BOPPPS combined with case-based learning for occupational therapy clinical placements: a single-centre randomised controlled trial

Clinical education is a cornerstone of occupational therapy (OT) training. However, traditional lecture-based learning (LBL) often fails to prepare students for the integration of theoretical knowledge, clinical reasoning, and clinical skills required in real-world practice. The BOPPPS model combined with case-based learning (CBL) has shown positive effects across various health professions, yet its application and effectiveness in OT clinical internships have not been evaluated. This study aimed to assess whether the multi-component BOPPPS-CBL educational prograrmme improved theoretical knowledge, clinical skills, and teaching satisfaction among undergraduate OT interns compared with traditional LBL. This randomized controlled trial was conducted at the Department of Rehabilitation Medicine, Suzhou Municipal Hospital, from November 2025 to March 2026. Sixty undergraduate occupational therapy interns were randomly assigned to an experimental group ( n = 30) receiving the multi-component BOPPPS-CBL educational programme or a control group ( n = 30) receiving traditional LBL. The multi-component BOPPPS-CBL educational programme integrated structured pre-class, in-class, and after-class activities centered on authentic clinical cases. Primary outcomes were theoretical knowledge (0–100) and clinical skills assessed by an Objective Structured Clinical Examination (0–100). Teaching satisfaction (20–100) was a secondary outcome, assessed using a 20-item questionnaire adapted from the SETQ framework (Cronbach’s α = 0.87). Between-group differences were analyzed using analysis of covariance (ANCOVA) with pre-test scores as covariates, with Bonferroni correction applied to the five satisfaction subdomains. No alpha adjustment was applied to the two co-primary outcomes.Due to a significant group × pre-test interaction for clinical skills, change-score analysis was used as the primary analysis for this outcome, with Bootstrap ANCOVA as a sensitivity analysis.The relationship between satisfaction and theoretical knowledge was examined using partial correlation controlling for both group allocation and pre-test scores. The trial was retrospectively registered (ChiCTR2600132112). The experimental group scored significantly higher than the control group on both post-test theoretical knowledge and clinical skills (both p < 0.001), with large effect sizes (partial η² = 0.91 and 0.895). The experimental group also reported significantly higher total teaching satisfaction ( p = 0.001) and higher scores in all five satisfaction subdomains after Bonferroni correction (adjusted p < 0.05 for all, including Teaching Enthusiasm, adjusted p = 0.015). For clinical skills, change-score analysis was used as the primary analysis due to a significant group × pre-test interaction, and Bootstrap ANCOVA confirmed the robustness of the findings.The association between satisfaction and theoretical knowledge was strong but exploratory (partial r = 0.860, p < 0.001). Students assigned to the multi-component BOPPPS-CBL educational programme achieved higher immediate post-intervention theoretical knowledge and clinical skills scores and reported greater teaching satisfaction than students receiving traditional LBL. However, because instructor identity was completely confounded with group allocation and the educational dosage was unequal, these findings should be interpreted as preliminary, exploratory evidence for the potential benefits of the entire educational package, rather than confirmation of the BOPPPS-CBL model itself. Future prospectively registered, multi-center trials with validated outcome measures, longer-term follow-up, and factorial or multi-arm designs that can isolate active components and control for instructor effects are required before widespread implementation can be recommended. The trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR) under the registration number ChiCTR2600132112 on September 9, 2026.