基于CBL的多学科诊疗模式在下丘脑垂体疾病教学中的应用和探讨

A multi-disciplinary team model based on CBL in clinical teaching of hypothalamus-pituitary diseases

目的探讨案例学习(CBL)联合下丘脑-垂体多学科诊疗团队(MDT)门诊在垂体疾病临床教学中的效果。方法对2019年1月至12月参加北京协和医院下丘脑-垂体MDT讨论并进行CBL教学的学员,在教学前后填写调查问卷,应用李克特5级评分法来评估教学效果。结果89名学员对于垂体无功能腺瘤、垂体功能性腺瘤、尿崩症、垂体柄增粗的鉴别诊断、垂体炎性疾病的鉴别诊断、垂体疾病影像学的掌握了解程度在参加下丘脑-垂体MDT前分别是41.57%、48.31%、49.44%、12.36%、12.36%和23.60%,参加教学后,了解程度分别提高到了74.16%、76.40%、82.02%、73.03%、78.65%和86.52%。对教学效果进行量化评分后,对比有明显差异(P<0.01)。结论基于CBL的下丘脑-垂体MDT的教学模式,能够提高初级和中级医师对于垂体疾病相关知识的掌握程度,这一教学方法值得在垂体疾病的临床教学中进行推广。

Objective To explore the effect of case-based learning(CBL)combined with hypothalamus-pituitary MDT clinic in clinical teaching of hypothalamus pituitary diseases.Methods The trainees who participated in the hypothalamus-pituitary MDT discussion and CBL teaching in Peking Union Medical College Hospital from January to December 2019 were requird to fill in the questionnaire about the learning outcomes before and after participating in hypothalamus-pituitary MDT discussion and teaching.Likert 5 grade score method was used to evaluate the teaching effect.Results Among the 89 trainees,the degree of understanding of pituitary nonfunctional tumors,functional pituitary tumors,diabetes insipidus,differential diagnosis of pituitary stalk thickening,differential diagnosis of pituitary inflammatory diseases,and imaging knowledge of pituitary diseases before participating in hypothalamus-pituitary MDT were 41.57%,48.31%,49.44%,12.36%,12.36%and 23.60%,respectively.The degree ofunderstanding increased to 74.16%,76.40%,82.02%,73.03%,78.65%and 86.52%respectively,and there was statistical difference after quantitative score(P<0.01).Conclusions The teaching mode of hypothalamus-pituitary MDT based on CBL can improve the resident and attending physicians'knowledge about pituitary diseases.This teaching manner is expected to be applied in the clinical teaching of pituitary diseases.