医学本科教育基础医学课程PBL教学效果的Meta分析

Meta-analysis of PBL teaching effect of basic medical courses in undergraduate medical edu-cation

目的：运用Meta分析的方法定量评价以问题为基础的学习（problem-based learning， PBL）与以讲座为基础的学习（lecture-based learning，LBL）在本科医学教育基础医学课程中的应用效果。方法计算机检索中国知网（CNKI）和维普（VIP）数据库，查找关于PBL教学在本科医学教育基础医学课程中应用的随机对照试验研究，其中实验组采用PBL教学，对照组采用LBL教学；课程考核以及格率或分数进行评价。检索时限均从建库时间至2012年12月。由2位研究员独立筛选文献、提取资料并评价质量后，采用Stata 11.0软件进行Meta分析。结果最终纳入28个研究，改良Jadad评分小于4分的有20篇研究文献（占71.4%），4分及以上的有8篇（占28.6%）；共3703名研究对象。 Meta分析结果显示，与传统教学相比，PBL教学并不能提高课程考试合格率[RR=1.05，95%CI（0.99，1.10），P=0.098]，但却能提高课程考试分数[SMD=0.73，95%CI（0.51，0.96）， P=0.000]。结论本科医学教育基础医学课程中PBL教学相比于LBL教学能够提高学生的考试分数，但并不能提高及格率。基础医学课程的PBL教学形式不一、标准不齐，其具体应用还需探索，且不应盲目开展。

Objective This study seeks to use a meta-analytical approach to quantitatively assess the results of applying the problem-based learning（PBL） teaching model and the traditional lecture-based learning（LBL）teaching model to basic medical courses in undergraduate medical education. Methods The CNKI and VIP databases were electronically searched to retrieve randomised controlled trial studies that examined the use of PBL methods for basic medical courses in under-graduate medical education. In these studies PBL teaching model was used in experiment group and LBL teaching model was used in control group. Pass rate or test scores was used to evaluate the effect of learning. The retrieved documents ranged from the time that each database was first constructed to December 2012. After two researchers performed literature screening independently, data extraction, and quality assessment procedures in strict accordance with the inclusion and exclusion criteria of this＆amp;nbsp;study, the Stata 11.0 software package was utilized to conduct the meta-analysis. Results This meta-analysis examined 28 studies that included a total of 3703 subjects. The modified Jadad scores of 20 studies（71.4%） were less than 4, and those of 8 studies（28.6%） were more than or equal to 4. The meta-analysis revealed that compared with the traditional teaching model, the PBL teaching model did not produce improved examination passing rates for a course [relative risk（RR）：1.05, 95%confidence interval（CI）：（0.99, 1.10）, P=0.098] but could improve examination scores for a course [standardized mean difference （SMD）： 0.73, 95% CI： （0.51, 0.96）, P＆lt;0.001]. Conclusion For basic medical courses in undergraduate medical education, compared to LBL teaching, PBL teaching can improve students＆#39; test scores but cannot improve students＆#39; pass rate. PBL used in basic medical courses has di-versified forms and lacks unified criterion, so there is still a long way to go for the appli-cation of PBL.