Application evaluation of Rain Classroom-supported tiered-prompt virtual case teaching for antimicrobial use decision-making training

Corresponding author: zhangyonghong, zhangyh@ccmu.edu.cn

DOI: 10.12201/bmr.202610.00044

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  Abstract: Objective To explore the educational application of Rain Classroom-supported tiered-prompt virtual case teaching for antimicrobial use decision-making training among clinical clerkship students, and to evaluate students'' performance across the initial response, prompted correction and new-case transfer task. Methods A single-group educational application study with a paired process-evaluation design was conducted. A total of 512 students who participated in infectious diseases teaching and completed the initial response to the original virtual case during the spring-summer rotation of the 2026 academic year in Beijing Youan Hospital, Capital Medical University were included, including 312 five-year-program students and 200 students in the “5+3” integrated program. The teaching process focused on the decision node of antibiotic use in an influenza case and followed the sequence of independent first response, tiered prompts, teacher debriefing and a new-case transfer task. The primary outcome was the paired difference in accuracy between the new-case task and the initial response to the original case. Results In the original case, 243 students (47.5%) answered correctly at the first attempt and 269 (52.5%) answered incorrectly. Among those with an incorrect first response, 221 (82.2%) corrected their answers within two tiers of prompts, and 48 (9.4%) required teacher debriefing. Among the 496 students who completed both tasks, the accuracy was 47.8% for the initial response and 55.0% for the new case, with an absolute difference of 7.3 percentage points (95%CI: 1.1-13.4 percentage points, P=0.025). A total of 140 students (28.2%) changed from incorrect to correct, whereas 104 (21.0%) changed from correct to incorrect. The questionnaire response rate was 93.6% (479/512), and the questionnaire data were used only for classroom feedback description. Conclusion Rain Classroom-supported tiered-prompt virtual case teaching can capture errors, prompt responsiveness and transfer-task performance in antimicrobial use decision-making training, providing process data for infectious diseases teaching and debriefing. Given the single-group design and the absence of strict equivalence testing between cases, the paired results should be interpreted as changes in classroom task performance.

  Key words: Infectious diseases; Rain Classroom; virtual case; tiered prompts; paired comparison; medical education

  Submit time: 19 October 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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