Integrating problem-based learning with virtual simulation in trauma orthopedic education: effects on learning outcomes and student satisfaction

BACKGROUND: Trauma orthopedics is a key component of orthopedic clinical education, but its teaching is often limited by complex fracture patterns, high demands for spatial understanding, and insufficient opportunities for hands-on practice. Although problem-based learning (PBL) and virtual simulation have each shown educational value, evidence regarding their combined use in trauma orthopedic teaching remains limited. This study aimed to evaluate the effectiveness of an integrated PBL and virtual simulation teaching model in trauma orthopedic education. METHODS: This assessor-blinded randomized controlled study included 50 clinical medical students undertaking internships at the First Affiliated Hospital of Wannan Medical University between July 2024 and June 2025. Participants were randomly assigned to a control group (n = 25), which received traditional lecture-based teaching, or an experimental group (n = 25), which received PBL combined with virtual simulation. Outcomes included theoretical knowledge, clinical skills, critical thinking ability, student evaluation of teaching effectiveness, and teaching satisfaction. Data were analyzed using t tests and chi-square tests. RESULTS: No significant between-group differences were observed in baseline theoretical knowledge or clinical skills scores before teaching. After the intervention, the experimental group achieved significantly higher written examination scores than the control group (88.48 ± 4.02 vs. 77.04 ± 5.31,mean difference = 11.44,95% CI: 8.76 - 14.12, p < 0.01) and significantly higher practical operation scores (86.28 ± 3.18 vs. 76.52 ± 3.39,mean difference = 9.76,95% CI :7.89 - 11.63,p < 0.01). The experimental group also showed higher total critical thinking scores (314.12 ± 10.68 vs. 270.28 ± 19.76,mean difference = 43.84,95% CI: 34.70 - 52.98, p < 0.05), overall teaching effectiveness scores (17.72 ± 1.24 vs. 12.72 ± 1.02,mean difference = 5.00,95% CI: 4.35 to 5.65,p < 0.01), and total teaching satisfaction scores (86.96 ± 6.46 vs. 70.24 ± 8.71,mean difference = 16.72,95% CI:12.35 - 21.09,p < 0.05). CONCLUSIONS: The integration of PBL with virtual simulation improved theoretical performance, clinical skills, critical thinking, and learning satisfaction in trauma orthopedic teaching, and may represent an effective strategy for clinical education reform in this field.