What question did this study set out to answer?

The study aims to assess the effectiveness of combining Case-Based Learning and Flipped Classroom teaching in training resident physicians in axillary vein puncture skills.

March 29, 2026Open Access

Effect of Case-Based Learning combined with Flipped Classroom on residents’ axillary vein puncture and catheterization ability

Key Points

The study aims to assess the effectiveness of combining Case-Based Learning and Flipped Classroom teaching in training resident physicians in axillary vein puncture skills.
Randomized controlled study with 93 resident physicians in an intensive care unit.
Participants assigned to reform and control groups with different teaching methods.
Used the Entrustable Professional Activities scale to assess competence in AVPC skills.
Compared groups on first puncture success rate, operation time, Mini-CEX scores, and satisfaction questionnaire.
Reform group had significantly higher first puncture success rate and shorter operation time (p < 0.05).
Mini-CEX scores showed marked improvement in operational skills and clinical judgment in the reform group (p < 0.05).
Higher EPA compliance rate observed in the reform group (p < 0.05).
Reform group reported greater satisfaction with teaching methods and resources (p < 0.05).

Abstract

Objective To evaluate the efficacy of the Case-Based Learning (CBL) combined with Flipped Classroom (FC) teaching model in training resident physicians to master axillary vein puncture and catheterization (AVPC) skills, and to provide an optimized teaching strategy for clinical skill training in critical care medicine. Methods This was a randomized controlled study conducted on 93 resident physicians rotating in the intensive care unit from September 2023 to September 2024. Participants were randomly assigned to the reform group ( n = 46) and the control group ( n = 47) via a random number table method. The reform group adopted the CBL-FC integrated teaching model, while the control group received conventional traditional teaching. After training, the Entrustable Professional Activities (EPA) scale was used to assess AVPC competence, and the two groups were compared in terms of AVPC first puncture success rate, operation time, Mini-Clinical Evaluation Exercise (Mini-CEX) scores, and EPA compliance rate. A questionnaire survey was also conducted to evaluate residents’ satisfaction with the teaching mode. Results The reform group had a significantly higher first puncture success rate and shorter operation time than the control group ( t = 6.474, 6.459, all p 0.05). Mini-CEX scores in the domains of operational skills, clinical judgment, and self-reflection learning of professional attitude were markedly higher in the reform group (all p 0.05). The EPA compliance rate of the reform group was significantly superior to that of the control group ( χ 2 = 24.373, p 0.05). Additionally, the reform group showed significantly higher satisfaction with course content, simulation practice, classroom interaction, teaching methods and course resources (all p 0.05). Conclusion The CBL-FC integrated teaching model exerts a remarkable educational effect on AVPC training for residents, effectively improving their clinical operational proficiency, clinical decision-making ability and learning engagement. It serves as a feasible and effective optimized teaching approach to replace traditional teaching, and can be popularized in clinical skill training for residents in critical care and emergency medicine, which provides a valuable reference for the reform of clinical teaching models in related medical fields.

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