Evaluation of a Multimodal Integrated Obstetric Teaching Model for Domestic and International Undergraduate Medical Students: A Cross-Country Quasi-Experimental Study

Abstract

Background Obstetrics is a clinically intensive, emergency-oriented core subject in undergraduate medical education. Traditional lecture-based teaching leaves a gap between theory and practice, especially in resource-limited medical schools in South Asia. Compared with China's more standardized medical education system, schools in Pakistan and nearby regions face persistent shortages of clinical training resources, high-fidelity simulation facilities, and structured bedside teaching. Few studies compare countries directly to check whether integrated teaching models help students from different resource backgrounds equally. This study built a standardized multimodal integrated obstetric teaching system and tested it on Chinese and Pakistani undergraduate medical students, to see whether it works across both settings. Methods- We ran a prospective quasi-experimental controlled study with 186 final-year undergraduate medical students from two cooperating universities, one in China and one in Pakistan. Students were split into a conventional teaching control group (n = 92) and a multimodal integrated teaching group (n = 94), and further split by nationality into a Chinese subgroup (n = 94) and a Pakistani subgroup (n = 92). The control group received traditional textbook lectures and passive ward observation. The intervention group went through a four-module framework: scenario-themed lectures, student-led case discussions, obstetric emergency simulation training, and standardized bedside teaching, over 8 weeks. We measured theory exam scores, OSCE scores, self-reported confidence in emergency management, and standardized satisfaction questionnaires, using SPSS 26.0, independent samples t-tests for quantitative data, and chi-square tests for categorical data, with P < 0.05 as the significance threshold.

Results- Age, gender, and pre-intervention academic performance did not differ significantly across groups or subgroups (all P > 0.05), so the baseline was balanced. After 8 weeks, the intervention group outperformed the control group overall: higher theory scores (82.36 ± 5.42 vs 73.15 ± 6.28, P < 0.05) and higher OSCE scores (85.74 ± 4.86 vs 74.62 ± 5.93, P < 0.05). The two subgroups improved differently. Chinese students in the intervention group improved steadily in theory and clinical skills, reaching a 95.7% theory pass rate and a 93.5% clinical skill pass rate. Pakistani students gained more: their clinical skill pass rate rose from 63.0% in the control group to 89.1% in the intervention group, and self-reported confidence in managing obstetric emergencies independently rose from 52.2% to 89.4%, a roughly 32-point jump. This suggests structured simulation and bedside training can make up for a lack of local clinical training resources. Overall, 92.6% of participants said the integrated model helped connect theory to clinical practice, and 88.3% reported real gains in clinical reasoning and case analysis. Conclusion- The multimodal integrated obstetric teaching model improved theoretical knowledge, clinical competency, and emergency decision-making in both Chinese and Pakistani undergraduate medical students. It produced steady gains for students already in a well-resourced system and larger gains for students in a resource-constrained one. The model is straightforward to run and low-cost, which makes it worth considering for undergraduate obstetric education across a range of economic and educational settings.

Keywords: obstetrics; integrated teaching model; medical undergraduates; cross-country medical education; clinical competency; simulation training; teaching evaluation