Pooled PBL-CBL versus LBL estimates for theoretical and practical scores show high heterogeneity and publication bias but remain robust in sensitivity and trim-and-fill analyses¶

Claim · All claims
Evidence · 1 study (2 entries) · quant-synthesis r2 · q2
Currency · newest study 2025 · checked against its sources 2026-11-01 (automated, 2 of 2 entries) · not reviewed by a person

Subclaims¶

q2 i? Heterogeneity was high for the four most-studied objective outcomes (I2 = 77–87%: theoretical 77%, practical skills 87%, physical examination 82%, case analysis 81%) but moderate for plaster immobilization (40%), with sample size below 80 identified as a potential source. → Xiong Xianghua 2025 q2 i? Trim-and-fill correction reduced pooled effect sizes (theoretical scores to SMD = 1.121; practical skills to SMD = 1.104) without reversing the direction of effect. → Xiong Xianghua 2025 (2)

Evidence¶

Xiong Xianghua 2025¶

Xiong Xianghua, Xu Jiongnan, Luo Mingyan, Niu Dongsheng, Bi Qing, Wang Zhaofu, Zhang Jun. (2025). Efficacy of problem-based learning combined with case-based learning versus lecture-based learning in orthopedic education: a systematic review and meta-analysis. BMC Medical Education. https://doi.org/10.1186/s12909-025-07741-3

q2 · i? · quant-synthesis · r2

The review's own heterogeneity assessment. The abstract's "I2 = 77–87%" covers theoretical scores (77%), practical skills (87%), physical examination (82%) and case analysis (81%); plaster immobilization was 40%, and debridement and aseptic awareness 0%, so the range is not true of every pooled objective outcome. Subgroup analyses of theoretical and practical scores suggested samples below 80 may be a source of heterogeneity. No effect size is attached to this finding.

"Heterogeneity was observed in the study (I2 = 77–87%), which may be related to differences in teaching duration, case design, and assessment criteria."

Xiong Xianghua 2025 (2)¶

Xiong Xianghua, Xu Jiongnan, Luo Mingyan, Niu Dongsheng, Bi Qing, Wang Zhaofu, Zhang Jun. (2025). Efficacy of problem-based learning combined with case-based learning versus lecture-based learning in orthopedic education: a systematic review and meta-analysis. BMC Medical Education. https://doi.org/10.1186/s12909-025-07741-3

q2 · i? · quant-synthesis · r2

Trim-and-fill analysis for theoretical scores (with 5 virtual studies added). The corrected pooled estimate was "SMD = 1.121, 95% CI (0.772–1.470)", and the article reports the direction of effect did not reverse. For practical skills the corrected estimate was SMD = 1.104.

"After trimming, the heterogeneity test yielded Q = 117.63 (P < 0.001), and the random-effects model pooled effect size was SMD = 1.121, 95% CI (0.772–1.470)."

Discussion¶

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