With the development of online education, a variety of online learning models have emerged, such as MOOC and other massive course sharing or trading platforms; this has attracted the attention of medical educators. Pei et al.16 conducted a meta-analysis of the literature in 2000–2017. They systematically reviewed 3700 articles, selected 16 articles that met the research standards, and discussed the degree of knowledge and skills mastered through online and offline learning for medical undergraduates. Compared with traditional offline learning, online learning is more effective in promoting the knowledge and skills of medical undergraduates; thus, it is a feasible method. Coincidentally, scholars such as Tang17 reviewed 45 studies and concluded that the integration of online courses into medical education has a high degree of acceptance and provides satisfying learning results for medical undergraduates.
Generally, early online educational methods adopted the recording and broadcasting class model. However, this one-way video courseware cannot form a complete learning loop, leading to problems such as students’ absence, teachers’ self-talk, and lack of teacher–student interaction. Our results also showed that maintaining the interactions between teachers and students is only difficult in online courses. Among the three teaching methods, no teacher chose a purely online teaching mode. This is because they observed that students found difficulty in adapting to this teaching method, and their expressiveness and passion were lower than that in offline courses. Therefore, online education alone should not be regarded as the most superior method. Compared with recording and broadcasting, live teaching is a more interactive method, which can create a better learning atmosphere and address the issue of mandatory learning to a certain extent18. According to the survey results of this study, as well as those of a recent study19, traditional face-to-face education is irreplaceable for medical courses.
In contrast to purely online educational methods, our online educational method combines live broadcast technology and online education, which appeals strongly to the Internet generation and compensates for the lack of online learning interaction20. This creates opportunities for the online education industry, which as a result, promotes the rise of live broadcast education. However, medical education is complex as it includes operational and humanistic concerns, which require teachers and students to interact sufficiently. Online and offline educational methods have their own advantages; however, combining them creates many problems, such as reduced classroom time and increased complexity of knowledge, which makes achieving satisfactory results difficult.
In this study, we successfully implemented SFCs and reformed the oral medicine curriculum of a college. The application of SFCs in oral medicine courses received satisfactory evaluations from learners and achieved satisfactory outcomes. Students (in grade 2015) who participated in the SFCs had significantly higher scores on their final exam than the control group (grade 2017). These results were similar to those based on the flipped-classroom courses analysed by other researchers21; this might be owing to the great benefits of flipped classrooms. In our study, the improved teaching results were not only evident in the visible exam score but also in the positive evaluations on the reform of teaching methods (Fig. 4). SFC methods encourage students to obtain new concepts and information in advance. Thus, students will be equipped with factual knowledge to understand concepts and search for references and information. Through the SFC teaching method, students apply metacognitive strategies by self-learning.21 For example, in this study, students who attended the SFCs chose a case and tried to make a diagnosis or solve some problems by themselves before class, rather than passively get the answers in traditional online or offline classes. Furthermore, implementing the SFC method in teaching oral medicine allowed students to develop critical thinking, analyse medical evidence rationally, and apply their knowledge to real clinical care practically. In the chapter ‘oral ulcerous diseases’, students strongly agreed that SFCs helped them understand new concepts and information in advance and helped extend their textbook knowledge.
Nonetheless, designing an SFC is not an easy task.22 During the course preparation process, educators may spend more time developing the knowledge points, collecting course materials, designing teaching methods, and recording video clips than they would for traditional offline classes. In contrast to fully flipped classes, the SFCs allowed educators to impart some knowledge during class time owing to the characteristics of oral medicine courses. Educators provided clear and detailed video clips to students so that they may learn before class; the educators used the classroom time to explain difficult points to inspire students to think independently and encourage interaction. Students were required to use the online courses, which entailed watching video clips and finishing the relevant exercises, to conduct self-learning before the class. This allowed them to attend class with some basic knowledge and specific questions. In the classroom, not only do students learn the curriculum content from the educators but also the methods to study medical science efficiently and solve real problems in clinical practice.
Interestingly, as teaching content increases, courses gradually become the foundation for basic or clinical research. However, some current controversial views or clinical doubt may be considered as scientific objections in the future. In our college, students are encouraged to engage in scientific research at an early stage. During summer holidays and other instances of spare time, students are guided to consult materials, participate in laboratory research projects (related to oral medicine), and write scientific papers. Consequently, we have achieved the goal of expanding students’ horizons, enlightening their thinking, developing their personality, and improving their overall ability. Moreover, encouraging students to participate in scientific research and academic exchange activities actively plays a positive role in maintaining the advanced nature of the curriculum system.23
Though the SFC educational method showed positive results, this study had some limitations. First, the experimental design was not ideal as many factors could not be set randomly, such as the participants, educational environment, and learning abilities. Second, the number of participants in this study was low. Future applications of this teaching method in larger groups are needed to determine whether the results achieved in this study are generally consistent. Third, our course contained only six classes, which was not enough to predict long-term training performance. Therefore, more studies are needed to track the long-term learning effect and determine whether the beneficial outcomes of SFCs are sustainable.