Teaching implementation
For the trial group, each course included three parts: introduction, main body, and summary. The teacher introduced herself (preface), presented a story or a clinical case to introduce the course, and shared the syllabus in the introductory section. The main body was divided into three to four blocks. Each block had a theme of approximately 10–20 min (depending on the content of the block). Each block included teaching, teacher–student interactions, and students answering block test papers (with one to five questions). The teacher presented the two-dimensional code of the block test papers when students were required to respond to the block test. The students scanned the two-dimensional codes with their mobile phones on the WeChat app, answered the questions, and submitted test papers to the Questionnaire Star website. Each test paper was completed within 2–3 min. The teacher instantly obtained the scores of every student and the rate of correct answers to every question on the Questionnaire Star website. When the rate of correct answers to one or more questions in the block test was less than 90%, the teacher obtained feedback (typically through communicating with students) and adjusted their teaching in the following blocks. The teacher communicated with the students (online and on-site students) who responded with incorrect answers to understand the reasons they chose the incorrect answers. The teacher further obtained feedback by observing students’ expressions and body language (on-site students). Before the next block, the teacher summarized the problems encountered in feedback of the previous block and improved on them in the following blocks. That is to say, between the two blocks, the teacher received and summarized feedback and adjusted the teaching once. In the summary section, the teacher summarized the key points of the course and provided homework.The control group also had three sections. The contents of the introduction and summary sections were similar to that of the trial group. The main section included teaching and teacher–student interactions. These interactions in both groups involved the teacher asking students questions randomly and the students answering the questions.