目的 探讨以病例为基础的学习(case-based learning,CBL)结合循证医学方法在儿科住院医师培训中的实施效果.方法 将52名住院医师随机分为实验组(CBL结合循证医学理念教学组26人)和对照组(灌输式教学组26人),教学均围绕病房患儿病例展开.实验组住院医师以2人为小组,由带组教师提出问题,住院医师下班后查阅文献；在每周固定的全科教学查房时间结合该病例进行循证医学证据总结汇报；全科室人员参与病例讨论和学习,带组教师进行总结.对照组采用传统的灌输式教学,以带教教师的临床经验指导住院医师作病例分析；住院医师有问题提出时,带教教师直接给予回答.轮转时间为4个月.教学效果评价分为问卷调查、理论试卷考试、临床技能考核三部分.用SPSS 16.0软件对考核成绩进行统计学分析,试卷考试和技能考核成绩用均数±标准差(x±s)表示,行t检验,以P＜0.05为差异具有统计学意义.结果 实验组住院医师认为,自身所接受的培养方式在提高自学能力、文献检索查阅能力、医师间团队合作精神、临床思维、幻灯片制作技术和语言表达能力方面更有优势.理论考试成绩显示,实验组平均成绩(75.460 ±6.646)分高于对照组(71.380 ±4.758)分,差异有统计学意义(P=0.014)；尤其表现在主观题部分.临床技能考核显示,实验组病例书写及临床思维成绩优于对照组.结论 CBL结合循证医学教学在提高自学能力、培养临床思维能力及文献检索和语言表达等方面明显优于传统的灌输式教学,适用于儿科住院医师培训.%Objective To explore the effect of evidence-based medicine combined withcase based learning(CBL) in pediatric residency training.Methods Totally 52 residents were equally divided into two groups:experiment group and control group.Method of CBL combined with the evidencebased medicine (Taking two residents as one group,firstly teacher posed the questions and then residents searched for references when off duty and made evidence-based case presentation at fixed time when doing teaching ward around,after wards all personnel in the department made case discussion,finally teacher made the summary) was used in experimental group while traditional teaching method (teacher guided the residents to analyze the case by clinical experiences,residents took notes and sometimes asked questions,teacher directly gave the answers)was used in control group.The teaching effect is evaluated by questionnaire,theory test and clinical skills assessment.Statistical analysis was carried out on appraisal results with SPSS 16.0 software,test results and appraisal results were expressed as ((x-) ±s) and t test was performed,P ＜ 0.05 was taken as statistically significant.Results Residents in experimental group had more advantages in self-study ability,literature retrieval ability,physician teamwork spirit,clinical thinking,PowerPoint making and language expression after receiving CBL combined with evidence-based medicine.Theory examination showed that average score of experimental group was better than that of control group (75.46 ± 6.646) vs.(71.38 ±4.758),with statistically significantly differences (P =0.014),especially in subjective items.Clinical skills assessment showed that experimental group was better than control group in writing medical records and doing clinical thinking.Conclusions Teaching method of evidence-based medicine combined with CBL is significantly better than traditional indoctrination teaching in improving the abilities of self-study,cultivating clinical thinking,literature retrieval,language performance and other skills.This teaching method is more suitable for pediatric residency training.
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