Application of renal pathology three-dimensional animation in clinical clerkship teaching for medical students: a randomized-controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was at the individual student level (not class or school), so class-level randomization to reduce contamination is not demonstrated.
    • "students were first randomly assigned using a random number table to either the conventional teaching group or the 3D animation group in a 1:1 ratio" (p. 7)
    • Relevant Quotes: 1) "93 students undertaking nephrology clerkships were randomly assigned 1:1 to either a conventional teaching group or a 3D animation group (intervention group)." (p. 2) 2) "students were first randomly assigned using a random number table to either the conventional teaching group or the 3D animation group in a 1:1 ratio" (p. 7) 3) "Within each program, both the traditional teaching group and the 3D animation group received instruction from the same instructor on the same day, with sessions held consecutively and separated by a few minutes." (p. 6) Detailed Analysis: Criterion C requires randomization at the class level (or stronger) to reduce contamination across students who share the same learning environment. In this study, the unit of randomization is explicitly "students" (individual-level assignment), not intact classes, clerkship groups, or sites. The consecutive same-day delivery by the same instructor to both groups further highlights a plausible contamination pathway (students in the same rotation environment can share information), which is exactly what class-level (or site-level) randomization is meant to mitigate. Final sentence: Criterion C is not met because randomization was conducted at the individual student level rather than at the class (or school/site) level.
  • E

    Exam-based Assessment

    • Outcomes were measured using locally developed Test A/Test B examinations rather than a widely recognized standardized exam.
    • "Two examination sets (Test A and Test B) of comparable difficulty, developed by senior nephrology faculty and renal pathologists..." (p. 7)
    • Relevant Quotes: 1) "Teaching effectiveness was assessed via pre- and post-teaching written examinations." (p. 2) 2) "Two examination sets (Test A and Test B) of comparable difficulty, developed by senior nephrology faculty and renal pathologists, were uniformly administered as pre- and post-intervention assessments to all participants across teaching groups and academic programs." (p. 7) 3) "Each examination was administered in a multiple-choice format consisting of 20 items, with a maximum attainable score of 100 points." (p. 7) Detailed Analysis: Criterion E requires a standardized, widely recognized exam-based assessment (e.g., national/state standardized tests), not an instrument created for the study. The paper states that Test A/Test B were "developed by senior nephrology faculty and renal pathologists" and provides formatting details, but does not identify the exams as externally standardized or widely used beyond this study. Final sentence: Criterion E is not met because the outcome measures were locally developed examinations rather than standardized exams.
  • T

    Term Duration

    • The intervention and measurement occurred within a 2-week rotation with immediate post-teaching testing, which is shorter than a full academic term.
    • "Both groups underwent a teaching effectiveness evaluation immediately following the session." (p. 7)
    • Relevant Quotes: 1) "the renal pathology 3D animations were directly integrated into targeted explanations of relevant topics throughout the standardized 2-week clerkship rotation period." (p. 6) 2) "Both groups underwent a teaching effectiveness evaluation immediately following the session." (p. 7) Detailed Analysis: Criterion T requires outcomes to be measured at least one academic term after the intervention begins (or at least term-long follow-up after a short intervention). Here, the instructional period is a "standardized 2-week clerkship rotation period," and the evaluation was conducted "immediately following the session." The paper does not describe any delayed (term-later) follow-up measurement. Final sentence: Criterion T is not met because outcomes were assessed immediately after teaching within a 2-week rotation rather than at least one term after intervention start.
  • D

    Documented Control Group

    • The control condition and baseline characteristics (including group sizes and demographics) are described with pre-test scores.
    • "These students were allocated to the conventional teaching group (n=47) ... and the 3D animation group (n=46)..." (p. 9)
    • Relevant Quotes: 1) "Conventional teaching group received instruction using traditional PowerPoint slides, including schematic diagrams and histopathological images, to explain renal microstructure and various pathological features." (p. 7) 2) "These students were allocated to the conventional teaching group (n=47), consisting of 28 clinical medicine and 19 stomatology students, and the 3D animation group (n=46), with 27 clinical medicine and 19 stomatology students." (p. 9) 3) "The group comprised 51 males and 42 females, with no significant difference in gender distribution between groups (59% male vs. 51% male, p=0.46)." (p. 9) 4) "pre-teaching assessment revealed comparable baseline performance between the two student groups (48.3±35.8 vs 50.1±35.3, p=0.08)." (p. 9) Detailed Analysis: Criterion D requires that the control group be clearly documented, including what it received and baseline characteristics to support comparability. The paper specifies the control instruction method (traditional PowerPoint slides), reports group sizes (including program breakdown), provides demographics (gender, age comparison), and reports baseline pre-test performance. Final sentence: Criterion D is met because the control condition and baseline comparability information are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Schools (or clerkship sites) were not randomized; students were individually assigned, so school-level randomization is absent.
    • "students were first randomly assigned ... to either the conventional teaching group or the 3D animation group" (p. 7)
    • Relevant Quotes: 1) "93 students undertaking nephrology clerkships were randomly assigned 1:1 to either a conventional teaching group or a 3D animation group (intervention group)." (p. 2) 2) "students were first randomly assigned using a random number table to either the conventional teaching group or the 3D animation group in a 1:1 ratio" (p. 7) Detailed Analysis: Criterion S requires randomization at the school (or equivalent implementation unit, such as clerkship sites/centers) level. The paper describes individual student assignment and does not describe randomization of sites, departments, or schools. Final sentence: Criterion S is not met because randomization was not conducted at the school/site level.
  • I

    Independent Conduct

    • The research team developed the animations and also collected and analyzed the data, with no clearly independent evaluator.
    • "Faculty members on the research team first referred to the syllabus and teaching objectives." (p. 5)
    • Relevant Quotes: 1) "Faculty members on the research team first referred to the syllabus and teaching objectives." (p. 5) 2) "The questionnaires were designed by the researchers based on a review of relevant literature." (p. 7) 3) "QZ, YXX, SM and WJW completed the informed consent procedures, conducted the questionnaires, and collected the data. QZ and WJW analyzed the data." (p. 14) 4) "The realism and accuracy of the 3D animations were independently reviewed and validated by a multidisciplinary panel comprising the teaching director, teaching supervisors, course instructors, and renal pathology specialists." (p. 6) Detailed Analysis: Criterion I requires that the evaluation be conducted independently from the intervention designers. The paper indicates the research team developed the 3D animations and that members of the author team designed the questionnaires, collected data, and analyzed the data. The "independently reviewed" panel is described as validating the realism/accuracy of animations, not as an independent trial evaluation or analysis team. Final sentence: Criterion I is not met because the intervention developers/authors also conducted key evaluation steps without a clearly independent evaluator.
  • Y

    Year Duration

    • The intervention and outcome measurement occurred over a 2-week rotation with immediate post-testing, far below 75% of an academic year.
    • "the standardized 2-week clerkship rotation period." (p. 6)
    • Relevant Quotes: 1) "Undergraduate students completing clerkships in the nephrology department between August 2025 and October 2025 were enrolled." (p. 4) 2) "the renal pathology 3D animations were directly integrated into targeted explanations of relevant topics throughout the standardized 2-week clerkship rotation period." (p. 6) 3) "Both groups underwent a teaching effectiveness evaluation immediately following the session." (p. 7) Detailed Analysis: Criterion Y requires outcome measurement at least 75% of an academic year after the intervention begins. While enrollment occurred across multiple months (August 2025 to October 2025) across cohorts, each participant experienced a 2-week rotation and was tested immediately after the session, which is far shorter than the required year-duration tracking. Final sentence: Criterion Y is not met because outcomes were measured immediately after a 2-week rotation, not over most of an academic year.
  • B

    Balanced Control Group

    • Instructional objectives and in-session teaching time appear matched across groups; the only extra resource (post-session online access) occurred after the immediate post-test, making any resource imbalance negligible for the main outcome.
    • "This plan ensured that the core learning objectives and key knowledge points were identical across both instructional methods." (p. 6)
    • Relevant Quotes: 1) "This plan ensured that the core learning objectives and key knowledge points were identical across both instructional methods." (p. 6) 2) "Within each program, both the traditional teaching group and the 3D animation group received instruction from the same instructor on the same day, with sessions held consecutively and separated by a few minutes." (p. 6) 3) "Both groups underwent a teaching effectiveness evaluation immediately following the session." (p. 7) 4) "Students in the 3D animation group were subsequently provided with an online link to access the animations for self-directed review." (p. 7) Detailed Analysis: Criterion B requires that time/resources be balanced between groups, unless the extra resources are explicitly the treatment variable. The paper indicates a standardized plan with identical objectives and key points across both methods, and the same instructor taught both groups on the same day. The only clear additional resource is that the 3D animation group received an online link for review. However, the primary learning outcome (post-teaching written exam) was administered "immediately following the session," before students could plausibly benefit from later self-directed review access. Therefore, for the main measured outcome, the resource difference is negligible. Final sentence: Criterion B is met because in-session instruction was standardized across groups and the only additional resource was provided after the immediate post-test.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication study is reported or identifiable as a direct replication of this specific RCT.
    • Relevant Quotes: (No quotes in the paper indicate an independent replication of this specific RCT.) External Search (replication by other authors): No peer-reviewed replication publications explicitly replicating this specific study were identified in publicly accessible sources at the time of this ERCT check. Detailed Analysis: Criterion R requires an independent replication by a different team, in a different context, published in a peer-reviewed venue. The paper presents a single-site RCT and does not mention any prior or subsequent independent replication. Given the paper's very recent publication timing, and the lack of identified replication reports, this criterion cannot be marked as met. Final sentence: Criterion R is not met because there is no quoted or independently verifiable evidence of replication by another research team.
  • A

    All-subject Exams

    • Because standardized exams are not used (criterion E not met), the all-subject standardized exam requirement cannot be met.
    • "Exam content, based on the syllabus and clinical diagnostic or therapeutic needs, covered renal pathology and related nephrology knowledge." (p. 7)
    • Relevant Quotes: 1) "Two examination sets (Test A and Test B) of comparable difficulty, developed by senior nephrology faculty and renal pathologists..." (p. 7) 2) "Exam content, based on the syllabus and clinical diagnostic or therapeutic needs, covered renal pathology and related nephrology knowledge." (p. 7) Detailed Analysis: Criterion A requires all-subject outcomes measured with standardized exam-based assessments, and ERCT rules state that if criterion E is not met, criterion A is not met. Here, the assessments are faculty-developed Test A/Test B (so E is not met). In addition, the described content is renal pathology/nephrology, not all core subjects for the relevant educational program. Final sentence: Criterion A is not met because criterion E is not met and the assessments are not standardized all-subject exams.
  • G

    Graduation Tracking

    • The study does not track participants to graduation and explicitly notes the lack of long-term follow-up; additionally, ERCT rules require criterion Y to be met for criterion G to be met.
    • "The lack of long-term follow-up to evaluate knowledge retention and the enduring impact of the animations represents a significant limitation." (p. 12)
    • Relevant Quotes: 1) "Both groups underwent a teaching effectiveness evaluation immediately following the session." (p. 7) 2) "The lack of long-term follow-up to evaluate knowledge retention and the enduring impact of the animations represents a significant limitation." (p. 12) External Search (follow-up papers by the same authors): No subsequent peer-reviewed follow-up publication by the same author team was identified that tracks this cohort to a graduation milestone. Detailed Analysis: Criterion G requires tracking participants until graduation from the relevant educational stage. The paper documents only immediate post-session testing and explicitly identifies the lack of long-term follow-up as a limitation. Additionally, ERCT rules state that if criterion Y (year duration) is not met, then criterion G cannot be met. Since this study does not meet criterion Y, criterion G must remain not met even before considering graduation endpoints. Final sentence: Criterion G is not met because the study did not include long-term follow-up through graduation and criterion Y is not met.
  • P

    Pre-Registered

    • The trial registration is explicitly described as retrospective and dated after enrollment, so it was not pre-registered before data collection began.
    • "Trial Registration Chinese Clinical Trial Registry ChiCTR2500112643, 2025-11-18, retrospective registration." (p. 2)
    • Relevant Quotes: 1) "Trial Registration Chinese Clinical Trial Registry ChiCTR2500112643, 2025-11-18, retrospective registration." (p. 2) 2) "students were first randomly assigned using a random number table to either the conventional teaching group or the 3D animation group in a 1:1 ratio (clinical trail registration number: ChiCTR2500112643, 2025-11-18, retrospective registration)." (p. 7) 3) "Undergraduate students completing clerkships in the nephrology department between August 2025 and October 2025 were enrolled." (p. 4) Detailed Analysis: Criterion P requires a publicly available pre-registered protocol dated before data collection begins. The paper explicitly labels the registration as "retrospective registration" with a date of 2025-11-18. The enrollment period is August 2025 to October 2025, which is earlier than 2025-11-18. Final sentence: Criterion P is not met because the study was registered retrospectively after enrollment/data collection had already occurred.