导师制临床医学实践教学方法的建立与作用评价

The impact of tutorial system established for clinical practice teaching

目的探索在本科临床医学教育中导师制临床实践教学方法的建立并评价其作用。方法在江汉大学第二附属医院中选择主要临床科室建立本科临床实践教学导师工作站，选择2007级本科临床医学专业3个班学生参与研究，其中2班为实验组，除完成原教学计划外在课余时间接受为期1个学年的临床实践导师制教学；1班和3班作为对照组，按照原教学计划完成规定的教学任务。经过第6学期、第7学期的导师制临床实践教学和第8学期的临床实习后，两组学生均接受实习中期多站式客观结构化临床考试，并在实验组学生中发放调查问卷。分析问卷调查结果，比较实验班和对照班学生多站式客观结构化考试成绩。结果在所调查的35个问题中，给予肯定性回答的占比81．1％，对其中有关获取隐性知识方面的问题表示怀疑性回答的占比14．1％，给予否定性回答的占比4．8％。多站式客观结构化临床考试标准化后可靠性系数0．721，平均难度0．67，平均区分度0．41，平均效度0．41。实验组学生平均成绩为（79．03±6．31）分，对照组2个班学生的平均成绩分别为（73．24±9．04）分和（74．21±8．18）分，P〈0．05，差异具有统计学意义。结论在本科临床医学专业实践教学中建立导师制教学平台很有必要且切实可行，有助于提高学生的临床实践能力。在临床实验教学评价中实施多站式客观结构化临床考试的信度、效度、区分度和难度基本可靠。

Objective To explore the impact of tutorial system established for clinical practice teaching during the stage of undergraduate course education of clinical medicine. Methods The tutorial system workstations were established in the one of two affiliated hospitals of our medical college. The study took three intact classes of 2007 grade undergraduate clinical medicine major as subjects, the second class as experimental group receiving the tutorial system clinical practice teaching during one academic year in addition to the original teaching plan and the first and third classes as comparison group receiving the original teaching plan. The objective structure clinical examination （OSCE） was carried out as clinical practice intermediate inspection in the three classes at the end of the eighth term after tutorial system clinical practice teaching during the sixth and seventh terms and the questionnaire was given out in experimental group for inquiry. The result of questionnaire and OSCE was analyzed and the achievement was compared with the experimental group and comparison group. Results The positive response rate to those 35 questions in the questionnaire was 81.1%, the suspicious about obtaining tacit knowledge was 14% and the negative was 5%. The reliability standardized, average difficulty, differentiate, and validity of OSCE were 0. 721, 0. 67, 0.41, and 0.41 respectively. The score of the 2nd class was （79.03±6.31） while that of the 1 st and 3rd classes were （73.24 ± 9.04） and （74.21 ± 8.18 ） respectively and the difference was significant and P〈0. 05. Conclusions It is necessary and feasible that tutorial system model of teaching is carried out for clinical practice teaching in undergraduate course education of clinical medicine. The clinical practical capability can be improved by the tutorial system clinical practice teaching. The reliability difficulty, differentiate, and validity of OSCE are reliable in principle.