目的 观察以问题为基础的学习模式(PBL)和以授课为基础的传统学习模式(LBL)在急诊重症加强治疗病房(EICU)示教中的应用效果.方法 选择新疆医科大学2007级和2008级五年制临床医学专业本科生312名,2007级108名,2008级204名学生.按随机数字表法分为两组,2007级每组各54名, 2008级每组各102名,使用交叉配对方法,两组学生前半学期分别以PBL和LBL进行示教,期中采用笔试考试 (WES)、客观结构化临床考试(OSCE)及自我评价问卷调查的方法对学生学习效果进行评估;在后半学期将两组学生对调进行上述教学方法,同样在学期末进行考试.学期结束时比较两组学生的考试成绩及问卷调查分数.结果 2007级及2008级两种教学模式学生WES、OSCE考核成绩比较,PBL模式教学WES、OSCE明显高于LBL模式〔前半学期:2007级:WES(分):23.20±3.33比22.78±4.41,OSCE(分):27.60±6.44比25.45±6.35,2008 级:WES(分):24.45±2.65 比 23.02±3.67,OSCE(分):29.53±4.67 比 27.57±6.83;后半学期:2007级:WES(分):24.60±3.67比23.46±2.57,OSCE(分):28.50±4.78比28.01±5.78,2008级:WES(分):23.54±3.56比22.56±6.89,OSCE(分):28.08±2.15比27.43±7.23,P<0.05或P<0.01〕.对2007级和2008级学生两种教学模式自评问卷结果显示:PBL模式教学的自主学习能力、积极性、理论联系实际能力、团队动力、注意力均较LBL模式提高〔2007级前半学期:自主学习能力(分):4.20±0.67比3.32±0.71,积极性(分):4.15±0.98比2.01±0.81,理论联系实际能力(分):4.09±0.65比3.52±0.89,团队动力(分):4.43±0.56比3.08±0.43,注意力(分):4.25±0.77比2.98±0.67;2007级后半学期:自主学习能力(分):4.23±0.77比2.11±0.98,积极性(分):4.59±0.85比3.20±0.73,理论联系实际能力(分):4.23±0.71比2.88±0.87,团队动力(分):4.66±0.63比2.21±0.64,注意力(分):4.21±0.73比2.28±0.43;2008级前半学期:自主学习能力(分):7.60±0.64比5.62±0.41,积极性(分):7.23±0.47比5.07±0.51,理论联系实际能力(分):7.04±0.67比4.56±0.59,团队动力(分):7.33±0.55比5.06±0.47,注意力(分):6.21±0.87比4.88±0.37;2008级前半学期:自主学习能力(分):7.03±0.71比5.11±0.48,积极性(分):7.89±0.57比5.20±0.33,理论联系实际能力(分):7.63±0.25比4.88±0.57,团队动力(分):7.64±0.33比5.21±0.67,注意力(分):7.01±0.89比6.01±0.90〕.结论 PBL教学法是一个值得探索及推广的教学模式,尤其在运用于医学这一重视实践的学科上,更能体现其重要性.%Objective To observe the effects of using problem-based learning (PBL) and lecture-based learning (LBL) in clinical teaching in emergency intensive care unit (EICU).Methods Three hundred and twelve 5-year clinical medicine undergraduates from Xinjiang Medical University including 108 students in 2007 class and 204 students in 2008 class were enrolled. The students in each class were randomly divided into two groups, 54 students in each group in 2007 class and 102 students in each group in 2008 class. Randomized controlled trial was conducted; in the first half of a semester, the students in the two groups of each class were taught by PBL method and LBL method respectively. At the middle of the semester, written examination (WES), objective structure clinical examinations (OSCE) and self assessment questionnaire test were carried out to evaluate students' learning effect. In the second half of the semester, the teaching method in the two groups of each class was exchanged, and at the end of the semester, the same examinations were carried out, and the examination and questionnaire scores in the two groups of each class were compared.Results The results of comparisons of the WES and OSCE scores between two modes in each class showed that the scores of WES and OSCE of the PBL mode were obviously higher than those in the LBL mode (the first half of semester in 2007 class: WES: 23.20±3.33 vs. 22.78±4.41, OSCE: 27.60±6.44 vs. 25.45±6.35, in 2008 class: WES: 24.45±2.65 vs. 23.02±3.67, OSCE: 29.53±4.67 vs. 27.57±6.83, in the second half of the semester in 2007 class: WES: 24.60±3.67 vs. 23.46±2.57, OSCE: 28.50±4.78 vs. 28.01±5.78, in 2008 class: WES: 23.54±3.56 vs. 22.56±6.89, OSCE: 28.08±2.15 vs. 27.43±7.23,P < 0.05 orP < 0.01). The score results of self assessment questionnaires of students in two groups of 2007 class and 2008 class showed that the self learning ability, initiative, linking theory with practice, team power and attentiveness were significantly higher in the PBL teaching mode than those in the LBL teaching mode [the first half of the semester in 2007 class: self learning ability (score): 4.20±0.67 vs. 3.32±0.71, the initiative (score): 4.15±0.98 vs. 2.01±0.81, linking theory with practice (score): 4.09±0.65 vs. 3.52±0.89, team power (score): 4.43±0.56 vs. 3.08±0.43, attentiveness (score): 4.25±0.77 vs. 2.98±0.67; the second half of the semester in 2007 class: self learning ability (score): 4.23±0.77 vs. 2.11±0.98, the initiative (score): 4.59±0.85 vs. 3.20±0.73, linking theory with practice (score): 4.23±0.71 vs. 2.88±0.87, team power (score): 4.66±0.63 vs. 2.21±0.64, attentiveness (score): 4.21±0.73 vs. 2.28±0.43; the first half of the semester in 2008 class: self learning ability (score): 7.60±0.64 vs. 5.62±0.41, the initiative (score): 7.23±0.47 vs. 5.07±0.51, linking theory with practice (score): 7.04±0.67 vs. 4.56±0.59, team power (score): 7.33±0.55 vs. 5.06±0.47, attentiveness (score): 6.21±0.87 vs. 4.88±0.37; the second half of the semester in 2008 class: self learning ability (score): 7.03±0.71 vs. 5.11±0.48, the initiative (score): 7.89±0.57 vs. 5.20±0.33, linking theory with practice (score): 7.63±0.25 vs. 4.88±0.57, team power (score): 7.64±0.33 vs. 5.21±0.67, attentiveness (score): 7.01±0.89 vs. 6.01±0.90].Conclusion PBL method of teaching is worthwhile to be explored and spread extensively, especially in medicine, a scientific course involving much attention on practice, it embodies more importance.
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