基于MDT引导的PBL在战创复合伤教学中的应用

The implementation of PBL guided by MDT in clinical teaching of war wound and trauma caused by compound factors

目的探讨以战创复合伤为案例开展多学科团队（multi—disciplinary team，MDT）协同引导的PBL的价值。方法教学人员紧贴战场和临床实践设计战创复合伤仿真案例，成立多学科教学成员组。将2012级临床实习学员随机分为实验组（23名）和对照组（22名）。实验组实施MDT引导的PBL教学，采取“六步法”，包括课前教员案例准备——学员独立分析——学员小组讨论——教员提炼问题与学员分工解答——课堂学员答题与辩论——课后学员梳理与总结。对照组采用传统教学，按照常规病例分析的步骤对战创伤案例进行课堂讲解，包括病例特点、诊断与诊断依据、需完善的检查、急救措施、一般及专科处理手段等。通过课堂评估和课后调研评价教学效果，运用SPSS22．0对组间比较行卡方检验。结果课堂评估结果显示，18名（78．3％）参与基于MDT引导的PBL教学的学员，提炼、分析与解答问题的能力、表达与演讲水平总体达到优良水平。课后调研结果表明，基于MDT引导的PBL教学更有助于提高学员的战场救治能力和战创伤诊疗水平，更能强化卫勤医疗保障的角色意识；能使学术困惑得到更为专业简洁的解答；能够增强学员的团队观念；强化学员的全局意识。结论以战创复合伤为案例的MDT引导的PBL教学，使临床实习学员不仅系统地复习了相关学科的重点知识，还锻炼了诊疗思路、熟悉了诊治方法，并做到了与战伤救治的有机结合，在临床医学和军事医学教学中具有重要应用价值。

Objective To explore the value of practicing PBL which was guided by MDT in teaching diagnoses and treatments of war wound and trauma caused by compound agents. Methods An emulational war wound case caused by compound factors was designed and a multi-disciplinary team been organized, then totally 45 interns who would graduate in 2017 were divide into two groups randomly, experimental group which had 23 cases received PBL model combined with MDT followed ＂six step＂ procedure which included case preparation by teachers, independent analysis and group discussion by interns, problem extraction by teachers and division of solution by interns before class, then answering and debating problems by interns in class, conclusion and reporting after class in the end, while the control group which had 22 cases received traditional teaching model in accordance with common case discussion in class including characteristics of patient, diagnosis and diagnostic basis, examinations needed to carry out, first aid measures and professional treatments. The effect of new teaching model was evaluated by assessment in class and questionnaire after class. The data was analyzed through Chi-square test by SPSS 22.0. Results Class assessment showed 18 （78.3%） interns in experimental group displayed good abilities of proposing, analyzing and resolving medical problem, as well as good presentation and speech skills. Questionnaire survey showed that not only clinical teaching of war wound and trauma could meet the demands of talent training in battle- field rescue, but also displayed new model, which could help interns to enhance abilities of first-aid and treatment of war wound on future war field, reinforce the consciousness of military medical support and service. In addition, it could clear confusion more professionally and strengthen teamwork and overall importance. Conclusion Applying PBL combined with MDT in teaching diagnoses and treatments of war wound and trauma can not only help interns to review and retain important knowledge of related subjects, but also improve the abilities of interns in clinical diagnoses and treatments, and moreover, it merges the medical knowledge and war wound cure together organically. In short, the new model is well worth applying in clinical teaching and military medical education because of its excellent effects.