以问题为基础的病案式教学在重症医学规范化培训中的应用

Application of clinical cases related problem-based-learning in critical care medical education

目的探讨以问题为基础的病案式教学在重症医学规范化培训中的应用效果。方法2013年8月至2015年7月，对重症医学科进行规范化培训住院医师84人，采用抓阄法随机分为实验组（42名）和对照组（42名）。实验组采用以问题为基础的病案式教学，按照“选择病例——临床资料收集——提出问题——归纳分析、制定诊疗方案——学习反馈、调整”的流程教学；对照组采用传统教学。培训结束后采用多元化临床能力考核和自我反馈式调查问卷对两种培训方法进行效果评估。采用SPSS17．0对两组住院医师数据行t检验。结果实验组和对照组人员在年龄、性别、教育背景和专业背景方面较为均衡。实验组学员在体现住院医师综合能力的题库考核[（80．26±8．89）VS．（86．10±9．32）]、病例答辩[（84．83±5．43）vs．（75．36±6．06）]、临床步骤直接观察[（88．81±6．68）VS．（82．70±6．98）]、仿真模拟平台考核[（79．86±10．09）vs．（72．71±9．30）]成绩方面，均优于对照组。问卷调查结果显示，实验组学员对自身培训方法在激发自主学习、培养独立思考习惯、提高临床问题分析能力、促进临床思维建立、提高临床沟通能力和团队协作等方面的满意度，均优于对照组对自身所受培训方法的评价。结论在重症医学科实施以问题为基础的病案式教学是可行的，有利于提高住院医师规范化培训效果。

Objective To evaluate the application of clinical cases related problem-based-learning （PBL） method in critical care medical standardized resident training program. Methods 84 residents were randomly divided into experimental group （n=42） and control group （n=42） by lottery way. The experimental group received PBL process during clinical case analysis while the control group learned completely through traditional teaching method. The residents＇ clinical competence were assessed by multiple scale mixed method including question bank examination （QBE）, case-based discussion （CBD）, direct observation of procedural skills （DOPS）, simulation etc, and Likert-type scale questionnaire was used to evaluate the feedback of training residents. SPSS 17.0 was used to do line t test to the data of both groups. Results Finally 84 residents finished the study. There were no difference in the general conditions in two groups. The PBL group achieved higher examination score during QBE [（80.26 ± 8.89） vs. （86.10± 9.32）], CBD [（84.83 ± 5.43） vs. （75.36 ± 6.06）], DOPS [（88.81± 6.68） vs. （82.70 ± 6.98）], simulation [（79.86 ±10.09） vs. （72.71 ± 9.30）]. Except two groups residents all gave high scores in enhancing cross connection in clinical knowledge [（4.786 ±0.470） vs. （4.571± 0.859）, P=0.16], and the questionnaire results showed that the resi- dents of PBL group gave higher points in exciting autonomous learning, improving clin-ical analysis ability, accelerating clinical thinking establish, developing independent thinking habits, improving the clinical communication skills and teamwork ability （P〈0.05）. Conclusion The clinical cases related PBL method can improve the training effects during critical care medical standardized resident training program. It can be used broadly after adapting modification in critical care medical education.