Pediatrics · Medical Literature
The application of quality control circle activities in the management of clinical undergraduate pediatric internship teaching.
Abstract
Traditional pediatric internship training for undergraduate medical students is often limited by student passivity and underdevelopment of clinical reasoning and skills. This study aimed to evaluate the effectiveness of the Quality Control Circle (QCC) method, integrated with Mini-Clinical Evaluation Exams (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) assessments, in enhancing clinical competencies and teaching outcomes during pediatric internships. Eighty-four medical students were randomly assigned to a QCC group (traditional teaching plus QCC activities) or a control group (traditional teaching only). Clinical skills were assessed using Mini-CEX and DOPS before and after the 4-week pediatric internship. Final exam results and teaching satisfaction were also compared. Baseline scores showed no significant differences. Post-intervention, both groups improved, but the QCC group demonstrated significantly greater improvement in all Mini-CEX domains (medical history taking, physical examination, professionalism, clinical judgment, communication, efficiency, overall competence) and all 11 DOPS items (e.g., procedural understanding, aseptic technique, communication) (P < 0.05). The QCC group also scored higher in final theoretical exams, skill operations, and medical record writing (P < 0.05). Self-evaluations indicated significant progress in eight comprehensive competencies, notably problem-solving and communication skills (P < 0.05). Teaching satisfaction was significantly higher in the QCC group (92.85%) than in the control group (76.19%) (P = 0.024). The QCC teaching model significantly enhances clinical skills, assessment performance, comprehensive competencies, and teaching satisfaction in pediatric internships compared to traditional methods, proving to be a valuable approach for improving clinical teaching quality.
Clinical relevance
Does integrating Quality Control Circle (QCC) activities with Mini-CEX and DOPS assessments into a traditional pediatric internship improve clinical competencies, examination performance, and teaching satisfaction in undergraduate medical students compared with traditional teaching alone? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (parallel-group, two-arm)","setting":"Not reported (institutional setting and country not explicitly stated in the abstract; authorship and journal context suggest China)","sampleSize":"n = 84 (QCC group: not reported per arm; control group: not reported per arm; total randomized = 84)","population":"Undergraduate medical students undertaking a clinical pediatric internship rotation; baseline Mini-CEX and DOPS scores showed no significant between-group differences","intervention":"Traditional pediatric internship teaching augmented by Quality Control Circle (QCC) activities, with Mini-CEX and DOPS used as both formative assessment and structured teaching tools","comparator":"Traditional pediatric internship teaching only (no QCC activities)","primaryOutcome":"Not explicitly designated as a single primary endpoint; outcomes assessed included Mini-CEX domain scores (medical history taking, physical examination, professionalism, clinical judgment, communication, efficiency, overall competence), all 11 DOPS items (including procedural understanding, aseptic technique, and communication), final theoretical exam scores, clinical skill operation scores, medical record writing scores, self-evaluated comprehensive competencies, and teaching satisfaction","followUp":"4 weeks (duration of the pediatric internship rotation)","fundingSource":"Not reported"}
Key findings
At the end of the 4-week intervention, both groups improved from baseline across Mini-CEX and DOPS domains; however, the QCC group demonstrated significantly greater post-intervention improvement across all seven Mini-CEX domains and all 11 DOPS items (P < 0.05 for all comparisons; absolute score differences and confidence intervals not reported). The QCC group also achieved significantly higher scores on the final theoretical examination, clinical skill operations assessment, and medical record writing (P < 0.05; absolute differences not reported). Self-evaluation revealed significant improvement in eight comprehensive competency domains in the QCC group, with problem-solving and communication skills highlighted as notable gains (P < 0.05). Teaching satisfaction was 92.85% in the QCC group versus 76.19% in the control group (P = 0.024; absolute risk difference = 16.66 percentage points [calculated]; NNT for one additional satisfied student ≈ 6 [calculated]). No adverse events or harms data were reported, consistent with the educational rather than clinical intervention nature of the study.
Practice implications
This RCT establishes a statistically significant association between QCC-augmented teaching and superior performance on structured workplace-based assessments (Mini-CEX, DOPS), final examination scores, and teaching satisfaction in undergraduate medical students during a 4-week pediatric rotation. The findings apply to undergraduate medical students in a pediatric internship context; generalizability to other specialties, postgraduate trainees, or settings with different baseline teaching infrastructure is not established. The study does not report effect sizes, confidence intervals, or blinding methodology for assessors, and the abstract designates no single pre-specified primary endpoint, raising risk of outcome multiplicity. Given the absence of absolute score data, the clinical magnitude of competency improvements — beyond statistical significance — cannot be determined from this abstract alone. The satisfaction difference (92.85% vs. 76.19%, P = 0.024) is potentially clinically meaningful. Whether competency gains are durable beyond the internship or translate to improved patient outcomes in pediatric practice was not assessed. Only the abstract was available for this review; full-text analysis may reveal additional methodological details, randomization procedures, allocation concealment, and assessor blinding that are critical to appraising internal validity. __LIMITATIONS__ No pre-specified primary endpoint declared in the abstract, raising concern for multiple comparisons across numerous Mini-CEX domains, DOPS items, exam scores, and competency self-ratings without correction,Absolute effect sizes, confidence intervals, and standardized mean differences not reported for any clinical competency outcome, preventing assessment of clinical magnitude,Assessor blinding not described; given that QCC involves group activities, blinding evaluators to group allocation would be challenging and its absence could introduce performance and detection bias,Small sample size (n = 84 total) with per-arm allocation not reported; underpowered to detect differential effects across individual subdomains,Short follow-up (4 weeks only); no data on durability of skills acquisition, retention, or transfer to clinical practice after rotation completion,Self-report used for eight 'comprehensive competency' measures, introducing social desirability bias, particularly in a non-blinded setting,Teaching satisfaction measured by unvalidated instrument not described in the abstract,Setting not reported; limits assessment of geographic, institutional, and cultural generalizability,Funding source not reported; potential conflicts of interest cannot be assessed,Only abstract available; full methodology, CONSORT flow, randomization concealment, and statistical analysis plan cannot be independently verified __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this small single-rotation RCT, integrating QCC activities into a 4-week undergraduate pediatric internship produced statistically significant improvements in Mini-CEX and DOPS scores, final examination performance, and teaching satisfaction relative to traditional teaching alone. The findings are directionally consistent and hypothesis-generating, but the absence of reported effect sizes, confidence intervals, a declared primary endpoint, and assessor blinding substantially limits interpretability. This intervention warrants further evaluation in larger, adequately powered, multi-center trials with longer follow-up before adoption as a standard teaching framework.