以案例为基础的多模影像教学在眼底病教学中的应用

Application of case-based learning combined with multimodal imaging in ocular fundus disease teaching

目的探讨以案例为基础的学习(CBL)联合多模影像教学在眼底病临床教学中的可行性。设计教学研究。研究对象北京同仁医院住院医师规范化培养期眼科学专业学位第二学年及第三学年硕士研究生25人,其中传统教学组11人,CBL多模影像教学组14人。方法传统教学组是在每个影像模式下进行各种常见眼底病特征表现的教学授课;CBL多模影像教学组是以眼底常见病的每个疾病为基础进行多模影像特征表现的教学。经过4周的临床影像阅片实践,最后对两组学生行出科理论考核和临床病例分析考核。主要指标各阶段理论考试、影像阅片及出科病例分析考试的评分成绩。结果CBL多模影像教学组多模影像综合阅片成绩(92.14±3.23)分、出科理论考试成绩(93.79±2.72)分、出科病例分析成绩(93.71±3.29)分,均高于传统教学组的(88.36±3.41)分、(90.82±4.19)分和(89.64±4.46)分(P均<0.05)。传统教学组中,第二学年影像基础知识考核(92.71±2.43)分、单模式影像阅片成绩(94.71±1.89)分,与第三学年(93.00±1.41)分和(94.00±2.45)分比较,差异无统计学意义(P均>0.05);第二学年学生多模影像阅片(86.86±3.18)分、出科理论考试(88.43±3.60)分、出科病例分析成绩(87.57±3.95)分,均低于第三学年的(91.00±2.00)分、(94.00±2.83)分和(93.25±2.75)分(P均<0.05)。CBL多模影像教学组中,第二学年的影像基础知识考核(93.46±2.07)分、单模式影像阅片(93.46±2.38)分、与第三学年(92.67±2.52)分、(94.66±2.30)分比较,差异无统计学意义(P均>0.05);第二学年组出科理论考试成绩(92.91±2.63)分,低于第三学年的(96.67±1.15)分(P=0.04);而多模影像阅片和出科病例分析能力成绩,第二学年组(91.91±3.35)分和(93.45±3.64)分,分别与第三学年(93.00±2.64)分和(94.67±1.53)分比较,差异无统计学意义(P均>0.05)。结论CBL多模影像教学更有利于提高学生的影像综合分析和临床病例分析能力,能够更有效地促使学生把所学知识应用于眼底病临床。

Objective To explore the feasibility and application value of case-based learning(CBL)combined with multimodal imaging in the clinical teaching of ocular fundus diseases.Design Teaching research.Participants 25 postgraduate students in ophthalmology during the standardized training of residents in Beijing Tongren Hospital.11 students in the traditional teaching group and 14 students in the CBL multimodal imaging teaching group.Methods After the basic knowledge training and examination of color fundus photogragh(CFP),fundus fluorescence angiography(FFA),and ocular coherence tomography(OCT),the traditional teaching group took lessons of the characteristics of various common ocular fundus diseases in each imaging mode;the CBL multimodal imaging teaching group were taught multimodal imaging characteristics based on each disease of common ocular fundus diseases.After 4 weeks of clinical practice,the two groups of students finally took theoretical examination and clinical case analysis examination.Main Outcome Measures Score results of theory examination,imaging analysis and case analysis examination at each stage.Results In CBL multimodal imaging teachinggroup,the scores of multimodal imaging analysis 92.14±3.23,final theoretical examination 93.79±2.72,and case analysis 93.71±3.29,were all higher than those in the traditional teaching group of 88.36±3.41,90.82±4.19,89.64±4.46(all P<0.05).In the traditional teaching group,the scores of image basic knowledge examination and single mode image analysis were 92.71±2.43 and 94.71±1.89 in the second year students,whereas 93.00±1.41 and 94.00±2.45 in the third year students(all P>0.05).The scores of the second year students were 86.86±3.18 in multimodal imaging analysis,88.343±3.60 in final theory examination,and 87.57±3.95 in case analysis,all lower than those of the third year students 91.00±2.00,94.00±2.83 and 93.25±2.75,with statistical significance(all P<0.05).In CBL multimodal imaging teaching group,the scores of image basic knowledge and single mode image analysis examination were 93.46±2.07 and 93.46±2.38 in the second year students,whereas 92.67±2.52,94.66±2.30 respectively in the third year students,the difference was no statistically significant between the two academic years(all P>0.05);the scores of final theory examination was 92.91±2.63 in second year students,lower than that(96.67±1.15)in the third year students(P=0.04);but there was no statistically significant difference between the scores of multimodal imaging analysis 91.91±3.35,case analysis 93.45±3.64 in the second year students,and that 93.00±2.64,94.67±1.53 in the third year students(all P>0.05).Conclusion CBL combined with multimodal imaging teaching can improve students'ability of comprehensive image analysis and clinical case analysis,andis more efficient to promote students to apply the knowledge to ocular fundus disease clinical application.