PBL教学在消化科临床实习中的应用

Application of problem based learning in clinical internship in department of gastroenterology

目的探讨以问题为基础的学习（problem—based learning，PBL）联合传统教学法在消化科临床实习中的教学效果。方法选择2006年3月至2007年12月，在保定市第二医院消化科实习的全日制医疗系临床医学专业本科生60名为研究对象，完全随机分为PBL教学组（简称PBL组）和传统教学组（简称传统组），每组30人。实习结束后，通过问卷调查、出科考试成绩评价不同教学法的实习效果。采用SPSS15．0软件进行数据分析，计数资料组间比较采用χ^2检验，计量资料用x±s表示，以P〈0．05为差异有统计学意义。结果PBL组在提高综合分析能力、学习主动性和学习效果方面均优于传统组，组问差异均有统计学意义，P值分别为0．001、0．007、0．005。PBL组在激发学生兴趣和对教学法的满意度方面的比例高于传统组，但组间差异无统计学意义（P〉0．05）。PBL组在课前准备充分积极、课堂全面准确表述观点、临床思维逻辑性强方面优于传统组，组间差异均有统计学意义，P值分别为0．002、0．000、0．002；在与患者沟通能力方面，组间差异无统计学意义，P=O．118。PBL组问答题、病例分析题和总成绩的分数高于传统组，组间差异有统计学意义，P值分别为0．005、0．045、0．013。名词解释和选择题的分值与传统组的差异无统计意义（P〉0．05）。结论PBL联合传统教学法适用于全日制医疗系临床医学专业本科生在消化科的实习教学，PBL教学能够较好地训练学生的临床综合分析能力，有助于培养其主动解决实际问题的能力。

Objective To evaluate the efficacy of applying problem based learning （ PBL ） com- bined with traditional teaching in clinical internship in department of gastroenterology. Methods Totally 60 full-time medical undergraduates of clinical medicine in clinical internship in department of gastroen- terology of the Second Hospital of Baoding were randomly divided into PBL group （ n=30 ） and traditional group （ n=30 ）. Practical effect of the different modes was evaluated by questionnaire and examination re- suits. Data were analyzed by SPSS 15.0. Enumeration data were compared between groups using χ^2 test and measurement data were manifested x ± s with P 〈 0.05 signifying significant difference. Results PBL group was superior to traditional group in comprehensive analysis capabilities, motivation to learn and learning outcomes with statistically significant differences between the two groups （ P values were 0.001, 0.007 and 0.005 ）. Concerning stimulating students＇ interest and satisfaction of the teaching mode, the dif- ference between the two groups was not statistically significant （ P 〉 0.05 ）. PBL group was superior to tra- ditional group in the pre-class preparation, full and accurate expression of views in classroom and clinical logic, with statistically significant differences between the two groups （ P values were 0.002, 0.000 and 0.002 ）. There was no difference in communicative abilities with patients between the two groups （ P= 0.118 ）. PBL group had higher scores than traditional group in the quiz, case analysis and overall perfor- mance, with statistically significant differences between the two groups （ P values were 0.005, 0.045 and 0.013 ）. Concerning score of glossary and multiple-choice questions, differences between two group were not statistically significant （ P〉O.05 ）. Conclusions PBL combined with traditional teaching method is suitable for internship teaching in the department of gastroenterology for full-time undergraduates of clini- cal medicine. PBL can improve students＇ clinical comprehensive analysis capabilities and helps to develop the ability to take the initiative to solve practical problems.