The application impact of integrated problem driven teaching method in clinical thinking of medical undergraduate students
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摘要:
目的 探究整合式问题驱动教学法(PBL)对医学本科生临床实习前临床思维能力的影响，为采取适合的临床授课方式提供理论依据。 方法 选取267名蚌埠医科大学2020级临床医学专业本科生作为研究对象，采用等距随机抽样法将研究对象分为PBL组和对照组，其中PBL组127人，对照组140人。对照组仅参与传统的以讲座为基础的教学计划，PBL组在对照组基础上增加PBL课程。比较2组研究对象的课堂表现和临床思维能力，并分析影响临床思维能力的相关因素。 结果 前测时，2组研究对象课堂表现分布差异无统计学意义(P>0.05)；后测时，2组研究对象课堂表现分布差异有统计学意义(P < 0.05)。前测时，2组研究对象批判性思维能力、系统性思维能力、循证性思维能力得分及总分比较差异均无统计学意义(P>0.05)；后测时，PBL组临床思维能力总分高于对照组[(73.71±12.65)分vs. (66.90±11.01)分，P＜0.05]，且各维度得分均高于对照组(P＜0.05)。多元线性回归分析结果显示，阅读医学文献的频率越高(B=6.811，P＜0.001)、PBL成绩排名越高(B=4.014，P=0.010)，临床思维能力越强。 结论 整合式问题驱动教学法对提高医学生临床思维能力有积极影响，其影响因素主要为阅读文献频率和PBL成绩排名。 Abstract:Objective Exploring the impact of integrated problem-driven teaching method on clinical thinking of medical undergraduate students before clinical internship, and providing theoretical basis for clinical teaching methods. Methods A total of 267 undergraduate students majoring in clinical medicine from Bengbu Medical University in 2020 were selected as the research subjects. The study subjects were divided into a PBL group and a control group using an equidistant random sampling method, with 127 cases in the PBL group and 140 cases in the control group. The control group only participated in traditional lecture-based teaching plans, while the PBL group added PBL courses on top of the control group. The classroom performance and clinical thinking ability of the two groups were explored, and the relevant factors that affect clinical thinking ability were analyzed. Results During the pre-test, there was no statistically significant difference in the distribution of classroom performance between the PBL group and the control group (P>0.05); During the post-test, there was a statistically significant difference in the distribution of classroom performance between the PBL group and the control group (P < 0.05). During the pre-test, there was no statistically significant difference in the scores of critical thinking ability, systematic thinking ability, evidence-based thinking ability, and total score between the two groups (P>0.05). During the post-test, the total score of clinical thinking ability in the PBL group was higher than that in the control group (73.71±12.65 vs. 66.90±11.01, P < 0.05), and the scores of all dimensions were higher than those in the control group (P < 0.05). The results of multiple linear regression analysis showed that the higher the frequency of reading medical literature (B=6.811, P < 0.001) and the higher the ranking of PBL scores (B=4.014, P=0.010), the stronger the clinical thinking ability. Conclusion The integrated problem-driven teaching method has a positive impact on improving the clinical thinking ability of medical students, with the main influencing factors being the frequency of literature reading and PBL course ranking. -
表 1 2组研究对象课堂表现比较[人(%)]
Table 1. Comparison of classroom performance between two groups of research subjects[people (%)]
组别 人数 前测 后测 优秀 良好 一般 差 优秀 良好 一般 差 PBL组 127 9(7.09) 96(75.59) 22(17.32) 0 35(27.56) 82(64.57) 10(7.87) 0 对照组 140 12(8.57) 102(72.86) 25(17.86) 1(0.71) 14(10.00) 106(75.71) 19(13.57) 1(0.71) Z值 1.125 15.234 P值 0.932 0.001 
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表 2 2组研究对象临床思维能力成绩比较(x ±s，分)
Table 2. Comparison of clinical thinking ability scores between two group (x ±s, points)
组别 人数 批判性思维能力 系统性思维能力 循证性思维能力 总分 前测 后测 前测 后测 前测 后测 前测 后测 PBL组 127 17.52±2.35 19.12±3.45b 29.61±4.91 33.14±5.95b 18.56±2.98 23.71±12.65b 65.61±9.17 73.71±12.65b 对照组 140 17.80±3.24 17.44±3.22 29.55±5.41 30.16±5.30b 18.86±3.24 19.36±3.43b 66.20±10.25 66.90±11.01 统计量 0.801a 15.823c 0.095a 3.155c 0.785a 29.417c 0.494a 8.461c P值 0.424 ＜0.001 0.925 ＜0.001 0.433 ＜0.001 0.622 ＜0.001 注：a为t值，c为F值；与同组前测比较，bP < 0.05。
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表 3 PBL组学生临床思维能力总分影响因素分析(x ±s，分)
Table 3. Analysis of factors influencing total score of clinical thinking ability in the PBL group
项目 人数 临床思维能力总分 统计量 P值 性别 0.336a 0.715 男性 63 74.34±14.00 女性 64 73.51±11.23 出生地 1.110a 0.269 城市 74 66.38±9.15 乡村 53 64.55±9.20 阅读文献频率 15.811b ＜0.001 >4篇/周 13 78.75±14.36 2~3篇/周 58 79.01±10.90 < 1篇/周 56 67.53±11.11 PBL自主学习时间 3.498b 0.018 >6 h/周 18 80.34±13.45 >4~6 h/周 39 74.41±11.86 2~4 h/周 48 73.93±12.52 < 2 h/周 22 67.78±11.43 PBL成绩排名c 3.998b 0.021 前30% 42 75.37±12.84 在前30%和后10%之间 68 74.99±12.24 后10% 17 66.05±11.44 注：a为t值，b为F值。cPBL成绩分类参照文献[5]。
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表 4 变量赋值情况
Table 4. Variable assignment
变量 赋值方法 阅读文献的频率 < 1篇/周=1，2~3篇/周=2，>4篇/周=3 PBL自主学习时间 < 2 h/周=1，2~4 h/周=2，>4~6 h/周=3，>6 h/周=4 PBL成绩排名 后10%=1，前30%和后10%之间=2，前30%=3
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表 5 PBL组医学生临床思维能力影响因素的多元线性回归分析
Table 5. Multiple linear regression analysis of factors influencing clinical thinking ability of medical students in the PBL group
变量 B SE β t值 P值 阅读文献的频率 6.811 1.634 0.354 4.170 ＜0.001 PBL自主学习时间 1.885 1.054 0.152 1.789 0.076 PBL成绩排名 4.014 1.540 0.208 2.607 0.010 注：F=11.624，校正R2=0.202，P=0.003。
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