Evaluating a problem-based learning model integrated with 3D anatomy software and software-assisted annotation in undergraduate spinal surgery education: a randomized controlled trial

Abstract Background Traditional lecture-based learning (LBL) faces limitations in teaching complex spinal anatomy and surgical procedures. This study aimed to evaluate the efficacy of a novel Problem-Based Learning (PBL) model integrated with three-dimensional (3D) anatomy software and software-assisted annotation in spinal surgery education. Methods A randomized controlled trial included 120 fifth-year clinical medicine undergraduates, starting in August 2024. Participants were divided into an experimental group (n = 60, receiving 3D + PBL + annotation-assisted teaching) and a control group (n = 60, receiving traditional LBL). Outcomes were assessed via written tests (objective/subjective questions) and standardized questionnaires evaluating knowledge mastery, learning motivation, academic atmosphere, teacher-student interaction, and knowledge retention. Results The experimental group scored significantly higher on subjective questions (case analysis) than the control group (39.33 ± 5.38 vs. 32.08 ± 4.79, P < 0.001). Questionnaire results indicated that the experimental group reported significantly higher self-rated mastery in spinal endoscopic procedures, anatomy, Michigan State University (MSU) classification of lumbar disc herniation (LDH), and differential diagnosis (all P < 0.05). In addition, students in the experimental group expressed greater satisfaction with learning motivation, academic atmosphere, teacher–student interaction, and knowledge retention (all P < 0.05). Conclusions Integrating 3D anatomy visualization, software-assisted annotation, and PBL significantly enhances clinical reasoning, spatial understanding, and student engagement in spinal surgery education. This multimodal approach addresses the limitations of traditional methods and is recommended for broader application in orthopedic training. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2400082568. Registered on 01 April 2024.