TBL联合CBL和PBL在肝胆外科见习中的实践及效果

摘要

目的 探讨TBL联合CBL和PBL在肝胆外科见习中的应用及效果.方法 选取64名首次到西南医院肝胆科见习的七年制(本科阶段)医学生为教学对象,分为TBL+CBL组、TBL+PBL组、PBL+CBL组及TBL+CBL+PBL组,每组16人.各组分别给予相对应的辅助教学措施.其中,针对TBL+CBL+PBL组,授课前将典型患者资料下发给学生,同时提供参考资料名称和预习问题;授课时,先解析学生资料查询结果以及预习问题,再进行测验,结合测验重点讲解理论知识难点和盲点等,之后对病例进行分解讨论,以及纠正与补充学生认知错误和不足等.教学结束后,各组学生均接受理论考试及教学和自我认可度问卷调查.应用SPSS 18.0统计考评数据,组间结果比较行方差分析或t检验或卡方检验.结果 TBL+CBL组、TBL+PBL组、PBL+CBL组及TBL+CBL+PBL组理论考试平均成绩分别为(75.313±8.260)、(74.875±9.818)、(77.125±9.667)和(82.000±6.491)分.TBL+CBL+PBL组学生平均成绩高于TBL+CBL组和TBL+PBL组(P<0.05).TBL+CBL+PBL组中原成绩较差学生的平均成绩[(74.000±1.414),n=4]高于PBL+CBL组原成绩较差学生[(66.000±0.817),n=4;t=0.356,P=0.000].问卷结果显示,TBL+CBL+PBL组学生对自身的见习兴趣度、利用工具学习能力和解决问题能力的评价,均优于其他三组学生(P<0.05).结论 TBL联合CBL和PBL教学可提高学生对理论知识的掌握,尤其能帮助原学习较差学生提高学习成绩和兴趣.%Objective To investigate practical effects of task based learning (TBL), case based learning (CBL) and problem based learning (PBL) integrated teaching method in clinical novitiate of hepatobiliary disease and pancreatopathy. Methods Total of 64 students majored in seven-year clinical practice were divided into TBL+CBL, TBL+PBL, PBL+CBL and TBL+CBL+PBL groups, using a cluster stratified random sampling method, with 16 students in each group. The students were taught with the same basic theoretical knowledge, followed by different course of the combination of TBL, CBL and PBL. In the TBL + CBL + PBL group, the typical patient data were sent to the students before the class, and at the same time, the catalogues of the reference materials and the preview questions were also provided for them. In the course of teaching, the results of the students' information and the answers to the preview questions were first carried out, and then the task test was carried out in the form of collective consultation, and then the students focused on the answers and tests . The theoretical difficulties and blind spots of the theory and the correction of mistakes, deficiency, the breakdown of the case after the end of the expla-nation, and the mistakes and shortcomings of the students' knowledge were discussed in class. The practical effects were evaluated by theory test, teaching and self-acceptance assessment. The data were analyzed by variance analysis, t test and Chi square test. Results Average scores of students in the TBL+PBL , TBL+PBL, PBL+CBL and TBL+PBL+CBL group were (75.313±8.260), (74.875±9.818), (77.125±9.667) and (82.000±6.491), respectively. Average scores of students in the TBL+PBL+CBL group are signifi-cantly higher than the TBL+PBL (t=0.217, P=0.016) and TBL+PBL (t=0.059, P=0.022) groups, while there was no difference with those of PBL+CBL groups (t=0.049, P=0.106). However, Tests grades of 4 students which were poor performance in TBL+CBL+PBL group were significantly higher than those of 4 students with poor performance in PBL+CBL groups (t=0.356, P=0.000). In addition, students in TBL+CBL+PBL group more greatly enhanced learning interest and initiative, and improved their comprehensive analysis ability than students in TBL+CBL ( x2 and P value: 5.565, 0.018; 5.109, 0.024; 4.167, 0.041), TBL+PBL ( x2 and P value:7.127, 0.008;5.367, 0.021;5.565, 0.018) and PBL+CBL ( x2 and p value:4.167, 0.041;5.000, 0.025; 8.866, 0.003). Conclusion TBL, CBL and PBL integrated teaching method can improve students' mastery of theoretical knowledge, and especially can help poor students to improve their academic perfor-mance and interest.