循证医学理念在军医大学八年制学员骨科临床实习教学中的引入

Application of evidence-based medicine concept in orthopedic clinical teaching for eight-year program medical students

目的：探讨军医大学八年制学员医学教育中引入循证医学（evidence-based medicine， EBM）理念的实施效果。方法选取2012年进入上海长征医院骨科轮转实习的临床医学八年制学员50人，随机分为实验组和对照组，各25人。实验组教员在查房过程中选取合适病例，根据临床中遇到的困难或不足以及设置相关战创伤情景对小组学员提出问题。让学员展开讨论，检索有关医学文献，找出最有用的相关资料进行EBM系统分析，把结果与当前病例结合进行讨论，同时对设置问题进行答辩。教员最后根据科室相关诊疗经验以及资料进行总结。对照组采取传统灌输式教学，通过教员的临床经验指导学员工作与学习，辅以大、小班课讲授教材以及临床新进展等。骨科实习结束后，对两组学员进行统一的出科考核；并对实验组学员行问卷调查。用SPSS 17.0软件对考试成绩进行统计学分析，计量数据以均数＆#177;标准差（x＆#177;s）表示，两组间均数比较采用t检验。结果实验组学员在理论考试中主观题和军事相关题平均成绩高于对照组学员，差异有统计学意义（P＆lt;0.001）。实验组在临床病例答辩中优良率达80%（20/25），对照组学员优良率为60%（15/25）。针对实验组的调查问卷结果显示，学员在学习中能够处于主导地位，学习主动性、综合运用能力等都得到增强，并且拓宽了知识面；其中96%（24/25）的学员提高了对既往接触较少的军事相关知识的学习效率，88%（22/25）的学员对教学法表示认同并希望继续实施。结论军医大学八年制学员开展EBM教学，能够培养学员的自学精神、严谨认真的态度和独立创新的能力。最终使学员能够掌握学习方法和科研思维，受用终身，同时能够加强学员对军事医学知识的认知和研究。

Objective To discuss the effect of applying evidence-based medicine （EBM） in orthopedic clinical teaching for eight-year program medical students in military medical university. Methods Totally 50 eight-year medical students in Shanghai Changzheng Hospital were equally divided into two groups：experimental group（EBM teaching group） and control group. The teacher of experimental group selected appropriate cases and set up the questions according to the difficulties encountered in clinical situation. Students retrieved the relevant medical literature and found out the most useful information for EBM system analysis. The results combined with the current cases were＆amp;nbsp;discussed. The teachers summarized clinical experiences and data according to the relevant depart-ment. Traditional direct infusion teaching mode was used in control group. Clinical work experiences were used to guide the students . After-department examination was conducted for both group after finishing the internship and questionnaire investigation was made among students in experiment group. Statistical analysis was carried out on the examination results with SPSS 17.0 software. Mea-surement data were expressed as x＆#177;s and comparison on mean differences between two groups was analyzed by t test. Results Average scores of subjective topic and military related topic in the theory exam were higher in experimental group than in traditional teaching group, with statistically significant differences（P＆lt;0.001）. Excellent rate was 80%（20/25） in case discussion in experimental group and 60%（15/25） in control group. Experimental investigation questionnaire showed that： students got enhanced in learning initiative and broadened knowledge. 96%（24/25） students strengthened the learn-ing efficiency of military related chapters. 88%（22/25） students accepted this method and expected to continue. Conclusions Using the method of evidence-based medicine in eight-year program medical students in military medical university can cultivate the spirit of the stu-dents＆#39; self-study actively and rigorous earnest attitude. Students can grasp learning methods and sci-entific thinking. It also can strengthen students＆#39; awareness of military medicine and research.