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Biophilic design has gained popularity in interior design areas owing to its numerous advantages. Nevertheless, globally, Interior Architecture/Interior Architecture and Environmental Design departments lack adequate biophilic design courses in their curricula. This research investigates the impact of involving students in syllabus design and applying innovative teaching methods in a pilot elective course focused on biophilic design in interior spaces on student engagement and course sustainability. A new pilot elective course was introduced in the 2022–2023 Spring Semester at the Interior Architecture Department, Faculty of Architecture, Near East University, aiming to establish an enduring and captivating learning environment for students. Initially, a focus group study was conducted to measure students’ awareness of biophilic design and integrate their ideas regarding innovative learning methods into the syllabus for an engaging elective course. Strategies like interactive learning tools, group tasks, and peer assessments were incorporated throughout the course to enhance engagement. Analysis of end-of-course surveys and student observations revealed an augmented awareness of biophilic design among students and a positive influence of innovative learning methods on course sustainability. Thus, the study suggests that an elective course offers the potential to mitigate the deficiency of biophilic design integration in undergraduate programs, augmenting students’ awareness in this field. Moreover, new elective courses could deliver more sustainable and engaging learning experiences for enrolled students when structured through student involvement and innovative learning methods.
Introduction.
The historical human-nature relationship has been disrupted by industrialization, leading to a growing recognition of the need for a mindful approach in the 21st century. Biophilia, our innate connection with nature, has evolved into Biophilic Design, enriching constructed spaces with natural elements. This design approach has proven advantages, enhancing workplace productivity, stress reduction, education outcomes, and healthcare recovery while aligning with sustainability efforts (Browning et al. 2014 ). Therefore, the incorporation of biophilic design in educational curricula has accumulated significant attention due to its confirmed benefits and to prepare students to meet industry demands because when considering the practice of interior architecture in the 21st century, it is observed that the understanding of biophilic design has been embraced by designers more than ever before in interior spatial design (Demirbaş & Demirbaş, 2019 ). Despite its acknowledged benefits, undergraduate education in biophilic design remains scarce, notably in Interior Architecture (IA) and Environmental Design (IAED). Few universities globally, in Türkiye and the Turkish Republic of Northern Cyprus (TRNC), offer specific courses in this field. According to the QS World University Rankings by Subject 2022: Art & Design indicates that out of the top 10 universities with IAED or IA departments, five universities do not offer any courses related to biophilic design. While one university includes a course on biomimicry, three lack accessible detailed course content. Only Aalto University offers an explicit course on biophilia, which is called “Biofilia ABC,” and a biophilia lab that emphasizes the integration of biophilic design into research and learning environments through interdisciplinary collaboration. The gap in biophilic design education is no different in Türkiye and the TRNC, where there are 84 universities with IAED or IA departments (41 having IAED departments 41 having IA departments, and 2 universities offering both), biophilic design education is significantly lacking. Out of these institutions, only 1 offers a dedicated “biophilic design” course at the undergraduate level (starting from 2023 to 2024 Fall Semester in İstanbul Galata University), and only 4 universities include the term “biophilia” in any course syllabus. Most universities have courses that focus on sub-topics of biophilic design, such as indoor landscaping, biomimicry, or the nature-human relationship and its representation. Surprisingly, 40 universities do not include any terms or subjects related to “biophilia” in their course names within the curriculum, further highlighting the scarcity of biophilic design education in the region. However, there’s a high demand for this knowledge among interior architects, indicating an educational gap that requires attention also supported by the survey conducted by Doğan ( 2021 ) targeting interior architects and space users, with a sample size of 285 respondents (139 interior architects and 146 general space users). The results indicated that 107 of the participating interior architects had not received formal education in biophilic design, underscoring the absence of biophilic design within many Turkish universities. However, 111 of the participants possessed knowledge of biophilic design, suggesting that they had sought information from external sources. To bridge the gap and promote biophilic design education at the undergraduate level, a dedicated elective course covering theoretical foundations and practical applications of biophilic design principles is crucial. By establishing a comprehensive biophilic design course, universities can equip students with the knowledge and skills needed to create sustainable, nature-inspired interior spaces and foster a deeper connection with the natural world. However, understanding students’ course selection motives, such as interest and perceived benefits, is crucial. Involving students in syllabus design enhances communication and caters to diverse learning styles, making courses more effective. This research investigates the impact of student involvement in creating a pilot elective on biophilic design for interior spaces. It explores how innovative teaching methods and course preparation influence student engagement and course longevity. Also, this research uses qualitative and quantitative methods, while delving into three key questions:
What is the awareness/knowledge level of undergraduate IA and IAED students in Türkiye and the TRNC regarding Biophilic Design?
Does a student-involved course syllabus preparation process enhance the sustainability and student commitment in biophilic design courses?
What challenges do instructors face in elective courses for Generation Z (Gen Z) students in IA and IAED programs? How can these be addressed to establish participatory course structures and enhance learning outcomes?
Biophilic design is currently a popular topic, but its full integration into IA and/or IAED curricula is still lacking. In addition, the content and method of teaching the designed course are important for the biophilic design to take its place in education because elective courses in the curriculum offer students the opportunity to explore their interests and develop their individuality. Since this study delves into the effects of students taking part in developing a trial elective focusing on biophilic design for interior spaces, it aims to examine the influence of creative teaching approaches and course planning on student participation and the sustainability of the course this literature review includes two sections. The first one is biophilic design and its applications in interior architecture, and the second one is the role of elective courses in architectural education.
Throughout history, humans have coexisted with and drawn valuable insights from the natural world (Turner et al. 2004 ; Wilson, 1996 ). However, the industrial revolution and global urbanization have severed this connection, resulting in significant environmental damage (Çorakçı, 2016 ). The civilizations that once dominated nature in the 18th and 19th centuries faced dire consequences for their environmental exploitation in the 20th century, leading to a growing realization in the 21st century of the need for a more conscientious approach to nature (Çorakçı, 2016 ). Erich Fromm introduced the concept of “biophilia,” signifying a deep love for all living beings (Heerwagen et al. 2012 ). Edward O. Wilson and Stephen R. Kellert expanded on this concept, proposing in “The Biophilia Hypothesis” (1993) that humans possess an innate inclination to connect with nature and other life forms (Kellert and Wilson, 1993 ). Biophilia is not an instinct-like breathing but emerges from biological tendencies shaped by learning and experiences, including emotions such as love, hate, and fear. Sociocultural factors influence its expression, evident in the symbolic use of nature in myths, religious beliefs, and meditations (Kellert and Wilson, 1993 ). Stephen Kellert’s research on biophilia led to its integration into architectural design, exemplified in “Building for Life” (2005). This laid the foundation for “Biophilic Design,” solidified in the initial edition of “Biophilic Design” (2008) with contributions from various researchers, defining it as “an innovative approach emphasizing the essential preservation, enrichment, and restoration of the positive human-nature connection within built environments” (Kellert et al. 2011 ).
Based on various research and perspectives, the principles and applications of biophilic design have been subject to numerous categorizations (Kellert et al. 2011 ; Browning et al. 2014 ). Nonetheless, at the core of all predominant categorizations lies the central theme of seamlessly incorporating elements of nature and natural phenomena into the constructed environment. In their seminal work, “Biophilic Design: The Theory, Science and Practice of Bringing Buildings to Life,” Kellert et al. ( 2011 ) delineated six fundamental principles of biophilic design, which encompass “Environmental Features, Natural Shapes and Forms, Natural Patterns and Processes, Light and Space, Place-Based Relationships, and Evolved Human-Nature Relationships.” These principles collectively offer a comprehensive framework for the establishment of harmonious human-built environments.
The application of biophilic design principles within interior spaces involves the deliberate integration of nature-inspired elements to foster a more harmonious and productive milieu. Common manifestations of biophilic applications include the utilization of natural lighting, incorporation of indoor flora, utilization of natural materials, the inclusion of water features, and the provision of vistas that connect with natural settings. The empirical evidence underscores the multifaceted advantages of biophilic design on human well-being and productivity. For instance, a study conducted by Sanchez et al. ( 2018 ) substantiates the notion that biophilic design features enhance workplace performance. In a subsequent study by Aristizabal et al. ( 2021 ), it was established that a multisensory biophilic environment not only improved cognitive performance but also mitigated stress levels while enhancing overall satisfaction with the workplace environment. Furthermore, research conducted by Sayed et al. ( 2021 ) has demonstrated that the incorporation of biophilic principles into educational spaces engenders improved concentration levels, higher attendance rates, and enhanced academic performance among students. Beyond the realms of work and education, the beneficial impact of biophilic design extends to healthcare settings, as underscored by studies conducted by Samir ( 2021 ) and Totaforti ( 2018 ). These studies reveal that biophilic design elements contribute to alleviating patient fatigue and expediting the healing process. Lastly, Newman et al. ( 2012 ) underscore the potential economic advantages associated with the integration of biophilia into design practices. This includes reduced energy consumption, enhanced biodiversity, and, in addition, improvements in well-being and productivity, ultimately aligning with sustainability and ecological preservation efforts.
Universities offer students various opportunities to pursue their academic goals. Elective courses, in particular, allow students to pursue their aspirations, develop virtual goals, and broaden their educational content (Movchan and Zarishniak, 2017 ). Also, elective courses enable students to study subjects that satisfy their interests, abilities, and career determination while seeking to develop the individuality of each student (Ghonim and Eweda, 2018 ). Architectural education is a multidisciplinary field that imparts both technical knowledge and social responsibility to students. Integrating elective courses into the curriculum can ensure a well-rounded education and exposure to a diverse range of subjects. This is essential for developing a holistic understanding of the role of architecture in society and the importance of ethical principles and values for architects (Ghonim and Eweda, 2018 ). Thus, there arises a compelling need to establish a novel pedagogical framework emphasizing self-directed learning among graduating architects guided by their mentors. Consequently, educational models must emphasize the cultivation of imaginative thinking, keen observation, and active engagement, especially when incorporating innovative instructional resources aligned with these objectives (Fernandez-Antolin et al. 2021 ). The flexible nature of the elective factor allows for dynamic updates to reflect contemporary issues and developments in the field, marketplace, and society. When offering new elective courses, considerations should include program orientation, student interests and needs, and faculty specialization (Ghonim and Eweda, 2018 ).
Additionally, to provide an effective elective course in architectural education, it is crucial to not only consider the students’ interests and needs but also their reasons for selecting an elective course. In the study conducted by Ting and Lee ( 2012 ), an investigation was undertaken to explore the various factors that exert an influence on students’ selection of elective courses. The researchers identified a multitude of determinants, which include the perceived level of interest in the subject matter, the perceived difficulty of the course content, the perceived leniency of the instructor, the potential acquisition of future career skills, the impact of external influences, the instructor’s popularity or personality, the timing of the class in terms of the day of the week and meeting hour, the reputation of the university, the suitability of the subject matter, and the class size. Another aspect of an effective elective course is the level of student involvement in the course. This process is not only limited by the course duration but might start from the syllabus design process. Research conducted by Cook-Sather ( 2014 ) has underscored the significance of involving students in the design of syllabi, highlighting its positive impact on teacher-student communication and collaboration. This proactive approach has enabled educators to gain a deeper understanding of students’ motivations and learning styles, facilitating the tailoring of instructional methods to better suit individual needs. Furthermore, a study conducted by Bovill et al. ( 2011 ) has demonstrated that the inclusion of students in syllabus design has resulted in heightened levels of self-regulation and metacognitive awareness. Students have become more attuned to their learning strategies, fostering an increased propensity for engaging in self-directed learning practices. Practitioner-researchers Zereyalp and Buğra ( 2019 ) have ascertained that the incorporation of students’ voices in syllabus development substantially contributes to the efficacy of the syllabus. This contribution manifests in the form of fostering open and constructive communication with students, thereby better aligning the syllabus with their needs and expectations.
This study adopted a mixed-method research approach, which integrated focus group studies, interviews, case studies, and participant observation methods. Since this research involves gathering both qualitative and quantitative data together into a single platform to obtain a comprehensive understanding of the topic from various perspectives, including those of students and instructors, a mixed research approach is considered well-suited for this study (Mulisa, 2022 ). The research methodology consisted of three distinct sequential steps.
In the initial step, the emphasis was on preparing the syllabus of the pilot elective course (case study) and addressing the first two research questions. Data collection was primarily facilitated through focus group studies and interviews, with subsequent qualitative analysis applied.
The second step involved data collection during the course period, treated as a case study for addressing both the second and third research questions. During this phase, participants (comprising students enrolled in the pilot elective course) were subject to observation, alongside the administration of concise questionnaires. Subsequently, the results obtained from these questionnaires, encompassing both qualitative and quantitative data, underwent rigorous analysis.
The third and final step entailed comprehensively analyzing the amassed data to substantiate the study’s hypotheses.
A succinct summary of the research methods and evaluation techniques utilized throughout the study is presented in Fig. 1 , the research methodology flowchart.
Methodology flowchart.
In the initial phase of data collection for this study, a pilot focus group investigation was undertaken with five sophomore students from Yaşar University’s (YU) Department IAED. These students were selected for their qualifications aligning with the primary focus group participants. The purpose of this pilot study was to assess the reliability of the research questions, as outlined by Nagle and Williams ( 2013 ), which had been prepared for the forthcoming focus group studies. The designated questions were sequentially presented to the students, and their responses were meticulously evaluated. The outcomes of this pilot focus group analysis indicated that the formulated questions were sufficiently effective in eliciting the necessary data for the subsequent primary focus group study. The selection of participants for the focus group sessions was carried out through the convenience sampling method to have individuals with characteristics of the overall population (students who enrolled in the elective course), proposed by Nagle and Williams ( 2013 ). The focus group inquiries were methodically administered to the students, and the ensuing responses were subjected to qualitative analysis. These focus group sessions were conducted on November 22nd and 23rd, 2022, involving ten students from Near East University (NEU), and subsequently on December 1st and 2nd, 2022, with the participation of eight students from YU.
The interview phase of the research was executed on November 22nd and December 2nd, 2022, involving three instructors from the Faculty of Architecture, each responsible for teaching various elective courses at YU and NEU. During these interviews, the instructors were probed about their approaches to curriculum development, the selection of assessment methods, strategies employed to foster student engagement, utilization of innovative pedagogical techniques, and their course adaptation procedures based on end-of-semester feedback.
The insights garnered from both the instructor interviews and the focus group sessions constitute the primary data sources for the case study under investigation. The subsequent step in the data collection process for this study was designed to coincide with the case study. During this stage, the students enrolled in the pilot elective course served as subjects of observation, while periodic administration of concise online but with clear, targeted questions that aligned with the learning objectives and teaching effectiveness of the course questionnaires allowed for ongoing data acquisition. The reason for choosing the online survey method for the end-semester feedback is that online surveys are straightforward, anonymous, and time-efficient (Moss & Hendry, 2002 ). Also, emphasizing the anonymity and confidentiality of responses can encourage students to provide honest feedback to have more reliable results even with a small group of sample. Last but not least, the necessary permissions were obtained from the NEU Scientific Research Ethics Committee for all stages requiring data collection.
In the initial phase of data collection, a comprehensive data analysis plan was formulated, which encompassed the incorporation of data derived from primary and secondary sources. The data amassed during this first step underwent a rigorous evaluation employing qualitative methodologies. Subsequently, an insightful case study was methodically created, drawing from the analytical findings obtained from the gathered data.
In the subsequent phase, which unfolded within the context of the aforementioned case study, the participants were subjected to systematic observations, and periodic surveys were administered to solicit their responses. Data collection culminated upon the conclusion of the case study. To facilitate a comprehensive analysis of these diverse data sources, a well-structured approach was devised, combining qualitative techniques for the assessment of participant observations and a blend of both qualitative and quantitative methods to scrutinize the results derived from the periodic surveys. In addition, the reliability of the course evaluation results was validated by triangulating the survey findings with other assessment measures, such as students’ academic performance or assignment quality.
Ultimately, the data at hand was subjected to a robust interpretative process, and it was the intent to engage in a thoughtful deliberation of the hypotheses in accordance with the insights gleaned from the case study.
For this study, pilot elective courses titled “TMF 444 İç Mimarlıkta Biyofilik Tasarım “ and “FAE424 Biophilic Design in Interior Architecture” were offered in both Turkish and English language departments during the 2022–2023 Spring Semester at the Faculty of Architecture, Department of Interior Architecture, Near East University. However, before opening the courses in line with the stated objectives and methodologies of the research, students were actively involved in the curriculum development processes of these courses, with the aim of creating a more efficient and dynamic elective course. Additionally, the opinions of various faculty members were sought.
Initially, a focus group study with open-ended questions was conducted with a total of 18 students, 10 from NEU’s and 8 from YU’s Faculty of Architecture. The responses from this study were evaluated using the MAXQDA 2022 (VERBI Software, 2021 ) program and subjected to the keyword analysis method. The study sought to ascertain the student’s familiarity with the concept of biophilic design, their expectations for an upcoming elective course on this subject, their preferences for course activities and assessment methods, their views on effective teaching techniques, and their integration into academic courses, as well as the motivating factors driving their active engagement in these courses. The analysis highlights from the focus group study are summarized in Table 1 .
The highlights from the interviews with the instructors indicated that it is important to approach students in a friendlier manner and use innovative teaching techniques to create a more engaging class environment while considering students’ voices to develop the course in general.
After evaluating the data in Table 1 and the interview outputs, course contents for TMF 444 and FAE 424 were developed following the NEU course content development rules. An overview of the course syllabus is presented in Table 2 .
The 14-week course commenced with an introductory week, determining the student demographic, midterm and final assessments, and administering a survey on students’ perceptions of biophilic design, innovative learning methods, and in-class motivations. Weeks 2–8 predominantly focused on various topics such as the concept of biophilia, patterns and health impact of biophilic design, differences and similarities between biophilic design and sustainable design, the concept of biophilic cities, and some practical ways of incorporating biophilic design principals to the interior spaces as well as the examination of example case studies. Week 9 centered around the midterm presentation, involving the analysis of a chosen structure based on biophilic design criteria. Weeks 10–14 were allocated for the creation of an interior design project emphasizing biophilic design, followed by desk critiques. Ultimately, developed projects were submitted as the final assessment.
In the proposed pilot elective course, 26 students enrolled in the Turkish section, while 11 students registered for the English section. Among these, 20 students attended the Turkish course, and 7 students attended the English course for the whole semester. The overall distribution of students by department and class includes 16 Interior Architecture students (14 undergraduate 3rd year, 2 undergraduate 4th year) and 9 Architecture students (1 undergraduate 1st year, pursuing a double major, 1 undergraduate 2nd year, 4 undergraduate 3rd year, and 3 undergraduate 4th year). Given that a substantial proportion of students enrolled in both FAE 424 and TMF 444 courses are representative of Generation Z, this study also investigates the challenges encountered by instructors in this demographic context. As the course unfolds, the difficulties of being an instructor in a class dominated by Gen Z learners are explored. The paramount question becomes: how can these challenges be effectively addressed, and what methods can be employed to construct a participatory course structure that enhances learning outcomes? Drawing inspiration from contemporary educational research, including works by Orr et al. ( 2021 ), Saxena and Mishra ( 2021 ), Szabó et al. ( 2021 ), Chan and Lee ( 2023 ), Mohr and Mohr ( 2017 ), Marie and Kaur ( 2020 ), and Jaleniauskiene and Juceviciene ( 2015 ) this study consolidates diverse strategies to enhance the student engagement and participation for teaching Gen Z in higher education. As, Orr advocates for an academic coaching model, emphasizing transformational learning. Saxena proposes gamification as a motivational tool, and Szabó underscores the significance of incorporating various information technologies, such as e-learning and gamification, to boost student motivation and skill development Chan’s study delves into Gen Z students’ perceptions of generative AI in higher education, noting their optimism for its benefits—enhanced productivity and personalized learning. However, it emphasizes the concerns raised by Gen X and Gen Y teachers regarding overreliance and ethical implications, highlighting the importance of integrating technology with traditional teaching methods for a more effective learning environment. Mohr’s study emphasizes the significance of understanding generational profiles to improve course assignments and communication approaches. The findings emphasize the need for instructors to adapt teaching methods to align with Gen Z’s preferences for technology-driven and visually engaging educational experiences, and Marie’s research highlights Gen Z’s inclination towards a digitized learning environment, emphasizing the importance of adapting academic opportunities to meet their diverse needs and foster critical 21st-century skills like critical thinking and creativity. Finally, Jaleniauskienė's study focuses on reshaping educational environments to cater to Gen Z’s learning preferences. The recommendations span from redesigning physical and non-classroom spaces to accommodate diverse learning styles, integrating active learning methodologies, fostering collaborative environments (both physical and virtual), and leveraging technology as mindtools to enhance cognitive functions and engage visually oriented learners. In summary, advocation for a multifaceted approach that integrates technology, personalized coaching, gamification, and varied pedagogical strategies to create engaging, transformative, and inclusive learning environments for Gen Z learners.
Therefore, interactive presentations were prepared during the course, leveraging Genially (Genially Web, S.L., 2021 ) and Gamma (Gamma Tech, Inc., 2022 ), as they facilitated engagement, aligning with the 5 students who identified the fluidity of course delivery as a significant motivator for participation. To maintain interactivity and motivation, quizzes at the end of the course were conducted through Quizizz (Gupta and Cheenath, 2015 ), with a 10-point bonus awarded to the student with the highest quiz average throughout the semester. Moreover, practical exercises were conducted utilizing Miro (Khusid and Shardin, 2011 ) to incorporate active learning strategies, thereby cultivating collaborative learning settings. A specific instance of the Miro exercise is illustrated in Fig. 2 .
In-class exercise by Miro.
While implementing the assignments, based on the findings from the focus group study, even if the majority of students expressed a preference for being able to choose assignment types, it was acknowledged in interviews that this approach might lead to potential issues, such as providing enough sources for each type of assignment or concerns related to students blaming each other for grades, finding others’ assignments easier, etc. Consequently, for this pilot course, it was decided that the assignment types would be determined by the course instructor, and for midterm and final assessments, students would be consulted at the beginning of the course to reach a decision by majority agreement. Additionally, as 8 of the students expressed the utility of peer evaluations, and recognized their potential to enhance motivation and interest in the course, a 10-point peer evaluation criterion was incorporated into one of the assignments and midterm presentations. The assignment incorporating peer assessment was a brief research task, designed to encourage students to share their findings during class and contribute to each other’s ideas. The assignment brief and grading criteria are outlined in Fig. 3 .
Assignment 1 brief and grading criteria.
For the midterm assessment, students were expected to select a structure and analyze it based on the principles of biophilic design, presenting their analysis during class. Peer assessment was incorporated during the midterm too, where students evaluated each other’s presentations. Last but not least, in the final assessment, influenced by both the preference for project submissions by 2 of the students and the suggestion of integration with project or studio courses 2 students were required to choose an area from project courses. They were expected to develop their designs for three weeks based on the desk critics, express them through technical drawings, and provide a written explanation of how they integrated biophilic design principles. The midterm and final briefs, along with grading criteria, are illustrated in Fig. 4 .
Midterm and final briefs.
Additionally, although field trips were identified as a factor that could enhance student motivation and contribute to achieving the learning outcomes of the course, they could not be added to the course content due to financial constraints. Nonetheless, an exploration of a diminutive village distinguished by a plethora of biophilic attributes in the TRNC was undertaken in collaboration with two students from the course. The ensuing research findings were subsequently disseminated and made publicly accessible via the webpage hosted by the biophilic cities network (Özbey et al. 2023 ).
This section includes the results of qualitative and quantitative assessment surveys conducted at the beginning and end of the course. The findings in this section are broadly analyzed in the discussion section.
A brief survey was administered to 27 enrolled students within the initial week of the course to measure their awareness and expectations concerning biophilic design, the course syllabus, and innovative learning methodologies. Furthermore, the delineation of a course syllabus was elucidated to students, and the impact of a student-contributed syllabus on enrolled students was examined. Out of the enrolled students, 25 participated in the survey, and the outcomes, encompassing their knowledge levels and application of biophilic design principles, have been consolidated in Fig. 5 .
Summary of pre-course survey (Biophilic design knowledge).
According to the table, participants’ familiarity with biophilic design varied across the terms “biophilia” and “biophilic design,” with a higher level of recognition for the former term than the latter. However, awareness of the “Six Principles of Biophilic Design” was notably lower, indicating a more diverse range of responses across the spectrum from familiarity to unfamiliarity with these principles. There’s a strong consensus among respondents that biophilic design should be integrated into interior design, particularly in emphasizing the importance of designs that amalgamate nature, humanity, and architecture. Participants largely acknowledge that the weakening of connections between nature and humanity can adversely affect human life. There’s substantial agreement on the positive impact of natural light and ventilation on health, success, and work productivity in spaces. The use of “plants” as a design element in interiors garners notable agreement, while the inclusion of a “water element” seems to have a mixed response.
When examining students’ expectations regarding course syllabus and innovative learning methods, a majority of respondents concur that the provided learning outcomes and resources exhibit direct relevance to the course. Furthermore, there is a prevailing consensus indicating that the assessment methods delineated in the syllabus maintain a sense of equilibrium. A significant majority of students express confidence in their ability to extrapolate and apply the course content to other academic subjects. The recognition of abundant opportunities for peer interaction, notably through group discussions and activities, is acknowledged by a substantial number of participants. Regarding familiarity with interactive learning tools such as Sli.do, Padlet, Kahoot, and similar platforms, respondents exhibit varying degrees of awareness and experience with these tools. A comprehensive summary of the distribution of students’ survey responses is outlined in Fig. 6 .
Summary of pre-course survey (evaluation, of course, syllabi, and innovative learning methods).
Feedback on the co-design process, learning environment, and their influence on student engagement.
Out of the 27 students attending the course, 23 voluntarily responded to the survey conducted at the end of the semester. When considering the effects of the student-contributed course syllabus and the interactive course format on student obligations, it becomes evident that students derive pleasure from the interactive format and perceive the course as a conducive space for engaging with their peers. Moreover, students found the short quizzes administered at the end of the course both enjoyable and beneficial. The evaluation methods, such as assignments, midterms, and finals determined based on the preferences of students enrolled in the class and who attended focus group sessions, have been deemed sufficient by a significant majority of students for assessing and presenting their knowledge. Additionally, students expressed enjoyment and perceived usefulness from the group activities and peer assessments conducted during the course. The responses of students regarding the co-design process and its impact on their engagement have been summarized in Fig. 7 .
The responses of students regarding the co-design process and its impact on their engagement.
In the end-of-term evaluation survey responded to by 23 students, in addition to gathering insights on students’ perspectives concerning the course period and assessment methods, inquiries were also posed regarding their understanding of biophilic design concepts, perceptions of the course’s learning outcomes, and the instructor’s behavior during the class.
In the students’ end-of-term survey regarding biophilic design, a notable pattern emerges: the respondents consistently exhibit a significant degree of familiarity and comprehension spanning a wide range of biophilic design concepts. This pattern underscores a robust knowledge improvement within the surveyed group, showcasing a comprehensive understanding of various aspects of the biophilic design domain. According to the survey results, there is a high level of agreement regarding the awareness of specific terminologies associated with biophilic design. However, there are slight differences in the degree of familiarity with specific aspects of biophilic design. Additionally, a substantial majority expressed confidence in their capability to extrapolate and apply the course content to other academic disciplines. Furthermore, students conveyed a sense of acquiring substantial knowledge and awareness about biophilic design during the course, enabling them to engage in comprehensive discussions on the subject and confidently evaluate the built environment using biophilic design principles by the course’s conclusion. The participants’ responses regarding their knowledge of biophilic design have been summarized in Fig. 8 .
The responses of students regarding the biophilic design knowledge.
About the evaluation of learning outcomes and instructor’s performance, there was a notable consensus among respondents. Nineteen students strongly agreed, and four students agreed that the learning outcomes were intricately linked to the course content. Moreover, a significant majority of students strongly agreed or agreed that the course provided pertinent resources aligning with the subject matter. Notably, students exhibited high positivity towards the course instructor, indicating satisfaction and understanding in various aspects. They strongly agreed or agreed that the instructor’s explanations regarding assessment methods were lucid, demonstrating a clear grasp of evaluation criteria. Moreover, students found the instructor’s approach in the course to be fitting and the responses indicate a high level of endorsement for the course. Twenty respondents strongly agreed, while three respondents agreed that they would recommend the course to others. The responses related to students’ perceptions of learning outcomes, the instructor, and the overall quality of the course are presented in Fig. 9 for reference.
Evaluation of learning outcomes, instructor’s behavior, and course quality.
In the context of IA/IAED teaching, the integration of student co-design processes into elective courses is not a deeply studied area. As mentioned in the introduction part, while there are several courses addressing biophilic design principles, there’s a noticeable gap in the literature regarding specific content and teaching methodologies employed in these courses. Therefore, this study not only delves into students’ perceptions and preferences but also aims to bridge this gap by showcasing how student input can enrich course content and delivery. The findings from the student co-design process provided valuable insights into various aspects of the course, including the students’ familiarity with biophilic design, their expectations for the elective course, their preferences for course activities and assessment methods, their views on effective teaching techniques, and the motivating factors driving their active engagement in the course. The majority preferred a practice-based course, indicating a desire for hands-on learning experiences. Additionally, suggestions for field trips, theory-based learning, online delivery, workshop sessions, multimedia, and flexible design options were also mentioned. These preferences highlight the importance of incorporating a variety of teaching methods and activities to cater to different learning styles and interests. The students’ preferences for course activities and assessment methods were also explored. Field trips, model-making assignments, discussion and debate sessions, and group work were suggested by the students. The majority of students found group work highly beneficial, while some expressed uncertainty. Peer evaluations were perceived as essential by a significant portion of students, although reservations were also expressed. End-of-course quizzes were valued by half of the students, but reservations were also present. These findings indicate the importance of incorporating a mix of individual and collaborative activities, as well as diverse assessment methods, to cater to the preferences and needs of the students. In terms of assessment type and selection preferences, project-based assignments and presentations were favored by the majority of students. Written assignments were also preferred by a significant portion of students, while research assignments were less favored. The students’ preferences for assignment types and their involvement in the selection process were also explored. The majority of students preferred to select their own assignment types, while some preferred a collective decision through group discussion. Only a small percentage believed that course instructors should determine the assignment types. These findings suggest that involving students in the assignment selection process can enhance their engagement and motivation. The students’ preferences for assessment methods were similar to their preferences for assignment types. Project-based assignments, presentations, and written assignments were the most preferred methods. Some students expressed a desire for a diverse array of assignments to be valued equally, while others had no specific preference. These findings highlight the importance of incorporating a variety of assessment methods to cater to the diverse preferences and strengths of the students. Based on the findings from the focus group study, interactive presentations, online quizzes, practical exercises, and peer evaluations were incorporated into the course. These strategies aimed to enhance student engagement, motivation, and collaborative learning. The findings from the student co-design process provided valuable insights into the students’ preferences, needs, and motivations, which were incorporated into the course structure. The incorporation of interactive and innovative teaching methods, diverse assessment methods, and opportunities for peer interaction aimed to enhance overall student engagement, motivation, and learning outcomes. Those preferences of the students including emphasis on interactive and innovative teaching methods, as well as opportunities for peer interaction and feedback, not only enhance student engagement and motivation but also reflect the changing educational environment in IA/IAED. By focusing on collaborative learning, student-centered methods, and incorporating real-world experiences into the curriculum by embracing the student co-design process, educators can create more dynamic and responsive learning environments that prepare students for the complexities and challenges of contemporary design practice.
Overall student satisfaction and engagement.
The findings from this study highlight the importance of incorporating diverse pedagogical strategies and technology tools to create engaging and inclusive learning environments for Gen Z learners. The recommendations provided for the course implementation, such as redesigning physical and non-classroom spaces, integrating active learning methodologies, fostering collaborative environments, and leveraging technology as mindtools, align with the preferences and motivations expressed by the students in this study. One of the key findings is the positive impact of interactive presentations prepared using Genially and Gamma. These tools facilitated engagement and were particularly appealing to the 5 of the students who identified the fluidity of course delivery as a significant motivator for participation. This suggests that incorporating interactive elements in presentations can enhance student engagement and motivation. To maintain interactivity and motivation throughout the course, quizzes were conducted using Quizizz. The inclusion of a 10-point bonus for the student with the highest quiz average throughout the semester further incentivized participation. The positive response from students indicates that gamification elements can enhance motivation and make the learning experience more enjoyable. Practical exercises conducted using Miro incorporated active learning strategies and fostered collaborative learning settings. This aligns with the recommendations for fostering collaborative environments, as students expressed a preference for group discussions and activities. The use of Miro allowed students to actively participate and contribute to each other’s ideas, further enhancing the collaborative learning experience. The findings also highlight the importance of considering potential issues when implementing certain assignment types. While the majority of students expressed a preference for being able to choose assignment types, concerns were raised about providing enough sources for each type of assignment and potential issues related to grades and comparisons among students. To address these concerns, the assignment types were determined by the course instructor, with student consultation for midterm and final assessments. This approach allowed for a balance between student preferences and practical considerations. The inclusion of peer evaluations in one of the assignments and the midterm presentation was well-received by students. Peer evaluations were identified as a utility by 8 of the students and were seen as a way to enhance motivation and interest in the course. The assignment incorporating peer assessment encouraged students to share their findings and contribute to each other’s ideas, fostering a collaborative learning environment. The positive response from students suggests that peer evaluations can be an effective tool for enhancing motivation and engagement. In the final assessment, students were given the opportunity to choose an area from project courses and develop their designs based on the principles of biophilic design. This aligns with the preferences expressed by 2 of the students for project submissions and integration with project or studio courses. By allowing students to apply their knowledge and skills to a real-world design project, the final assessment provided a meaningful and relevant learning experience. Although field trips were identified as a factor that could enhance student motivation and contribute to achieving the learning outcomes of the course, financial constraints prevented their inclusion in the course content. However, an exploration of a diminutive village with biophilic attributes was undertaken in collaboration with two students from the course. These research findings were disseminated and made publicly accessible, providing an alternative way for students to engage with real-world examples of biophilic design.
The survey results regarding students’ understanding of biophilic design concepts indicate a high level of familiarity and comprehension. The respondents consistently exhibited a significant degree of knowledge improvement, showcasing a comprehensive understanding of various aspects of biophilic design. This suggests that the course content and interactive learning methods were effective in enhancing students’ knowledge and awareness of biophilic design. The evaluation of learning outcomes and the instructor’s performance received a notable consensus among respondents. Students strongly agreed that the learning outcomes were intricately linked to the course content and that the course provided pertinent resources aligning with the subject matter. The high positivity towards the course instructor indicates satisfaction and understanding in various aspects, including the clarity of assessment methods and the instructor’s approach to the course. Overall, the findings from this study support the recommendations for a multifaceted approach that integrates technology, personalized coaching, gamification, and varied pedagogical strategies to create engaging, transformative, and inclusive learning environments for Gen Z learners. The incorporation of interactive presentations, quizzes, practical exercises, peer evaluations, and real-world design projects was well-received by students and contributed to their engagement, motivation, and knowledge improvement.
The analysis of students’ familiarity with the terms “biophilia” and “biophilic design” at the beginning and end of the term indicates a notable shift in their comprehension. At the start of the term, a majority of respondents were not acquainted with these terms, with a significant number either undecided or expressing disagreement with their familiarity. However, by the term’s conclusion, there was a remarkable increase in familiarity with both concepts. For “biophilia,” the number of respondents familiar with the term rose considerably, from 9 at the beginning to 23 by the term’s end, with no disagreement or uncertainty recorded at the conclusion. Similarly, for “biophilic design,” familiarity surged notably, with 22 respondents indicating acquaintance at the term’s end, compared to 10 at the outset. These shifts underscore a significant improvement in students’ understanding and awareness of these fundamental concepts related to biophilic design throughout the course duration. This finding is supported by the strong consensus among the respondents, with 21 students strongly agreeing and 2 agreeing that they feel confident in their understanding of biophilic design. This indicates that the course has effectively imparted the necessary information and concepts related to biophilic design, enabling students to engage in discussions about it with others. This is an important outcome, as it demonstrates that the students have not only acquired knowledge but also the ability to communicate and share their understanding of biophilic design with their peers and beyond. Furthermore, the majority of respondents also expressed confidence in their ability to assess the built environment using the principles of biophilic design. This finding is significant as it suggests that the course has not only provided theoretical knowledge but has also equipped students with practical skills to apply these principles in real-world scenarios. The high number of students who feel confident in their ability to evaluate environments based on biophilic principles indicates that they have developed a strong understanding of how to analyze and assess the built environment through the lens of biophilic design.
The insights derived from the student co-design process within the interior architecture course present a rich tapestry of students’ perspectives, expectations, and preferences, offering profound implications for the realm of interior design education. Student’s alignment of assessment method preferences with specific assignment types, notably favoring project-based tasks, presentations, and written assignments, underscores the need for a diverse array of evaluation techniques catering to varying student preferences and strengths. These findings emphasize the importance of incorporating multifaceted assessment approaches to accommodate diverse student needs effectively. Leveraging the insights gleaned from focus group studies, the course structure was revamped to integrate interactive presentations, online quizzes, practical exercises, and peer evaluations, aiming to augment student engagement, motivation, and collaborative learning experiences. These adjustments reflect an alignment with students’ identified preferences and requirements, enhancing the overall pedagogical environment. In the realm of interior design education, these findings bear pivotal implications. The involvement of students in shaping course elements not only empowered their engagement but also streamlined the course content to meet their needs and motivations. The integration of interactive teaching methodologies, diverse assessment strategies, and avenues for peer interaction aimed to foster heightened student engagement, motivation, and ultimately, enriched learning outcomes within the IA and IAED curriculum. Moreover, the study’s broader implications resonate beyond the educational sphere. The students’ strong confidence in discussing biophilic design and applying it to varied contexts underscores the significance of interdisciplinary approaches in design education. Equipping students with transferable skills cultivates a comprehensive understanding of design principles, essential in the multifaceted domain of IA and IAED, where considerations encompass human well-being, spatial functionality, and environmental sustainability. The findings also suggest a potential cadre of competent professionals poised to advocate for and implement biophilic design principles within the industry. In conclusion, this study delineates the success of the course in imparting knowledge, nurturing critical thinking abilities, and enabling practical application of learning. Moving forward, it underscores the importance of continuous exploration and development of innovative teaching methodologies, advocating for immersive and experiential learning activities to enhance students’ grasp and application of biophilic design principles within the sphere of IA and education.
The purpose of this research was to investigate the impact of an elective course, designed collaboratively with student contributions and integrated with innovative learning methodologies, focused on biophilic design for interior spaces. Addressing specific research questions, this study examined the preparation process of the course, the influence of innovative learning methods on student participation, and the enduring impact of the course.
First, the study assessed the curricula of IA/IAED programs in Turkey and TRNC and found a significant educational gap, which was also supported by literature (Doğan, 2021 ). Only one university offered a dedicated course (Galata University, starting from 2023 to 2024 Fall Semester) and a few as part of sustainability-related courses. Therefore, to improve the improved student awareness and confidence in understanding biophilic design, indicating effective education advancement and real-world application readiness a newly introduced elective course was offered.
Additionally, the study aimed to evaluate how effective a course structure designed by students was in enhancing the long-term retention of biophilic design knowledge in interior spaces. It drew from research advocating for student-driven content to increase engagement and commitment, focusing on creating a more interactive learning environment. The study emphasized collaborative learning methods, group work, presentations, project-based assignments, and peer interactions by involving students in designing the course syllabus and analyzing their expectations through group sessions. The student-influenced course structure received positive feedback from end-of-term surveys, with students expressing satisfaction and active engagement, particularly appreciating group activities, peer assessments, and interactive formats such as quizzes.
Lastly, the research investigated the specific hurdles encountered by instructors teaching elective courses primarily attended by students from Gen Z enrolled in IA or IAED programs. These challenges encompassed addressing short attention spans, tendencies towards multitasking, and the need for technical proficiency. To mitigate these challenges, the study proposed potential solutions, including incorporating frequent breaks, employing interactive teaching methodologies, and providing targeted, concise assignments tailored to accommodate the unique traits of Gen Z learners. The study underscores the importance of utilizing an interactive course format, highlighting the significance of diverse teaching methods and technology in effectively engaging Gen Z students. The recommendations put forward, such as promoting active learning, creating collaborative spaces, and integrating technological tools like Genially and Gamma, are aligned with the preferences of these students. The integration of interactive presentations and quizzes on platforms like Quizizz served to motivate active participation, while the use of Miro for exercises fostered collaborative learning, resonating with students’ preference for group engagement and discussions. These strategic approaches significantly elevated student engagement and contributed to cultivating an inclusive and enriching learning environment.
Lastly and significantly, summarizing the instructor’s observations and dialogs with students during the pilot course, the use of interactive materials and methods significantly contributed to students’ engagement levels. Student feedback reflects a positive reception towards the interactive quiz format, contrary to their anticipation of traditional or system-based exams, finding the interactive format enjoyable and engaging. Personal observations indicate that students, being accustomed to short quizzes at the end of classes, consciously ensure their phones are charged before class and quickly review their notes or discuss potential questions during breaks. Furthermore, the activities conducted on Miro transformed into templates and content used by students in midterms and finals. Students have taken peer evaluations seriously, demonstrating fairness in the assessment process. Notably, there is alignment observed between the instructor’s grading and the grades derived from peer evaluations, even among students who have reported personal issues. Some students have gone above expectations, opening additional subsections for thorough grading in peer evaluations. However, despite these positive aspects, the success achieved in midterms was not replicated in finals due to scheduling conflicts during the final exam period and students’ prioritization of mandatory courses. Despite being informed that desk critics before the final submission influence their final grades, only a minimal group actively participated in all critiques.
Conclusively, this research underscores the vital role of student-inclusive and innovative courses in addressing educational gaps, emphasizing the need for dedicated biophilic design education in IA or IAED programs. By fostering interactive learning and addressing Generation Z’s learning needs, tailored courses can significantly enhance engagement and knowledge acquisition. This study encourages the integration of innovative teaching methods to create inclusive and engaging learning environments in design education.
Since the course was offered as a faculty elective course in Near East University for the 2022–23 Spring Semester, only the proposed pilot elective course attracted a total of 26 students in the Turkish section and 11 students in the English section. Out of these, only 20 students attended the Turkish course for the entire semester, while 7 students attended the English course consistently. The relatively small sample size and the imbalance between the two language sections may affect the generalizability of the findings. However, while the numbers do highlight a relatively small sample size and an imbalance between the two language sections, these factors might not entirely undermine the validity of the findings. The consistent attendance of 20 students in the Turkish section and 7 students in the English section throughout the semester might actually provide a focused understanding of how interactive activities impact a committed subset of students. Furthermore, while the sample size could restrict the application of these findings to a wider population, it does not invalidate the insights gained from this specific group. Other research studies, as highlighted by Fernandez-Antolin et al. ( 2021 ), have also utilized similar approaches with smaller student cohorts. These attendance figures could still offer meaningful qualitative data regarding the effectiveness of hands-on activities in engaging students within the context of this pilot elective course. Also, the lack of technological infrastructure in the classrooms constrained the effortless delivery of innovative learning methods by requiring rapid solutions for those issues and another limitation despite high demand for a class trip, logistical constraints, including insufficient public transportation and a lack of support from the university, prevented the planning and execution of the trip. Last but not least, during the final exams, clashes with mandatory courses and students’ prioritization of these compulsory subjects resulted in a lack of success in finals. The limited time and attention dedicated to the elective course due to conflicting schedules may have impacted students’ performance and hindered a comprehensive assessment of their understanding and application of biophilic design concepts.
To pave the way for future course enhancements and comprehensive research there are several recommendations gathered from this study.
First of all, the inclination of 12 students towards selecting their own assignment types, while acknowledged during focus study and surveys, raises concerns about potential issues like sourcing adequacy for diverse assignment types or apprehensions regarding mutual grading accountability and perceived workload disparities among peers. Consequently, for the pilot course, assignment types were structured by the instructor. Moreover, for mid-term and final evaluations, student consultation at the course outset, leading to consensus-based decisions, was adopted. However, a future course iteration might permit students to choose their assignment types, necessitating the formulation of an assessment methodology. Additionally, as a recommendation for future terms, setting clearer final expectations earlier in the semester might allow students more time to prepare for finals. However, integration issues with other courses could arise, and students, due to their workload, might still defer final preparations until the last weeks or, as an alternative solution, reduce the percentage weight of finals and emphasize greater participation and completion of assignments throughout the term is believed to elevate the overall success level of the course.
Secondly, ensuring the successful integration of student-contributed syllabi and innovative pedagogical methods warrants a focused inquiry into teacher training and support mechanisms. Investigating the efficacy of teacher training initiatives and devising strategies to augment educators’ proficiency in fostering student engagement and learning within these frameworks would be pivotal. Moreover, the incorporation of more qualitative research tools such as interviews or focus groups for post-course reflections and feedback might diversify the nuanced perspectives, experiences, and hurdles encountered by students regarding student-contributed syllabi and innovative learning methods and those pedagogical methodologies implemented in this course, could potentially find applicability in other elective courses across the academic spectrum.
Last but not least, based on the instructor’s observation, it is advisable specifically for the biophilic design course to customize this course for upper-year students majoring in Architecture, IA/IAED. This is because students in their 1st and 2nd years may have limited technical knowledge and project development skills. Also, over time, students can cultivate their interest in elective courses with specific content such as this one, thereby the application of the course material in their project courses or their professional lives easier. In addition, if this course is offered during the Semester when the weather conditions are more favorable, it could facilitate more interaction by conducting classes outdoors and organizing field trips more easily.
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Department of Interior Architecture, Faculty of Architecture, Near East University, Nicosia, North Cyprus, Cyprus
Fulya Özbey & Simge Bardak Denerel
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This article is primarily based on Fulya Özbey’s PhD dissertation, and Simge Bardak Denerel, as the second author, contributed as thesis advisor to the study.
Correspondence to Fulya Özbey .
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The authors declare no competing interests
The questionnaire and methodology for this study were approved by the NEU Scientific Research Ethics Committee (Ethics approval numbers: YDÜ/FB/2022/170 and YDÜ/FB/2023/193). All research was performed in accordance with the relevant guidelines of the NEU Scientific Research Ethics Committee.
To obtain the ethics approvals, an example of informed consent is provided to the NEU Scientific Research Ethics Committee. After the approvals, both the focus group study and interviews were conducted face-to-face, with participants expressing consent through wet signatures. While the original forms are securely stored and can be presented upon request, they are not initially attached individually due to containing personal participant information. For the online course surveys, informed consent was presented at the beginning of the survey; however, given the need to maintain student anonymity, individual consent is not collected during online course surveys.
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Özbey, F., Bardak Denerel, S. Student involvement and innovative teaching methods in a biophilic design education pilot elective course in interior architecture. Humanit Soc Sci Commun 11 , 1155 (2024). https://doi.org/10.1057/s41599-024-03559-4
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Cardiovascular diseases present a significant challenge in clinical practice due to their sudden onset and rapid progression. The management of these conditions necessitates cardiologists to possess strong clinical reasoning and individual competencies. The internship phase is crucial for medical students to transition from theory to practical application, with an emphasis on developing clinical thinking and skills. Despite the critical need for education on cardiovascular diseases, there is a noticeable gap in research regarding the utilization of artificial intelligence in clinical simulation teaching.
This study aims to evaluate the effect and influence of AI-empowered scenario-based simulation teaching mode in the teaching of cardiovascular diseases.
The study utilized a quasi-experimental research design and mixed-methods. The control group comprised 32 students using traditional teaching mode, while the experimental group included 34 students who were instructed on cardiovascular diseases using the AI-empowered scenario-based simulation teaching mode. Data collection included post-class tests, “Mini-CEX” assessments, Clinical critical thinking scale from both groups, and satisfaction surveys from experimental group. Qualitative data were gathered through semi-structured interviews.
Research shows that compared with traditional teaching models, AI-empowered scenario-based simulation teaching mode significantly improve students’ performance in many aspects. The theoretical knowledge scores( P < 0.001), clinical operation skills( P = 0.0416) and clinical critical thinking abilities of students( P < 0.001) in the experimental group were significantly improved. The satisfaction survey showed that students in the experimental group were more satisfied with the teaching scene( P = 0.008), Individual participation( P = 0.006) and teaching content( P = 0.009). There is no significant difference in course discussion, group cooperation and teaching style of teachers( P > 0.05). Additionally, the qualitative data from the interviews highlighted three themes: (1) Positive new learning experience, (2) Improved clinical critical thinking skills, and (3) Valuable suggestions and concerns for further improvement.
The AI-empowered scenario simulation teaching Mode plays an important role in the improvement of clinical thinking and skills of medical undergraduates. This study believes that the AI-empowered scenario simulation teaching mode is an effective and feasible teaching model, which is worthy of promotion in other courses.
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Cardiovascular diseases, including myocardial infarction and arrhythmia, frequently manifest abruptly and progress rapidly, placing individuals in critical situations. In addition to the physical distress, the substantial rates of disability and mortality linked to these conditions impose a significant burden on both families and society. Furthermore, the presence of commodities such as diabetes and chronic obstructive pulmonary disease in many cardiovascular disease patients adds further complexity to treatment strategies [ 1 , 2 ]. In light of this context, the importance of internship training in cardiology is underscored [ 3 ]. In China, when medical students enter their fourth and fifth years of undergraduate study, they will be placed in hospitals for a clinical internship lasting one to two years. Internship plays a critical role in the development of medical students, facilitating the transition from theoretical knowledge to practical application and fostering the growth of clinical reasoning and skills [ 4 ]. Nevertheless, the prevailing mode of internship education primarily relies on conventional instructional approaches, which prioritize teacher-led dissemination of knowledge through lectures and demonstrations [ 5 , 6 ]. Although these methods are successful in facilitating knowledge acquisition, they are inadequate in motivating students, promoting clinical reasoning, and cultivating the skills necessary to manage emergency situations, particularly when dealing with critically ill patients. As a result, it is essential to implement a shift in teaching methodologies, specifically within the realm of cardiology internship training.
In recent years, the rapid development of Artificial Intelligence (AI) technology has led to the emergence of various products profoundly impacting various aspects of people’s lives [ 7 ]. Generative AI, a type of AI based on deep learning, involves training large-scale language models to generate new text, images, or other types of data. Notably, models like OpenAI’s ChatGPT use deep learning algorithms trained on extensive datasets to generate human-like responses in conversation. In the realm of education, generative AI exhibits tremendous potential. Firstly, it can offer personalized learning experiences by tailoring learning paths based on individual student needs and proficiency levels, enhancing learning effectiveness and making education more targeted and efficient [ 8 , 9 ]. Secondly, generative AI plays a crucial role in automatic assessment and feedback, providing students with immediate and constructive feedback, promoting better understanding and mastery of knowledge. Additionally, through simulated dialogues, role-playing, and other mode, generative AI can help students improve communication and problem-solving skills, offering new possibilities for flexible, intelligent teaching mode and driving innovation and progress in education [ 10 ].
Scenario-based simulation teaching is an instructional method that involves simulating real-world situations for teaching purposes, commonly used in clinical education. In this approach, students are placed in virtual or real scenarios where they face specific problems, challenges, or tasks, engaging in practical activities and decision-making to proficiently apply knowledge [ 11 ]. This teaching method emphasizes practicality and interactivity, allowing students not only to apply theoretical knowledge in simulated situations but also to actively participate in discussions, collaborate on problem-solving, and enhance their practical application and teamwork skills [ 12 ]. Research indicates that scenario-based simulation teaching stimulates student interest, increases motivation, and fosters critical thinking and innovation by integrating theoretical knowledge into practice [ 13 ].
Nowadays, with the rapid development of science, new technologies such as Virtual Reality and Augmented Reality have brought significant changes to clinical medicine. For example, clinical scenario simulation surgery allows doctors to create a virtual surgical training platform. This allows them to practice complex surgical skills in a safe, repeatable practice environment [ 14 , 15 , 16 , 17 ]. While studies have demonstrated the effectiveness of scenario-based simulation teaching in clinical courses [ 11 , 12 , 13 , 18 ], there is currently no research on the application of generative AI in simulating clinical scenarios related to cardiovascular diseases. In this study, we aim to investigate the effectiveness of the AI-empowered scenario-based simulation teaching mode in cardiovascular disease education. Our goal is to explore the impact of this innovative teaching model on clinical interns, focusing on their basic knowledge, clinical operation ability and clinical critical thinking ability.
A combination of quasi-experimental research design and descriptive qualitative research methods was employed to form both a control group and an experimental group. Our study integrated Kolb’s experiential learning model into the experimental group’s teaching methods to enhance the learning process [ 19 , 20 ]. Kolb’s experiential learning model involves providing learners with real or simulated situations and activities. Under the guidance of teachers, learners participate in these activities to gain personal experience. They then reflect on and summarize their observations, developing theories or conclusions, which are ultimately applied in practice (Fig. 1 ).
Kolb’s experiential learning model
A total of 66 first-year students from two classes in the clinical major at Nantong University were selected as the study participants. Inclusion criteria comprised: (1) absence of current physical or mental abnormalities; (2) full-time undergraduate students in medical majors; (3) no prior experience using the AI platform for medical course learning before the experiment; (4) voluntary participation in the study with the signing of an informed consent form. The control group consisted of 32 students, following a traditional teaching model, while the experimental group comprised 34 students undergoing scenario-based simulation teaching mode empowered by AI.
All students entered university directly through the national college entrance examination (gaokao) after completing 12 years of education. After inclusion, an assessment of the characteristics of the two student groups, including age, gender in pre-professional courses, revealed comparable learning abilities between the two groups ( P > 0.05). Both groups received instruction in internal medicine. The students in both groups used the ninth edition of the textbook “Internal Medicine,” edited by Ge Junbo and others and published by People’s Medical Publishing House, and were taught by the same instructor.
Teaching mode of control group.
The control group adopted the traditional teaching model, and the course arrangement was divided into two parts: theoretical classes and practical classes. In weekly theoretical classes, teachers use PPT to impart knowledge according to the teaching objectives and syllabus. The contents of these theoretical courses include basic knowledge of cardiovascular diseases, pathophysiology, diagnostic methods and treatment principles. Teachers help students understand complex medical concepts through detailed explanations and illustrations, and answer students’ questions in class to ensure they master the necessary theoretical knowledge.
In the practical class, the teacher led the students to conduct practical training based on the teaching content of the previous theoretical class. Practical classes were usually conducted in simulated wards or clinical skills laboratories. Teachers first demonstrated the operations on a standardized patient(SP), including specific operating steps such as cardiac examination, auscultation, and electrocardiogram interpretation. Teachers explained in detail the key points and precautions of each operation link, and demonstrated on-site how to communicate with patients to improve students’ clinical operation skills and doctor-patient communication abilities.
After the demonstration, students were divided into groups for operational exercises, with teachers guiding them, correcting mistakes in a timely manner and providing feedback. In this way, students not only consolidated theoretical knowledge, but also enhanced practical operational abilities and developed clinical thinking and decision-making abilities. In addition, practical courses also emphasized teamwork and communication skills. Students simulated real clinical environments through group discussions and role-playing to improve their overall quality and professional abilities.
The team of this study was composed of 2 chief physicians, 3 attending physicians, 2 resident physicians, 5 teaching assistants, and 4 graduate students. This team consisted of teachers with more than five years of teaching experience. Before the lectures, they all underwent training in scenario simulation teaching mode and were proficient in using ChatGPT.
The teaching model of the experimental group innovatively incorporated generative artificial intelligence technology, providing students with a brand new scene simulation teaching experience. In this teaching model, teachers first provided an in-depth explanation of theoretical knowledge to ensure that students could master the core points of the course, such as the characteristics of different types of arrhythmias in electrocardiograms. These points are the basis for understanding the complexity of cardiovascular disease and are the knowledge that students must skillfully apply in subsequent simulation practices.
Students then watched a video simulating scenarios related to cardiovascular disease. These videos not only vividly reproduced clinical scenes, but also contained rich medical information and situational challenges, which greatly stimulated students’ interest in learning and enthusiasm for participation. While watching the video, students were encouraged to play the role of doctors and use the theoretical knowledge they had learned to conduct detailed analysis and inferences on the signs, symptoms, and pathogenesis shown in the video.
Students needed to use critical thinking to identify the occurrence and development of the disease from the patient’s clinical manifestations and, at the same time, master the key points of diagnosis and the basic principles of treatment. This process not only exercises the students’ clinical thinking skills but also deepens their understanding of the disease diagnosis and treatment process.
After the scenario simulation, students participated in group discussions to share their observations and analyses, complementing each other and improving their understanding of the disease. This interactive learning method promoted the exchange of knowledge and the collision of ideas, helped students examine problems from different angles, and improved their problem-solving abilities.
Finally, students would complete thinking questions related to the course content, consolidate the knowledge they have learned, and test the learning effect. Students could ask ChatGPT questions at any time, and when they had more questions, they could get help from their teachers. Except for learning theoretical knowledge, all clinical practice processes were consistent with those of the control group.
Reasonable grouping is an important prerequisite for team learning. To enhance group learning and achieve optimal learning outcomes, each group had a maximum of 6 students. Therefore, before class, teachers determined the groups based on students’ average GPAs to ensure that each group had similar overall learning abilities. Eventually, the students in the experimental group were divided into 6 groups. Based on feedback from teachers on student performance, adjustments to group members were made in the first week. In each group, one student was selected as the group leader, responsible for organizing group activities. Clear division of team roles ensured the participation of each member and promoted cooperation within the group.
Writing scenario simulation scripts.
The cardiovascular teaching research group wrote script stories based on teaching objectives and typical cardiovascular cases, enriching the background and character features of the plot to make it as close to real clinical situations as possible.
In the production of clinical case scenario simulation videos, the breakdown script played a crucial role, providing guidance and basis for AI drawing for each scene. By inputting the case directly into ChatGPT and instructing, “How many scenes can this script be broken down into for animation video creation?” ChatGPT would then offer a breakdown of scenes as an example, subject to review by the teachers for alignment with educational goals and accuracy.
By inputting the prompt “I need you to act as the Midjourney command optimization master, generating scene descriptions for the above scenes separately, I want Midjourney to draw them, please provide concise descriptions in both Chinese and English,” specific instructions would be obtained. This prompt asks ChatGPT to generate a concise description for each scenario. These descriptions should include necessary details to help Midjourney draw the scene accurately. Each scene description was reviewed, and then each English description was input into Midjourney to generate animation materials. These materials were imported into editing software to complete the production of video content, with subtitles automatically generated and added to the video.
In the process of compiling a question bank for cardiovascular teaching, ChatGPT generates questions based on the plot content of the script when prompted with the instruction, “This is a case in cardiovascular teaching, what questions can be given to students?” ChatGPT would write questions based on the relevant plot content of the script. The teacher could continue to instruct to change the format and description of the questions and could also request answers and scoring criteria for the corresponding questions.
The assessment of question and answer accuracy and scientific validity, the adjustment of question difficulty in alignment with teaching objectives, and the precise placement of questions within the video were carried out to finalize the production of cardiovascular scenario simulation teaching videos. Subsequently, these videos were integrated into the class app for classroom instruction. Feedback from both students and teachers was solicited to enhance the content and quality of the scenario simulation teaching videos(Fig. 2 ).
Flow chart of research on teaching reform programmes
Post-class test.
Students in both the experimental group and the control group took the post-class test, and the test content and grading criteria were exactly the same. The theoretical knowledge level and practical operational ability were each scored out of 100 points, with higher scores indicating more vital student abilities. The theoretical knowledge assessment used exam questions prepared by the teaching team, while practical operational ability used a “Mini-CEX” scoring sheet customized for cardiovascular medicine. The Mini-CEX evaluation form was adapted by the teaching and research team from a scale for assessing clinical skills written by John J Norcini et al. [ 21 ]. It is designed according to the characteristics of cardiovascular medicine. It mainly evaluates clinical history recording, electrocardiogram interpretation, humanistic care, Clinical diagnosis, communication skills and overall competency. There were five parts in total; each part had four questions, and each question adopted Likert’s five-point scoring system. The Cronbach’s alpha of the scale was 0.90, and the Cronbach’s alpha of each dimension was 0.753–0.772.
Based on Robert Ennis’s critical thinking framework and related theories, relevant questions were adapted according to the experimental purpose and subjects [ 22 ]. The final clinical critical thinking scale consisted of four dimensions, including logical reasoning, central argument, argumentation evidence and organizational structure, with a total of 5 questions in each dimension and 5 points in each question, for a total of 100 points.
The teaching and research team developed a teaching satisfaction questionnaire. Students completed the Teaching Satisfaction questionnaire on the WJX.cn at the end of the final exam. The questionnaire included six aspects: teaching scene satisfaction (Q1 ∼ Q4), course discussion satisfaction (Q5 ∼ Q8), group cooperation satisfaction (Q9 ∼ Q11), individual participation (Q12 ∼ Q14), teaching content satisfaction (Q15 ∼ Q18), and teaching teacher satisfaction (Q19 ∼ Q20). Each question was set on a scale of 1 to 5 (strongly disagree to strongly agree on five scales). Final satisfaction (%) is score/total score (100 points) *100%. After analyzing the preliminary collected data, Cronbach’s alpha coefficient was 0.85, indicating high internal consistency and reliability.
At the end of the course, we conducted a semi-structured interview to survey students in the experimental group and teachers on their evaluation of the use of AI in teaching cardiovascular disease. In selecting interviewees, we considered the gender and age and then conducted purposive sampling among the experimental group to ensure a diversity of opinions.
In order to fully understand the teaching effect and the real experience of teachers and students with the application of AI teaching mode, the research team first conducted preliminary interviews with two students and determined the final outline of the interview: (1) How do you feel about the learning of this teaching mode? (2) Do you think your learning/teaching style has changed since before? (3) What are your suggestions for the future development of this teaching mode?
A researcher who was well-versed in interviewing techniques was assigned to conduct the interviews independently. The interviews were conducted during the week following the course in a quiet and relaxing session to avoid errors as much as possible. Based on their final test results, they were divided into three grades, with three boys and three girls randomly selected from six groups from three different levels. Each interview lasted approximately 20 min. The students’ conversations were recorded using a voice recorder, and the research team pledged to keep them confidential. Recordings of the interviews were transcribed verbatim within 24 h of the end of the conversation.
Data entry and analysis were performed using Rstudio software (version 4.3.1). The following R packages were utilized: “stats”, “car”, “doBy”, and “ggplot2”.
For quantitative data, independent sample t-tests were employed to analyze differences between groups. For qualitative data, the chi-square test was utilized. A significance level of P < 0.05 was considered statistically significant, indicating differences between groups.
The experimental group consisted of 34 students aged 22–24 years (mean age 23.03 ± 0.626). The Control group comprised 32 students from clinical professional classes, with ages ranging from 21 to 25 years (mean age 23.14 ± 0.976). Before the class, we assessed the basic clinical knowledge of the two groups of students, and the results showed that there was no significant difference in the demographic characteristics of the two groups ( P > 0.05), and we found that there was no significant difference between them, which was comparable (Table 1 ).
Statistical analysis of examination scores for two groups revealed that students in the experimental group had an average score of 83.26 on the theoretical final exam, whereas students in the control group had an average score of 79.56. The scores of the control group were significantly lower than those of the experimental group ( p < 0.05). Regarding Mini-CEX examination scores, students within the experimental group attained an average score of 76.24, which was notably greater than the average score of 70.19 achieved by students in the control group ( p < 0.001). Furthermore, the clinical critical thinking proficiency of the experimental group surpassed that of the control group, as indicated by statistical significance ( p < 0.001) (Table 2 ).
After investigation and recovery, a total of 66 students completed the satisfaction questionnaire, and 66 valid questionnaires were recovered, with a total completion rate of 100%. As shown in the questionnaire results (Table 3 ), it can be seen that the overall satisfaction of experimental group in teaching scene, individual participation and teaching content is higher than that of control group, and the difference between the two groups is statistically significant ( P < 0.05). There were no significant differences in other aspects ( P > 0.05).
In summarizing the interview findings, three primary themes emerge for analysis: (1) A new learning (teaching) experience; (2) Enhancement of clinical critical thinking ability; (3) Suggestions for improvement.
“In the past, we have always learned knowledge from books. Some things are very complicated and not easy to understand. With the help of AI, I think a lot of complicated knowledge has suddenly become simple and clear.”(S1).
“It is a very unimaginable experience. Through the scenario simulation course, I can intuitively see the physiological changes of the heart and blood vessels, and many theoretical knowledge are easier to understand.”(S2).
“The scenario simulation course enables us to visually see the electrophysiology and pathophysiological changes of the heart and blood vessels. Seeing the complete process makes it easier to remember and understand.”(S3).
“I’ve seen a lot of animations during the learning process, and through this method, I have a better understanding of clinical analysis and judgment.”(S4).
“I think the course preparation process is very easy, with the help of ChatGPT, many educational resources can be found quickly, and I am even more incredible that it can produce a complete clinical simulation video! I believe I will be able to perform better in the field of clinical teaching in the future!”(T1).
Leveraging AI in medical and educational fields, students can utilize AI interactive platforms to simulate disease processes, enhancing their understanding of cardiovascular diseases and developing critical thinking and problem-solving skills.(S1).
“With AI assistance, my knowledge becomes more systematic and detailed. For example, when learning about acute myocardial infarction, I saw numerous relevant images such as anatomical slices of coronary arteries, their distribution, and corresponding myocardial perfusion areas, which enhances our analytical and judgment abilities.”(S2).
“During leisure time, I can use AI interactive platforms for learning and engage in question-and-answer conversations with AI, which makes self-directed learning more effective and motivating.”(S5).
“I could see the students’ progress in their learning from the exercise tests at the end of the lesson and the final Mini-CEX exam. Through the communication and discussion with them after the lesson, I found that they became more logical in their thinking about the problems, and their ability to analyse the conditions during the Mini-CEX exam was greatly improved.”(T2).
Regarding the application of AI in cardiovascular medicine education, students and teachers actively provided some suggestions.
“This teaching format and content are vivid and illustrative. However, I feel that some content, when interacting with AI, cannot answer my questions well.”(S3).
“With this mode of teaching, I feel that I have a higher level of mastery of this course than any other subject and am more interested and motivated to learn. I have been very willing to use ChatGPT in other courses to assist me in my studies, but I felt slightly uncomfortable communicating with the AI as opposed to the teacher.”(S4).
“This way of preparing teaching materials and the mode of lectures is indeed very innovative, with the help of ChatGPT, my pre-course preparation process will be relatively easier, and the use of it in the classroom has also greatly improved the motivation of students. However, I am concerned that the drawbacks of AI, such as academic honesty and accuracy of answers, will also have an impact on the final teaching results, so we teachers should be cautious about AI.”(T2).
With the rapid development of technology and AI, the form of medical education is undergoing continuous changes [ 23 , 24 ]. Traditional teaching mode, characterized by inefficiency and dull content, no longer meet the needs of modern medical education. This is particularly evident in the teaching of cardiovascular system diseases [ 25 ], where the content is complex and difficult to remember, often leading to a lack of student engagement and understanding during clinical practice, thereby impacting the cultivation of clinical thinking skills [ 26 ]. Currently, AI is widely applied across various fields, and research shows that it plays a crucial role in education [ 27 , 28 ], including personalized learning, intelligent tutoring, instructional design, and student assessment, greatly enhancing learning outcomes and promoting educational innovation. Moreover, studies have also shown the widespread promotion and application of scenario-based teaching models in clinical practice teaching [ 29 , 30 , 31 ].
In this study, the scenario-based teaching model is implemented based on ChatGPT 3.5. We believe that the scenario-based teaching model based on generative AI is an important mode and development direction for educational practice reform. ChatGPT, with its outstanding adaptability, versatility, efficiency, intelligence, and comprehensive coverage, has become a favored choice for many developers and is widely used in the education sector [ 32 , 33 ]. Through clever integration with the scenario-based teaching model, a new teaching experience is created.
For teachers, ChatGPT provides powerful support, significantly improving lesson preparation efficiency. Teachers can use ChatGPT’s intelligently generated dialogue scenarios to present abstract and difficult-to-understand concepts in vivid and interesting scenarios, making it easier for students to understand and remember. Additionally, teachers can adjust the generated dialogues according to students’ learning situations, personalize teaching, and improve teaching effectiveness. For students, in the scenario-based teaching model, they feel as if they are in a vivid teaching theater. They take on detective roles, cultivating clinical thinking and case analysis skills as they solve problems. ChatGPT’s intelligent dialogue can also customize learning plans based on students’ learning styles and progress, improve memory efficiency through mnemonic devices, and stimulate their interest in learning and self-directed learning motivation.
The findings of the study indicate that students enrolled in AI-assisted teaching programs exhibit higher scores in theoretical knowledge, Mini-CEX examination performance, and clinical critical thinking skills compared to their counterparts in traditional teaching settings. These results suggest that a hybrid teaching approach may enhance students’ comprehension of knowledge and proficiency in clinical procedures, this is consistent with the findings of Yujiwang et al [ 34 , 35 , 36 , 37 ]. The possible reason is that in the interaction of scenario simulation, students can independently explore the process of illness and take the initiative to find and solve problems. According to Kolb’s experiential learning model [ 19 , 20 ], experience to reflection to abstract concepts to practice, and finally to experience, interlocking and progressive, prompting students to understand knowledge from scenario simulation, then apply it to practice, and then find problems, which not only improves their independent learning ability, but also improves their critical thinking ability. Additionally, student interviews revealed that the new teaching method facilitates their exploration and identification of clinical issues, thereby preparing them effectively for future clinical practice.
Through an analysis of students’ teaching satisfaction questionnaires, it was found that the experimental group exhibited significantly higher levels of satisfaction in teaching scene, individual participation, and teaching content compared to the control group. These results suggest that the mixed teaching mode utilizing the AI platform may be more feasible and suitable for practical teaching in cardiovascular internal medicine. Although we found no statistically significant differences in course discussion, teamwork, and instructor teaching style, this may be due to the following reasons. First, the small sample size and short duration of this study limited the power to detect significant differences. Future research could improve this by increasing the sample size and extending the duration of the study. In addition, traditional teaching methods are already relatively mature in these aspects, and student satisfaction in these three aspects is already at a high level, and may not show significant advantages in the short term. At the same time, teaching satisfaction is affected by many factors, and a single change is not enough to significantly improve overall satisfaction. Therefore, we will continue to optimize the new AI-powered teaching model and strengthen its integration with course discussions and teamwork. We look forward to seeing more significant effects in future research.
Moreover, students say that the teaching method of scenario simulation not only helps them systematically understand and master the content of the course, but also stimulates their interest in independent learning and improves their ability to discover and solve problems. The vast majority of students hold a positive attitude towards the AI empowered scenario-based simulation teaching mode, and some students also put forward their own views on this teaching mode, mainly focusing on the accuracy and understanding of AI. This also provides us with valuable suggestions for the improvement of further study.
This study also has the following limitations: (1) The number of participants in the survey is relatively small, resulting in insufficient data and interview views collected; (2) In this study, we used version 3.5 of generative AI ChatGPT. However, it is worth noting that a more advanced version 4.0 of ChatGPT is already available on the market. Therefore, the version we use does not fully represent the highest computing power of AI technology.
In comparison to the conventional teaching methodology, the novel teaching mode demonstrates clear benefits. Findings from examinations, assessments, satisfaction surveys, and interviews suggest that this innovative teaching method offers a more efficient means for interns to gain contemporary professional knowledge and enhance their clinical practice proficiency. Additionally, the cultivation of clinical critical thinking and problem-solving skills through this approach is expected to greatly support their long-term career viability. The utilization of an AI-empowered scenario-based simulation teaching mode has the potential to enhance students’ engagement and motivation, as well as improve their problem-solving skills in clinical settings. Consequently, the implementation and dissemination of our AI-empowered scenario-based simulation teaching mode in cardiovascular medicine practice teaching is recommended.
Our research encompasses sensitive personal identity information of students. Due to the potential risk of breaching individual privacy, the datasets analyzed in this study cannot be made publicly accessible. We emphasize that the data remains confidential and is not open to the public. However, if you have a compelling need for access, please reach out to the corresponding author at [email protected] to request the data.
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Innovation and Entrepreneurship Training Program for College Students in Jiangsu Province (202313993027Y). Teaching Reform Research Project of Nantong University (2023B10).
Koulong Zheng, Zhiyu Shen and Zanhao Chen contributed equally to this work.
Nantong University, Qi Xiu Road, Nantong, Jiangsu, 226007, China
Koulong Zheng, Zhiyu Shen, Zanhao Chen, Chang Che & Huixia Zhu
The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
Koulong Zheng
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KLZ and HXZ designed the trial. KLZ prepared the clinical cases. HXZ collected the data. HXZ and ZYS analyzed the data. HXZ, ZHC and CC wrote the manuscript. All authors have read and approved the final manuscript.
Correspondence to Huixia Zhu .
Ethics approval and consent to participate.
This study has obtained ethical approval from the Ethics Committee of the Second Affiliated Hospital of Nantong University. All methods were conducted in accordance with relevant guidelines and regulations(approval number 2024KT045). All participation was voluntary and signed informed consent forms were obtained from each participant.
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The authors declare no competing interests.
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Zheng, K., Shen, Z., Chen, Z. et al. Application of AI-empowered scenario-based simulation teaching mode in cardiovascular disease education. BMC Med Educ 24 , 1003 (2024). https://doi.org/10.1186/s12909-024-05977-z
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Accepted : 02 September 2024
Published : 13 September 2024
DOI : https://doi.org/10.1186/s12909-024-05977-z
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