Practical application of the BOPPPS model in infectious diseases education: a randomized controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was performed at the individual student level within a single cohort, not at the class or school level, so the class-level RCT criterion is not satisfied.
    • "Participants were randomized using a random number table into experimental (n = 40) or control (n = 40) groups."
    • Relevant Quotes: 1) "Clinical medicine undergraduates from Chongqing Medical University (2019 cohort) were enrolled via cluster sampling. Participants were randomized using a random number table into experimental (n = 40) or control (n = 40) groups." (p. 2) 2) "A randomized controlled trial (RCT) enrolled 80 clinical medicine undergraduates, randomly assigned to an experimental group (BOPPPS pedagogy, n = 40) or a control group (traditional teaching, n = 40)." (Abstract, p. 1) 3) "To prevent cross-contamination between groups, experimental and control sessions were scheduled on different days, and students were instructed not to discuss the course content with classmates until after the 1-week follow-up assessment." (p. 2) Detailed Analysis: The ERCT 'C' criterion requires randomization by entire class or by school (unless the intervention is one-to-one tutoring or personal teaching). Here the unit of randomization is the individual student: 80 undergraduates were allocated by a random number table into two groups of 40. Although the authors mention "cluster sampling" for enrollment, the actual random assignment to conditions was at the student level, not at the level of intact classes or schools. The intervention is a classroom lecture delivered to groups of students, not a tutoring or personal-teaching intervention, so the exception does not apply. The authors acknowledge a contamination risk by scheduling sessions on different days and asking students not to discuss content, which itself confirms students from the same cohort were split across conditions rather than whole classes being randomized. Criterion C is not met because randomization was conducted at the individual student level within a single cohort rather than at the class or school level.
  • E

    Exam-based Assessment

    • Outcomes were measured with study-specific test scores, skills checklists, and satisfaction surveys rather than a recognized standardized exam.
    • "Pre-class, intra-class, and post-class assessments included test scores, operational skills, and satisfaction surveys."
    • Relevant Quotes: 1) "Pre-class, intra-class, and post-class assessments included test scores, operational skills, and satisfaction surveys." (Abstract, p. 1) 2) "Knowledge retention: pre-test (immediately before the lecture), immediate post-test (right after the lecture), and 1-week delayed test." (p. 2) 3) "Skill-attitude integration: clinical skills were evaluated via a standardized protective operation checklist 1 day after the lecture; humanistic literacy was measured using a validated anti-discrimination attitude scale at the same time point." (p. 3) 4) "Learning experience: a 5-point Likert scale survey was administered immediately after the lecture, evaluating comprehension, engagement, applicability, and instructor support." (p. 3) Detailed Analysis: Criterion E requires a widely recognized, externally standardized exam-based assessment that was not custom-built for the study. The knowledge outcomes here are pre-test, immediate post-test, and 1-week delayed test scores tied directly to the AIDS lecture content; no named national or state-wide standardized examination is reported. The skill/attitude measures are a "protective operation checklist" and an "anti-discrimination attitude scale," and the experience measure is a Likert satisfaction survey. Although the paper labels the checklist as "standardized" and the attitude scale as "validated," these are study-internal instruments aligned to the intervention rather than recognized standardized achievement exams. None corresponds to a known external standardized test. Criterion E is not met because the study relied on custom, study-specific assessments rather than a recognized standardized exam.
  • T

    Term Duration

    • The intervention was a single 40-minute lecture with outcomes measured immediately and at one week, far short of one academic term.
    • "Both groups received a 40-min lecture on AIDS by the same instructor."
    • Relevant Quotes: 1) "Both groups received a 40-min lecture on AIDS by the same instructor (trained in BOPPPS, ISW, and IFW methodologies), using identical materials and content." (p. 2) 2) "The study was conducted from March to April 2023." (p. 2) 3) "Knowledge retention: pre-test (immediately before the lecture), immediate post-test (right after the lecture), and 1-week delayed test." (p. 2) Detailed Analysis: Criterion T requires that outcomes be measured at least one full academic term (~3-4 months) after the intervention begins. The intervention here is a single 40-minute lecture. The latest outcome measurement is the 1-week delayed knowledge retention test, with skill/attitude measured 1 day after and satisfaction immediately after. The longest interval from intervention start to measurement is about one week, vastly shorter than a term. The overall study window of March to April 2023 reflects logistics, not a term-long tracking of participants from the intervention. Criterion T is not met because the maximum intervention-to-measurement interval was about one week, far less than one academic term.
  • D

    Documented Control Group

    • The control group's size, demographics, baseline pre-test scores, and business-as-usual treatment are documented, allowing comparison with the intervention group.
    • "no statistically significant difference was observed in pre-test scores between the two groups (BOPPPS group: 73.2 ± 6.8 vs. traditional group: 72.8 ± 7.1, p > 0.05), indicating comparable baseline knowledge levels."
    • Relevant Quotes: 1) "randomly assigned to an experimental group (BOPPPS pedagogy, n = 40) or a control group (traditional teaching, n = 40)." (Abstract, p. 1) 2) "The cohort included 37 males and 43 females, aged 18-20 years (mean 18.67 ± 0.23). All participants provided informed consent." (p. 2) 3) "Control group: traditional lecture introducing AIDS via the 'Red Ribbon' symbol and epidemiological data, followed by sequential coverage of definition, etiology, pathophysiology, clinical manifestations, diagnostics, treatment, prognosis, and prevention." (p. 2) 4) "no statistically significant difference was observed in pre-test scores between the two groups (BOPPPS group: 73.2 ± 6.8 vs. traditional group: 72.8 ± 7.1, p > 0.05), indicating comparable baseline knowledge levels." (p. 3) Detailed Analysis: Criterion D requires that the control group be well-documented, including size, demographics, baseline performance, and the conditions it received. The paper specifies the control group size (n = 40), provides cohort demographics (37 males, 43 females, aged 18-20, mean 18.67 ± 0.23) for the full sample, reports the control group's baseline pre-test score (72.8 ± 7.1) establishing baseline comparability, and clearly describes what the control group received (a traditional didactic lecture on AIDS covering definition through prevention). This documentation is sufficient to assess comparability and the treatment received by the control group. Criterion D is met because the control group's size, baseline scores, demographics, and business-as-usual condition are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Randomization occurred at the individual student level within a single university cohort, not at the school level.
    • "Participants were randomized using a random number table into experimental (n = 40) or control (n = 40) groups."
    • Relevant Quotes: 1) "Clinical medicine undergraduates from Chongqing Medical University (2019 cohort) were enrolled via cluster sampling. Participants were randomized using a random number table into experimental (n = 40) or control (n = 40) groups." (p. 2) 2) "A randomized controlled trial (RCT) enrolled 80 clinical medicine undergraduates, randomly assigned to an experimental group ... or a control group ..." (Abstract, p. 1) Detailed Analysis: Criterion S requires randomization among schools (or equivalent implementing units such as sites or centers), not classes or students within a single institution. This study randomized 80 individual students from one cohort at a single university (Chongqing Medical University) into two groups. No multiple schools, sites, or institutions were randomized; the entire trial occurred within one institution at the student level. Criterion S is not met because randomization was at the individual student level within a single university, not at the school level.
  • I

    Independent Conduct

    • The same authors designed, delivered, and evaluated the intervention, with no independent or third-party evaluator involved.
    • "Both groups received a 40-min lecture on AIDS by the same instructor (trained in BOPPPS, ISW, and IFW methodologies), using identical materials and content."
    • Relevant Quotes: 1) "Both groups received a 40-min lecture on AIDS by the same instructor (trained in BOPPPS, ISW, and IFW methodologies), using identical materials and content." (p. 2) 2) "Author contributions: XW: Writing - original draft. SZ: Writing - review & editing, Conceptualization, Investigation. HL: Writing - review & editing." (p. 5) 3) "The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest." (p. 5) Detailed Analysis: Criterion I requires that the study be conducted independently of the people who designed the intervention, typically via a third-party or external evaluation team. Here the same research team conceptualized and investigated the study and delivered the lecture intervention, with assessments run by the same group. There is no statement of an external evaluation agency, independent data collection, or blinded third-party administration of the trial. The author contributions and the single-instructor delivery indicate the intervention's designers also implemented and evaluated it. Criterion I is not met because the same team designed, delivered, and evaluated the intervention without independent oversight.
  • Y

    Year Duration

    • Because Term Duration (T) is not met and the intervention/measurement spanned only about one week, the year-duration criterion is not met.
    • "Both groups received a 40-min lecture on AIDS by the same instructor."
    • Relevant Quotes: 1) "Both groups received a 40-min lecture on AIDS by the same instructor ... using identical materials and content." (p. 2) 2) "Knowledge retention: pre-test (immediately before the lecture), immediate post-test (right after the lecture), and 1-week delayed test." (p. 2) 3) "The study was conducted from March to April 2023." (p. 2) Detailed Analysis: Criterion Y requires outcomes measured at least 75% of a full academic year (~9-10 months) after the intervention begins, and per the standard if T is not met then Y cannot be met. The intervention was a single 40-minute lecture and the longest follow-up was one week, with the entire study confined to March-April 2023. This is nowhere near a full academic year. Criterion Y is not met because the intervention-to-measurement interval was about one week and the prerequisite Term Duration criterion is not satisfied.
  • B

    Balanced Control Group

    • Both groups received an identical 40-minute lecture from the same instructor using the same materials and content, so instructional time and resources were balanced.
    • "Both groups received a 40-min lecture on AIDS by the same instructor (trained in BOPPPS, ISW, and IFW methodologies), using identical materials and content."
    • Relevant Quotes: 1) "Both groups received a 40-min lecture on AIDS by the same instructor (trained in BOPPPS, ISW, and IFW methodologies), using identical materials and content." (p. 2) 2) "Control group: traditional lecture introducing AIDS via the 'Red Ribbon' symbol and epidemiological data, followed by sequential coverage of definition, etiology, pathophysiology, clinical manifestations, diagnostics, treatment, prognosis, and prevention. Experimental group: BOPPPS-structured lecture ..." (p. 2) Detailed Analysis: Criterion B asks whether the control condition receives comparable time, budget, and resources to the intervention, unless additional resources are the explicit treatment variable. Applying the decision tree: the intervention does not add extra instructional time or budget over the control. Both the experimental (BOPPPS) and control (traditional) groups received the same 40-minute lecture, taught by the same instructor, using identical materials and content. The only difference is the pedagogical structure (BOPPPS six-stage closed loop vs. didactic sequence), which is the teaching method being tested rather than an added quantity of time or resources. Because there is no extra time or budget given only to the intervention group, the balance requirement is satisfied (the EXTRA_RESOURCES_PRESENT branch is false -> met). Criterion B is met because both groups received an equal 40-minute lecture from the same instructor with identical materials, leaving only the teaching method as the difference.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific BOPPPS AIDS-education trial by a different team is reported or identified.
    • Relevant Quotes: 1) "However, reports revealed that <2% of BOPPPS studies focused on infectious diseases, with scarce empirical data in emerging infections (7, 8)." (p. 2) 2) "This aligns with the meta-analysis by Chen et al., which reported that BOPPPS ... can improve clinical skill acquisition rates by 35%-52% ..." (p. 3) Detailed Analysis: Criterion R requires that this specific study or its central experimental claim be independently replicated by a different research team, published in a peer-reviewed journal. The paper was published very recently (10 April 2026), making downstream replication unlikely. An internet search across PubMed, Frontiers, and general sources identified related BOPPPS trials and meta-analyses in other domains (anatomy, pharmacokinetics, nursing, radiology, oral surgery) and a related Chongqing SPOC/flipped-classroom infectious-diseases RCT, but no study independently replicates this particular BOPPPS AIDS-education trial in the same context and design by a different team. The paper itself notes infectious-diseases applications are scarce (<2%). The cited works are related applications and meta-analyses, not independent reproductions of this specific trial. Criterion R is not met because no independent replication of this specific BOPPPS infectious disease education trial was reported or found.
  • A

    All-subject Exams

    • Outcomes were limited to a single AIDS/infectious disease topic without standardized exams across all core subjects, and criterion E is not met.
    • "To evaluate the tripartite efficacy of the BOPPPS model in AIDS education, focusing on knowledge acquisition, skill-attitude integration, and learning experience."
    • Relevant Quotes: 1) "To evaluate the tripartite efficacy of the BOPPPS model in AIDS education, focusing on knowledge acquisition, skill-attitude integration, and learning experience." (Abstract, p. 1) 2) "This RCT investigates BOPPPS efficacy in AIDS education ..." (p. 2) 3) "This randomized controlled trial confirms that the BOPPPS model significantly improves three core dimensions of learning ... in an HIV/AIDS thematic module within infectious disease education." (p. 4) Detailed Analysis: Criterion A requires measuring impact across all main subjects using standardized exam-based assessments, and it explicitly depends on criterion E being met. Here the assessment was confined to a single AIDS/HIV thematic module within infectious diseases, with no measurement of other core subjects. Furthermore, criterion E (standardized exam-based assessment) is not met because study-specific tests and surveys were used. Per the standard, if E is not met then A cannot be met. Criterion A is not met because only one narrow topic was assessed and the prerequisite standardized exam-based assessment criterion (E) is not satisfied.
  • G

    Graduation Tracking

    • Tracking stopped at one week after a single lecture, with no follow-up to graduation, and the prerequisite Year Duration criterion is not met.
    • "Knowledge retention: pre-test (immediately before the lecture), immediate post-test (right after the lecture), and 1-week delayed test."
    • Relevant Quotes: 1) "Knowledge retention: pre-test (immediately before the lecture), immediate post-test (right after the lecture), and 1-week delayed test." (p. 2) 2) "students were instructed not to discuss the course content with classmates until after the 1-week follow-up assessment." (p. 2) Detailed Analysis: Criterion G requires following participants through to graduation from their educational stage, and it depends on criterion Y being met. The longest follow-up here is the 1-week delayed knowledge retention test; there is no tracking through the end of the undergraduate program or graduation. An internet search for follow-up papers by the same authors tracking this cohort to graduation found no such publication; a related paper by overlapping authors (Wang X, Li H, Zhong S et al., "Enhancing clinical competency in infectious disease training: a longitudinal study of Mini-CEX implementation for medical interns," Front Med 2025, 12:1582218) concerns a different intervention and cohort and does not track this trial's participants to graduation. Additionally, criterion Y (Year Duration) is not met, so per the standard G cannot be met. Criterion G is not met because tracking ended one week after the lecture with no graduation follow-up and the prerequisite Year Duration criterion is unmet.
  • P

    Pre-Registered

    • No pre-registration of the study protocol on any registry is mentioned anywhere in the paper.
    • Relevant Quotes: 1) "The studies involving humans were approved by Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University." (p. 5) 2) "The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation." (p. 5) Detailed Analysis: Criterion P requires that the full study protocol be pre-registered on a recognized registry (e.g., ClinicalTrials.gov, ISRCTN) before data collection began, with a verifiable registration date. The paper reports ethics committee approval and a data availability statement but contains no mention of any trial registration, registry ID, or pre-registration date. There is no evidence that hypotheses and analysis plans were registered before data collection. Criterion P is not met because the paper provides no pre-registration reference or registry identifier.