Enhancing surgical education through output-driven input: implementation and evaluation of the O-SITE teaching model in clinical medical students

Abstract Objectives Surgical education in undergraduate medical curricula often faces fragmented content delivery, insufficient student engagement, and uneven teaching competencies. To address these issues, we developed and implemented the O-SITE model (O emphasizes the Output-driven input concept; SITE fosters student output and improves faculty teaching through Skilled demonstration, Intellectual expression, Train-the-trainer model, and Emotional expression). Methods This study adopted a mixed-methods approach to evaluate the effectiveness of the O-SITE model. A cohort of 119 clinical medical students (O-SITE group) received surgical education based on the O-SITE framework, and 108 students served as historical controls under traditional teaching. Quantitative outcomes included formative and summative assessment scores and the Dundee Ready Education Environment Measure (DREEM) questionnaire. Qualitative insights were derived from semi-structured interviews with 12 students and analyzed using thematic analysis. Results Compared to controls, the O-SITE group demonstrated significantly higher formative ([84.5 ± 5.2] vs. [81.2 ± 5.5]) and summative ([81.3 ± 5.7] vs. [80.1 ± 5.6]) assessment scores (both p<0.001). DREEM scores in all five dimensions, including perceptions of learning, teachers, academic self-perception, atmosphere, and social self-perception, significantly improved in the O-SITE group (all p<0.001). Thematic analysis identified three key outcomes: increased learning initiative, enhanced clinical reasoning and skills, and improved empathy and professional identity. Conclusions The O-SITE model effectively promotes active learning and clinical competency through structured multidimensional student output. By integrating learner-centered design with faculty development, this approach addresses the core deficiencies in traditional surgical education and provides a scalable framework for competency-based medical training.