Abstract Background: In optometry education, insufficient theoretical depth and limited practical opportunities during clinical rotations contribute to gaps in theoretical knowledge and operational skills. While MOOCs offer flexible resource integration and digital twin technology provides high-fidelity simulation, standalone applications have limitations. This study therefore evaluated the effectiveness and acceptability of a novel MOOC-digital twin hybrid clinical internship model in optometry, specifically assessing its impact on students' theoretical mastery, clinical operational ability, and comprehensive learning experience, to provide empirical evidence for educational reform. Methods: Fifty-four ophthalmology graduate students were divided into an experimental group and a control group. The experimental group utilized the MOOC platform for pre-class theoretical learning and employed digital twin technology to simulate corneal refractive surgery procedures. The control group received traditional classroom lectures and demonstrations. Learning outcomes were compared using in-class tests, final subject assessments (theoretical and practical), and questionnaires. Data were analyzed using independent samples t-tests. Results: The experimental group achieved significantly higher scores in both refractive surgery (pre-test: t = 4.096, P < 0.001; final exam: t = 3.642, P = 0.001) and amblyopia modules (t = 2.33, P = 0.024), with progressive improvement over time. They also reported superior teaching satisfaction, task-clinical relevance, and course interest (all P < 0.05). Instructors (92%) noted enhanced student comprehension and improved learning climate (t = 6.211, P < 0.001). Conclusions: The MOOC-digital twin hybrid mode, structured around a "theory → simulation → practice" framework, effectively synergizes the flexibility of MOOCs with the practical realism of digital twins, significantly enhancing students' active learning capabilities and clinical reasoning in optometry training. This study provides empirical support for the model's efficacy as a tool for medical education innovation.
Kang et al. (Mon,) studied this question.