PBL联合腹腔镜手术在妇科教学中的应用

Application of PBL combined with laparoscopy in teaching of gynecology

目的探讨以问题为基础的学习（problem-based learning，PBL）联合腹腔镜手术教学在妇科住院医师规范化培训中的价值。方法选择2015年9月至2016年9月在浙江大学医学院附属邵逸夫医院进行妇产科规范化培训的学员46名。随机平均分为两组；观察组采用PBL教学联合腹腔镜手术教学，对照组采用传统教学。以考试及问卷调查的方法对两组进行教学效果的评估。采用SPSS20．0统计软件对结果进行卡方检验或t检验。结果观察组学员理论及技能操作考试成绩均明显高于对照组[（90．78±2．73）vs．（85．09±3．78）；（89．13±2．90）vs．（80．87±4．19）]，差异有统计学意义；观察组腹腔镜操作考试通过率高于对照组（91．30％vs．65．21％，P=0．035）；操作时间明显少于对照组[（16．74±3．08）vs．（20．43±3．94），P=0．001]；观察组学员在临床应变能力、临床操作能力、学习积极性、带教满意度方面均优于对照组（P〈0．05）。结论在相同课时内，PBL教学联合腹腔镜手术教学能更有效地提高住院医师的基础理论知识和临床实践能力。

Objective To explore the value of problem-based learning （PBL） model combined with laparoscopy in the standardized training for gynecological residents. Methods A total of 46 standardized surgical trainees students in obstetrics and gynecology in Sir Run Run Shaw Hospital of Zhejiang University from September 2015 to September 2016 were enrolled and randomly divided into the observation group and the control group. The observation group was taught with PBL combined with laparoscopic teaching, while the control group was taught with the traditional teaching mode. Examinations and questionnaires were conducted to evaluate the teaching effect of the two groups. Statistical analyses were performed with Chisquare test or t-test using SPSS software （version 20.0）. Results The scores of theoretical and practical skill examination were significantly higher in the observation group than in the control group [（90.78 ±2.73） vs. （85.09± 3.78）;（89.13 ±2.90） vs. （80.87 ~ 4.19）], and the difference was significant. The pass rate of laparoscopic operation examination in the observation group was higher than that in the control group（91.30% vs. 65.21%, P=0.035）. Moreover, the operating time was significantly less in the observation group than in the control group [（16.74 ± 3.08） vs. （20.43 ± 3.94）, P=-0.001]. The clinical adaptability, clinical operation skills, learning enthusiasm and satisfaction with teaching（P〈0.05）were better in the observation group than in the control group. Conclusion During the same class hours, PBL combined with laparoseopic surgery can effectively improve the basic theoretical knowledge and clinical practice ability of residents.