Application of the BOPPPS model combined with flipped classroom in clinical practice competency training for gastroenterology residents in standardized residency programs

Abstract

The bridge-in, objective, preassessment, participatory learning, postassessment, summary (BOPPPS) instructional model and flipped classroom pedagogy are increasingly recognized as effective active learning strategies in medical education. However, their combined application in gastroenterology residency training has not been systematically evaluated. This study investigated the impact of the BOPPPS + flipped classroom model on clinical practice competency, clinical thinking, self-directed learning, and teaching satisfaction among gastroenterology residents. A randomized controlled design was employed. A total of 120 first-year undergraduate-degree residents who completed their gastroenterology rotation at the Third People's Hospital of Yunnan Province between January 2025 and December 2025 were enrolled and randomly assigned to an observation group ( n  = 60; BOPPPS + flipped classroom) or a control group ( n  = 60; traditional lecture-based teaching). The intervention lasted 12 weeks (one session per week, two class hours per session). Teaching effectiveness was assessed using standardized clinical practice simulations (admission interview/consultation, clinical reasoning case analysis, and procedural skills), the primary trait analysis (PTA) clinical thinking scale (eight domains), the Self-Directed Learning Readiness Scale (SDLRS), and a validated satisfaction questionnaire. Primary analyses employed analysis of covariance adjusting for corresponding baseline values, with effect sizes reported as adjusted Cohen's d . For multiple secondary comparisons, the Benjamini–Hochberg false discovery rate (FDR) correction was applied. Ordinal PTA scale data were additionally analyzed using non-parametric Mann–Whitney U -tests as sensitivity analyses. The observation group achieved significantly higher scores than the control group across all clinical performance measures: admission interview [adjusted mean difference (aMD) = 3.02, 95% confidence interval (CI): 1.46–4.58, P  < 0.001, adjusted d  = 0.69], clinical reasoning (aMD = 6.85, 95% CI: 4.75–8.95, P  < 0.001, adjusted d  = 1.36), and clinical skills (aMD = 9.52, 95% CI: 7.22–11.82, P  < 0.001, adjusted d  = 2.18). PTA scores were significantly higher in the observation group for all eight clinical thinking dimensions (all P  < 0.001 after FDR correction). SDLRS total scores were also markedly higher in the observation group (aMD = 13.82, 95% CI: 10.35–17.29, P  < 0.001, adjusted d  = 1.38). Satisfaction rates exceeded 86% across all domains in the observation group, compared with 34.3%–54.3% in the control group (all P  < 0.05). The BOPPPS + flipped classroom model significantly enhances clinical practice competency, clinical thinking, self-directed learning, and teaching satisfaction among gastroenterology residents compared with traditional instruction. However, the very large effect sizes observed should be interpreted with caution, as the intervention combined multiple instructional components (preclass preparation, supervised hands-on practice, and structured feedback) that were not isolated. Implementation decisions should consider local resources and the specific training contexts.