Effect of Optimized Clinical Teaching Mode for Orthopedic Standardized Residency Training on Pass Rates of Two Key Examinations in a Municipal Tertiary Class-A Hospital

Objective: To evaluate the impact of an optimized clinical teaching model for orthopedic standardized residency training (SRT) on trainees' first-attempt pass rate of the National Medical Licensing Examination (NMLE) and their performance in the final SRT assessment, and to provide empirical evidence for teaching reform of orthopedic residency training in municipal tertiary Class-A hospitals in China. Methods : We conducted a retrospective historical cohort study. A total of 42 SRT trainees admitted to the Department of Orthopedics at a municipal tertiary Class-A hospital between January 2017 and December 2019 were allocated to the traditional teaching group, which received routine clinical preceptorship. Another 45 trainees admitted between January 2020 and December 2022 were assigned to the optimized teaching group, which received a comprehensive teaching model integrating case-based learning (CBL), simulation skills training, formative assessment, and a mentor accountability system. Outcome measures included the first-attempt NMLE pass rate, final SRT assessment scores (theoretical, practical, and total scores), teaching satisfaction, and clinical competence evaluation. Categorical variables were compared using the chi-square test, continuous variables were compared using the independent samples t-test, and multivariate logistic regression was performed to identify factors associated with examination pass rates. Results : The first-attempt NMLE pass rate was significantly higher in the optimized teaching group (88.89%, 40/45) than in the traditional teaching group (69.05%, 29/42) (χ2=5.87, P=0.015). The optimized group also achieved significantly higher final SRT assessment scores, with theoretical (82.35±6.21 vs. 73.48±7.12), practical (85.62±5.38 vs. 76.25±6.89), and total scores (83.98±5.76 vs. 74.86±6.53) all exceeding those of the traditional group (t=6.32, 7.05, and 7.58, respectively; all P