PBL在妇产科临床教学中的应用

Application of PBL in clinical teaching of gynecology and obstetrics

目的研究以问题为基础的学习（problem-based learning，PBL）在妇产科临床带教中的效果。方法将在妇产科见习的2008级临床医学专业学生170人随机分为2组，均采用大课讲授理论知识、病房学习临床病例的形式进行教学。实验组87人采用PBL教学，即大课结束后，教师选择临床病例，学生分小组询问病史、体格检查、讨论、拟订治疗方案，查阅资料、咨询专科医师、确定治疗方案，小组汇报，最后由教师总结、点评。对照组83人采用传统教学，即大课结束后由教师带领学生询问病史、体格检查，分析诊断、鉴别诊断及治疗，然后对其中涉及的知识点进行提问和解答。通过出科考核（包括理论知识和病例分析）、问卷调查评估学生解决实际问题的能力。数据采用SPSS11．5进行统计分析，计量资料采用t检验，数据用均数±标准差（x±S）表示，计数资料采用r检验。以P≤O．05为差异具有统计学意义。结果实验组与对照组的理论成绩差异无统计学意义，但实验组病例分析成绩明显高于对照组（t=2．236，P=0．017），实验组学生对PBL教学的满意度明显高于对照组学生对传统教学法的满意度。结论在妇产科临床教学中，PBL优于传统教学，可以提高学生分析问题、解决问题的能力。

Objective To study the efficacy of problem-based learning （ PBL ） in clinical teach- ing of gynecology and obstetrics. Methods Totally 170 students in our department for probationary were divided into two groups randomly. Students in the two groups were taught by theoretical lecture and case study in the ward. PBL （ After the lectures, teachers choose clinical cases, students inquire medical his- tory and do physical examination, students discuss on the case and propose treatment scheme, students look up references and consult specialist to determine treatment scheme, students do team report and tea- chers give comments ） was used in experimental group （ n=87 ） while traditional teaching method （ teach- ers guide students to inquire medical history, do physical examination, analyze the cases and make diag- nosis, do differential diagnosis and give treatment as well as answer the questions posed by students ） in control group （ n=83 ）. Ability of students to solve the practical problems was assessed by final examina- tion （ theoretical exam and case analysis ） and the efficacy of PBL was investigated by questionnaire sur- vey. SPSS 11.5 soft ware was employed to do statistic analysis. Measurement data were analyzed by t test and manifested asand enumeration data were analyzed by chi-square test. P≤ 0.05 stands for statistical differences. Results There was no difference in theoretical score between experimental group and control group. Score of case analysis was higher in experimental group than in control group （ t=2.236, P=-0.017 ）. Students＇ satisfaction degree of PBL was much higher than that of traditional teaching method. Conclusions PBL is better than traditional teaching method in clinical teaching of gynecology and obstetrics. It can improve students＇ ability of problem-analyzing and problem-solving, therefore should be promoted in clinic education.