A Case-Driven and Knowledge Graph-Supported Approach to Pathology Education: Effects on Knowledge Retention and Clinical Reasoning.

OBJECTIVE

Given the issues of knowledge fragmentation and insufficient clinical reasoning associated with traditional linear pathology teaching, this study developed and evaluated a "case-driven, knowledge-graph-supported" curriculum restructuring model. The model was designed to shift the instructional approach from a discipline‑centric logic toward a clinical diagnostic reasoning framework.

METHODS

Fifty-four five-year clinical medicine undergraduates at Peking University Health Science Center participated. Using clinical cases as the organizing framework, the "Urinary System Pathology" course was restructured into a knowledge graph-supported progressive learning framework. A mixed-methods evaluation design was adopted to comprehensively assess teaching effectiveness, including three in-session formative tests, a 14-day delayed knowledge retention assessment, and a structured student learning experience questionnaire.

RESULTS

Students showed significant improvements across the three immediate in-session formative tests, with median percentage scores of 76.6%, 87.8%, and 85.9%, respectively (P < 0.001). In the day-14 retention test, the median percentage score under open-book conditions was higher than the average of the three in‑session tests (91.8% vs 83.5%, P < 0.001). Additionally, the closed-book median percentage score was also higher than that of the three in‑session tests (89.0% vs 83.5%, P = 0.016), with no significant difference found between open- and closed-book conditions (P = 0.69). Students' self-rated competency in renal disease diagnosis showed a marked increase, with the average score rising from 2.0 to 4.4 (P < 0.001). However, alongside these positive learning outcomes, the course also presented notable challenges for a subset of learners. 14.8% of participants reported challenges related to course pace and excessive cognitive load during the learning process.

CONCLUSION

The proposed model was associated with improved student performance in our cohort. These preliminary findings suggest potential benefits for addressing knowledge fragmentation and inert knowledge in pathology education. However, controlled studies are needed to establish causality. In addition, the pacing challenges identified in this study highlight the need for continued curriculum refinement to balance the benefits of case-based learning against the cognitive demands it places on students. Future studies should also adopt multi-center longitudinal designs with control groups to further examine the long-term learning transfer and sustained educational effects of this teaching model.