Effect of the BOPPPS-PBL teaching model on clinical pharmacotherapeutics education for four-year pharmacy undergraduates in Central China: a non-randomized controlled study

Technical Summary: Effect of the BOPPPS-PBL Teaching Model on Clinical Pharmacotherapeutics Education

Problem Statement
Clinical pharmacotherapeutics is a core, cross-disciplinary course bridging basic pharmacy and clinical medicine, essential for training pharmacists to design individualized drug treatment regimens. However, the current educational landscape in China faces significant challenges. The traditional Lecture-Based Learning (LBL) model, while systematic in knowledge dissemination, is characterized by teacher-centered instruction, passive student reception, and a lack of interaction. This approach often fails to integrate theoretical knowledge with clinical practice, resulting in graduates who lack critical thinking, clinical decision-making skills, and the ability to communicate effectively with medical teams. Furthermore, existing curriculum systems often lack unified planning, and assessment methods rely heavily on written tests rather than process evaluation, failing to meet the demands of the shifting "patient-centered" and "rational drug use" paradigms in healthcare. While both the Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) model and Problem-Based Learning (PBL) have shown individual efficacy in medical education, their integrated application in clinical pharmacotherapeutics for pharmacy undergraduates remains underexplored.

Methodology
This study employed a prospective, non-randomized controlled trial design involving 318 four-year undergraduate pharmacy students from Zhengzhou University in Central China. The participants were divided into two cohorts based on academic year:

• Control Group (Class 2019, n=156): Received traditional LBL instruction. Teaching involved unilateral PowerPoint delivery, passive note-taking, and homework assignments without interactive problem-solving.
• Experimental Group (Class 2020, n=162): Received instruction using the integrated BOPPPS-PBL model.

The BOPPPS-PBL intervention was structured around six specific phases:

1. Bridge-in: Introduction of clinical cases (e.g., antibiotic resistance scenarios) and scientific stories to stimulate curiosity.
2. Objective: Clear articulation of learning goals and key points.
3. Pre-assessment: Online quizzes to gauge prior knowledge and identify learning gaps.
4. Participatory Learning: The core phase where students were divided into groups to solve problem chains derived from real clinical cases. Activities included literature review, group discussion, and diverse presentations (role-play, simulations, etc.), with teachers acting as facilitators.
5. Post-assessment: Online quizzes to evaluate immediate knowledge mastery.
6. Summary: Structured consolidation of knowledge by both students and teachers.

Effectiveness Assessment
Data was collected at the end of the semester using three primary metrics:

1. Knowledge Mastery: Course grades comprising formative assessment (attendance, participation, homework) and final assessment (theoretical knowledge and clinical case analysis).
2. Course Experience: Anonymous surveys using the Course Experience Questionnaire (CEQ) to measure student perceptions of teaching quality, workload, and skill development.
3. Critical Thinking: The Critical Thinking Disposition Inventory of Chinese Version (CTDI-CV) to assess traits such as truth-seeking, open-mindedness, and analytical ability.
4. Teacher Self-Efficacy: The Teachers' Sense of Self-Efficacy (TSES) scale to evaluate instructors' confidence in strategies like questioning, assessment, and student motivation.

Key Results

• Academic Performance: The BOPPPS-PBL group achieved significantly higher total scores (80.41 vs. 69.28, P < 0.001) compared to the LBL group. This improvement was driven by significantly higher scores in formative assessments, particularly in "participation in class" and "homework," as well as the "comprehension application" section of the final exam. No significant difference was found in basic theoretical knowledge scores or attendance.
• Student Experience: Students in the BOPPPS-PBL group reported significantly higher confidence in tackling unfamiliar problems, improved problem-solving skills, enhanced analytical abilities, and better teamwork capabilities. They also perceived the teaching staff as more effective in explaining concepts, providing feedback, and making the course interesting. Notably, the new model did not increase perceived learning pressure or workload compared to LBL.
• Critical Thinking: While baseline critical thinking scores were similar, the BOPPPS-PBL group showed significant post-intervention improvements in total CTDI-CV scores and specific dimensions of truth-seeking, analytical ability, and inquisitiveness. The effect sizes for these improvements were large (e.g., d = 1.008 for analytical ability). The LBL group showed no significant change in critical thinking scores.
• Teacher Efficacy: Instructors in the BOPPPS-PBL model reported significantly higher self-efficacy in crafting good questions, utilizing diverse assessment strategies, implementing alternative instructional methods, and motivating students with low interest.

Significance and Claims
The paper concludes that the BOPPPS-PBL model is a superior teaching approach for clinical pharmacotherapeutics education compared to traditional LBL. The study claims that this integrated model not only enhances students' mastery of knowledge but also significantly improves learning efficiency and teaching effectiveness. Specifically, it fosters essential professional competencies such as critical thinking, problem-solving, and teamwork, which are crucial for the transition from "drug-centered" to "patient-centered" pharmaceutical care.

The authors position this research as the first to integrate BOPPPS and PBL specifically for clinical pharmacotherapeutics in this context. They suggest that the model effectively bridges the gap between theoretical knowledge and clinical application without increasing student burden. Consequently, the paper advocates for the adoption of such comprehensive teaching approaches by educational policymakers and medical schools to cultivate high-quality pharmacy professionals capable of meeting modern clinical demands. The study acknowledges limitations regarding its single-center design and lack of long-term follow-up, calling for future multicenter randomized controlled trials to validate these findings further.