PBL教学法在《诊断学》实验教学中应用的效果评价

发布时间：2018-02-21 01:51

  本文关键词： PBL教学法 诊断学 实验教学 效果评价　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景《诊断学》是研究如何运用诊断疾病的基础理论、基本知识和基本技能对患者提出正确诊断,及对医学生进行临床诊断性思维培养的一门学科,它是基础医学向临床医学过渡的重要桥梁课程之一,也是临床各科的基础课程,在医学生整个医学教育过程中发挥重要作用。《诊断学》是一门实践性较强的课程,诊断学实验教学在整个教学过程中占有重要地位,因此教学时间的安排明显倾向于实验教学。理论教学时间和实验教学时间课时的安排通常是1：1,每学期的课时分别为36学时。另外实验教学还大量利用周末、晚上及自习课等业余时间来开放实验室,开放实验室的时间每学期大约为18学时,这样每学期理论为36学时,实验为54学时,实验教学时间已远远超过理论授课时间。诊断学实验教学任务既要培养学生牢固地掌握临床各项基本技能,还要培养学生的诊断性思维,教会学生如何通过问诊和体格检查真实客观地获得第一手资料,并能将以前所学的解剖、生理、病理生理等基础课与诊断学进行有机结合并融会贯通,全面培养医学生临床职业的综合素质。这些素质的培养不但对于后期开设的临床课程的学习,是否完成临床见习、实习的顺利过渡,以至于将来走向工作岗位后的临床工作水平和质量都有着至关重要的影响。但是《诊断学》作为一门桥梁课,学科涉及范围广,几乎涉及到了医学所有的基础医学课程和和临床医学课程。其概念、操作标准及规范、生理指标的正常值、异常值等内容较多,而且大都琐碎、枯燥无味,有些内容还模糊、抽象,单纯死记硬背很难激起学生的学习兴趣,学习的热情很难维持太久。而传统的实验教学方法也只是将这些技能的操作方法机械地传授给学生,记住大量的正常参考值及其异常时的临床意义,忽略了学生综合利用通过检查而获取的信息进行处理的能力培养,阻碍了学生临床综合分析思维的发展和提高,由于学习缺乏目的性,学生学习的主动性、积极性差,学习效果欠佳,不能完全达到预期的教学目标,也就不能很好地完成由学校学习进入临床学习的顺利过渡。研究目的“基于问题的学习”(Problem-Based Learning,PBL)是以问题为基础,以学生为主体,以小组讨论为形式,在老师的参与下,围绕某一专题或具体病例的诊治等问题进行探讨的一种学习方法。该法最早起源于20世纪50年代美国西余大学医学院的综合课程教育,目前已成为国际上较为流行的一种教学方法。国内、外专家研究PBL教学可使学生通过主动学习,小组内学生的充分交流与沟通,小组成员的协作与团队的集体智慧,解决学习过程中一个又一个问题,使学生不仅学习到了知识,而且更重要的是培养了学生的自主学习能力、临床思维能力、解决问题能力、沟通交流能力和团队协作精神。在PBL实验教学过程中,围绕典型病例展开的学习,不但集知识获取与能力培养于一体,且能够有效地强化学生对理论知识的理解,并能促进知识的实践与迁移,从而实现理论知识与实践能力的同步构建。但PBL这种行之有效的教学方法在医学理论的授课中应用较多,都取得了较好的教学效果。PBL教学法在《诊断学》实验教学过程中应用的研究尚未见报道。所以我们针对目前诊断学实验教学的现状,在实验教学过程中尝试部分开展PBL教学,目的是探索PBL教学法在《诊断学》实验教学过程中的可行性和优越性；同时了解一下这种新的教学方法在开展的过程会存在哪些困难,存在的困难可以通过什么措施进行解决,也可以结合学校实际,大胆尝试,希望发挥PBL先进教学模式优越性的同时,也为更顺利地推进实验教学工作的开展。研究方法以整群随机抽样的方法,从2011级临床医学专业20个班内随机抽取6个班,然后将6个班随机分成A组和B组。然后分别在A组和B组内再采用二阶段抽样的方法,从每个班随机抽取2/3的学生组成实验组和对照组。实验组和对照组学生分别为109人,研究对象共计218人。为消除由不同教师授课带来的偏差,固定一名教师作为研究对象的实验带教老师。实验组采用PBL教学法,对照组采用传统教学法。课程开始前、课程结束后,发放调查问卷,收集两组学生的阶段性实验考试成绩、调查问卷结果,将所得资料建立数据库,利用EXCEL和SPSS17.0软件对数据进行统计学分析,定量资料采用均数±标准差表示,问卷1、2：将‘"A"、"B"、"C"、"D"、"E"选项分别赋值“1”、“2”、“3”、“4”及“5”分,组间比较采用两独立样本的t检验、x2检验,问卷3：将“A”、“B”、“C”选项分别赋值为“1”、“2”、“3”分,组间比较采用两独立样本的χ2检验。P0.05认为差异有统计学意义。研究结果经研究发现,在诊断实验课程开始前,实验组和对照组的学生在学习习惯、专业思想态度方面并没有明显差异(P0.05)。在诊断学实验课程开始后,使用PBL教学法的实验组学生与使用传统教学方法的对照组学生相比,实验组学生能够积极开动脑筋,提出问题,分析问题,最后解决问题。在学习习惯的改善、专业思想态度加强、临床诊断性思维的培养、学习积极性主动性提高、人际交流能力的提高等方面,实验组明显高于对照组(P0.05),在实施PBL教学的整个过程中,培养了医学生多方面的能力,同时实验阶段性操作考试成绩实验组和对照组也存在明显差异,其中实验组心肺听诊平均得分7.27+1.14分、体格检查平均得分8.10±0.88分、病历书写平均得分8.39±1.11分、实验考试总分为23.75±2.22。而对照组心肺听诊平均得分7.18±1.07分、体格检查平均得分7.78±0.73分、病历书写平均得分7.95+0.76分、实验考试总分为22.91±1.61。除心肺听诊实验成绩差异无统计学意义差异(P0.05)外,其余几项成绩实验组均高于对照组(P0.05)。结论与建议PBL教学法同样适用于《诊断学》实验教学,在实验教学中相对于传统教学方法具有明显的优越性。在实施的过程中我们结合教学实际情况给予适当改进是可行的、有效的。PBL教学法是顺应当今医学教育形势发展的一种教学方法。尽管目前在《诊断学》实验教学中全面实施PBL教学法还存在着一些困难,但不能因为在实施过程中存在的困难就否定该种教学方法的优越性,我们应契合当今医学教育发展的有力条件,整合各种教学资源,充分调动师生的工作学习积极性,培养适合时代发展的高素质医学人才
[Abstract]:< > background diagnostics is the basic theoretical research on how to use the diagnosis of diseases, basic knowledge and basic skills of correct diagnosis of patients, and for medical students in clinical diagnostic thinking of a subject, it is one of the important bridge course of basic medicine to clinical medicine and clinical departments of transition, basic course, play in the process of medical students in the whole medical education plays an important role in diagnosis. < > is a practical course of diagnostics teaching occupies an important position in the whole process of teaching, so the teaching schedule was inclined to experiment teaching. The theory of teaching time and the time of experiment teaching arrangement is usually 1:1, each semester hour was 36 hours. The other experimental teaching but also a large number of the weekend, and evening self-study class of spare time to open laboratory, open laboratory time per term About 18 hours per semester, this theory is 36 hours, the experiment for 54 hours, the time of experiment teaching has been far more than the theory of teaching time. Diagnostics teaching task is to train the students to master the basic skills of clinical firmly, but also cultivate the diagnosis of thinking of students, teach students how to inquiry and physical examination objectively to obtain first-hand information, and the previous study of anatomy, physiology, pathophysiology and other basic courses and diagnostics are combined and mastery, all-round development of clinical medical students occupation. The quality of training not only for clinical courses later opened learning, whether the completion of clinical probation, the smooth transition of practice and that future work after the clinical work level and quality are important influence. But < diagnostics > as a bridge class, subject area Broad, involving almost all medical courses in Basic Medical Sciences and clinical medicine courses. Its concept, operation standards and norms, physiological indexes of normal, abnormal value more content, and most of them are trivial, some content is still vague, dull as ditch water, abstract, Dan Chunsi rote is difficult to arouse students' interest in learning, learning passion is difficult to maintain for a long time. And the traditional experiment teaching method is the method of operation of these mechanical skills to teach their students, remember the normal reference a large number of values and clinical significance of abnormal, neglected to cultivate students' ability of comprehensive utilization of the information obtained through the examination process, hinders the development of students' clinical comprehensive analysis of thinking and improve, because of the lack of purpose of learning, students' learning initiative, enthusiasm, learning effect is poor, can not fully achieve the desired teaching goal, also cannot Well done by the school for a smooth transition into clinical learning. The purpose of the study of "problem based learning" (Problem-Based Learning PBL) is a problem based, student-centered, group discussion to form in the teacher's participation, a method of learning a subject or problem on specific cases diagnosis and treatment are discussed. The method of integrated curriculum originated in the United States in 1950s more than the West University School of medicine and education, has become a kind of teaching method is more popular in the world. Domestic and foreign experts on PBL teaching can make students through active learning, full exchange and communication within the group of students, cooperation and collective wisdom the team members of the learning process, to solve a problem, so that students not only learn knowledge, but more important is to cultivate students' autonomous learning ability and clinical thinking ability To solve the problem, ability, communication skills and teamwork spirit. In the PBL experiment teaching process, focus on typical cases of learning, not only in knowledge acquisition and ability training in one, and can effectively enhance the students' understanding of theoretical knowledge, and can promote the transfer of knowledge and practice, so as to realize the synchronous construction of theoretical knowledge and practice ability. But the effective teaching method of PBL in medical theory teaching in the application of more, have achieved good teaching effect of.PBL teaching method in the diagnosis of < Application > in the process of experiment teaching has not yet been reported. So we aimed at the status of the diagnosis of experimental teaching, try to carry out the teaching part in PBL in the process of experimental teaching, the aim is to explore the teaching method of PBL in the diagnosis of "the feasibility and superiority of science" in the course of experimental teaching; at the same time learn about this new teaching method in To carry out the process there will be difficulties, difficulties can be solved by what measures can also be combined with the actual school, a bold attempt, I hope to play the superiority of the PBL advanced teaching mode at the same time, also to more successfully promote experimental teaching work. The research method using a cluster random sampling method from 6. Class 2011 randomly selected 20 classes of the clinical medicine, then 6 classes were randomly divided into A group and B group. Then respectively in A group and B group with two stage sampling, randomly selected from each class of 2/3 students in the experimental group and control group. The experimental group and control group students 109 people were the object of study, a total of 218 people. In order to eliminate the bias caused by different teachers, fixed a teacher as the research object of the experiment teachers. The experimental group adopted PBL teaching method, the control group used the traditional teaching method. The course before the start ,璇剧▼缁撴潫鍚，

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