模拟病例和小组讨论教学方式在临床思维培养课程中的应用  

The exploration and practice of clinical thinking course conducted by computer-based case simulation and small group discussion for interns

作　　者：李颖[1] 宋浩明[2] 杨军 刘琦[2] 李冰[4] 葛艳丽[5] 靳令经[6] 程黎明[6] Li Ying;Song Haoming;Yang Jun;Liu Qi;Li Bing;Ge Yanli;Jin Lingjing;Cheng Liming(Medical Education Division,Tongji Hospital of Tongji University,Shanghai 200065,China;Diagnostics Teaching and Research Section,Tongji Hospital of Tongji University,Shanghai 200065,China;Practice Training Center,Tongji University School of Medicine,Shanghai 200070,China;Department of Hematology,Tongji Hospital of Tongji University,Shanghai 200065,China;Department of Gastroenterology,Tongji Hospital of Tongji University,Shanghai 200065,China;President's office,Tongji Hospital of Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院教育处,上海200065 [2]同济大学附属同济医院诊断学教研室,上海200065 [3]同济大学医学院实训中心,上海200070 [4]同济大学附属同济医院血液科,上海200065 [5]同济大学附属同济医院消化科,上海200065 [6]同济大学附属同济医院,上海200065

出　　处：《中华医学教育杂志》2020年第12期983-987,共5页Chinese Journal of Medical Education

基　　金：同济大学研究生教学改革项目(2018GH330);同济大学附属同济医院教学改革课题(2017JGKT01)。

摘　　要：目的探索在临床思维培养模块化课程中应用模拟病例和小组讨论教学的效果。方法2018年6月至2019年1月,将在同济大学附属同济医院实习的同济大学医学院2014级临床医学专业40名学生以随机数字表法分为试验组和对照组,每组20名学生。试验组首先应用DxR Clinician(后文简称DxR)模拟病例教学软件实施DxR模块教学,随后进行小组讨论模块教学,而对照组的模块教学顺序相反。应用调查问卷了解学生对教学方式的评价,应用DxR评分和期中、期末客观选择题考核评估教学效果。结果76.7%(31/40)的学生认为DxR模块对培养临床思维能力有帮助,90.0%(36/40)的学生喜欢小组讨论教学并认为其对临床思维培养有帮助。对照组学生期中考核成绩、DxR评分总体表现的后阶段评分均高于试验组[(75.4±13.5)分比(66.7±10.7)分,57.3(53.7,59.0)分比46.0(43.0,53.0)分];对照组DxR评分的后阶段总体表现高于前阶段[57.3(53.7,59.0)分比46.0(39.0,48.7)分],差异均具有统计学意义(均P<0.01)。结论以DxR软件和小组讨论方式进行临床思维培养模块化教学,学生接受度高,课程运行顺利。先进行小组讨论模块教学有利于形成友好的学习氛围、增强学习主动性,能够提高DxR软件的教学效果。2种教学方式能够互相补充,从不同维度促进临床思维能力的提升。Objective To explore the effect of simulated cases and small group case discussion teaching in a modular course of clinical thinking training for medical students in the internship stage.Methods From June 2018 to January 2019,40 clinical medical students enrolled in 2014 in Tongji University School of Medicine were randomly divided into experimental group(n=20)and control group(n=20).The experimental group was given DxR teaching module first,then group discussion module,and the control group was taught in the reverse order.Students'evaluation of teaching methods was got by questionnaire.Score of DxR clinician and tests by multiple choice questions were used to assess the teaching effect.Results 76.7%(31/40)students thought that DxR module was helpful to cultivate clinical thinking ability,and 90.0%(36/40)students liked group discussion teaching and thought it was helpful to cultivate clinical thinking ability.The scores of mid-term examination and DxR score in the later stage of control group were significantly higher than those in the experimental group[(75.4±13.5)vs.(66.7±10.7),57.3(53.7,59.0)vs.46.0(43.0,53.0),all P<0.01];the overall performance of DxR in the latter stage of the control group was significantly higher than that in the former stage[57.3(53.7,59.0)vs.46.0(39.0,48.7),P<0.01].Conclusions This modular course conducted by DxR clinician and small group discussion was implemented smoothly and were highly accepted by students.Small group discussion module ahead of DxR module could improve the teaching effect of DxR probably by forming friendly learning atmosphere and enhancing learning initiative.The application of two teaching methods could complement each other and improve clinical thinking ability from different dimensions.

关 键 词：计算机模拟病例 小组讨论 临床思维 

分 类 号：R0[医药卫生]