RGE-Based Cell Physiology Education for International Medical Students

This study evaluated an integrated active-learning model for teaching cell physiology to international medical students at Tehran University of Medical Sciences during the 2024-2025 academic year.

The study was conducted in two consecutive semesters and included two independent cohorts of international medical students. The first cohort included 82 students and the second cohort included 46 students. Both cohorts received the same educational intervention. The study used a single-group, non-randomized, and unblinded design.

The educational program was developed according to the five phases of the ADDIE instructional design model: Analysis, Design, Development, Implementation, and Evaluation. During the development process, physiology faculty and medical education specialists examined students' learning needs, language-related difficulties, available resources, and contextual factors. The resulting educational program consisted of four cell physiology sessions using a modified Re-teaching, Guidance, and Enrichment (RGE) strategy combined with a flipped classroom model.

Before each face-to-face session, students received recorded instructional videos and written materials to review in advance. Each session began with a brief review followed by a short paper-based assessment. Based on their scores, students were assigned to one of three groups: Re-teaching (\<50% correct), Guidance (50-80% correct), or Enrichment (>80% correct).

Students in the Re-teaching group received additional explanation and instruction on concepts they had not adequately understood. Students in the Guidance group worked together to review and discuss the questions, with support from their peers when needed. Students in the Enrichment group acted as peer instructors and circulated among the Re-teaching groups to answer questions and explain difficult concepts. Instructors monitored all groups, provided guidance when necessary, and facilitated the learning process. When students had difficulty understanding or explaining a concept in English, they were allowed to use their first language.

The latter part of each session included one or two clinical scenarios designed to help students apply basic physiological concepts to clinical situations. Students worked through the scenarios in the same small groups used for the RGE activities. They discussed the questions, reached group answers, and reviewed the key points with their peers and instructors at the end of the session. Small rewards were provided to Enrichment students in recognition of their contribution to peer learning.

The student evaluation questionnaire was adapted from an instrument developed by Sahu et al. to assess medical students' views of small-group teaching. The adapted questionnaire included demographic questions and 35 items rated on a five-point Likert scale. The items addressed seven areas: flipped classroom, peer-assisted small-group learning, scenario-based learning, teamwork, self-confidence, communication skills, and the instructor's role. A final open-ended question invited students to describe the benefits and challenges they experienced during the educational program.

The questionnaire underwent translation and cultural adaptation. Content validity was assessed through a Delphi process involving ten physiology faculty members and medical education specialists, with 90% consensus. The Content Validity Ratio was 0.63 and the Content Validity Index was 0.79. The questionnaire was piloted with 30 students and administered again 15 days later. Internal consistency was acceptable, with a Cronbach's alpha of 0.80.

A separate qualitative questionnaire was prepared for faculty members to capture their experiences of the educational program. The questionnaire addressed perceived strengths, implementation difficulties, achievement of educational objectives, content coverage, and possible improvements. Because this instrument was qualitative, CVI, CVR, and reliability coefficients were not calculated.

Program evaluation was based on the first two levels of the Kirkpatrick model: Reaction and Learning. Attendance varied across the four sessions, with 88 students attending Session 1, 106 attending Session 2, 96 attending Session 3, and 118 attending Session 4. All 118 students who attended the fourth session completed the student questionnaire.

Student responses and placement in the RGE groups were analyzed descriptively. Data from the two cohorts were combined for each session and expressed as percentages because attendance varied across sessions. A line chart was used to illustrate changes in the proportions of students assigned to the three RGE groups across the four sessions.

Demographic characteristics, including gender, age, and year of study, were summarized using frequencies and percentages. Responses to the five-point Likert-scale questionnaire were analyzed after reverse-coding negatively phrased items. The five items belonging to each questionnaire domain were initially examined individually. Responses were then pooled within each Likert category to obtain an overall percentage distribution for each domain, and the results were displayed graphically. Students' open-ended comments and faculty responses were reviewed and synthesized descriptively, with attention to recurring observations regarding the learning experience, implementation difficulties, strengths, and possible improvements.