Effectiveness of a Specialty-Focused, Outpatient-Based Case Teaching Model in Residency Training for Metabolic Dysfunction-Associated Steatotic Liver Disease.

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the most prevalent chronic liver diseases worldwide and requires comprehensive clinical management involving risk stratification, longitudinal assessment, and integrated decision-making. Developing residents' clinical reasoning and stratified management competence remains a challenge in traditional residency training, which often relies on fragmented case exposure. This study aimed to evaluate the effectiveness of a specialty-focused, outpatient-based case teaching model embedded in a MASLD clinic for residency training. MASLD was used as a representative context of chronic disease management to evaluate a specialty-focused, outpatient-based case teaching model applicable to residency training.

Methods: This quasi-experimental teaching quality improvement study included 232 residents rotating through a hepatology department between November 2024 and October 2025. Participants were allocated to a traditional teaching group (n = 104) or a specialty clinic-based case teaching group (n = 128) according to rotation arrangements. The intervention integrated authentic outpatient cases with on-site demonstration, structured reflection, and integrated clinical decision-making. Teaching outcomes were assessed across multiple domains, including theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, traditional Chinese medicine (TCM) pattern differentiation, and teaching satisfaction. Group comparisons were performed using independent-sample t tests and chi-square tests.

Results: Residents in the specialty clinic-based teaching group achieved significantly higher scores than those in the traditional group across all continuous outcome measures, including theoretical knowledge, clinical skills, diagnostic and stratification ability, clinical reasoning, TCM pattern differentiation, and teaching satisfaction (all P < 0.001). Skill assessment pass rates and the proportion of residents achieving an overall performance rating of "good or above" were also significantly higher in the specialty group. Subgroup analysis showed no significant differences between undergraduate and postgraduate residents within the traditional group. In contrast, within the specialty teaching group, postgraduate residents demonstrated significantly higher diagnostic and stratification scores than undergraduate residents (P = 0.030).

Conclusions: This study suggests that a specialty-focused, outpatient-based case teaching model embedded within a MASLD clinic may improve residents' clinical competence and learning satisfaction compared with traditional teaching approaches. It may also support stratified training and serve as a practical complement to residency education in chronic disease management settings.