危重病教学CBL评估体系的探索

摘要

目的 探索危重病教学中以病例为基础的学习(Case-based learning,CBL)评估方法.方法 将53名2010年至2012年在我院实习的上海交通大学医学院临床医学系本科学生分为传统教学组和CBL教学组,CBL教学组采用传统教学结合CBL教学,选择重症急性胰腺炎及多发伤2种重症监护病房(Intesive care unit,ICU)常见危重病病例为CBL案例.2组学生均在教学实习结束后进行理论知识、迷你临床评估训练( Mini-clinical evaluation exercise,Mini-CEX)及直接观察操作技能(Direct observation of procedural skills,DOPS)评估.结果 2组在理论知识考核中差异无统计学意义；在Mini-CEX评估中,CBL教学组在医疗面谈能力(P=0.000)、人文关怀(P=0.013)、临床诊断(P=0.035)、咨商卫教(P=0.009)、整体临床能力方面(P=0.008)明显优于传统教学组；CBL案例中所讨论到的气管插管(P=0.016)及中心静脉穿刺(P=0.001)的DOPS评分,CBL教学组明显高于传统教学组.结论 传统理论知识考核在CBL教学评估中意义不大；针对临床综合能力及技能操作能力的Mini-CEX及DOPS评估更能体现CBL教学的优势.%Objective To explore the effective evaluation methods of case-based learning (CBL) in critical disease teaching.Methods Totally 53 undergraduate students in department of clinical medicine of Shanghai Jiao Tong University,who practiced in our hospital from 2010 to 2012,were divided into the traditional teaching group and CBL teaching group.We used traditional teaching combining with CBL teaching in CBL group.Common cases of critical illness(severe acute pancreatitis and multiple trauma)in intensive care unit (ICU) were selected for CBL cases.The evaluation of theoretical knowledge,mini-clinical evaluation exercise(Mini-CEX)and direct observation of procedural skills (DOPS) were continued after teaching and practice.Results These was no significant difference in the theoretical knowledge examination between the two groups. In Mini-CEX,the students in CBL group were better concerning the medical interview capacity (P=0.000),humanistic care (P=0.013),clinical diagnosis(P=0.035),counseling(P=0.009) and the overall clinical competence (P=0.008) than those in traditional teaching group.The DOPS scores of endotracheal intubation (P=0.016)and central venous catheterization (P=0.001)discussed in CBL teaching were significantly higher in CBL group.Conclusion Traditional theoretical knowledge examination has little significance in the assessment of CBL teaching,but Mini-CEX and DOPS can reflect the advantages of CBL teaching better in the assessment of clinical abilities and skills.