案例教学法结合视频反馈教学法在诊断学基本技能训练的应用与探索

Application and Exploration of Case-Based Learning Combined with Video-Feedback in Basic Skill Training of Diagnostics

背景:教育部临床医学专业认证工作委员会颁布了中国本科医学教育标准2016年版,规定了临床医学专业本科毕业生应达到的基本要求,而且在临床能力方面提出了更高的要求,因此诊断学必须加强实践教学,提高临床实践能力,同时促使教师改变临床技能训练方法,以期达到基本要求。目的:探讨案例教学法结合视频反馈教学法在诊断学基本技能训练的效果和意义。方法:选取本校2016级临床医学本科生217人,随机分成传统教学组(对照组,n=106),采用传统诊断学技能训练教学模式授课;案例教学法结合视频反馈教学组(实验组,n=111),在传统教学模式授课之前和之后分别加入案例分析和录制视频反馈。将基本技能分成病史采集和体格检查模块,量化各技能环节,实验组使用真实背景又能够紧扣相关技能的临床案例,利用摄像机或手机采集学生视频操作数据进行分析反馈。以各组期末技能考核成绩作为课程学习成效的评估,并对学生进行问卷调查,了解学生对教学方法的评价。结果:实验组,体格检查模块:操作的熟练流畅程度,操作顺序,操作手法规范正确,人文关怀等表现优于对照组;病史采集模块:问诊内容、病史收集(收集过程、问诊技巧)、交流沟通能力(提问表达、沟通技巧)、人文素养(社会主义核心价值观、医德医风、文明礼仪、人文关怀)等表现优于对照组(P<0.001)。期末技能考核成绩:实验组(91.80±3.94)分,对照组(81.87±6.59)分,差异有显著性(t=16.92,P<0.001)。实验组过程性考核成绩与技能考核成绩具有较强相关性,实验组对案例教学结合视频反馈教学具有较高满意度。结论:将案例教学法结合视频反馈教学法应用于诊断学临床基本技能教学中,可以更好地培养学生自主学习能力、医患沟通能力、临床实践能力和良好的临床思维能力等,显著提高学生的诊断学操作技能及综合素质。

Background:Working Committee for the Accreditation of Medical Education,Ministry of Education,P.R.China,Standards for Basic Medical Education in China,The 2016 Revision,which stipulated the basic requirements of clinical medicine graduates,and put forward higher requirements in clinical ability.Therefore,the teaching of diagnostics must strengthen practical teaching,improve clinical practice ability,and at the same time urge teachers to change the training methods of clinical skills,in order to meet the basic requirements.Objective:To explore the effect and significance of video-feedback combined with case-based learning in basic skills training of diagnostics.Methods:Selected 217 undergraduates in clinical medicine in 2016,randomly divided into traditional teaching groups(control group,n=106),using the traditional diagnostic skills training teaching model;video-feedback combined with case-based learning teaching group(experimental group,n=111),using the teaching mode combining CBL plus video feedback and traditional teaching methods.The basic skills were divided into history taking and physical examination modules,and each skill link was quantified.The experimental group used clinical cases with real background and closely related skills,and collected students'video operation data by camera or mobile phone for analysis and feedback.The results of skill examination at the term end of each group are taken as the evaluation of the effectiveness of course learning,and a questionnaire survey is conducted among students to understand their evaluation of teaching methods.Results:the experimental group and physical examination module were superior to the control group in proficiency and fluency,operation sequence,standardized operation techniques and humanistic care.Medical history collection module:the performance of interrogation content,medical history collection(collection process,interrogation skills),communication skills(questioning expression,communication skills),and humanistic quality(socialist core values,medical ethics,civilized etiquette,humanistic care)are superior to those of the control group(P<0.001).The final skill examination scores were(91.80±3.94)in the experimental group and(81.87±6.59)in the control group,with significant difference(t=16.92,P<0.001).There is a strong correlation between formative assessment scores and skill assessment scores in the experimental group,and the experimental group has a high degree of satisfaction with the video-feedback combined with case-based learning.Conclusion:The video-feedback combined with case-based learning can cultivate students'autonomous learning ability,doctor-patient communication ability,clinical practice ability and good clinical thinking ability,and significantly improve students'diagnostic operation skills and comprehensive quality.