Artificial Intelligence-Integrated BOPPPS Case-Based Learning for Nephrology Clerkship Education

Clinical case analysis performance was assessed using a study-specific three-case written assessment developed by the nephrology teaching team. The assessment evaluated students' ability to apply nephrology knowledge to clinical case analysis, diagnostic reasoning, treatment planning, and critical appraisal of AI-generated clinical recommendations. Total scores ranged from 0 to 70 points, with higher scores indicating better overall clinical case analysis performance.

Theoretical knowledge was assessed using a study-specific post-class test covering acute kidney injury and chronic kidney disease. The test consisted of 15 single-choice questions, with each correct answer worth 2 points. Total scores ranged from 0 to 30 points, with higher scores indicating better theoretical knowledge performance.

Clinical reasoning was assessed using Cases 1 and 2 of the study-specific Clinical Case Analysis Assessment. The cases addressed acute kidney injury and chronic kidney disease and evaluated students' ability to identify clinical problems, interpret clinical and laboratory information, formulate diagnoses, assess complications, and develop appropriate management plans. Scores ranged from 0 to 48 points, with higher scores indicating better clinical reasoning performance.

AI critical appraisal ability was assessed using Case 3 of the study-specific Clinical Case Analysis Assessment. Students evaluated an AI-generated treatment plan for a patient with acute kidney injury and severe hyperkalemia, identified clinically inappropriate or unsafe recommendations, explained the reasons, prioritized immediate management, and proposed an appropriate treatment plan. Scores ranged from 0 to 22 points, with higher scores indicating better ability to critically appraise AI-generated clinical recommendations.

Knowledge gain was calculated as the post-class theoretical knowledge test score minus the pre-class theoretical knowledge test score. Both tests consisted of 15 single-choice questions and had possible total scores ranging from 0 to 30 points. Therefore, knowledge gain scores could range from -30 to +30 points. Higher values indicate greater improvement in theoretical knowledge, a score of 0 indicates no change, and negative values indicate a lower post-class than pre-class score.

Course feedback was assessed using a study-specific 8-item questionnaire developed by the research team. Items assessed perceived learning gains and teaching satisfaction. Each item was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores ranged from 8 to 40 points, with higher scores indicating more favorable perceptions of the educational experience.