This study was conducted in accordance with the Declaration of Helsinki and received approval from the institutional review board and ethics committee of the Second Xiangya Hospital (Z0005-01). In accordance with institutional guidelines for educational research, the intervention was classified as minimal risk and considered part of the routine evaluation of teaching quality. All participants were informed of the study’s purpose, procedures, and the planned use of the collected data, and all provided written informed consent before participation. Participant anonymity was strictly protected, with all data deidentified and analyzed only in aggregated form. No study procedures posed risks beyond those ordinarily encountered in standard educational activities.

A total of 108 fifth-year undergraduate students from Xiangya Medical College of Central South University, all of whom had passed the Chinese National Entrance Examination, participated in the study. The cohort consisted of 42 (38.9%) male and 66 (61.1%) female participants, aged 20 to 22 years. Participants were randomly assigned into 6 groups of 18 students each using Microsoft Excel to generate random numbers to ensure unbiased distribution. In this study, students were informed of their group assignments due to the nature of the teaching intervention, but evaluators responsible for assessing the examination results were blinded to group allocation to minimize assessment bias. The new teaching methods were implemented outside their regular class schedules, primarily during evenings and weekends. This approach presented unique challenges, including an increased workload for both students and instructors, as it required students to allocate additional time beyond their standard academic hours to participate in the study. Additionally, coordinating schedules among all faculty members and students involved posed challenges, which required careful planning and communication to ensure participation without conflicting with existing institutional educational policies. Both intervention and control groups received instruction in dedicated classrooms at the hospital, which facilitated a conducive learning environment (Table 1).

We selected primary angle-closure glaucoma (PACG) as the topic for applying the WeChat-based PBL approach in this study, as the diagnosis and treatment of PACG represent crucial skills that students must acquire. The textbook used for this study was Ophthalmology, 9th edition, published by the People’s Medical Publishing House [23].

The traditional teaching model involved the instructor predominantly delivering comprehensive explanations of foundational knowledge, adhering to a prescribed multimedia teaching outline. In this model, students were not divided into smaller groups and were not required to give formal presentations during the course. Both groups completed the same quizzes and questionnaires, and the results did not affect course grades or performance. The study design is summarized in Figure 1.

The efficacy and satisfaction of both teaching methods were evaluated through a combination of questionnaire surveys for subjective assessment and examinations for objective evaluation.

Figure 2 shows a flowchart of participation for the 108 medical students in this study. Among them, 54 (50%) students were randomly selected to participate in the WeChat-based PBL, while the other 54 (50%) received traditional teaching. Among the participants, there were 42 (38.9%) male and 66 (61.1%) female individuals who were aged 20 to 22 years. The mean age of the WeChat-based group was 20.426 (SD 0.602) years, and the mean age of the traditional teaching group was 20.296 (SD 0.571) years. There was no significant difference in gender and average age between the two groups (Table 3).

The closed-book examination was administered 1 week after course completion to allow students sufficient time for review while minimizing long-term memory effects. This clarification has been included in the revised manuscript. Examination questions were designed by 3 instructors and included 6 types of questions: single-choice questions, multiple-choice questions, noun definitions, short-answer questions, essay questions, and comprehensive questions. The exam assessed 3 cognitive levels—memorization, understanding, and application, which accounted for 50%, 20%, and 30% of the total score, respectively. The memorization section evaluated students’ ability to recall fundamental facts, definitions, and terminology. The understanding section assessed their capacity to interpret information, explain concepts in their own words, and demonstrate deeper comprehension beyond simple recall. The application section examined students’ ability to apply their knowledge and understanding to new or practical situations, such as problem-solving, formula application, and case analysis. Notably, the sections on understanding and application emphasized students’ flexible mastery of knowledge and its practical implementation. The goal was to enable students to apply theoretical knowledge in clinical contexts, thereby improving their diagnostic and treatment skills as well as their ability to analyze and solve clinical problems.

Our analysis indicated that although students in the WeChat-based PBL group scored marginally lower in memorization compared to their peers in the traditional teaching group (traditional vs WeChat groups: 37.6, SD 2.8 vs 32.0, SD 4.1; t₁₀₆=-8.426; P=.006; n=54), they exhibited markedly superior levels of understanding (traditional vs WeChat groups: 24.1, SD 1.8 vs 28.0, SD 1.3; t₁₀₆=12.753; P=.007; n=54) and knowledge application (traditional vs WeChat groups: 24.3, SD 1.9 vs 27.6, SD 1.3; t₁₀₆=10.899; P=.008; n=54). However, when considering the total score, there was no significant difference between the two groups (traditional vs WeChat: 85.8, SD 4.9 vs 87.4, SD 5.1; t₁₀₆=1.694; P=.60; n=54).

All 108 (100%) students responded to the questionnaire for the comparison of students’ perceptions between the WeChat-based PBL and lecture-based class (Table 4). More students believed (rather than did not believe) that the WeChat-based PBL class enhanced their learning motivation (traditional group: mean 3.5471, SD 0.7915; WeChat group: mean 1.8333, SD 0.5746; P=.004), helped them acquire knowledge (traditional group: mean 3.6667, SD 0.7770; WeChat group: mean 1.8704, SD 0.7017; P<.001), and improved their performance on the final examination (P=.001). They also believed that it encouraged them to express opinions (traditional group: mean 3.5556, SD 0.7181; WeChat group: mean 1.9630, SD 0.5482; P=.001), enhanced their communication skills (traditional group: mean 3.8889, SD 0.8393; WeChat group: mean 1.7222, SD 0.5961; P<.001), improved their self-learning ability (traditional group: mean 3.5741, SD 0.7673; WeChat group: mean 1.8519, SD 0.4917; P<.001), improved their clinical thinking (traditional group: mean 2.9444, SD 0.8777; WeChat group: mean 1.9630, SD 0.6132; P=.012), and enhanced their ability to analyze and resolve problems (traditional group: mean 3.2037, SD 0.6553; WeChat group: mean 1.8519, SD 0.5287; P=.001). However, a majority of students in the WeChat-based PBL class felt that the course occupied too much of their spare time (traditional group: mean 3.7963, SD 0.7618; WeChat group: mean 1.9630, SD 0.5482; P<.001).

This study aimed to assess the effectiveness of WeChat-based PBL in ophthalmic education compared with traditional teaching methods. Our analysis revealed that while students in the WeChat-based PBL group exhibited slightly lower scores in memorization than those in the traditional teaching group, they demonstrated significantly higher levels of understanding and application of knowledge. This suggests that the WeChat-based PBL approach fosters deeper engagement, allowing students to grasp critical concepts more effectively, despite having less focus on rote memorization. Moreover, students in the WeChat group reported enhanced collaboration, motivation, and willingness to participate actively in their learning process.

WeChat has been used as a platform for PBL because of its time efficiency and convenience [26-28]. Students were able to present questions and engage in discussions with instructors at any time and from any location via WeChat. Moreover, it allows the sharing of images, videos, links, and other related resources. This capability greatly aids discussion and ensures that all members can access case-related or problem-related resources promptly. Everyone can share their opinions and suggestions, receiving feedback from others anytime and anywhere. This timely and efficient communication via WeChat offers a better understanding among team members [26,27,29]. Successful collaboration guarantees the productivity of the team, and instructors can actively participate in students’ discussions and debates, responding to questions and offering advice to enhance the efficiency of the learning process [26,27].

Although the primary benefit of WeChat-based PBL is time-saving and convenience, as traditional PBL can be a time-intensive approach [30], the perception that WeChat-based PBL occupied too much spare time underscores the need for careful consideration of time management and workload in educational program design. One of the reasons could be the additional time dedicated to self-learning [31] and discussion among the team members increased the pressure and burden on the students. Increased preparation time can lead to deeper understanding and better retention of the material as students engage with content more thoroughly before class discussions. This proactive approach enhances participation during PBL sessions and ultimately improves learning outcomes. To optimize learning efficiency while preventing overload, several refinements are warranted. Specifically, preclass materials should be streamlined to emphasize key concepts and reduce redundancy, and brief in-class reviews can help reinforce complex topics, minimizing postclass study demands. Periodic guided learning sessions can also be scheduled to help balance students’ independent study and supervised learning time. These refinements aim to alleviate cognitive load while maintaining the effectiveness of the teaching model. Moreover, it is essential to refine the new teaching approach to effectively integrate the advantages of the PBL model with the interactive capabilities of the WeChat platform. Furthermore, instructors should also receive appropriate training to embrace this innovative teaching approach [32]. Dolmans and Wolfhagen [33] have highlighted that a tutor’s actions significantly influence both the productivity and effectiveness of a PBL group’s efforts. To enhance the effectiveness of tutors in PBL tutorials, ongoing training that encourages reflective practice on their development as educators is recommended [34,35]. These efforts can effectively strike a balance between optimal learning outcomes and manageable student workload.

At the same time, the increase in students’ out-of-class learning hours also implied additional workload for instructors. Although instructor workload in asynchronous chat facilitation was not quantitatively measured, informal feedback indicated a moderate increase. Instructors reported spending an additional 15 to 20 minutes per day monitoring discussions and providing timely feedback. Despite this, they generally considered this extra time acceptable and valuable, as it enabled closer observation of students’ reasoning and early identification of misconceptions. The main challenges involved balancing prompt responses with other duties and managing message overload during peak activity. Nonetheless, most instructors agreed that the improved engagement and learning outcomes justified the additional effort. A rotating instructor schedule for online facilitation and setting clearer expectations for response timelines may help balance instructional workload while maintaining effective student-teacher interaction.

Our statistical analysis revealed that the WeChat-based PBL group exhibited slightly lower scores in memorization than the traditional teaching group. However, their levels of understanding and application of knowledge were higher than the traditional teaching group. This discrepancy may be attributed to the engagement of students in the WeChat-based PBL group with a broader array of relevant information, extending beyond textbook content. Consequently, while the WeChat-based PBL group demonstrated a better performance in understanding and application of knowledge, their memorization of textbook-specific information was slightly weaker. Nevertheless, the WeChat-based PBL group showed advantages in mastering key knowledge points and achieving higher total scores.

However, several factors must be considered while implementing WeChat-based PBL. For instance, it is advisable to keep the number of students in each team small, as smaller groups facilitate easier administration and instruction. Teachers should contact students at least 1 week in advance to provide questions or case reports, ensuring both teachers and students are well prepared to achieve optimal educational outcomes. By adapting to real-time situations, teachers can enhance students’ interest in learning, invigorate the classroom dynamics, and correct students’ misconceptions. Teachers should act as a resource and facilitator, responding promptly to students’ inquiries throughout their research. Overall, the WeChat-based PBL model marks a significant departure from the traditional didactic “cramming education” approach, fostering a more engaging and active learning environment. Therefore, WeChat-based PBL should be increasingly incorporated into future ophthalmology education to enable continuous identification and refinement of relevant issues [36].

There are several limitations that should be acknowledged. First, while students covered the same core content on PACG, differences in teaching methodologies could have influenced memorization outcomes and overall comprehension. This research was performed targeting a single textbook chapter on PACG. Therefore, the conclusion requires further verification in other subject fields. Second, questionnaire results indicated that students in the WeChat-based PBL group spent more extracurricular time preparing course materials. Therefore, understanding their perceptions and attitudes toward this additional workload is particularly important. However, as the students involved in this study have already graduated, it was not possible to collect further feedback from them. This limitation prevents a more comprehensive understanding of their long-term perceptions of the learning burden and its potential impact on sustained engagement and clinical competency development. Future research will include longitudinal follow-up surveys or interviews to further evaluate students’ attitudes, learning experiences, and workload perceptions. Third, the necessity for student participation in additional discussions and presentations may have affected their independent study time and overall academic performance. Fourth, the lack of blinding may have introduced biases, as awareness of the teaching method could have influenced both students’ and instructors’ expectations and engagement levels. Fifth, the generalizability of our findings is also limited by the single-institution context and the sample size of 108 fifth-year undergraduate medical students, which may not reflect broader educational settings or diverse student populations. Finally, in our study, we did not compare the effects of traditional PBL and WeChat-based PBL methods. Further research should compare the functions between these two approaches in future studies. Moreover, future research should explore the long-term impacts of WeChat-based PBL on learning outcomes across different medical disciplines and institutions. Further empirical testing is necessary to assess the effectiveness of this approach in various contexts and to identify best practices for implementation. Optimizing digital communication tools such as WeChat holds great promise for enhancing educational experience and fostering collaborative learning in medical education.

In summary, compared to traditional teaching, integrating PBL methods combined with WeChat as a communication platform improved the effectiveness of ophthalmic education. Although students invested more time in preclass, they did not perceive it as a waste of their spare time. Instead, they recognized that the WeChat-based PBL mode facilitated more effective communication among students and between students and teachers. It enhanced their motivation to learn; promoted knowledge acquisition; encouraged expression of opinions; and improved self-learning abilities, clinical reasoning, and problem-solving. This innovative teaching mode may represent a superior alternative to conventional teaching methods. However, further exploration to optimize the students’ spare time for effective online communication is warranted. This new method merits continued refinement and evaluation based on the findings of this study.