基于案例学习对不同学习风格医学生批判性思维的影响

Impact of case-based learning to critical thinking disposition in medical students with different learningstyles

目的 本研究通过比较基于案例学习(case-based learning,CBL)教学对不同学习风格的医学生批判性思维的影响,探讨提高医学生批判性思维的教学策略.方法 选取上海交通大学2012级五年制临床医学专业51名学生为研究对象,在实施CBL教学前后进行学习风格与批判性思维的评估,比较不同学习风格学生批判性思维能力的差异及对CBL教学反馈的差异.结果 学生的学习风格以适应型为主,其次为聚合型,同化型最少.不同学习风格的学生在批判性思维能力、出科考试表现和CBL考试方面差异均无统计学意义(均P>0.05).在CBL教学前后,适应型学习风格的学生批判型思维能力总分提高最为显著(238.82±26.04比253.47±18.98,F=0.404,P=0.028);发散型风格的学生在批判性思维的自信心和求知欲的维度上,由负性水平提高到中等水平(28.55±4.57比32.00±5.71,t=2.680,P=0.023;29.18±5.58比31.55±6.23,t=2.729,P=0.021);而在同化型和聚合型风格的学生中未观察到这些现象.结论 CBL教学能够提高医学生的批判性思维能力,对发散型和适应型学习风格的学生效果较为显著.在医学生的临床教学中需要考虑到学生的学习风格这一重要因素.

Objective To investigate the impact of case-based learning ( CBL) to the critical thinking disposition in medical students with different learning styles. Methods The medical students rotated in Department of Pediatrics in Shanghai General Hospital affiliated to Shanghai Jiao Tong University in 2016-2017 were randomly enrolled to the study. Their learning styles were assessed with Kolb learning style questionnaire before rotation. During the 6 weeks period of rotation, case-based learning was conducted. The critical thinking disposition was assessed with CTDI-CV questionnaire and compared before and after the rotation. The impact of CBL to the critical thinking disposition was compared in students with different learning styles. Results Accommodate style was the most common learning style, followed by convergent, while assimilate was the least common. There were no significant differences in critical thinking disposition, CBL assessment and academic performance between different learning styles. After CBL conducted, students with accommodate style had significant increased CTDI-CV score (238. 82±26. 04 vs 253. 47±18. 98, F=0. 404, P=0. 028);while students with divergent style has significant increased scores in critical thinking self-confidence and inquisitiveness ( 28. 55 ± 4. 57 vs 32. 00 ± 5. 71, t=2. 680, P=0. 023; 29. 18 ± 5. 58 vs 31. 55 ± 6. 23, t=2. 729, P=0. 021) . Conclusions CBL could improve the critical thinking disposition in medical students with divergent and accommodate learning styles. Learning styles as an important individualized characteristic, should be considered when designing teaching strategy.