渐进式PBL在神经病学教学中的应用效果

Effect of progressive problem-based learning in teaching of neurology

目的：研究渐进式以问题为基础的学习（problem-based learning，PBL）在神经病学教学中的应用效果。方法将110名5年制本科生随机分为传统教学（lecture-based learning，LBL）组和渐进式PBL教学组，每组55名学生。教学内容包括基础知识、临床技能、病例剖析和文献检索。渐进式PBL按引入阶段、过渡阶段、PBL阶段渐进式教学。教学结束分别以理论知识、实践技能考试成绩及问卷调查作为指标，比较LBL组和渐进式PBL教学组的教学质量。并采用皮尔逊χ2检验分析学生性别、生源地城乡属性、相关学科基础知识掌握程度和组内贡献对渐进式PBL教学考试成绩的影响。结果渐进式PBL组理论知识成绩低于LBL组[（78.49±3.15） vs.（81.94±5.37），t=-4.11，P=0.000]，临床技能操作成绩[（86.34±9.16） vs.（80.96±7.85），t=1.63，P=0.003]和临床病例分析成绩[（82.25±5.17） vs.（70.54±3.85），t=13.47，P=0.000]高于LBL组。渐进式PBL教学组对学习兴趣（χ2=7.21，P=0.007）、自学能力（χ2=6.70，P=0.010）、知识综合运用能力（χ2=7.92，P=0.005）、分析思考能力（χ2=4.36，P=0.037）、表达能力（χ2=9.17，P=0.003）的满意度高于LBL组。学生性别（χ2=0.0109，P=0.917）、生源地属性（χ2=0.045，P=0.831）对渐进式PBL教学考试成绩无显著影响。相关学科知识掌握程度（χ2=6.82，P=0.009）和组内贡献（χ2=4.91，P=0.027）对渐进式PBL教学考试成绩存在显著影响。结论渐进式PBL教学可提高学生临床技能操作和病例分析能力，学生前期基础知识水平和组内贡献程度对渐进式PBL教学效果存在显著影响。

Objective To evaluate the effect of progressive problem-based learning （PBL） in teach-ing of neurology and study its impact factors. Methods A total of 110 5-year undergraduate students were randomly divided into LBL and progressive PBL groups, with 55 students in each group. Both groups ac-cepted basic knowledge, clinical skills, case analysis and document retrieval teaching. Progressive PBL were given by three steps including introduction phase, transition phase and PBL stage. At the end of the internship, theoretical knowledg,practical skill scores and questionnaires were used to evaluate the effects of different teaching methods. Pearsonχ2 test was used to analyze the effects of gender, urban-rural character, mastery of relevant based knowledge and intra-group contribution on examination results of progressive PBL. Results Theoretical knowledge score of progressive PBL group was significantly lower than LBL group [（78.49 ±3.15） vs. （81.94 ±5.37）, t=-4.11, P=0.000], while clinical skill score [（86.34 ±9.16） vs. （80.96±7.85）, t=1.63, P=0.003] and clinical analysis score [（82.25±5.17） vs. （70.54±3.85）, t=13.47, P= 〈br〉 0.000] of progressive PBL group were significantly higher than LBL group. Teaching satisfaction scales of learning interest （ χ2=7.21, P=0.007）, self-learning ability （ χ2=6.70, P=0.010）, knowledge use ability （ χ2=7.92, P=0.005）, analytical thinking ability （χ2=4.36, P=0.037） and expression ability （χ2=9.17, P=0.003） in progressive PBL group were significantly higher than LBL group. Gender（ χ2=0.0109,P=0.917） and urban-rural character （χ2=0.045, P=0.831） showed no significant impact on examination results of progressive PBL. While relevant based knowledge （χ2=6.82, P=0.009） and intra-group contribution （χ2=4.91, P=0.027） showed significant impact on examination results of progressive PBL. Conclusion Progressive PBL can improve the clinical skill and case analysis ability of students. Relevant based knowledge and intra-group contribution have significant impact on the effect of progressive PBL.