儿科学早临床长学制医学生开展临床课程的可行性研究

Feasibility study on developing clinical pediatrics curriculum for medical students engaged in long schooling system in the pre-clinical stage

目的分析儿科学早临床长学制医学生开展临床课程的可行性,为后续课程改革提供依据。方法纳入重庆医科大学附属儿童医院长学制儿科学医学生90人,包括早临床组(G1,二年级第三学期,n=47)和临床见习组(G2,四年级第七学期,n=43)。对两组进行问卷调查,从临床兴趣、学习方法、学习能力进行对比。两组分别抽取24名、20名学生参与一次临床课程教学,对比组间形成性评价和随堂测试得分,以了解两组学习表现和学习效果的差异。运用SPSS 22.0进行数据分析。计数资料比较采用卡方检验,不满足卡方检验条件时采用Fisher精确检验。计量资料进行正态性检验,正态分布资料的组间比较采用两独立样本t检验,偏态分布资料的组间比较采用Mann-Whitney U检验。结果两组学生临床兴趣及早临床兴趣差异无统计学意义(P=0.252、1.000)。学习方法有部分差异:G1组课后学习时间更长(Z=-2.36,P=0.018),利用课余时间学习更多(Z=2.53,P=0.011),学习方式更依赖于作业(P=0.020),预习率更高(Z=-5.07,P<0.001)。学习能力有部分差异:G2组文献检索能力更强(χ^(2)=10.57,P=0.001),G2课堂及延展课堂表现得分更高(t=-3.18,P=0.004;t=-10.14,P<0.001)。学习效果方面,G2仅一道多选题正确率高于G1(t=-2.46,P=0.022)。结论儿科学早临床长学制医学生有一定的兴趣和能力接受临床课程。充分的课前准备和恰当的课程设计有助于学生临床思维的早期培养。

Objective To analyze the feasibility of developing clinical pediatrics curriculum for pediatric students at the pre-clinical stage,and to provide a basis for the subsequent curriculum construction.Methods A total of 90 pediatric medical students were enrolled,including pre-clinical group(G1,third semester of the second year,n=47)and the clinical clerkship group(G2,seventh semester of the fourth year,n=43).A questionnaire survey was conducted to compare the two groups from three aspects:clinical interest,learning methods and learning ability.And 24 and 20 students were randomly selected from the two groups to participate a clinical course respectively.Both of the formative evaluation and in-class test were carried out to compare the learning performance and learning effect between G1 and G2.SPSS 22.0 was used for data analysis.The counting data were described by case number and rate,and the frequency between groups was compared by chi-square test.When the chi-square test condition is not met,Fisher's exact test was performed.Normal distribution test was carried out for measurement data.Two independent sample t test was conducted for the comparison between groups of normal distribution data and Mann-Whitney U test for the comparison between groups of skewed distribution respectively.Results There was no significant difference in clinical interest and pre-clinical interest between the two groups(Fisher's exact probability method,P=0.252,1.000).There were partial differences in learning methods:G1 spent more time learning after class(Z=-2.36,P=0.018),learned more in spare time(Z=2.53,P=0.011),learned more on the homework(P=0.020),and had a higher preview rate(Z=-5.07,P<0.001).There were also partial differences in learning ability:G2 had better literature retrieval ability(χ^(2)=10.57,P=0.001);G2 had higher scores on class and extended class performance(t=-3.18,P=0.004;t=-10.14,P<0.001).In terms of learning effect,G2 scored higher scores on only one multiple choice question(t=-2.46,P=0.022).Conclusion The pediatrics students at the pre-clinical stage have certain interest and ability to receive clinical pediatrics courses.Sufficient pre-class preparation and appropriate curriculum design are helpful to the early cultivation of student's clinical thinking.