融合循证医学理念的PBL在血液内科临床教学中的实践

摘要

Objective To investigate the value of the application of evidence-based medicine combining problem-based learning (EBM-PBL) in hematology internal teaching.Methods All the interns (n=112),who studied in hematology department from Mar.2013 to Feb.2014,were divided into two groups by parallel.One group received the traditional classroom oriented learning model (n=57),the other was trained how to obtain the most effective and correct evidence and autonomous learning (EBM-PBL,n=55).After two weeks learning,the different effectiveness was evaluated by comparing the oral and written tests holding instantly and annual final exam.Further,feedbacks were anonymously collected from the teachers and students in EBM-PBL group.Results The test scores of oral and written test in EBM-PBL are both significantly higher than those in control group (P=0.000),especially the oral exam.Compared with the instant test,the scores in later oral (P=0.054) and written (P=0.023) examinations were slightly decreased in EBM-PBL group,while they both dramatically dropped in control group (P=0.000).The performance of eight-and seven-year students was generally better than those of five-year students,however,five-year students seemed to get more benefits from EBM-PBL teaching.Feedbacks showed that most of the teachers and students agreed that they all made progress from the practice of EBM-PBL teaching.Conclusion It showed that EBM-PBL helps to cultivate students' self updating of medical knowledge and clinical skills,which ensuring them to follow the development in major field.Thereby,they could transform into excellent clinicians from the students.In addition,it also promoted the teachers to renew their knowledge system and the ability of teaching.%目的 探讨融合循证医学理念的以问题为基础的学习(evidence based medicine combining problem based learning,EBM-PBL)在血液内科教学中的应用.方法 将2013年度112名实习学生平行分为传统以课堂为导向的教学组,以及提供循证医学技巧的自主学习型EBM-PBL组,分别为57人和55人.两周后,通过比较两组学生近、远期的成绩差异,并无记名采集师生对EBM-PBL模式的反馈意见,评估EBM-PBL的可行性.应用SPSS 18.0软件包,采用配对t检验,对两组学生的考试成绩进行统计学处理.结果 EBM-PBL组的近、远期口试和笔试成绩均高于对照组(P=0.000),口试成绩尤甚;近、远期成绩对比,EBM-PBL组口试(P=0.054)、笔试(P=0.023)成绩下降不明显,面对照组明显下降(P=0.000);八年制和七年制学生成绩普遍优于五年制学生,但五年制EBM-PBL组学生成绩更优于对照组.教学反馈显示,多数师生均认可EBM-PBL有利于教学相长,提升了学生学习的兴趣和能力.结论 EBM-PBL教学有助于培养学生自我更新医学知识和临床技能的方法和技巧,使其紧跟专业发展步伐,从而顺利由学生向出色的临床医师转型.同时,EBM-PBL教学也促进了教师的知识体系更新,提升了其对诊治细节的处理和综合教学能力.