) ( Table 1).
We also compared the theoretical examination results of internal medicine courses of the two groups of students. e scores of class 1 students were (69.81 ± 7.01) and class 2 were (71.48 ± 7.20), with no significant difference (t � 0.934, p � 0.354) ( Table 2). Finally, we also compared the theoretical examination results of surgery courses of the two groups of students. e scores of class 1 students were (80.78 ± 7.52) and class 2 students were (81.68 ± 7.42), with no significant difference (t � 0.476, p � 0.603) ( Table 3). So, we think the two groups of students are comparable.

Implementation of Teaching.
e recording process of clinical anesthesiology online course is as follows: ① e Department of Anesthesiology of our school organized all teachers to discuss and select 78 knowledge points for online teaching from 39 chapters of clinical anesthesia course. ② e director of the Department of Anesthesiology organized all teachers to arrange and shoot online courses. Each knowledge point was filmed with one video, each video lasting 15 minutes. All videos were filmed with the assistance of "wisdom tree online education platform." e shooting of online courses encourages the participation of young teachers and arranges experienced backbone teachers to give guidance to young teachers in teaching methods, teaching skills, etc. ③ After the shooting of all knowledge points is completed, the director of the Department of Anesthesiology organizes all teachers to organically combine online knowledge points and offline content through collective lesson preparation, forming 26 complete teaching units of "teaching knowledge points offline-watching video materials online-answering questions offline." ④ e Department of Anesthesiology and the academic affairs office jointly set up an online course website and reasonably arranged the courses of "1 class hour for offline knowledge point teaching + 1 class hour for online video learning + 1 class hour for offline question answering and puzzle solving" according to the teaching units to jointly promote the implementation of the mixed teaching method. Both groups of students used the fourth edition of the textbook "Clinical Anesthesiology," edited by Guo Qulian and Yao Shanglong. e teaching hours were 78 , and the teachers who teach all the courses in the control group are exactly the same as those in the experimental group.

Implementation of Experimental Group Teaching.
e students in the experimental group adopt the mixed teaching methods. ① Offline Teaching. It is divided into two parts. e first part is the offline knowledge point teaching part. According to the curriculum arrangement, teachers will explain the theoretical knowledge involved in this course in detail through the traditional centralized teaching method and strive to make every knowledge point clear. e second part is a question-answering part. e instructor will arrange an offline question-answering course after the online course for each teaching unit is completed. e course consists of two parts: answering questions and sorting out knowledge points. e method of group discussion (four students form a group) is adopted. Students can consult teachers or discuss with classmates about knowledge points that they do not understand, so as to truly convert book knowledge into their own knowledge reserves. e number of offline teaching hours is 52 hours, and the knowledge point teaching course and the question answering course each account for 1 hour. erefore, the offline course for each teaching unit is 2 hours, with a total of 26 classes. Considering the time arrangement of teachers, offline teaching arranges the knowledge point teaching part and the question answering part in a 2-hour course: the first hour is the teaching of new knowledge points, and the second hour is the question answering part of the previous knowledge point after the students have seen online video materials. ② Online Teaching. e academic affairs office of school has arranged a unified time for students to watch the video materials, which are videos of case knowledge and anesthesia skills related to theoretical knowledge points, thus strengthening the theoretical knowledge learned. Online teaching does not require the on-site participation of teacher, but only the supervision of counselors. Students can discuss in groups during the watching process. Students can also watch online video resources repeatedly on the online course platform after class. ere are 26 hours of online teaching, 1 hour at a time, and 26 classes in total.

Control Group Teaching Implementation.
e students in the control group adopted the traditional teaching method; that is, the teachers prepared the teaching contents according to the teaching syllabus and gave detailed lectures on theoretical knowledge, relevant case knowledge, and anesthesia skills. e control group had 78 hours of teaching, 3 hours for each course, and 26 classes in total. In order to ensure the students' mastery of knowledge points, the last hour of each course is the time for answering questions. e students also take the form of group discussion (grouping method is the same as the experimental group), or they can directly consult teachers about their doubts.

eoretical Examination.
After the course is over, the two groups of students will take a written examination of the same examination paper at the same time. e examination paper will be compiled by all teachers of clinical anesthesiology course and finally approved by the director of the Department of Anesthesiology. e examination time is 90 minutes.

Questionnaire Survey.
Considering that the two groups of students received traditional teaching methods in the previous course study, in this study, the experimental group of students accepted the mixed teaching methods, so we chose to conduct a questionnaire survey on the experimental group of students to understand their evaluation of the mixed teaching methods compared with traditional teaching methods.
We compiled a questionnaire based on literature reading and expert consultation. e questionnaire involves students' understanding of teaching content, cultivation of autonomous learning ability, cultivation of clinical thinking ability, activity degree of classroom atmosphere, and whether they like this teaching method, etc. ere are 12 scoring questions.
In order to ensure the reliability of the questionnaire, in June 2018, the members of our research group used convenient sampling method to conduct a preliminary survey on 15 students.
e Cronbach coefficient of the tested questionnaire is 0.921, which is reliable. e formal questionnaire survey was completed by the students organized by the members of our research group in October 2018 after the "Clinical Anesthesiology" course was completed. e questionnaire was distributed on the spot and collected on the spot in an anonymous way.

Statistical Analysis.
e measurement data represent the mean ± SD. ere were no missing, lost, or excluded data. All data in this study were continuous data; first of all, carry on   Education Research International the normality test; if each group satisfies the normal distribution, and the variance between the two groups is equal, use t test to compare between groups. e counting data are expressed by frequency and percentage (n (%)), and significance was determined at the p < 0.05 level. Statistical analyses were performed using Prism 6.0 software (GraphPad Software, San Diego, CA).

eoretical Examination Results of the Two
Groups. e theoretical examination results of the experimental group students ((79.31 ± 4.54)) were higher than those of the control group students ((75.61 ± 4.88)), and the difference was statistically significant (t � 3.118, p � 0.002) ( Table 4).

3.2.
Results of the Questionnaire Survey. 32 questionnaires were distributed to the students in the experimental group and 32 valid questionnaires were recovered. e recovery rate of valid questionnaires was 100%. e survey results show that the students have a high degree of approval of the mixed teaching method, which is better than the traditional teaching method. e specific results are shown in Table 5.

Discussion
e specialty of anesthesiology has remarkable characteristics, strong practicability, and high employment rate, which has always been a key specialty in our university. Students majoring in anesthesiology not only need to master the basic theoretical knowledge and skills of basic medicine, clinical medicine, and anesthesiology, but also need to master the basic operations of anesthesia, first aid, and cardiopulmonary resuscitation. How to train qualified anesthesiology professionals has always been a problem for us to think about. "Clinical Anesthesiology" covers the theoretical basis of clinical medicine and skilled routine clinical operation skills, which is a combination of basic courses and clinical courses of anesthesiology, and plays an important role as a bridge [10].
e teaching system should fully consider the learning needs of students, help students improve their knowledge level, achieve learning effect, and obtain a pleasant and effective learning experience. In the last decade, the continuous progress of information and communication technology has had a far-reaching impact on human daily life, involving economic, social, medical, educational, and other fields, especially in the field of education. Schools, universities, and educational organizations of lifelong learning tend to use technological progress to promote the teaching process and improve learning outcomes [11]. ese technological advances include the development of webbased educational methods and forms of education that use personal computers and mobile devices as learning tools. e online and offline mixed teaching method came into being under this background [12,13].
In the case of limited class hours and teachers, we try the online and offline interactive teaching method, make full use of network teaching resources, effectively break the shackles of traditional teaching, and greatly extend the time and space of the classroom.
e curriculum system is shown in an omni-directional, multi-level, and three-dimensional way by the combination of both inside and outside the school, online and offline. Compared with the previous teaching model, the students' participation and autonomy have been stimulated to establish a flexible and practical teaching system of clinical anesthesiology, and some results have been achieved.

Online and Offline Mixed Teaching Method Improves Students' eoretical Examination Results.
e results of this study show that the theoretical examination results of the students in the experimental group are higher than those in the control group. Compared with the traditional teaching method, 87.5% of the students in the experimental group think that the mixed teaching method is more conducive to mastering the teaching content. e reason is that we organically combine offline teaching with various forms of online teaching, which greatly extends the time and space of the classroom. e course teaching of the students in the experimental group is divided into online teaching and offline teaching. e traditional teaching method adopted by teachers in offline teaching can fully explain important theoretical knowledge points, and students also have time to digest and absorb them in class. e video resources for online teaching are all specific knowledge points, including case analysis, operation demonstration, anesthesia equipment, physical display of drugs, and their operation, etc. Students can watch them repeatedly [14]. e video includes interactive links such as questions and answers on the playing screen set by the teachers, which not only ensures the effect of students' video learning, but also inspires students' thinking. At the same time, the content of video resources is rich and varied, which effectively alleviates the aesthetic fatigue caused by a single teaching method and enhances students' interest in learning. It is precisely because of the organic combination of online teaching and offline teaching that the experimental group students have a more solid grasp of theoretical knowledge of clinical anesthesiology and their theoretical examination results are improved.

Online and Offline Mixed Teaching Method Is More Beneficial to Improve Students' Participation in Learning.
Some studies have found that providing personalized and adaptive digital education is more conducive to the creation of a student-centered learning environment and can increase  [15]. Our research also confirms this. e results of this study show that, compared with the traditional teaching method, 75% of the students in the experimental group think that the mixed teaching method can better enhance the communication between teachers and students and enliven the classroom atmosphere. 81.3% of the students think that the mixed teaching method enhances the interest of learning. 71.9% of the students think that the mixed teaching method can also improve the ability of language expression. ese benefits are due to the fact that we arrange question-and-answer courses after the end of the knowledge points teaching course of each teaching unit and the network video watching course, and the teaching form is carried out in the form of group discussion. Group learning is a way of students' cooperative learning. It can not only revise and improve each student's knowledge in the process of discussion, but also effectively arouse students' enthusiasm for learning [15]. And in the process of answering questions, teachers adopt the teaching method of simulating clinical scene, allowing students to play the roles of doctor and patient, respectively. In this process, doctors participate in doctor-patient communication, weigh the pros and cons, and choose the best treatment and anesthetic methods. Not only does this enable students to bring in scene learning to deepen understanding and increase interest in learning, but also situational teaching can better cultivate students' clinical thinking, as well as the ability to analyze and solve problems, which is difficult to do in traditional teaching [16].

e Mixed Teaching Method Has Higher Teaching Satisfaction.
e results of this study show that, compared with the traditional teaching method, 87.5% of the students in the experimental group think that the mixed teaching method is better than the traditional teaching method. Because the mixed teaching method breaks the traditional classroom teaching method, the teaching method of "rote memorization" is adopted in the classroom, and the method of "teaching knowledge points-strengthening key and difficult points-combing knowledge points" is more beneficial for students to master what they have learned [17,18]. e mixed teaching method, whether it is a video watching course or a questionanswering course, has left students with sufficient time to consult materials and discuss freely. It can give full play to students' learning autonomy and creativity, which not only is conducive to the interactive learning between students, but also strengthens the communication between students and teachers, thus obtaining higher satisfaction from students. e online and offline mixed teaching method is produced under the background of the Internet. is method is the innovation and optimization of traditional teaching methods, which can ease the tense classroom atmosphere, create a lively classroom teaching environment, and guide the combination of students' theory and reality making the knowledge look richer, fuller, and more textured.
To sum up, in the teaching of clinical anesthesiology, compared with traditional teaching methods, mixed teaching not only improves students' theoretical examination scores, but also increases students' participation in learning, and has higher teaching satisfaction. However, the pre-recording of web-based courses requires a lot of human, material, and financial resources and requires all teachers to prepare lessons and discuss collectively in order to ensure the teaching quality of online video resources. At the end of the study, we provided all the online video materials of the mixed teaching method to the students in the control group and arranged for a teacher to answer questions by e-mail. is study lacks a follow-up study on the clinical working ability of students in the experimental group after entering the workplace. In the future study, we will follow up and collect the students in the experimental group and the control group. e evaluation data of clinical working ability can further improve the teaching reform of clinical anesthesiology and provide reference for other related courses.

Data Availability
Some or all data, models, and code generated or used during the study are available from the corresponding author upon request (Hongxia Mei: 20655776@qq.com).