混合式教学在我国临床医学专业教学中应用效果的系统评价和Meta分析

Effectiveness of blended learning in clinical medicine teaching in China:a systematic review and Meta-analysis

目的采用Meta分析方法探讨混合式教学在我国临床医学专业教学中的应用效果,为培养临床医学人才、提高医学教育质量提供参考。方法在PubMed、中国知网(CNKI)、万方(WanFang Data)和中国生物医学文献数据库(SinoMed)中检索有关临床医学专业混合式教学的文献,由两位研究者独立进行文献筛选、资料提取及质量评价,采用Stata12.0软件进行Meta分析。通过亚组分析探讨异质性来源、敏感性分析探讨单个研究对合并效应量的影响。结果共纳入66篇文献,纳入研究间的异质性较大,基于随机效应模型的Meta分析结果显示,在理论知识[SMD=1.73,95%CI(1.32,2.15),P<0.05]、实践/操作技能[SMD=1.28,95%CI(0.81,1.75),P<0.05]、满意度[RR=1.35,95%CI(1.23,1.49),P<0.05]方面,混合式教学均优于传统教学;未发现不同学历层次学生在理论知识、实践/操作技能方面存在差异;本科学生在理论知识[SMD=1.79,95%CI(1.27,2.31),P<0.001]、实践/操作技能[SMD=1.62,95%CI(1.12,2.13),P<0.001]方面,混合式教学均优于传统教学;专科学生在理论知识[SMD=1.28,95%CI(0.60,1.96),P<0.001]方面,混合式教学优于传统教学,而实践/操作技能[SMD=-0.11,95%CI(-2.48,2.26),P=0.929]方面差异无统计学意义。结论相较于传统教学,混合式教学对提高我国临床医学专业学生理论知识和实践/操作技能效果更佳,且满意度更高,提示可以充分发挥混合式教学的优势,助力医学教育改革及临床医学人才的培养。

Objective To explore the effectiveness of blended learning in clinical medicine teaching in China using Meta-analysis,so as to provide a reference for cultivating clinical medical talents and improving the quality of medical education.Methods PubMed,CNKI,WanFang Data,and SinoMed databases were searched for studies investigating blended learning in clinical medicine teaching.Literature screening,data extraction and quality assessment were independently conducted by two researchers.Meta-analysis was performed using Stata12.0 software.Heterogeneity was evaluated by subgroup analyses,and sensitivity analysis was performed to detect the influence of any single study on the overall prevalence estimates.Results A total of 66 studies were included with significant betweenstudy heterogeneity.The results of a Meta-analysis based on a random-effects model showed that blended learning had a significantly better positive effect size on theoretical knowledge[SMD=1.73,95%CI(1.32,2.15),P<0.05],practical/operational skills[SMD=1.28,95%CI(0.81,1.75),P<0.05]and satisfaction rating[RR=1.35,95%CI(1.23,1.49),P<0.05]than traditional learning.There was no significant difference found in theoretical knowledge and practical/operational skills among students with different educational levels.Blended learning showed significantly better outcomes for both theoretical knowledge[SMD=1.79,95%CI(1.27,2.31),P<0.001],and practical/operational skills[SMD=1.62,95%CI(1.12,2.13),P<0.001]among undergraduate students.Blended learning was found to have a positive effect on theoretical knowledge[SMD=1.28,95%CI(0.60,1.96),P<0.001]compared with traditional learning in junior college students,however,this effect was not observed in their practical/operational skills.Conclusion Compared with traditional learning,blended learning was shown to have a better effect on theoretical knowledge and practical/operational skills,and higher satisfaction ranking among clinical medical students in China,suggesting that more attention should be given to the advantages of blended learning and this could help the reform of medical education and the cultivation of clinical medical talents.