现代综合立体教学在呼吸内科临床见习中的应用

Application of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine

目的：探索现代综合立体教学在呼吸内科教学中的应用及效果。方法将以问题为基础的学习（ problem-based learning ， PBL ）、基于标准化病人的练习（ stan-dardized patient experiences/exam，SPE/Xs）和迷你临床检查练习方法（mini clinical examination exercise，Mini-CEX）等有机结合应用于呼吸内科临床见习，并将其命名为“现代综合立体教学”。将60名学生随机分为现代综合立体教学组（30名）和传统教学组（30名），分别采用现代综合立体教学和以主题为基础的学习（subject based learning，SBL）进行呼吸内科见习带教。教学结束后，采用成绩测试和受试者问卷调查评价两组学生的教学效果。组间比较采用SPSS行t检验。结果现代综合立体教学组学生的测试成绩为（86.91±4.77）分，高于对照组的（79.00±7.51）分（t=12.4，P=0.0260）。其中主观题（如论述题和病例分析）成绩方面，现代综合立体教学组（47.63±2.14）分，明显优于传统组的（36.00±6.71）分（t=21.6，P=0.0019）。对两组学生进行调查问卷显示：相比传统教学，现代综合立体教学更能提高学生的主观能动性和对学习的积极性；提高学生综合分析问题的能力和促进临床思维的形成；有利于学生高效、全面掌握呼吸内科基本知识和基本技能（χ2=16.2，P=0.0160）。结论针对呼吸内科临床见习实施现代综合立体教学有助于提高教学效果。

Objective To evaluate the effect of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine. Method The problem based teaching method PBL （problem-based learning）, the standardized patient-based practice SPE/Xs （standardized patient experiences/exam） and Mini clinical examination practice Mini-CEX （Mini clinical examination exercise） method and other methods were organically combined and used in respiratory medicine clini-cal practice, and it was named“modern comprehensive three-dimensional teaching mode”. 60 students were randomly divided into the modern comprehensive three-dimensional teaching method group （30 students） and the traditional teaching method （SBL） （30 students）, using the modern com-prehensive three-dimensional teaching method and the SBL breathing internal medicine practice teaching respec-tively. After the teaching, the methods of performance testing and questionnalre survey were used to evaluate the teaching effect of two groups of students. SPSS software was used to compare t test. Results The test results of modern three-dimensional integrated teaching method group was （86.91±4.77）, higher than that of the control group （79.00±7.51） points （t=12.4, P=0.026 0）. In the subjective questions （such as discourse analysis problem and case）, modern three-dimensional integrated teaching group （47.63± 2.14） points is obvi-ously superior to the traditional group （36.00±6.71） points （t=21.6, P=0.001 9）. According to the results of the survey, the modern comprehensive teaching method can improve students＇ subjective initiative and enthusiasm for learning, improve students＇ ability of comprehensive analysis, promote the formation of clinical thinking, and help students master the basic knowledge and basic skills of respiratory diseases. Conclusions In the respiratory medicine teaching, implementation of modern comprehensive three-dimensional teaching method is helpful to improving the teaching effect.