Comparative effectiveness of orthopedic teaching methods in China: a Bayesian network meta-analysis of randomized trials

BACKGROUND: In medical education, scores of theoretical knowledge examinations represent the quantitative reflection of theoretical mastery; results of practical skills tests are the evaluative conclusions of hands-on operational capabilities; learning interest refers to the positive inclination during learning; clinical thinking ability denotes the logical thinking capacity in diagnosis and treatment; communication and expression skills stand for the ability to convey information; and autonomous learning ability is the capacity for proactive learning. These competencies are particularly crucial for physicians. This study aims to systematically evaluate the application effects of different educational methods in undergraduate and postgraduate orthopedic education in China through the aforementioned aspects. METHODS: A comprehensive search was conducted in PubMed, the China National Knowledge Infrastructure (CNKI) database, the Weipu database, and the Wanfang database to collect studies up to December 2, 2024. These studies evaluated the performance of various teaching methods in undergraduate and graduate orthopedic education in China. Under the Bayesian framework, R software (version 4.2.1) was used to call JAGS software (version 4.3.1) for statistical analysis using the Markov Chain Monte Carlo (MCSC) method for direct and indirect comparisons. The GRADE method was employed to assess the quality of evidence for each outcome indicator. RESULTS: A total of 50 studies were included for the meta-analysis. 3D-PBL (Three Dimensional-Problem Based Learning) is the best orthopedic teaching model in China. It demonstrated significant improvements in theoretical assessment scores, skill assessment scores, learning interest, clinical thinking, communication skills, and self-directed learning. CONCLUSIONS: Network meta-analysis showed that among various teaching methods applied in undergraduate and postgraduate orthopedic education in China, three-dimensional problem-based learning (3D-PBL ) outperforms other methods in improving teaching effectiveness, effectively enhancing the quality of orthopedic education in theoretical knowledge, clinical practice, and other aspects.