Effectiveness of a Specialty-Focused,Outpatient-Based Case Teaching Model in Residency Training for Metabolic Dysfunction

Abstract

Background

Metabolic dysfunction–associated steatotic liver disease (MASLD) has become one of the most prevalent chronic liver diseases worldwide and requires comprehensive clinical management involving risk stratification, longitudinal assessment, and integrated decision-making. Developing residents’ clinical reasoning and stratified management competence remains a challenge in traditional residency training, which often relies on fragmented case exposure. This study aimed to evaluate the effectiveness of a specialty-focused, outpatient-based case teaching model embedded in a MASLD clinic for residency training. MASLD was used as a representative context of chronic disease management to evaluate a specialty-focused, outpatient-based case teaching model applicable to residency training.

Methods

This quasi-experimental teaching quality improvement study included 232 residents rotating through a hepatology department between November 2024 and October 2025. Participants were allocated to a traditional teaching group (n = 104) or a specialty clinic–based case teaching group (n = 128) according to rotation arrangements. The intervention integrated authentic outpatient cases with on-site demonstration, structured reflection, and integrated clinical decision-making. Teaching outcomes were assessed across multiple domains, including theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, traditional Chinese medicine (TCM) pattern differentiation, and teaching satisfaction. Group comparisons were performed using independent-sample t tests and chi-square tests.

Results

Residents in the specialty clinic–based teaching group achieved significantly higher scores than those in the traditional group across all continuous outcome measures, including theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, TCM pattern differentiation, and teaching satisfaction (all P < 0.001). Skill assessment pass rates and the proportion of residents achieving an overall performance rating of “good or above” were also significantly higher in the specialty group. Subgroup analysis showed no significant differences between undergraduate and postgraduate residents within the traditional group. In contrast, within the specialty teaching group, postgraduate residents demonstrated significantly higher diagnostic and stratification scores than undergraduate residents (P = 0.030).

Conclusions

This study suggests that a specialty-focused, outpatient-based case teaching model embedded within a MASLD clinic may improve residents’ clinical competence and learning satisfaction compared with traditional teaching approaches. It may also support stratified training and serve as a practical complement to residency education in chronic disease management settings.

Keywords

metabolic dysfunction–associated steatotic liver disease residency training;medical education case-based learning clinical reasoning teaching quality improvement outpatient-based education

Introduction

Metabolic dysfunction–associated steatotic liver disease (MASLD) has become one of the most prevalent chronic liver diseases worldwide in recent years. With the increasing prevalence of metabolic syndrome, the demand for comprehensive management of MASLD has grown substantially. Clinical care for MASLD requires not only accurate diagnosis but also risk stratification, longitudinal assessment, and integrated decision-making. These demands challenge residents to integrate information across multiple domains and apply clinical reasoning in a systematic manner during training.¹

Standardized residency training aims to develop residents’ independent clinical thinking and decision-making skills. However, in routine clinical teaching practice, traditional educational approaches often rely on ward rounds, case discussions, and classroom-based instruction. Such approaches frequently expose trainees to fragmented clinical information and discontinuous disease courses.² As a result, residents may have limited opportunities to experience the full clinical trajectory of chronic diseases, which can hinder the development of systematic clinical reasoning and comprehensive judgment skills.³

Specialty outpatient clinics provide a learning environment characterized by concentrated case exposure, continuous disease follow-up, and clearly defined disease stratification.⁴ MASLD, in particular, presents distinct clinical stages, ranging from simple steatosis to metabolic dysfunction–associated liver injury and progressive fibrosis. Its management requires the integration of lifestyle intervention, metabolic risk control, imaging-based assessment, and, in some settings, traditional Chinese medicine (TCM)–based pattern differentiation. These features make MASLD well suited for incorporation into a specialty-focused teaching framework within residency training. Nevertheless, evidence regarding the use of MASLD specialty clinics as a structured educational platform for residency training remains limited, and systematic evaluations of related teaching models are scarce.^5,6

In response to these challenges, the present study developed a specialty-focused, outpatient-based case teaching model embedded within a MASLD clinic.⁷ This model emphasizes authentic clinical exposure, on-site demonstration, structured reflection, and integrated clinical decision-making.^8-12 By comparing this approach with traditional teaching methods, we aimed to evaluate its effectiveness in improving residents’ theoretical knowledge, clinical skills, clinical reasoning ability, TCM pattern differentiation competence, and teaching satisfaction. In addition, subgroup analyses based on educational background were conducted to explore whether this teaching model supports stratified training and facilitates the development of advanced competencies among residents with different learning foundations.

Methods

Study Design and Participants

This study adopted a quasi-experimental educational intervention design and was conducted as a teaching quality improvement activity. A total of 232 residents who completed rotations in the Department of Hepatology between November 2024 and October 2025 were included. All participants underwent a standardized hepatology rotation with a duration of 4 weeks.

According to rotation arrangements and the implementation of teaching models, residents were allocated to either a traditional teaching group or a specialty clinic–based case teaching group. The traditional teaching group comprised 104 residents who received conventional residency instruction, while the specialty teaching group included 128 residents who participated in a MASLD specialty outpatient clinic–based case teaching program.

Inclusion criteria were as follows: (1) enrollment in a standardized residency training program and completion of the hepatology rotation as scheduled; (2) voluntary participation in teaching outcome evaluation; and (3) availability of complete evaluation data. Exclusion criteria included: (1) a hepatology rotation duration of less than two weeks; and (2) missing key outcome measures.

Baseline characteristics, including age, sex, educational background, years of training, and prior rotation experience in MASLD-related clinical settings, did not differ significantly between the two groups (all P > 0.05), indicating comparability at baseline.

Teaching Interventions

Traditional Teaching Model

Residents in the traditional teaching group received conventional instructional approaches routinely used in residency training, including ward rounds, oral case presentations, diagnostic and treatment plan discussions, and classroom-based lectures. Teaching was primarily instructor-led, with residents participating in supervised clinical activities and case discussions. Opportunities for systematic exposure to structured outpatient cases and continuous disease trajectories were relatively limited. To ensure comparability, the duration of rotation and overall teaching time were equivalent between the two groups. In addition, efforts were made to maintain comparable supervision structures and teaching intensity across groups, although minor variations inherent to different clinical settings could not be entirely eliminated.

Specialty-Focused Outpatient-Based Case Teaching Model

Residents in the specialty teaching group were trained in a MASLD-focused outpatient clinic setting.

Each session typically included 3–5 residents supervised by one attending physician. During clinic sessions, approximately 20–30 patients with MASLD were seen, allowing residents to encounter a range of disease stages, from simple steatosis to steatohepatitis and fibrosis. This setting provided broader exposure to diverse clinical presentations without extending overall teaching time.

Under supervision, residents were involved in routine clinical work, including history taking, physical examination, and interpretation of laboratory and imaging results. Teaching was conducted alongside patient care, with supervisors explaining diagnostic reasoning, disease staging, and management decisions as cases were discussed.

After clinic sessions, brief discussions were held to review representative cases. Residents were encouraged to reflect on their diagnostic approach, consider alternative explanations, and identify areas for improvement.

The teaching also incorporated elements of traditional Chinese medicine (TCM), where pattern differentiation was discussed together with biomedical assessment, helping residents develop a more integrated approach to clinical decision-making.

Outcome Measures

Teaching effectiveness was evaluated across multiple competency domains using written examinations, workplace-based assessment tools, and case-based evaluations.

Theoretical Knowledge

Theoretical knowledge was assessed using a structured multiple-choice examination (single best answer format) consisting of 50 questions. The examination covered key aspects of MASLD, including diagnosis, risk stratification, and management. Each question included four options with one correct answer. For example, items required residents to interpret laboratory findings and determine the most likely diagnosis, such as distinguishing MASLD or metabolic dysfunction–associated steatohepatitis (MASH) based on elevated liver enzymes, lipid abnormalities, and associated metabolic risk factors.

Clinical Skills

Clinical skills were evaluated using the Mini-Clinical Evaluation Exercise (Mini-CEX),^13,14 based on direct observation of residents during real patient encounters. Assessment domains included history taking, physical examination, clinical judgment, and communication skills, each scored on a standardized 9-point scale by trained supervisors.

Diagnostic and Stratification Ability

Diagnostic and stratification ability was assessed through standardized case scenarios. Residents were asked to interpret laboratory results, imaging findings, and clinical data to determine disease stage and risk category.

Clinical Reasoning

Clinical reasoning was evaluated through structured case-based discussions, focusing on the integration of clinical information, formulation of differential diagnoses, and development of appropriate management plans.

TCM Pattern Differentiation

TCM pattern differentiation was assessed using standardized criteria commonly applied in integrative hepatology, based on symptom patterns, tongue and pulse findings, and overall clinical presentation. Residents were expected to identify typical patterns, such as liver qi stagnation and damp-heat accumulation, and propose corresponding treatment principles.

Teaching Satisfaction

Teaching satisfaction was measured using a structured questionnaire that assessed satisfaction with teaching content, teaching format, perceived improvement in competence, and overall learning experience.

All assessments were conducted by senior physicians serving as residency supervisors. To minimize inter-rater variability, all evaluators underwent standardized training prior to the study.^15,16

Statistical Analysis

Statistical analyses were performed using SPSS version 26.0. Continuous variables are presented as means ± standard deviations and were compared between groups using independent-sample t tests. Categorical variables are presented as frequencies and percentages and were compared using chi-square tests. All statistical tests were two-sided, and a P value of less than 0.05 was considered statistically significant. Figures and tables were generated based on the original data to illustrate comparisons between teaching groups.

Results

Baseline Characteristics of Participants

There were no significant differences between the traditional teaching group and the specialty clinic–based teaching group in baseline characteristics, including age, sex, educational background, years of training, or prior rotation experience related to MASLD (all P > 0.05), indicating comparability between the two groups. Detailed baseline characteristics are presented in Table 1.

Table 1.

Baseline Characteristics of Residents in the Traditional Teaching Group and the Specialty Clinic–Based Teaching Group

Variable	Traditional group (n = 104)	Specialty group (n = 128)	t/χ²	P
Age (years, mean ± SD)	24.55±1.74	24.45±1.65	0.460	0.646
Years of training (years, mean ± SD)	1.45±0.86	1.57±0.77	-1.107	0.270
Sex (male/female, n [%])	47 (45.2%)/57 (54.8%)	52 (40.6%)/76 (59.4%)	0.489	0.484
Educational background (undergraduate/postgraduate, n [%])	38 (36.5%)/66 (63.5%)	45 (35.2%)/83 (64.8%)	0.048	0.827
Prior rotation experience in hepatology (yes/no), n (%)	40 (38.5%)/64 (61.5%)	49 (38.3%)/79 (61.7%)	0.001	0.978

Note. Data are presented as mean ± standard deviation (SD) or n (%). Continuous variables were compared using independent-sample t tests, and categorical variables were compared using χ² tests.

Comparison of Teaching Outcomes Between Groups

Comparison of Continuous Outcome Measures

Across seven core competency domains—including theoretical examination scores, history-taking performance, physical examination skills, diagnostic and stratification ability, treatment planning, TCM pattern differentiation, and clinical reasoning—the specialty clinic–based teaching group achieved significantly higher scores than the traditional teaching group (all P < 0.001).

Similarly, residents in the specialty teaching group reported significantly higher levels of teaching satisfaction across four domains, including satisfaction with teaching content, teaching format, perceived improvement in competence, and overall satisfaction (all P < 0.001). Detailed comparisons of continuous outcome measures are shown in Table 2 and Figure 1.

Table 2.

Comparison of Continuous Outcome Measures Between the Traditional and Specialty Clinic–Based Teaching Groups

Outcome measure	Traditional group (n = 104)	Specialty group (n = 128)	t	P
Theoretical examination score	78.19 ± 5.25	85.34 ± 6.00	−9.541	< 0.001
History-taking score	80.06 ± 6.54	88.11 ± 5.25	−10.174	< 0.001
Physical examination score	78.58 ± 6.08	87.13 ± 5.91	−10.823	< 0.001
Diagnostic and stratification score	78.80 ± 5.47	87.87 ± 5.46	−12.579	< 0.001
Management planning score	80.91 ± 6.18	88.18 ± 6.28	−8.830	< 0.001
TCM syndrome differentiation ability score	73.37 ± 6.03	85.23 ± 5.00	−16.061	< 0.001
Clinical reasoning ability score	79.43 ± 5.72	89.24 ± 6.08	−12.557	< 0.001
Teaching content satisfaction score	3.82 ± 0.40	4.49 ± 0.37	−13.285	< 0.001
Teaching format satisfaction score	3.65 ± 0.36	4.56 ± 0.35	−19.257	< 0.001
Self-perceived improvement score	3.67 ± 0.39	4.53 ± 0.34	−18.082	< 0.001
Overall satisfaction score	3.78 ± 0.37	4.68 ± 0.33	−19.554	< 0.001

Note. Data are presented as mean ± standard deviation (SD). Continuous variables were compared between groups using independent-sample t tests. All tests were two-sided, and a P value of < 0.05 was considered statistically significant.

Figure 1.

Comparison of core competency scores between the traditional and specialty clinic–based teaching groups. Data are presented as mean ± standard deviation. Higher scores indicate better performance. All comparisons between groups were performed using independent-samples t tests

Comparison of Pass Rates and Categorical Outcomes

The pass rate for the theoretical examination was 100.0% in both groups, with no significant difference observed (P = 1.000). In contrast, the pass rate for clinical skills assessment was significantly higher in the specialty teaching group than in the traditional teaching group (96.9% vs. 41.4%, χ² = 84.996, P < 0.001).

In addition, the proportion of residents achieving an overall performance rating of “good or above” was significantly greater in the specialty teaching group than in the traditional teaching group (100.0% vs. 29.8%, χ² = 127.862, P < 0.001). Comparisons of categorical outcomes are summarized in Table 3.

Table 3.

Comparison of Achievement Rates Between the Traditional and Specialty Clinic–Based Teaching Groups

Outcome	Traditional group (n = 104)	Specialty group (n = 128)	χ²	P
Pass rate of theoretical examination	104 (100.0%)	128 (100.0%)	—	—
Achievement rate of skill assessment	43 (41.3%)	124 (96.9%)	87.728	< 0.001
Proportion rated as “good” or above in overall evaluation	31 (29.8%)	128 (100.0%)	131.096	< 0.001

Note. Data are presented as n (%). Group comparisons were performed using χ² tests. χ² values were not calculated when proportions were identical in both groups.

Subgroup Analysis by Educational Background

Traditional Teaching Group

Within the traditional teaching group, no significant differences were observed between undergraduate and postgraduate residents in theoretical examination scores, clinical skills scores, TCM pattern differentiation scores, clinical reasoning scores, or teaching satisfaction measures (all P > 0.05). Detailed subgroup comparisons are provided in Table 4.

Table 4.

Comparison of Continuous Outcome Measures Between Undergraduate and Postgraduate Residents Within the Traditional Teaching Group

Outcome measure	Undergraduate (n = 38)	Postgraduate (n = 66)	t	P
Theoretical examination score	78.56 ± 5.54	77.98 ± 5.11	0.539	0.591
Overall clinical skills score (mean of four domains)	80.05 ± 2.50	79.32 ± 3.22	1.207	0.230
TCM syndrome differentiation ability score	73.63 ± 5.91	73.22 ± 6.15	0.334	0.739
Clinical reasoning ability score	79.11 ± 4.89	79.61 ± 6.17	−0.430	0.668
Teaching content satisfaction score	3.87 ± 0.40	3.79 ± 0.39	0.914	0.363
Teaching format satisfaction score	3.60 ± 0.38	3.69 ± 0.34	−1.256	0.212
Self-perceived improvement score	3.62 ± 0.41	3.70 ± 0.37	−0.979	0.330
Overall satisfaction score	3.85 ± 0.34	3.73 ± 0.39	1.504	0.136

Note. Data are presented as mean ± standard deviation (SD). Continuous variables were compared between groups using independent-sample t tests. All statistical tests were two-sided, and a P value of < 0.05 was considered statistically significant.

Specialty Clinic–Based Teaching Group

Within the specialty clinic–based teaching group, no significant differences were found between undergraduate and postgraduate residents across most outcome measures (all P > 0.05). However, postgraduate residents demonstrated significantly higher scores in diagnostic and stratification ability compared with undergraduate residents (88.64 ± 5.03 vs. 86.46 ± 5.19, P = 0.030). Subgroup analysis results are presented in Table 5.

Table 5.

Comparison of Continuous Outcome Measures Between Undergraduate and Postgraduate Residents Within the Specialty Clinic–Based Teaching Group

Outcome measure	Undergraduate (n = 45)	Postgraduate (n = 83)	t	P
Theoretical examination score	86.11 ± 5.49	84.93 ± 6.25	1.065	0.289
Overall clinical skills score (mean of four domains)	86.92 ± 2.61	88.31 ± 2.52	−2.933	0.004
TCM syndrome differentiation ability score	85.28 ± 4.29	85.21 ± 5.38	0.075	0.941
Clinical reasoning ability score	88.77 ± 6.46	89.50 ± 5.88	−0.652	0.515
Teaching content satisfaction score	4.48 ± 0.40	4.49 ± 0.36	−0.140	0.889
Teaching format satisfaction score	4.59 ± 0.35	4.54 ± 0.35	0.736	0.463
Self-perceived improvement score	4.52 ± 0.38	4.54 ± 0.32	−0.258	0.797
Overall satisfaction score	4.71 ± 0.31	4.67 ± 0.35	0.698	0.486
Diagnostic and stratification score	86.46 ± 5.13	88.64 ± 5.51	−2.189	0.030

Summary of Results

Overall, residents in the specialty clinic–based teaching group outperformed those in the traditional teaching group across all continuous competency measures and key categorical outcomes, including clinical skills pass rates and overall performance ratings (all P < 0.001). Subgroup analyses revealed that postgraduate residents in the specialty teaching group showed superior performance in diagnostic and stratification ability, whereas no educational background–related differences were observed within the traditional teaching group. In addition, teaching satisfaction scores were consistently higher in the specialty clinic–based teaching group.

Discussion

This study evaluated a specialty-focused, outpatient-based case teaching model embedded within a MASLD clinic and demonstrated its effectiveness in enhancing multiple domains of residency training. Compared with traditional teaching approaches, this model was associated with higher performance in theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, TCM pattern differentiation, and teaching satisfaction.¹⁷ In addition, subgroup analyses suggested that this teaching model may better support stratified training by allowing residents with higher educational backgrounds to demonstrate advantages in advanced clinical competencies. Importantly, these improvements may reflect enhanced clinical reasoning and decision-making processes fostered by authentic outpatient exposure, rather than advantages specific to MASLD itself. Furthermore, the assessed competencies (e.g., clinical reasoning and risk stratification) are not disease-specific but are broadly applicable across chronic disease settings.

One key finding of this study is the educational value of authentic and continuous clinical exposure in promoting clinical reasoning development. Traditional residency teaching often exposes trainees to fragmented clinical encounters that lack longitudinal context, particularly in chronic disease management. In contrast, the specialty clinic–based teaching model centered on real outpatient encounters enabled residents to engage with complete clinical processes, including patient assessment, disease stratification, and management planning.¹⁸ Such immersive, context-rich learning experiences are likely to facilitate the integration of clinical information and the development of systematic reasoning skills. The higher clinical reasoning scores observed in the specialty teaching group support the importance of authentic clinical environments in cultivating higher-order clinical competence, although the magnitude of these differences should be interpreted with caution, particularly in terms of their educational relevance.

Another important aspect of the specialty clinic–based model lies in the inherent suitability of MASLD for structured and stratified teaching. MASLD management requires the identification of metabolic risk factors, evaluation of disease progression, stratified risk assessment, and long-term follow-up strategies. These characteristics provide a clear framework for residents to understand disease trajectories and management logic. In the present study, residents exposed to the specialty clinic–based teaching model demonstrated higher diagnostic and stratification performance compared with those receiving traditional instruction. Furthermore, within the specialty teaching group, postgraduate residents achieved higher scores in diagnostic and stratification ability than undergraduate residents, whereas no such educational background–related differences were observed in the traditional teaching group. This finding suggests that specialty clinic–based teaching may be particularly useful in supporting the development of advanced competencies among learners with greater baseline readiness. However, as the teaching model was MASLD-focused, some degree of content-related advantage in assessment cannot be excluded.

Integrating traditional Chinese medicine (TCM) pattern differentiation with modern medical assessment represents another strength of the specialty clinic–based teaching model. MASLD is well recognized as a condition that benefits from integrated management approaches, incorporating biochemical markers, imaging-based fibrosis assessment, and individualized pattern-based interventions.^19,20 By embedding TCM pattern differentiation into real outpatient decision-making processes, residents were encouraged to consider both biomedical and holistic perspectives when formulating management plans. The improved TCM pattern differentiation scores observed in the specialty teaching group suggest that this integrated approach may enhance residents’ ability to apply comprehensive clinical reasoning within an integrative medicine framework.

In addition to competency development, the instructional design of the specialty clinic–based model appears to positively influence learners’ engagement and satisfaction. The combination of on-site demonstration and structured reflection encouraged residents to move beyond passive observation and actively participate in clinical decision-making. Structured reflection guided by the FAIR framework provided residents with opportunities to analyze their reasoning processes, identify gaps, and refine future clinical approaches. Higher teaching satisfaction scores in the specialty teaching group suggest that this participatory and reflective learning environment may promote greater learner motivation and perceived educational value. Importantly, these educational benefits appear to arise from the structure of the outpatient teaching model itself—particularly the use of authentic cases, longitudinal exposure, and guided reflection—rather than from characteristics unique to MASLD. As such, the underlying educational principles of this approach may be extended to residency training for other chronic diseases that require longitudinal assessment and integrated clinical decision-making.

Limitations

This study has several limitations. First, its quasi-experimental design and non-random allocation of participants may introduce potential selection bias. Second, the study was conducted at a single institution, which may limit the generalizability of the findings to other training settings. Third, some outcome measures relied on subjective assessments despite the use of standardized scoring criteria and rater training. In addition, pre- and post-intervention assessments were not performed, which limits the ability to evaluate individual learning gains. Furthermore, although efforts were made to standardize teaching time and supervision across groups, variations in clinical exposure and supervisor engagement may have influenced the results. Finally, as the specialty model was MASLD-focused, potential content-related bias in knowledge assessment cannot be fully excluded. Future multicenter studies with randomized designs and more objective assessment tools are warranted to further validate the effectiveness of this teaching model.

Conclusion

This study suggests that a specialty-focused, outpatient-based case teaching model embedded within a MASLD clinic is associated with improved performance across multiple competency domains in residency training. Compared with traditional teaching approaches, this model was linked to higher scores in theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, and teaching satisfaction. Moreover, the specialty clinic–based teaching model may support stratified training by enabling residents with higher educational backgrounds to demonstrate advantages in advanced clinical reasoning competencies. By integrating authentic clinical exposure, on-site demonstration, and structured reflection, this approach may facilitate the development of systematic clinical thinking and learner engagement. Overall, specialty clinic–based case teaching represents a potentially valuable complement to traditional residency education in chronic disease management settings.

Footnotes

Acknowledgements

The authors would like to thank all residents and supervising physicians who participated in and supported the teaching activities involved in this study.

ORCID iD

Wei Li

Ethical Considerations

This study was conducted as a teaching quality improvement project using anonymized data collected during routine residency training activities. According to institutional policies, this type of educational research is exempt from formal ethical approval. The study protocol was reviewed by the Ethics Committee of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, and ethical approval was waived due to the non-interventional design, minimal risk to participants, and use of de-identified data. The study was conducted in accordance with the Declaration of Helsinki.

Consent to Participate

All participants were informed about the purpose of the study, and informed consent to participate was obtained from all residents prior to data collection.

Consent for Publication

Informed consent to publish was obtained from all participants. All data were anonymized, and no identifiable personal information is included in this manuscript.

Author contributions

All authors contributed to the study conception and design.

Wei Li: Conceptualization, Supervision, Formal analysis, Writing – Original Draft, Writing – Review & Editing.

Hongye Shang: Formal analysis, Visualization, Writing – Review & Editing.

Wentao Zhang: Methodology, Validation, Writing – Review & Editing

Xiangjin Liu: Investigation, Data Curation.

Jingfeng Zhao: Methodology, Writing – Review & Editing.

All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to their use in internal residency training evaluation but are available from the corresponding author on reasonable request.*

Use of Generative Artificial Intelligence

The authors used ChatGPT (OpenAI, GPT-4) to assist with language editing and improvement of clarity. The AI tool was not used to generate data, perform analyses, or make scientific decisions. All content was reviewed and approved by the authors, who take full responsibility for the manuscript.

Appendix

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Effectiveness of a Specialty-Focused,Outpatient-Based Case Teaching Model in Residency Training for Metabolic Dysfunction–Associated Steatotic Liver Disease

Abstract

Background

Methods

Results

Conclusions

Keywords

Introduction

Methods

Study Design and Participants

Teaching Interventions

Traditional Teaching Model

Specialty-Focused Outpatient-Based Case Teaching Model

Outcome Measures

Theoretical Knowledge

Clinical Skills

Diagnostic and Stratification Ability

Clinical Reasoning

TCM Pattern Differentiation

Teaching Satisfaction

Statistical Analysis

Results

Baseline Characteristics of Participants

Comparison of Teaching Outcomes Between Groups

Comparison of Continuous Outcome Measures

Comparison of Pass Rates and Categorical Outcomes

Subgroup Analysis by Educational Background

Traditional Teaching Group

Specialty Clinic–Based Teaching Group

Summary of Results

Discussion

Limitations

Conclusion

Footnotes

Acknowledgements

ORCID iD

Ethical Considerations

Consent to Participate

Consent for Publication

Author contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

Use of Generative Artificial Intelligence

Appendix

References