Academic Performance and Student-Reported Learning Experiences of International Medical Students in an Integrated Biomedical Course: A Mixed-Methods Observational Study of "Molecules, Cells and Tissues”

Aksara Regmi,1,* Cihang Qian,2,* Jie Yang,3 Yoshifumi Yamaguchi,4 Yong Zuo,3 Ying Wang31Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2International Students Office, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ying Wang, Email [email protected]: Integrated preclinical courses commonly combine Team-Based Learning, TBL and Case-Based Learning, CBL with the aim of supporting active participation and clinical contextualization. Evidence from multilingual international medical programs remains limited. This study described academic performance patterns and student-reported learning experiences in the integrated course "Molecules, Cells and Tissues, MCT” and compared historical academic records labeled offline or online.Methods: We conducted a single-institution mixed-methods observational evaluation using three analytically separate samples: 194 academic records (105 labeled offline and 89 labeled online), 82 post-course questionnaire responses, and 10 semi-structured interviews. Academic outcomes were compared using Welch’s independent-samples t-tests. An exploratory linear model examined examination-score associations with categorical Mandarin proficiency and delivery label using HC3 heteroskedasticity-robust inference. Survey results were summarized descriptively, interview data were analyzed thematically, and the three sources were integrated only during interpretation.Results: In the academic-record sample, examination scores were higher in records labeled online than offline (68.39 ± 21.13 vs 60.25 ± 23.65; mean difference, 8.14 points; 95% CI, 1.80 to 14.48; p = 0.012; Cohen’s d = 0.36), whereas TBL/CBL scores did not differ significantly (90.05 ± 5.55 vs 90.72 ± 5.76; mean difference, − 0.67; 95% CI, − 2.28 to 0.93; p = 0.411; d = − 0.12). Mandarin-proficiency categories were imbalanced across delivery labels (χ2(3) = 20.28, p < 0.001). In the HC3-adjusted model, the Mandarin-proficient category differed from HSK Level 4 (B = 22.99; 95% CI, 13.39 to 32.58; p < 0.001), but the delivery-label coefficient was not significant (B = 2.92; 95% CI, − 2.97 to 8.81; p = 0.329). Among survey respondents, 78/82 rated TBL as helpful and 81/82 rated CBL as helpful. Interview participants described peer accountability, clinical relevance, and differing preferences for TBL and CBL.Conclusion: Examination scores differed modestly between historical records labeled online and offline, but the delivery-label association was attenuated and not statistically significant after adjustment for Mandarin-proficiency category. Because delivery label coincided with cohort period and assessment equivalence was not established, the observed score difference cannot be attributed to instructional modality. Separately, survey respondents and interview participants generally reported favorable experiences with TBL and CBL. These findings are hypothesis-generating and warrant prospective evaluation with linked data and standardized assessments.Keywords: integrated curriculum, international medical education, MBBS international students, molecules, cells and tissues, team-based learning, case-based learning, mixed methods