Discussion
Clinical epidemiology is generally considered to be the basic science of clinical medicine [Educational researchers have conducted numerous experiments to develop more feasible and effective teaching methods in epidemiology education. Dyke et al. [In this study, we aimed to fully understand the needs of students and to apply practical and clinical courses to the epidemiological instruction of undergraduate medical interns. Through this course, students in the experimental group participated in conducting a cohort study and learned to deal with problems arising in the study process, which instructs students in the flexible application of theoretical knowledge and clinical scientific research. After the course, students in the experimental group had significantly higher survey scores in course understanding and clinical practice skills, while no significant difference was found in the control group, indicating that the additional practical course helped students deepen their comprehension of the course content (At the end of the course, more than 65% of students in both groups agreed that they have improved their understanding of clinical epidemiological information. Over 90% of the students admitted that this course was very rewarding and substantively helpful for them. The percentage of students who disagreed increased from 12.50% to 26.83% in the experimental group and from 35.29% to 55.88% in the control group, which demonstrated that some students were still unable to keep pace with the teaching content. There are two possible reasons for 17.65% of the students in the control group to express reluctance to participate in practical courses. One is that they may not be interested in practical course design and implementation, as they have taken epidemiology classes before, and the other is that they may be more accustomed to passive and exam-centred traditional methods, which is likely the main reason why 6.25% of students in the experimental group were dissatisfied with the course.Although the results of follow-up tests showed that there were no significant differences between the scores of the two groups and the pass rate in both the theoretical part and the case analysis part, we still considered the practical course to have had a positive effect on strengthening the learning initiative, course understanding and clinical application of epidemiological knowledge and skills. Because the tests only covered a small portion of the knowledge points and the capability of practical application cannot be accurately evaluated simply with single choice questions even if several of those questions relate to actual case analysis.Generally, students who participated in this two-week practical course exhibited a higher level of interest and learning enthusiasm, as well as a better mastery and utilization of epidemiological knowledge and skills.This study also has some limitations. First, we only recruited undergraduate medical students who had enrolled in internships with The Fourth Affiliated Hospital of Zhejiang University in this study and over 70% of students came from Zhejiang University. Thus, the sample size was insufficient, and the results in this study may be unable to be generalized to all medical interns regarding practical courses. Moreover, the participants were randomly divided into the experimental group and the control group before the pre-course survey. However, the experimental group manifested higher interests than the control group before the study, which may lead to stronger learning motivation in the experimental group and result in biased outcomes. The role of the practical course may not be explained since significant difference in the baseline interests. Finally, the practical course allowed students to participate in all steps of clinical epidemiology research, but the research method used in this project was fixed (cohort study). This may familiarize students with cohort studies but leave them without an understanding of or capacity with other research methods, such as case‒control studies and cross-sectional studies. To better reveal the actual level of mastery and application ability of epidemiological knowledge and clinical skills, the further long-term study is needed. There is still a long way to go building developing and testing a suitable teaching evaluation system and confirming the effectiveness of its application.In conclusion, offering a practical course in epidemiology to satisfy the needs of students is necessary, and this study showed that such practical courses are a beneficial supplement to the traditional teaching method, and it is conducive to strengthening students' learning enthusiasm and clinical practice ability as well as improving scientific research and clinical decision-making in general. Our study provides a new method and novel evidence for the development of an epidemiological teaching mode.