混班制教学在全科临床诊疗思维课程中的实践  

Blended team-based learning in the course of clinical reasoning in general practice

作　　者：翟佳燚 陆媛 马琳琳 于德华 Zhai Jiayi;Lu Yuan;Ma Linlin;Yu Dehua(Academic Department of General Practice,Tongji University School of Medicine,Shanghai 200092,China;Department of General Practice,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China)

机构地区：[1]同济大学医学院全科医学系,上海200092 [2]同济大学附属杨浦医院全科医学科,上海200090 [3]上海市全科医学与社区卫生发展研究中心,上海200090

出　　处：《中华医学教育探索杂志》2025年第1期98-103,共6页Chinese Journal of Medical Education Research

基　　金：中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2020年医学教育研究立项课题(2020B-N08139);上海市医药卫生发展基金会课题(SE1201933);全国医学专业学位研究生教育指导委员会中国医药学研究生在线课程群建设项目(B-YXC2022-01-01-10)。

摘　　要：目的探讨混班制教学对于提升不同生源的全科医生临床诊疗思维能力的应用。方法2021年9月至12月,选择同济大学医学院52名全科医学方向硕士作为研究对象,根据学习背景及执业经历分为住培组、社区组、专科组。在《全科临床诊疗思维》课程中,对全体学员进行混班制教学,在课程前后通过病史采集、体格检查、医患沟通和病历书写4站客观结构化临床考试(the objective structured clinical examination,OSCE)测试来评价教学效果。采用SPSS 22.0软件对收集数据进行统计分析。计量资料以(均数±标准差)表示,组间比较采用方差分析或Kruskal-Wallis检验;组内前后比较根据差值是否符合正态分布,采用配对样本t检验或Wilcoxon符号秩和检验。计数资料以频数和百分数表示。结果从课程前后得分来看,体格检查方面社区组、专科组、住培组学员课程前分别为(44.88±9.17)分、(45.85±8.18)分、(42.38±15.30)分,课程后分别为(78.06±12.11)分、(68.65±13.10)分、(76.44±16.46)分,差异有统计学意义(t=-12.49、-6.43、-5.98;P<0.001);医患沟通方面社区组和住培组课程前分别为(63.00±13.84)分、(60.00±15.50)分,课程后分别为(78.69±7.10)分、(70.88±6.44)分,差异有统计学意义(t/Z值分别为-4.33、-2.12;P<0.05);病历书写方面3组学员课程前分别为(60.19±17.96)分、(47.77±12.59)分、(37.00±15.50)分,课程后分别为(79.69±14.25)分、(80.31±12.93)分、(75.88±15.88)分,差异有统计学意义(t=-2.96、-6.26、-7.25;P<0.05)。各模块得分组间比较来看,培训前病历书写得分社区组为(60.19±17.96)分、专科组为(47.77±12.59)分、住培组为(37.00±15.50)分,差异有统计学意义(χ^(2)=13.04,P=0.001);培训后医患沟通得分社区组为(78.69±7.10)分、专科组为(63.46±19.40)分、住培组为(70.88±6.44)分,差异有统计学意义(χ^(2)=10.13,P=0.006)。结论混班制教学在全科临床诊疗思维课程中不仅能够提�Objective To investigate the application of blended team-based learning(BTBL)in improving the clinical reasoning ability of general practitioners from different sources.Methods From September to December in 2021,52 postgraduates of general practice in Tongji University School of Medicine were selected as subjects,and according to their study background and practice experience,they were divided into residency training group,community group,and specialist group.BTBL was adopted for all students in the course of clinical reasoning in general practice,and a 4-station objective structured clinical examination(OSCE)test was conducted before and after the course to evaluate teaching effectiveness from the aspects of medical history collection,physical examination,doctor-patient communication,and medical record writing.SPSS 22.0 was used to perform a statistical analysis of data.Continuous data were expressed as mean±standard deviation,and an analysis of variance or the Kruskal-Wallis test was used for comparison between groups;the paired samples t-test or the Wilcoxon signed rank sum test was used for comparison of normally distributed or non-normally distributed data within each group.Categorical data were expressed as frequency and percentage.Results There was a significant change in the score of physical examination after the course in the community group(44.88±9.17 vs.78.06±12.11,t=-12.49,P<0.001),the specialist group(45.85±8.18 vs.68.65±13.10,t=-6.43,P<0.001),and the residency training group(42.38±15.30 vs.76.44±16.46,t=-5.98,P<0.001).There was a significant change in the score of doctor-patient communication after the course in the community group(63.00±13.84 vs.78.69±7.10,t/Z=-4.33,P<0.05)and the residency training group(60.00±15.50 vs.70.88±6.44,t/Z=-2.12,P<0.05).There was also a significant change in the score of medical record writing after the course in the community group(60.19±17.96 vs.79.69±14.25,t=-2.96,P<0.05),the specialist group(47.77±12.59 vs.80.31±12.93,t=-6.26,P<0.05),and the residenc

关 键 词：混班制 全科医学 临床诊疗思维 人才异质性 

分 类 号：R-05[医药卫生]