医学模拟教学在重症医学PBL教学中的应用

Role of simulation based medical education in critical care medicine PBL teaching

目的：探讨医学模拟教学（simulation based medical education，SBME）在重症医学以问题为基础的学习（problem-based learning，PBL）中的效果。方法选择2012至2013年在我院参与重症医学PBL教学的上海交通大学医学院临床医学专业五年制学生46名为研究对象，分为2组。24名2009级学生为PBL组，22名2010级学生为医学模拟-PBL组（SBME-PBL组）。教学结束后，采用问卷调查、理论知识考核、直接观察操作技能（direct observation of procedural skills， DOPS）和迷你临床评估训练（mini-clinical evaluation exercise，Mini-CEX）等评分系统进行教学效果的评估。数据采用SPSS 17.0软件进行统计分析，问卷调查数据用百分比表示，考核成绩用x^-±s表示，分别采用χ^2和t检验进行统计分析，P〈0.05为差异有统计学意义。结果①问卷调查显示：在学习兴趣（P=0.665，0.937，0.746）和学习能力（P=0.937，0.665）方面2组差异无统计学意义，但在协作能力方面SBME-PBL组要明显高于PBL组，2组差异有统计学意义（P=0.019，0.038，0.024）。②在理论知识考核中2组差异无统计学意义（P=0.743）。③临床基本操作技能的DOPS评估显示：SBME-PBL组的各项操作技能评分均明显高于PBL组（P 心肺复苏=0.000，P 气管插管=0.023，P 电除颤=0.002， P 中心静脉穿刺=0.047）。④Mini-CEX评估显示：相对于PBL组，SBME-PBL组在体格检查（χ^2=0.790）、临床判断（P=0.426）方面2组差异无统计学意义，但是在医疗面谈、人文关怀、沟通技能、组织效能和整体临床能力方面有提高，P值分别为0.002、0.001、0.017、0.029、0.024。结论 SBME能够提高重症医学PBL教学中医学生的团队协作能力、临床基本操作技能、临床综合处理能力。

Objective To evaluate the effectiveness of applying simulation based medical education （SBME） in critical care medicine PBL teaching. Methods Totally 46 undergraduates in medical college of Shanghai JiaoTong University , who participated in critical care medicine PBL teaching in our Hospital from 2012 to 2013 were chosen as research objects. These students were divided into two groups： PBL group （2009 grade, n=24） and SBME-PBL group （2010 grade, n=22）. The teaching effectiveness was evaluated by questionnaire survey, theoretical exam, direct observation of procedural skills （DOPS） and mini-clinical evaluation exercise （Mini-CEX）. Data were analyzed by SPSS 17.0 software. The data of questionnaire survey were expressed as percentage and the assessment results were expressed as x^-±s. Chi-square and t test were used to do statistical analysis. P〈0.05 signifies for statistically significant differences . Results ①The results of questionnaire survey showed that：there was no significant difference between two groups in study interests（P=0.665, 0.937, 0.746） and study ability（P=0.937, 0.665）. But regarding collaboration ability, SBME-PBL group performed better than PBL group （P=0.019, 0.038, 0.024）. ②These was no significant difference in the theo-retical knowledge exam between PBL and SBME-PBL group（P=0.743）. But the DOPS scores of cardiopulmonary resuscitation （P=0.000）, endotracheal intubation （P=0.023）, defibrillation （P=0.002） and central venous catheterization（P=0.047） were all significantly higher in SBME-PBL group than in PBL group. ③In Mini-CEX, there was no statistical difference in physical examination skills （P=0.790） and clinic judgment（P=0.426） between the two groups. However, SBME-PBL group performed better in medical interviewing capacity（P=0.002）, humanistic care （P=0.001）, counseling skills（P=0.017）, organization efficiency（P=0.029） and overall clinical competence（P=0.024） than PBL group. Conclusions SBME can promote the students＇ team work spirit, basic clinical skills and comprehensive clinical capacity in critical care medicine PBL teaching and can improve the teaching quality of critical care medicine.