Logo Medical Science Monitor

Call: +1.631.470.9640
Mon - Fri 10:00 am - 02:00 pm EST

Contact Us

Logo Medical Science Monitor Logo Medical Science Monitor Logo Medical Science Monitor

17 January 2021: Clinical Research  

The Smart Class Teaching Module for Rehabilitation Medicine English Education in China

Qiang Lin1234ACDEF, Yaxian Qiu12CDE, Junjie Liang123CD, Yuxin Zheng123C, Yujun Liao12B, Huina Huang12B, Lingying Hou12B, Shijuan Lang123DF, Biyi Zhao1C, Zulipiya Yiming1C, Qinghua Yan5BCD, Haining Ou1234ADG*, Yanni Zhang123ABCDG

DOI: 10.12659/MSM.929834

Med Sci Monit 2021; 27:e929834



BACKGROUND: Learning medical English is particularly challenging for non-native English-speaking medical students. The Smart Class teaching module is a new online teaching module for rehabilitation-related medical English, the efficacy of which has yet to be established in the literature. Gender differences should also not be ignored in our study, taking into account the proven performance differences between males and females in language learning.

MATERIAL AND METHODS: First-year physiotherapy students in Grade 2018 and Grade 2019 at Guangzhou Medical University were recruited to participate in this study. Grade 2019, as the experimental group, completed the Smart Class teaching module, while Grade 2018, as the control group, completed the Traditional Class teaching module. The efficacy of both modules was assessed objectively using the students’ medical English exam scores and subjectively using the students’ responses to a questionnaire.

RESULTS: In total, 242 questionnaires were distributed, and 210 valid questionnaires were returned, of which 119 were from the Smart Class teaching module group and 91 were from the Traditional Class teaching module group. There was no statistically significant difference between the medical English exam scores of the 2 groups (P=0.324). However, the subjective assessment revealed that the students experienced a significantly greater burden from the workload in the Smart Class teaching module group (P<0.001).

CONCLUSIONS: We found both the Smart Class teaching module and the Traditional Class teaching module achieved similar teaching outcomes. Therefore, the former represents a viable alternative teaching option for situations where traditional class teaching is not possible.

Keywords: Education, Medical, Undergraduate, Rehabilitation, Teaching, Adolescent, Computer-Assisted Instruction, Limited English Proficiency, Physical Therapy Specialty, Students, Health Occupations, Teaching Materials, Translating, young adult


Medical English is one of the important basic medical professional courses and includes the specialized vocabulary used by healthcare professionals and clinical researchers. Learning medical English is conducive to international professional communication, literature comprehension, and scientific research [1]. However, for non-native English medical students, learning medical English is particularly difficult because it necessitates acquiring both language and medical knowledge [2]. Moreover, different medical sub-specialties have different medical English learning priorities. College-level education in rehabilitation and physical therapy started late in China and needs to be better aligned with international standards [3]; as such, it lacks the experience and professionalism of other medical fields. Additional challenges facing teaching practice include increased content, frequent updates, and challenging self-study assignments.

The Smart Class teaching module (also known as blended learning) is a new teaching module that mixes traditional class teaching modules and network-based autonomous learning, which relies on modern information technology and network media to build a teaching platform covering teaching resources, real-time classrooms, and interactive communication. It helps teachers foster an effective educational environment for students [4,5]. In medical English education for rehabilitation medicine college students, the traditional class teaching module mostly utilizes a passive study method (only relying on learning from the teacher’s in-class teaching) and ignores the cultivation of students’ autonomous learning. Therefore, we employed the Smart Class teaching module to teach medical English at the college level with the aim of identifying any differences in teaching outcomes between the Smart Class teaching module and the Traditional Class teaching module, as well as to aid in the reform of medical English teaching in China. In addition, since gender differences in language learning performance have been found and replicated in numerous studies [6–8], we also investigated the impact of gender differences on medical English learning in our study.

Material and Methods


The Grade 2018 and Grade 2019 physiotherapy students at the Physical Therapy and Rehabilitation College of Guangzhou Medical University were recruited to participate in this study. Our study was approved by the Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University and was performed in accordance with their ethics standards. Inclusion criteria were: (i) age 17–22 years old, (ii) completed the medical English course in their first year, (iii) a first-year undergraduate student of physiotherapy, and (iv) willing and able to participate in the study. The questionnaire was distributed by cell phone as an online survey to the physiotherapy students during the first week after final exams. The questionnaires were distributed to 242 students in total.


Two teaching modules were used in this study at the first academic year. Grade 2019 (the experimental group) completed the Smart Class teaching module for medical English study, whereas Grade 2018 (the control group) completed the Traditional Class teaching module for medical English study. The same textbook, syllabus, classes (18 hours of theoretical coursework), and teacher team were used for the 2 medical English teaching modules. Then, the students from both groups completed the medical English exam (final exam with a full score of 100) which included 20 single-answer questions and 5 multiple-answer questions, 6 translation questions, and 3 case-analysis questions. It was used primarily to evaluate the students’ mastery of professional terminology, their English reading ability of professional references, and their ability to analyze clinical cases in professional medical English.


All of the students taking the 2 teaching modules (Smart Class teaching module and Traditional Class teaching module) were asked to voluntarily complete the same anonymous, online questionnaire 1 week after the medical English course finished (student questionnaire seen in the Supplementary 1 for details). This student questionnaire included a student’s basic information (grade, age, gender, college entrance examination scores, characteristics of learning English, objectives for learning English, time spent learning English each week) and 14 multiple-choice questions about their medical English course, which could be grouped into 5 main topics: 1) Course attractiveness (Question 8, Question 9, and Question 10); 2) Course teaching effectiveness (Question 11, Question 12, Question 13, and Question 14); 3) Course workload (Question 15 and Question 16); 4) Curriculum resources (Question 17 and Question 18); 5) Curriculum improvement (Question 19, Question 20, and Question 21). The respondents provided their answers to each of the 14 questions using 5-point Likert-type scales.

We used Sample Size Calculator (the public service of Creative Research Systems survey software: https://www.surveysystem.com/sscalc.htm#one ) to determine how many valid questionnaires we required in order to get results that reflect the target populations as precisely as needed. We set a confidence level of 95% and a confidence interval of 5, and found a required minimum sample size of 152.

External reliability was assessed by Spearman’s correlation coefficients. The value should be more than 0.60, which represents a strong correlation, indicating good external reliability of the questionnaire [9]. Internal reliability was assessed by Cronbach’s alpha coefficient. Cronbach’s alpha score was found to be more than 0.70, which indicates an acceptable level of questionnaire reliability [10]. Moreover, the questionnaire validity was assessed by Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) and Bartlett’s sphericity test. KMO value should be more than 0.60 and the statistically significant value should be less than 0.001 (P<0.001), which indicate that the sampling was sufficient and data had normal distribution [11].


Statistical analysis was carried out using IBM SPSS 25.0 software. Normally distributed data are represented using the mean±standard deviation, data that do not conform to the normal distribution are represented using the median, and count data are represented by constituent ratio or rate. The measurement data from the 2 groups (Smart Class teaching module vs. Traditional Class teaching module; male vs. female) that conform to normal distribution and the homogeneity of variance were compared using an independent samples t test. Measurement data from the 2 groups that do not conform to the normal distribution and the uniformity of variance were compared using the nonparametric rank-sum Mann-Whitney U test. The 5 answers to the 14 multiple-choice questions on the student questionnaire were assigned values of 1 to 5 according to responses A to E, with lower values indicating a worse or more negative situation versus the higher values indicating a better or more positive situation. The average score was calculated within the 5 thematic categories, and then the 2 groups were statistically analyzed. The test level was statistically significant at P<0.05.



In our study, 242 questionnaires were distributed, and 210 valid questionnaires were returned (age, 19.08±0.79 years old; 79 male students and 131 female students). Of these, 119 valid questionnaires were collected from the Smart Class teaching module group (age, 19.06±0.76 years old; 48 male students and 71 female students) and 91 valid questionnaires were collected from the Traditional Class teaching module group (age, 19.11±0.83 years old; 31 male students and 60 female students). The English entrance exam scores for the different teaching modules were 119.51±11.57 for the Smart Class teaching module group and 117.92±13.20 for the Traditional Class teaching module group.

No statistically significant differences were found in age, gender ratio, gender distinction, or total English entrance exam scores. However, the English entrance exam scores of the male students were lower than those of the female students in both teaching module groups (Smart Class teaching group: male 111.86±14.24, female 119.51±11.57, P=0.013; Traditional Class teaching group: male 115.15±12.42, female 111.86±14.24, P<0.001) (Table 1, Figure 1).


No statistically significant difference in medical English exam scores was found between the Smart Class and Traditional Class teaching modules. However, female students scored higher than male students in both teaching module groups (Smart Class teaching module: male 73.82±13.49 scores, female 81.93±6.20, P<0.001; Traditional Class teaching module: male 77.03±13.00 scores, female 82.49±8.44, P=0.006) (Table 2, Figure 2).


We performed reliability (external and internal reliability) and validity tests for the student questionnaire. Eleven students from Grade 2019 were randomly selected to fill in the questionnaire twice with a 2-week interval. The external reliability coefficient of the questionnaire was 0.814, indicative of good external reliability. The alpha coefficient was 0.762, which indicated good internal reliability. The KMO value was 0.832, which indicated that the validity of the questionnaire was good.

There were no statistically significant differences in course attractiveness, teaching effect, course resources, or course improvement between the 2 teaching modules by gender, except for academic load. The Smart Class teaching module group reported a greater academic load than the Traditional Class teaching module group (Smart Class teaching module: 2.64±0.54, Traditional Class teaching module: 3.02±0.65; P<0.001). Moreover, the responses to Question 15 (the extra burden from medical English study) and Question 16 (the difficulty of preview and review of medical English) were significantly different between the 2 groups, indicating that the students in the Smart Class teaching module experienced significantly greater academic load than those in the Traditional Class teaching module (Question 15: Smart Class teaching module 2.82±0.83, Traditional Class teaching module 3.35±0.86, P<0.001; Question 16: Smart Class teaching module 2.50±0.78, Traditional Class teaching module 2.84±0.82, P=0.003) (Table 3). In addition, there were no significant differences in the perception of both teaching module methodologies between male and female students (Figure 3). Figure 4 shows that the largest percentage of learning type (Question 5) in both teaching modules was reading type. The 2 largest percentages of objectives of learning medical English (Question 6) in both teaching modules were passing the exam and application of medical English. The largest percentage of extra time off-class learning (Question 7) in both teaching modules was 0 hours. The majority of students in both teaching modules thought it was necessary to increase practice of medical English (Question 21).

There were 24 students in the Smart Class teaching module group and 13 students in the Traditional Class module group who gave an answer to Question 22. In the Smart Class teaching module group, 29.2% of students indicated that they need more self-discipline in learning for preview, versus 8% of students in the Traditional Class teaching module group. Other suggestions involved adding practice class hours and increasing more learning materials specific to rehabilitation medicine.



Students’ English entrance scores could not be correlated to their medical English exam scores due to the assurance of anonymity, which ensured the objectivity of the survey. Therefore, the student questionnaire does not take into account the impact of English entrance scores on the medical English exam scores.


This study compared the outcomes of the Smart Class teaching module and the Traditional Class teaching module in the Medical English course practice among rehabilitation therapy students. We found both teaching modules achieved a similar teaching effect. The Smart Class teaching module may be an alternative teaching method for situations where the Traditional Class teaching module is not possible, such as geographical restrictions and public health emergencies. Overall, the findings of the present study indicate that the medical English curriculum still requires further optimization.

Supplementary Data

Supplementary 1. Student questionnaire for medical English study


Dear student/subject for Medical English study,


This is a student questionnaire for Medical English study in Guangzhou Medical University, which is used in order to understand the study situation and to help guide further teaching practice.

Our study was approved by the Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University and is in accordance with its ethical standards. If you have any other questions, please contact the research executive Haining Ou (Tel. 86 1591 8673 453).


This Student Questionnaire includes a student’s basic information (grade, age, sex, college entrance examination scores, characteristics of learning English, objectives for learning English, time spent learning English each week) as well as 14 multiple-choice questions about your Medical English course.

The whole questionnaire will take you about 10 minutes to complete.

Please understand that your careful and truthful answers are essential to scientific conclusions. You do not have to guess the design of the study or the intention of the question, and there is no right or wrong answer.


Confidentiality does not collect of this study is to identify your personal identity of sensitive information and there is no sensitive issues involved. All data in this study will be used for scientific purposes only.


Since this research is used for teaching reform and there is no economic benefit for anyone, no corresponding compensation is provided

Because of confidentiality, do NOT put your signature on the questionnaire. If you continue on the next page, that means you have read the above and volunteered to participate in this study. Thank you for your patience and reply.


1. Yang Y, Dou C, The teaching of Medical English and the cultivation of medical students’ scientific research quality : Medical Education Research and Practice, 2019; 323-27

2. Rashid MA, Xu L, Nicholson JG, Gill D, “Doctor, teacher, translator:” International medical students’ experiences of clinical teaching on an English language undergraduate medical course in China : Educ Health (Abingdon), 2020; 33(1); 20-23

3. Lin Q, Lu J, Chen Z, A Survey of speech-language-hearing therapists’ career situation and challenges in Mainland China : Folia Phoniatr Logop, 2016; 68(1); 10-15

4. Tan X, Chen X, Gu X, Liao R, Research on the Mixed Teaching Moule of Medical English based on the Network Teaching Platform – Taking the teaching practice of Basic Medical English as an example : Medical Education Research and Practice, 2020; 5

5. Evans L, Vanden Bosch ML, Harrington S, Flipping the classroom in health care higher education: A systematic review : Nurse Educ, 2019; 44(2); 74-78

6. Shaywitz SE, Shaywitz BA, Fletcher JM, Escobar MD, Prevalence of reading disability in boys and girls. Results of the Connecticut Longitudinal Study : JAMA, 1990; 264(8); 998-1002

7. Rutter M, Caspi A, Fergusson D, Sex differences in developmental reading disability: New findings from 4 epidemiological studies : JAMA, 2004; 291(16); 2007-12

8. Stoet G, Geary DC, Sex differences in mathematics and reading achievement are inversely related: within- and across-nation assessment of 10 years of PISA data : PLoS One, 2013; 8(3); e57988

9. Yilmaz O, Gul ED, Bodur H, Cross-cultural adaptation and validation of the Turkish version of the Hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) : Rheumatol Int, 2014; 34(1); 43-49

10. Streiner DL, Starting at the beginning: An introduction to coefficient alpha and internal consistency : J Pers Assess, 2003; 80(1); 99-103

11. Bowling A, The psychometric properties of the older people’s quality of life questionnaire, compared with the CASP-19 and the WHOQOL-OLD : Curr Gerontol Geriatr Res, 2009; 2009 298950

12. Pei L, Wu H, Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis : Med Educ Online, 2019; 24(1); 1666538

13. Vaccani JP, Javidnia H, Humphrey-Murto S, The effectiveness of webcast compared to live lectures as a teaching tool in medical school : Med Teach, 2016; 38(1); 59-63

14. Fleetwood J, Vaught W, Feldman D, MedEthEx Online: A computer-based learning program in medical ethics and communication skills : Teach Learn Med, 2000; 12(2); 96-104

15. Day FC, Srinivasan M, Der-Martirosian C, A comparison of Web-based and small-group palliative and end-of-life care curricula: A quasi-randomized controlled study at one institution : Acad Med, 2015; 90(3); 331-37

16. Tang WN, Zhang HW, Tan XResearch on reform of epidemiology teaching: Zhonghua Liu Xing Bing Xue Za Zhi, 2018; 39(7); 1009-12 [in Chinese]

17. Rajab MH, Gazal AM, Alkattan K, Challenges to online medical education during the COVID-19 pandemic: Cureus, 2020; 12(7); e8966

18. Etchell A, Adhikari A, Weinberg LS, A systematic literature review of sex differences in childhood language and brain development : Neuropsychologia, 2018; 114; 19-31

19. Wallentin M, Putative sex differences in verbal abilities and language cortex: A critical review : Brain Lang, 2009; 108(3); 175-83

In Press

04 Dec 2023 : Animal Research  

Effects of Intrathecal Ketamine on Cerebrospinal Fluid Levels of Brain-Derived Neurotrophic Factor and Mech...

Med Sci Monit In Press; DOI:  

01 Dec 2023 : Clinical Research  

Risk Factors and Clinical Outcomes of COVID-19 Infection in Multiple Sclerosis Patients: A Retrospective St...

Med Sci Monit In Press; DOI:  

30 Nov 2023 : Review article  

Decoding the Neurological Sequelae of General Anesthesia: A Review

Med Sci Monit In Press; DOI:  

30 Nov 2023 : Clinical Research  

Enhanced Pain Relief and Muscle Growth in Individuals with Low Back Instability: The Impact of Blood Flow R...

Med Sci Monit In Press; DOI:  

Most Viewed Current Articles

13 Nov 2021 : Clinical Research  

Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...

DOI :10.12659/MSM.932788

Med Sci Monit 2021; 27:e932788


30 Dec 2021 : Clinical Research  

Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...

DOI :10.12659/MSM.935379

Med Sci Monit 2021; 27:e935379


14 Dec 2022 : Clinical Research  

Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase Levels

DOI :10.12659/MSM.937990

Med Sci Monit 2022; 28:e937990


08 Mar 2022 : Review article  

A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...

DOI :10.12659/MSM.936292

Med Sci Monit 2022; 28:e936292


Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750