Physiology is a core course in basic medicine and presents both key content and challenges in international medical education. Physiology experiment serves not only as a complement to theoretical teaching but also as a crucial link for cultivating students’ practical abilities and scientific thinking [1]. The Health Science Center of Yangtze University began enrolling international students in 2010. After over a decade, international student enrollment continues to expand, with students from more than 60 countries. The clinical medicine program, a six-year curriculum, primarily attracts students from Pakistan, India, Nepal, Bangladesh, Tanzania, and several African countries.

However, international students face common problems such as limited Chinese proficiency, difficulty understanding specialized terminology, and significant cultural differences. Research shows that their academic foundations are uneven: Pakistani students often have weaker backgrounds in mathematics and physics, while African students have stronger foundations but different learning habits. Language barriers significantly affect classroom teaching effectiveness [2]. The traditional “teacher explanation, student imitation” approach rarely achieves good results; students tend to rely excessively on teachers to solve problems during operations, and learning stops once the experiment ends.

In recent years, micro-lectures and TBL have achieved positive results in international medical education [3][4]. Micro-lectures are short online videos, typically around 10 minutes. TBL is a team-based method that emphasizes student self-directed learning [5]. Since 2018, the Department of Physiology at Yangtze University has explored a blended model combining micro-lectures and TBL for international students in physiology experiment courses. This paper summarizes the implementation methods and effects of this model, aiming to provide a reference for reforming international student experimental teaching.

Study design and participants: This single-cohort teaching reform evaluation included second-year international medical students (MBBS program) enrolled in the Fall 2025 Physiology Experiment course at Yangtze University. Inclusion criteria were: 1) full enrollment in the course, 2) completion of all teaching activities, and 3) voluntary participation in the post-course questionnaire. No students were excluded. A total of 98 students participated.

Questionnaire development: An eight-item questionnaire was self-developed and adapted from previously published instruments on blended learning and team-based learning in medical education [3][4]. The draft was reviewed by three senior physiology educators for content validity, then piloted with 10 international students not in the study cohort. Minor wording adjustments were made based on pilot feedback. Reliability was assessed using Cronbach’s alpha (α = 0.86), indicating good internal consistency.

Dimension definitions: The questionnaire covered three dimensions: 1) Recognition: students’ perceived usefulness of the micro-lecture + TBL model for understanding experimental procedures and concepts; 2) Satisfaction: students’ satisfaction with the clarity of teaching content, bilingual subtitles, and integration of theory with experiments; 3) Teaching inspiration: students’ perceived benefit of the model for developing clinical thinking, research ability, hands-on skills, and team collaboration spirit. The eight questionnaire items, covering the three dimensions described above, are presented in Table 1.

After the course, we conducted an anonymous questionnaire survey among 98 clinical medicine international students (mainly from Pakistan, India, Nepal, Bangladesh, Tanzania, etc.) who participated in this teaching model. The questionnaire included eight questions covering the three dimensions described above. Each question had four levels: “strongly agree”, “agree”, “disagree”, and “strongly disagree”. All 98 questionnaires were recovered (100% recovery rate, 100% validity).

Analysis method: Descriptive statistics (frequencies, percentages) were used. The agreement rate for each dimension was defined as the average percentage of students selecting “agree” or “strongly agree” across items within that dimension. No inferential statistical tests were performed. The full survey results are presented in Table 1 below.

Table 1.Student satisfaction and recognition survey results (N = 98).

Based on the data in Table 1, we calculated agreement rates (the proportion of students selecting either “agree” or “strongly agree”) for each dimension. The results were as follows: Summary of agreement rates (agree + strongly agree): The recognition dimension showed rates of 90.8% (Item 1), 88.8% (Item 2), and 92.9% (Item 3). The satisfaction dimension showed rates of 88.8% (Item 4) and 86.7% (Item 5). The teaching inspiration dimension showed rates of 84.7% (Item 6), 86.7% (Item 7), and 90.8% (Item 8).

These results indicate that the majority of students held positive perceptions of the micro-lecture combined with TBL teaching model across all three dimensions.

International students responded positively. An Indian student said, “Micro-lectures can be watched repeatedly, so I’m not afraid of not understanding. Everyone does the experiment together in a group, which is more reassuring than doing it alone.” A Pakistani student said, “I used to dare not operate, but because of the team division of labor, I can also try anesthesia.”

Micro-lectures provide personalized learning, transforming the traditional pattern of “listening in class, practicing after class” into “listening before class, practicing in class”, without being limited by class time. Students can take initiative and freely choose learning time and content. Teachers can organize classes more effectively and teach according to students’ aptitudes. Combined with TBL, teacher-student and student-student communication are strengthened. Group learning enables advanced students to help those lagging behind, complementing each other’s strengths. Sufficient discussion time in class also deepens and broadens understanding.

Although this model achieved good results, some specific problems remain in international student teaching.

Problem 1: Persistent language barriers. Some international students are non-native English speakers (e.g., from French-speaking or African regions) with strong local accents and limited medical terminology. While micro-lectures provide flexible learning time, they also weaken teacher supervision. Some students do not watch micro-lectures or preview before class, nor review after class, leading to knowledge gaps. Countermeasures: Continuously solicit student feedback to improve micro-lecture quality. Encourage students to participate in micro-lecture production, which requires systematizing knowledge and gives students a sense of achievement. Drawing on cooperation experience with clinical teaching bases such as Jingzhou Second People’s Hospital, arrange teaching assistants to provide real-time translation or keyword prompts. The school also uses stratified teaching strategies in the preparatory education system to provide differentiated language support.

Problem 2: Uneven participation in discussion sessions. In TBL experimental and discussion sessions, some students consistently engaged in hands-on tasks, while others remained passive observers or disengaged. This relates to lack of active learning attitudes and significant differences in learning habits. Countermeasures: Advocate role rotation across multiple experiments, with students taking turns performing various surgical operations. In discussion sessions, rotate the team leader and the presenting student each time, ensuring everyone has responsibilities. Adopt a “write before speaking within the group” approach (writing key points first, then stating them) to reduce language pressure.

Problem 3: Uneven academic foundations. International students come from different countries with significantly different educational backgrounds. In the 2025 Health Science Center postgraduate entrance interview, source countries included Pakistan, Canada, India, and Tanzania, with varying educational systems. Pakistani students have relatively weak math and physics foundations, while African students have stronger foundations but different learning habits [2]. This manifests in physiology experiments as some students struggling to understand mechanisms and principles. Countermeasures: Fully consider heterogeneity when grouping to achieve complementary advantages. Add supplementary explanation modules for basic knowledge in micro-lecture production for students with weak foundations to learn independently. The school can draw on stratified teaching strategies from the preparatory education system to provide personalized learning support.

Several limitations should be acknowledged. First, this was a single-center study with only 98 international students, which limits the generalizability of our findings. Second, the outcomes were based entirely on students’ self-reported perceptions rather than objective measures such as exam scores or skill assessments. Third, the absence of a comparator group (e.g., traditional teaching or micro-lecture alone) prevents us from definitively attributing the observed learning gains to the blended model. Therefore, future research should test this model in other basic science courses, such as pharmacology or pathology, using a controlled design and incorporating objective learning outcomes.

The application of the micro-lecture combined with TBL teaching model in international student physiology experiment teaching fully utilizes the repeatability and visualization advantages of micro-lectures, compensating for teaching obstacles caused by language and cultural differences. Simultaneously, through TBL’s team collaboration mechanism, it promotes mutual learning and active participation among international students. The questionnaire survey shows that this model was associated with positive student perceptions regarding learning interest, hands-on ability, and team collaboration spirit. We have conducted a new exploratory attempt of this blended model, which may offer mutual benefits for both teachers and students.

Currently, international student education at the Health Science Center of Yangtze University is moving toward high-quality development. The school continues to improve the preparatory education system for international students in China and promote the “Study at Yangtze University” brand. In 2025, the Health Science Center successfully completed a new round of postgraduate enrollment for international students while deepening cooperation with clinical teaching bases to build early clinical practice bridges. In the future, we will further optimize micro-lecture resources, improve the evaluation system, follow medical teaching reform trends, promote this model in more international student medical courses, and contribute to cultivating international medical talents who know and love China and possess excellent medical skills.