EBM结合PBL在我国住院医师规范化培训中应用效果的Meta分析

Meta-analysis of the effect of EBM combined with PBL in the standardized training of residents in China

目的 系统评价以循证医学(evidence-based medicine,EBM)结合以问题为基础教学(problem-based learning,PBL)模式在住院医师规范化培训(简称住培)中的教学效果。方法 检索中国知网、万方、维普、EMbase和PubMed数据库,限定主题为住培教学,试验组干预措施为EBM结合PBL教学方法,对照组采用传统的以授课为基础的(lecture-based learning,LBL)教学方法,检索时间为建库至2022年8月。搜索并筛选文献后,采用Cochrane系统进行质量评价及偏移风险评估,采用RevMan 5.3软件进行Meta分析。结果 共纳入19篇文献,1 203例研究对象。Meta分析结果显示,EBM+PBL组学生的理论成绩(WMD=5.26,95%CI=3.25~7.26;P<0.001)、实践成绩(WMD=7.45,95%CI=4.14~10.77;P<0.001)、病例分析成绩(WMD=9.41,95%CI=6.51~12.31;P<0.001)均高于LBL教学组。此外,EBM结合PBL教学明显提高学生学习兴趣与自主学习能力、临床思维能力、沟通表达能力、团队协作能力和分析与解决问题能力。结论 从出科理论成绩、实践成绩和病例分析成绩看,EBM结合PBL教学效果比传统LBL教学更有优势;同时,EBM结合PBL教学可提高学生的临床问题分析能力,在今后的住培教学改革中可大力推广结合循证医学思维的PBL教学法。

Objective To systematically evaluate the effect of problem-based learning(PBL) combined with evidencebased medicine(EBM) teaching mode in the standardized training of residents(referred to as "residence training").Methods CNKI,Wanfang Data,VIP,EMbase,and PubMed databases were searched,and the subject was limited to residential training.The intervention in the experimental group was PBL combined with EBM teaching method,and the control group used traditional lecture-based learning(LBL) teaching method,and the retrieval period was from the establishment of the database to August 2022.After searching and screening the literature,Cochrane system was used for quality assessment and drift risk assessment,and RevMan 5.3 software was used for meta-analysis.Results A total of 19 articles with 1 203 subjects were included.The results showed that the theoretical scores(WMD=5.26,95%CI=3.25-7.26;P0.001),practical scores(WMD=7.45,95%CI=4.14-10.77;P0.001),and case analysis scores(WMD=9.41,95%CI =6.51-12.31;P0.001) of the students in the EBM combined with PBL teaching mode were higher than those in the LBL teaching group.In addition,the EBM combined with PBL teaching mode significantly improved students' interest in learning and autonomous learning ability,clinical thinking ability,communication and expression ability,teamwork ability,and analysis and problem-solving ability.Conclusion From the perspective of theoretical scores,practical scores and case analysis scores,the teaching effect of PBL combined with EBM has more advantages than traditional LBL teaching;at the same time,PBL combined with EBM teaching can improve students' ability to analyze clinical problems.In the future teaching reform of residential training,the PBL teaching method combined with evidence-based medicine thinking can be vigorously promoted.