以病例为基础的讨论式教学模式在临床教学中的应用

目的:探讨以病例为基础讨论式学习(case-based discussion and learning,CBDL)在临床教学中的应用效果。方法:将40位临床医学本科专业学生随机分为两组,其中20人采用CBDL教学,20人采用传统教学,并且通过理论基础考试和临床技能考试的形式评价学生的学习效果,通过问卷的形式调查学生对教学方法的满意度。结果:CBDL教学组的理论考试、临床技能考试及总成绩得分均较传统教学组明显提高(P0.01),CBDL教学组学生对教学的满意度分别为:教学方法 100%,教学效果90%,小组功能95%,教师评价95%。结论:CBDL教学法较传统教学方法更能提高学生的基础和临床能力,为临床工作中独立解决问题打下了基础。     

PBL教学在内科学教学中的应用

目的：探讨以问题为基础PBL教学在内科学临床教学中的应用。方法：对在内科学课程教学中50位内科临床医学本科专业学生随机分为2组,对26人采用PBL教学、24人采用传统教学之后,进行理论考试和临床技能考试,并调查学生的满意度。结果：PBL教学组的理论考试成绩（94.12±8.56 vs 83.76±7.79）、临床技能考试成绩（95.93±9.73 vs 81.08±8.06）、总成绩得分（95.03±9.01 vs 82.42±7.91）均较传统教学组明显提高,学生对PBL教学方法的满意率为96.15%,对教学效果的满意率为100%,对小组功能的满意率为92.31%,对教师评价的满意率为96.15%。结论：PBL教学法在内科学教学中优于传统教学方法,学生的基础理论和临床技能均有明显提高,教学满意度高。     

Teaching communication skills to clinical students.

Seven years'' experience in teaching communication skills to first year clinical students at St Mary''s Hospital School of Medicine is described. The first component consists of a day during the introductory clinical course; this is divided into a lecture and small seminar groups and involves behavioural scientists and clinicians from many departments. The second component uses simulated patients and video feedback and takes place in small groups later in the year. Participation of the students through active critical discussion, role play, and interactive video feedback are important aspects in the success of the course. The methods have been refined through evaluation by students and tutors. This article aims to allow others, already running or considering such a course, to develop effective courses within the practical constraints of their own institutions.     

PBL和TBL的双轨教学法在胸外科专业学位研究生教学中的应用

目的:研究PBL联合TBL的双轨教学法在胸外科专业学位研究生教学中的应用。方法:选取进入我院进入科室进行临床工作的硕士研究生及博士研究生共60人,随机分为教学改革组与传统教学组,每组30人,教学改革组采用PBL联合TBL教学法。在为期1年时间结束后,分别采用闭卷考试、小组成员互评及导师对学员的评价等多种评价模式比较教学改革组与传统教学组的学习效果。同时还采用闭卷考试与问卷调查方式评价教学效果。结果:教学改革组客观成绩与学习效果即出科考试成绩、增设考试成绩与对专业知识掌握程度的客观成绩优于传统教学组,差异具有统计学意义,并且PBL联合TBL的双轨教学法对于提高学生临床思维培养能力、表达能力、交流能力均优于传统教学组,并且提高了学生在实习期间的热情度。结论:联合PBL和TBL的双轨教学发在胸外科专业学位研究生教学中有较好的效果。     

Video demonstrations seed alternative problem-solving techniques in wild common marmosets

Studies of social learning and tradition formation under field conditions have recently gained momentum, but suffer from the limited control of socio-ecological factors thought to be responsible for transmission patterns. The use of artificial visual stimuli is a potentially powerful tool to overcome some of these problems. Here, in a field experiment, we used video images of unfamiliar conspecifics performing virtual demonstrations of foraging techniques. We tested 12 family groups of wild common marmosets. Six groups received video demonstrations (footage of conspecifics either pulling a drawer open or pushing a lid upwards, in an ‘artificial fruit’); the other six groups served as controls (exposed to a static image of a conspecific next to the fruit). Subjects in video groups were more manipulative and successful in opening the fruit than controls; they were also more likely to use the technique they had witnessed and thus could serve as live models for other family members. To our knowledge, this is the first study that used video demonstrations in the wild and demonstrated the potent force of social learning, even from unfamiliar conspecifics, under field conditions.     

医学生循证医学PBL教学方法的教学效果评估研究

目的:分析医学生循证医学PBL教学方法的教学效果,为改进教学方法、提高教学效果提供依据。方法:随机抽取第四军医大学2008、2009和2010级五年制、八年制临床医学学生696人,统一组织填写"教学效果评估调查问卷"。分别计算各指标的平均分,采用方差分析,检验不同年级学生的各指标得分是否存在差异;采用t检验,分析不同专业学生的各指标得分是否存在差异。结果:问题设置、自学过程、学习效果、教学方式四个一级指标的平均得分分别是3.6、3.2、3.7和3.8。2010级学生各指标的得分高于2008和2009级学生,其中自学过程(Q2)、学习效果(Q3)得分存在显著差异(Q2:F=3.28;Q3:F=4.25;P值均0.05)。八年制学生各指标的得分高于五年制学生,其中Q2、Q3得分存在显著差异(Q2:t=2.33;Q3:t=2.08;P值均0.05)。结论:PBL教学取得了较好的教学效果;随着时间的推移,学生对PBL教学的认可度和学习效果均有提高;PBL教学在八年制学生中的教学效果优于五年制学生。     

Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years

Background

Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning.

Methods

We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education.

Results

In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3^rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2^nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum.

Interpretation

Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.     

PBL结合询证医学模式在普通外科临床教学中的应用

目的:基于问题的学习(PBL)结合询证医学(EMB)模式在普通外科临床教学中的应用。方法:选择2015年9月到2016年1月在我院学习的普通外科专业学生74例纳入本次研究,根据简单数字随机表法将其划分为观察组(PBL结合EBM教学模式)以及对照组(传统教学模式)各37例,对比两组考试成绩,课程相关指标,以及评优情况。结果:观察组的基础知识得分、主观题考试得分、个案分析得分以及总分均分别明显高于对照组,差异均有统计学意义(均P0.05)。观察组的课前准备时间、课堂发言次数及授课满意度均明显大于对照组,差异均有统计学意义(均P0.05)。观察组药物选择合理、患者状态评估准确以及符合临床实际上的评优率均明显高于对照组,差异有统计学意义(P0.05)。结论:PBL结合EBM模式应用在普通外科的临床教学过程中,效果明显,能较好地激发学生学习兴趣并提高其学习成绩,还可提升学生的评优率,值得给予推广。     

Collaborative testing enhances student learning

Examinations and quizzes should be used as learning as well as assessment tools. To achieve this goal, an assessment procedure was developed to enhance as well as assess student learning. Students were tested on four different topics of cardiovascular physiology. Each topic was tested by a different type of quiz (fill in the blanks, single best response multiple choice, short essay, or true/false). The students first completed a quiz individually. Once the quiz was completed individually, the students completed the same quiz in groups. Eighty percent of the score on the quiz was based on the individual results, and 20% of the score on the quiz was based on the group results. The performance on the quizzes was significantly higher (P < 0.001) when students completed the quizzes in groups than when they completed the quizzes individually. Results document that completing the quizzes in groups enhances the understanding of the material. In addition, students rated this format superior to the traditional method.     

An evaluation of case-based teaching: evidence for continuing benefit and realization of aims

A cross-sectional evaluation of case-based teaching (CBT), a novel physiology learning environment for medical undergraduates, revealed that second, third, and fourth year students, together with their tutors, valued CBT as an experience that met its three major aims. The initiative not only integrated physiology with related basic sciences and clinical medicine but importantly linked students' developing knowledge of theory to practice. CBT was also valued by students as their first introduction to clinical skills, with most tutors believing that it was the nonthreatening environment that helped students gain confidence for their first "real patient" encounters. The greatest support for CBT came from third year medical students, at the crossroads between their preclinical and clinical environments. Fourth year students, now encountering real patients, had moved on to developing their skills in the hospital environment.     

基于标准病例的案例教学法在普外科见习教学中的应用探讨

目的:探讨基于标准病例(SP)的案例教学法(CBL)在普外科见习教学中的应用效果。方法:选取2014年6月至2015年6月我院见习的五年制临床本科医学生共112人,利用随机数字表的方法将其分为对照组和研究组,两组人数各56人。对研究组采取基于SP的CBL教学法,而对照组则使用传统临床带教方法,1个月后对理论、技能进行评价,并对学生和教师的满意进行问卷调查。结果:在技能考核和病例分析方面,研究组学生的得分显著高于对照组(P0.05),理论成绩无明显差异(P0.05)。对学生满意度的调查中,在"课堂气氛活跃"、"对学习兴趣的激发"、"利于理论与实践结合"以及"有利于形成正确临床思维"四个方面,研究组的满意度显著高于对照组(P0.05)。在对教师满意度调查中,认为试验组教学法的效率要高于对照组教学法(P0.05),而在"易实施性"满意度低于对照组教学法(P0.05),在"可操作性"方面差异无统计学意义(P0.05)。结论:与传统教学模式比较,基于SP的CBL教学法具有显著的优势,能更直观的展示某种疾病的特征,使学生通过实践巩固对基础知识的记忆,值得进一步探索并推广。     

军校五年制学员营养学PBL教学模式的构建及效果评价

目的:探讨PBL教学模式在营养学教学中的作用及不足,并评价其教学效果。方法:采用随机抽样的方法,选取第四军医大学2012级五年制营养学专业学员(114名)实施PBL教学,2011级五年制临床专业学员(159名)实施传统教学;从四个方面(考试成绩、教学满意度、学员解决未知问题的方式、学习兴趣及积极性)综合评价PBL教学效果。结果:与传统教学组相比较,PBL教学组的考试成绩、教学满意度、学员解决未知问题的方式以及学习兴趣均显著升高。结论:PBL教学模式不仅提高了学员的考试成绩,还提高了学员的学习能力与素质,有必要进一步优化并大力推广。     

网络云交互技术辅助外科实践教学的创新应用探索

目的:探索传统教学模式结合网络云交互技术在外科实践教学中的应用效果。方法:于我校2011级五年制临床医学专业本科生中选取76人,随机平均分为两组,分别采取单纯传统大课教学模式、传统教学结合网络云交互技术教学模式;课程结束后进行闭卷理论考试和实践操作考试,综合两项成绩进行评定。同时向两组学员发放调查问卷,以此评价使用网络云交互技术辅助教学的效果。结果:采取传统教学结合网络云交互技术教学模式组的成绩优于采取单纯传统教学模式组,两组成绩差异具有统计学意义(P0.05)。结论:在传统教学模式的基础上添加网络云交互技术更能激发学生的学习兴趣,大大提高了学习效率,更有利于本科生外科实践的教学以及教学资源的整合及教学档案的建立。     

PBL 与LBL 教学法在胸外科临床教学中的对比研究

目的:对比研究以问题为中心教学法(PBL)与基于课堂的学习(LBL)即传统教学法在胸外科临床教学中教学的效果.方法:随机抽取临床专业学生100名,随机分为LBL教学组及LBL教学组各50人.在学习结束时,采用闭卷考试的形式进行成绩考核;同时采用不记名问卷调查,进行两种教学效果和教学模式的评价.结果:共纳入99例学生,分析显示PBL教学法与LBL教学法对医学生相关知识的掌握有影响.PBL教学法的教学模式在理论成绩与实践考核等方面优于传统教学法.结论:采用PBL教学法有助于提高学生的自主临床思维、提高学生的学习积极性,最终可以有效提高学习效果.     

基于合作学习的翻转课堂在微生物生态实验教学中的探索

借鉴合作学习的翻转课堂的理论和方法,以微生物生态实验教学为例,创造性构建了让学生参与到实验准备及教学视频录制的教学模式。该模式强化了学生对实验准备环节的学习认知,激发了学生的主观能动性,提高了实验技能、团队协作和创新意识等方面的教学效果,以期为高校实验教学改革提供借鉴。     

CBL教学法结合PBL教学法在肝胆外科教学中的应用

目的:研究以案例为基础的学习(CBL)教学法结合以问题为基础的学习(PBL)教学法在肝胆外科教学中的应用,为临床教学提供依据。方法:选取2014年1月到2015年6月我院肝胆外科实习生270例为研究对象,按照随机数字表法将实习生分为I组、II组和III组,每组90例,I组给予PBL联合CBL教学法,II组给予PBL教学法,III组给予传统学习(LBL)教学法,比较三组教学效果。结果:I组和II组学习兴趣、自主学习能力以及课堂氛围评分显著高于III组,I组知识理解评分显著高于II组和III组,II组显著高于III组,比较差异具有统计学意义(P0.05);I组基础知识分显著高于II组和III组,I组和II组临床技能评分显著高于III组,比较差异具有统计学意义(P0.05);I组和II组调查满意度显著高于III组,且I组显著高于II组,比较差异具有统计学意义(P0.05)。结论:PBL联合CBL教学法用于肝胆外科教学中能显著提高实习生的知识理解能力和满意度。     

微课和翻转课堂在生理学实验教学中的应用

目的:探讨微课(Microlecture)结合翻转课堂(Flipped Classroom)在生理学实验教学中的应用及效果。方法:以第四军医大学2010级临床医学专业五年制学员作为研究对象,随机分为对照组(A班,42人)和试验组(B班,42人),A班(7组,6人/组)接受传统方式的授课,B班(7组,6人/组)接受微课和翻转课堂模式的授课。课程结束后,以试卷考试,统计分析考试分数,同时用问卷调查评价教学效果。结果:试验组的总成绩明显高于对照组(P0.05)。学员对微课和翻转课堂教学法的效果评价明显优于传统的授课方式,微课结合翻转课堂在生理学实验教学中的应用明显提高了学员的实验兴趣、独立思考能力、动手能力、团队协作能力及自主学习能力。结论:微课结合翻转课堂在实验教学中的应用不但可以加深理论知识的理解,提高学员的各种技能,而且可推广应用到其他实验课程。     

双师带教模式在胸外科研究生临床见习教学中的应用效果

目的:探讨双师带教模式在胸外科研究生临床见习教学中的应用效果。方法:选择新疆医科大学附属肿瘤医院2011级~2015级胸外科轮转硕士研究生56人为研究对象,依据随机数字表法将学生分为观察组和对照组,各28人,分别采用双师带教和普通带教进行临床教学,实习8周后统一安排出科考试和满意度评价。结果:两组出科成绩比较,理论考试成绩差异没有统计学意义(P0.05),临床操作得分观察组高于对照组,差异具有统计学意义(P0.05);学生对课程的满意度评价,观察组为85.71%,显著高于对照组的60.71%,差异有统计学意义(P0.05)。结论:在胸外科临床实践教学中运用双师带教制,能充分发挥不同医师的特长,引导学生学习热情,提升临床实习效果,值得在临床实践中推广。     

Treatment of specific macrovascular beds in patients with diabetes mellitus

Background

A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts.

Methods

This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year.

Results

We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score.

Conclusions

This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.     

Effectiveness of IV cannulation skills laboratory training and its transfer into clinical practice: a randomized, controlled trial

Background

The effectiveness of skills laboratory training is widely recognized. Yet, the transfer of procedural skills acquired in skills laboratories into clinical practice has rarely been investigated. We conducted a prospective, randomised, double-blind, controlled trial to evaluate, if students having trained intravenous (IV) cannulation in a skills laboratory are rated as more professional regarding technical and communication skills compared to students who underwent bedside teaching when assessed objectively by independent video assessors and subjectively by patients.

Methodology and Principal Findings

84 volunteer first-year medical students were randomly assigned to one of two groups. Three drop-outs occurred. The intervention group (IG; n = 41) trained IV cannulation in a skills laboratory receiving instruction after Peyton''s ‘Four-Step Approach’. The control group (CG; n = 40) received a bedside teaching session with volunteer students acting as patients. Afterwards, performance of IV cannulation of both groups in a clinical setting with students acting as patients was video-recorded. Two independent, blinded video assessors scored students'' performance using binary checklists (BC) and the Integrated Procedural Protocol Instrument (IPPI). Patients assessed students'' performance with the Communication Assessment Tool (CAT) and a modified IPPI. IG required significantly shorter time needed for the performance on a patient (IG: 595.4 SD(188.1)s; CG: 692.7 SD(247.8)s; 95%CI 23.5 s to 45.1 s; p = 0.049) and completed significantly more single steps of the procedure correctly (IG: 64% SD(14) for BC items; CG: 53% SD(18); 95%CI 10.25% to 11.75%; p = 0.004). IG also scored significantly better on IPPI ratings (median: IG: 3.1; CG: 3.6; p = 0.015;). Rated by patients, students'' performance and patient-physician communication did not significantly differ between groups.

Conclusions

Transfer of IV cannulation-related skills acquired in a skills laboratory is superior to bedside teaching when rated by independent video raters by means of IPPI and BC. It enables students to perform IV cannulation more professionally on volunteer students acting as patients.