中医临床翻转与传统课堂教学效果Meta分析

Meta Analysis of Teaching Effects of TCM in Flipped and Traditional Classroom

目的:采用Meta分析方法系统评价翻转课堂与传统课堂教学模式在中医院校临床教学中的开展和应用效果。方法:计算机检索PubMed、the Cochrane Library、Embase、Web of Science、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)、万方数据知识服务平台(WANFANG DATA)、维普(VIP)数据库。检索时间自建库至2019年12月,未限制发表语言。手工检索相关中、英文文献,追溯相应参考文献。由2名评价员分别独立将检索到的文献依据循证医学方法进行严格筛查并纳入文献。使用Cochrane风险偏倚评估工具评估纳入研究的方法学质量,改良Jadad量表将其量化,用RevMan 5.3软件进行Meta分析。结果:共纳入9篇研究,均为随机对照试验。改良Jadad量表评分显示:3篇研究4分,6篇研究3分。共纳入学员1072人,其中试验组550人,对照组522人。Meta分析结果显示:翻转课堂与传统课堂教学模式在学生理论成绩(MD=5.75,95%CI[-2.41,13.92],P=0.17)、综合测评成绩(MD=13.26,95%CI[-5.50,32.01],P=0.17)方面比较差异无统计学意义;翻转课堂在学生操作成绩(MD=9.25,95%CI[6.35,12.15],P<0.000 01]、临床思维能力(RR=1.94,95%CI[1.08,3.50],P=0.03)、临床操作技能能力(RR=1.68,95%CI[1.11,2.57],P=0.02)方面优势凸显。在课堂满意度(RR=1.49,95%CI[1.22,1.81],P<0.000 1)、学习兴趣(RR=1.49,95%CI[1.13,1.98],P=0.005)、学生自主学习能力(RR=1.91,95%CI[1.22,2.99],P=0.005)等方面均优于传统课堂。结论:翻转课堂教学模式在中医院校临床教学工作中的开展和应用效果优于传统课堂教学模式。该教学模式能强化学生临床实践操作能力,提高学生解决临床实际问题的能力,形成良好的临床思维,能全面提升学生医学素养。

Objective:To systematically assess application effects and the development of flipped classroom and traditional classroom teaching mode in clinical teaching in TCM colleges and universities by adopting Meta analysis method.Methods:PubMed,the Cochrane Library,Embase,Web of Science,CNKI,SinoMed,WANFANG DATA and VIP were searched by computer.The retrieval time was between the establishment of the database to December 2019,with no restrictions on publishing language,manually search the relevant Chinese and English documents and trace the corresponding references.The retrieved papers were screened strictly by two evaluators independently and respectively according to evidence-based medicine and included in the literature.The methodological quality of the included studies was assessed using the Cochrane risk bias assessment tool,quantified with the modified Jadad scale,and perform the Meta-analysis with Revman 5.3 software.Results:All nine studies were included,and they were randomized controlled trials(RCTs).The scores of modified Jadad scale showed that three RCTs obtained four points and six three points.Altogether 1,072 persons were included,among them,there were 550 in the trial group and 522 in the control group.The results of Meta analysis displayed that no significant difference was found between flipped classroom and traditional classroom teaching mode in students’ theoretical scores(MD=5.75,95%CI [-2.41,13.92],P=0.17)and comprehensive evaluation results(MD=13.26,95%CI[-5.50,32.01],P=0.17);flipped classroom owned the obvious advantages in students’ operation performance(MD=9.25,95%CI[6.35,12.15],P<0.000 01),clinical thinking ability(RR=1.94,95%CI[1.08,3.50],P=0.03)and clinical operation skills and abilities(RR=1.68,95%CI [1.11,2.57],P=0.02),classroom satisfaction(RR=1.49,95%CI [1.22,1.81],P<0.000 1),learning interest(RR=1.49,95%CI [1.13,1.98],P=0.005) and students’ autonomous learning ability(RR=1.91,95%CI [1.22,2.99],P=0.005)were notably better than these of traditional classroom.Conclusion:Application effects and the development of flipped classroom teaching mode are notably better than these of traditional classroom teaching mode in clinical teaching in TCM colleges and universities.The teaching mode could enhance students’ clinical practice and operation ability,raise students’ ability of solving practical clinical problems,form good clinical thinking and generally improve students’ medical literacy.