摘要
目的探讨进展性案例结合鱼骨图教学在普外科临床实习教学中的应用效果,评估其对医学生理论知识掌握、临床实践能力及系统性思维培养的影响。方法选取2022年7月至2023年12月在普外科实习的60名临床医学本科生为研究对象,随机分为对照组(n=30)和观察组(n=30)。对照组采用传统案例教学,通过集中授课、小组讨论和总结答疑完成教学。观察组实施进展性案例结合鱼骨图整合教学,通过设计进展性案例、鱼骨图实施教学。采用理论考核、实践考核和教学满意度对教学进行评价。采用SPSS 22.0进行t检验和卡方检验。结果观察组实习生理论考核总分高于对照组[(86.97±4.60)vs.(66.06±5.96),t=-17.79,P<0.001],其中诊疗规范[(17.03±1.82)vs.(14.07±2.35)]和鉴别诊断[(12.85±1.42)vs.(8.92±2.37)]得分差异尤为明显。实践考核中,观察组实习生总分[(90.19±5.04)vs.(68.63±4.30,t=-17.82,P<0.001)]及各分项成绩均优于对照组,特别是在急腹症评估[(18.23±1.72)vs.(14.37±2.05)]、腹腔镜空间定位[(8.83±0.95)vs.(5.92±1.38)]和术中突发情况处理[(8.95±0.97)vs.(6.05±1.23)]方面表现突出。观察组实习生各项满意度评分均高于对照组(P<0.001),其中临床思维提升[(4.65±0.61)vs.(3.10±0.71)]和师生互动质量[(4.72±0.53)vs.(3.11±0.63)]的提升幅度最大。结论进展性案例结合鱼骨图教学通过动态呈现病例演变过程和结构化分析工具的应用,显著提高了实习生的理论成绩、实践操作能力和临床决策水平,且教学满意度更高。
Objective:To explore the application effects of a method combining progressive case study and fishbone diagram in clinical teaching of interns in general surgery,and evaluate its impact on medical students'theoretical knowledge mastery,clinical practice ability development,and systematic thinking cultivation.Methods:Sixty undergraduate clinical medicine students who interned in the Department of General Surgery from July 2022 to December 2023 were selected as the research subjects and randomly divided into a control group(n=30)and an observation group(n=30).The control group received traditional case-based teaching through centralized lectures,group discussions,and review/Q&A sessions.The observation group received an integrated teaching approach combining progressive case study and fishbone diagram through the design of progressive cases and fishbone diagrams.Teaching effectiveness was evaluated through theoretical assessment,practical assessment,and teaching satisfaction survey.SPSS 22.0 was used for t-test and χ^(2) test.Results:The total score of theoretical assessments for the observation group interns was higher than that of the control group[(86.97±4.60)vs.(66.06±5.96),t=-17.79,P<0.001].The differences in scores of diagnosis and treatment standards[(17.03±1.82)vs.(14.07±2.35)]and differential diagnosis[(12.85±1.42)vs.(8.92±2.37)]were particularly significant.In the practical assessments,the total score of the observation group interns[(90.19±5.04)vs.(68.63±4.30),t=-17.82,P<0.001]and their scores in individual assessments were higher than those of the control group,especially in acute abdomen evaluation[(18.23±1.72)vs.(14.37±2.05)],laparoscopic spatial positioning[(8.83±0.95)vs.(5.92±1.38)],and intraoperative emergency management[(8.95±0.97)vs.(6.05±1.23)].The satisfaction scores of the observation group interns were higher than those of the control group(P<0.001),with the greatest improvement in clinical thinking[(4.65±0.61)vs.(3.10±0.71)]and teacher-student interaction quality[(4.72±0.53)vs.(3.11±0.63)].Conclusions:The teaching method combining progressive case study and fishbone diagram significantly improved interns'theoretical assessment scores,practical operation ability,and clinical decision-making level through the dynamic presentation of case evolution processes and the application of structured analysis tools,and also enhanced the teaching satisfaction.
作者
黄思敏
魏宇轩
杨伟帮
王绮雯
蒋小峰
Huang Simin;Wei Yuxuan;Yang Weibang;Wang Qiwen;Jiang Xiaofeng(Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Department of Surgery Laboratory,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)
出处
《中华医学教育探索杂志》
2025年第6期814-818,共5页
Chinese Journal of Medical Education Research
基金
广州医科大学本科教学质量与教学改革工程建设项目(2023ZLGC026)。
关键词
进展性案例
鱼骨图教学
普外科
实习
Progressive case
Fishbone diagram teaching
General surgery
Intern
