目的：探索传统教学法联合基于案例学习(Case-Based Learning, CBL)教学法在我院心血管内科住院医师急性心肌梗死临床教学中的应用价值及效果评价。方法：以2021年11月至2023年11月期间在陕西省人民医院心血管内一科参加住院医师规范化培训的学员为研究对象，随机分为对照组和试验组，每组42人；将传统的教学法应用于对照组，将传统教学法联合CBL教学法应用于试验组。出科前对所有学员进行考核，包括理论考核和实践技能考核，比较学员对两种教学方法的满意度评价及两种教学方法效果评价。结果：试验组学员的理论考试及技能考核成绩均显著高于对照组，试验组学员对带教的满意度明显优于对照组，两组差异均有统计学意义(P < 0.05)。结论：传统教学法联合CBL教学法在心血管内科住院医师临床教学中可显著提高住院医师的理论知识和实践技能水平，亦可提高临床教学质量，教学效果优于传统教学法。 Objective: To explore the application and effectiveness evaluation of traditional teaching methods combined with Case Based Learning (CBL) teaching methods in the clinical teaching of acute myocardial infarction among resident cardiovascular physicians in our hospital. Method: Participants who participated in standardized training for resident physicians in the Cardiovascular Department of Shaanxi Provincial People’s Hospital from November 2021 to November 2023 were selected as the research subjects. They were randomly divided into a control group and an experimental group, with 42 participants in each group. The traditional teaching method was applied to the control group, and the combination of traditional teaching method and CBL teaching method was applied to the experimental group. Before graduation, all students will be assessed, including theoretical assessment and practical skill assessment, to compare their satisfaction evaluation of the two teaching methods and the effectiveness evaluation of the two teaching methods. The results showed that the theoretical exam and skill assessment scores of the experimental group were significantly higher than those of the control group. The satisfaction of the experimental group with teaching was significantly better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion: The combination of traditional teaching method and CBL teaching method can significantly improve the theoretical knowledge and practical skills of resident physicians in cardiovascular medicine clinical teaching, and also improve the quality of clinical teaching. The teaching effect is better than traditional teaching method.
目的：探索传统教学法联合基于案例学习(Case-Based Learning, CBL)教学法在我院心血管内科住院医师急性心肌梗死临床教学中的应用价值及效果评价。方法：以2021年11月至2023年11月期间在陕西省人民医院心血管内一科参加住院医师规范化培训的学员为研究对象，随机分为对照组和试验组，每组42人；将传统的教学法应用于对照组，将传统教学法联合CBL教学法应用于试验组。出科前对所有学员进行考核，包括理论考核和实践技能考核，比较学员对两种教学方法的满意度评价及两种教学方法效果评价。结果：试验组学员的理论考试及技能考核成绩均显著高于对照组，试验组学员对带教的满意度明显优于对照组，两组差异均有统计学意义(P < 0.05)。结论：传统教学法联合CBL教学法在心血管内科住院医师临床教学中可显著提高住院医师的理论知识和实践技能水平，亦可提高临床教学质量，教学效果优于传统教学法。
心血管内科，急性心肌梗死，CBL教学法，传统教学法，临床教学实践，教育
Meijuan Ma1,2, Xiaoyan Huang3, Yanmei Liu4,Shuxia Wang1, Jing Yang1, Huaibin Tang1, Yujuan Wang1, Fuqiang Liu2, Guo’an Zhang5*
1Cadre Physical Examination Center, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
2Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
3Central Laboratory, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
4West Hospital Second Ward, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
5Department of Cardiovascular Surgery, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi
Received: Dec. 20th, 2023; accepted: Feb. 2nd, 2024; published: Feb. 9th, 2024
Objective: To explore the application and effectiveness evaluation of traditional teaching methods combined with Case Based Learning (CBL) teaching methods in the clinical teaching of acute myocardial infarction among resident cardiovascular physicians in our hospital. Method: Participants who participated in standardized training for resident physicians in the Cardiovascular Department of Shaanxi Provincial People’s Hospital from November 2021 to November 2023 were selected as the research subjects. They were randomly divided into a control group and an experimental group, with 42 participants in each group. The traditional teaching method was applied to the control group, and the combination of traditional teaching method and CBL teaching method was applied to the experimental group. Before graduation, all students will be assessed, including theoretical assessment and practical skill assessment, to compare their satisfaction evaluation of the two teaching methods and the effectiveness evaluation of the two teaching methods. The results showed that the theoretical exam and skill assessment scores of the experimental group were significantly higher than those of the control group. The satisfaction of the experimental group with teaching was significantly better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion: The combination of traditional teaching method and CBL teaching method can significantly improve the theoretical knowledge and practical skills of resident physicians in cardiovascular medicine clinical teaching, and also improve the quality of clinical teaching. The teaching effect is better than traditional teaching method.
Keywords:Cardiovascular Medicine, Acute Myocardial Infarction, CBL Teaching Method, Traditional Teaching Methods, Clinical Teaching Practice, Education
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心血管疾病是发达国家和发展中国家人群死亡的最大杀手之一，每年全球约有1700万人因心血管疾病死亡。根据《中国心血管病报告2018》 [
选择2021年11月至2023年11月在陕西省人民医院心血管内一科进行住院医师规范化培训的84名学员随机分为两组，试验组42名学生(其中男生20名、女生22名)，对照组42名学生(其中男生18名、女生24名)；试验组年龄平均(25.1 ± 2.8)岁，对照组年龄平均(24.9 ± 3.6)岁；试验组本科学历人数及占比(12/28.6%)，硕士学历人数及占比(30/71.4%)；对照组本科学历人数及占比(13/31.0%)，硕士学历人数及占比(29/69.0%)，两组学历、性别、年龄差异无统计学意义(P > 0.05)，详见表1。将传统的教学法应用于对照组，将传统教学法联合CBL教学法应用于试验组。
1) 试验组采用将传统教学法联合CBL教学法。教学模式：带教教师首先对所有试验组学员进行传统教学法教授急性心肌梗死的理论知识，包含急性心肌梗死定义、流行病学、病因与发病机制、病理与病理生理、临床表现、实验室检查、诊断与鉴别诊断、并发症、治疗策略、预后与预防等，对必须掌握和学习的重点及难点进行强调。其次，住院医师培训学员结合病房急性心肌梗死患者充分理解掌握理论知识，内容有详细的病史询问采集、心脏专科查体、病历规范书写、开具医嘱、检验检查单解读分析等。在此过程中带教教师给予适当的指导和检查。再次，查房学习结束培训学员需进行病历幻灯汇报，大家可以进行提问和讨论，学员和带教教师均可回答，最后，由带教教师做总结归纳。
2) 对照组采用传统的教学法，主要是带教教师以授课的方式将急性心肌梗死的理论知识传授给学员，包含急性心肌梗死定义、流行病学、病因与发病机制、病理与病理生理、临床表现、实验室检查、诊断与鉴别诊断、并发症、治疗策略、预后与预防等，如学员有不懂或疑问，可以请教带教教师，教师将进行答疑。
出科前两组培训学员均需要进行考核，包括理论考核、临床实践技能考核及满意度评价。理论考核满分100分，包含基础理论知识50分、临床案例分析50分；临床技能考核满分100分，包含病史询问采集20分、心脏专科查体20分、心电图解读20分、心肺复苏20分、诊疗计划20分。满意度评价采用问卷调查形式，包括不满意、比较满意和非常满意，满意度 = (非常满意人数 + 比较满意人数)/总人数 × 100%，所有出科培训学员84人均接受问卷调查，收回问卷84份，有效回收率达100%。
采用SPSS 25.0统计学软件对数据进行分析。计数资料用(n, %)表示，组间采用χ2检验比较；计量资料用( x ¯ ± s )表示，组间采用t检验比较，P < 0.05表示差异具有统计学意义。
两组培训学员在年龄、性别、年龄三个方面差异均无统计学意义(P > 0.05)，两组间具有可比性，详见表1。
| 试验组 | 对照组 | t/χ2值 | P值 | |
|---|---|---|---|---|
| 年龄( x ¯ ± s ，岁) | 25.1 ± 2.8 | 24.9 ± 3.6 | 0.28419 | 0.77701 |
| 男性(n/%) | 20/47.6% | 18/42.9% | 0.19222 | 0.6611 |
| 女性(n/%) | 22/52.4% | 24/57.1% | 0.19222 | 0.6611 |
| 学历(n/%) | ||||
| 本科 | 12/28.6% | 13/31.0% | 0.056949 | 0.8114 |
| 硕士 | 30/71.4% | 29/69.0% | 0.056949 | 0.8114 |
表1. 两组培训学员一般情况比较(n = 42)
出科前，两组培训学员均进行了考核，试验组培训学员在基础理论知识、临床病例分析、临床技能考核方面的成绩均显著高于对照组培训学员，差异均具有统计学意义(P < 0.05)，详见表2。
| 试验组 | 对照组 | t值 | P值 | |
|---|---|---|---|---|
| 基础理论知识 | 46.2 ± 3.5 | 42.9 ± 3.0 | 4.6394 | 0.00001 |
| 临床案例分析 | 44.5 ± 2.2 | 41.6 ± 3.1 | 4.9441 | <0.00001 |
| 临床技能考核 | ||||
| 病史采集 | 18.1 ± 1.5 | 15.7 ± 2.5 | 5.3349 | <0.00001 |
| 心脏专科查体 | 17.6 ± 1.9 | 16.1 ± 2.3 | 3.2585 | 0.00165 |
| 心电图解读 | 16.0 ± 2.5 | 14.8 ± 2.4 | 2.2441 | 0.02753 |
| 心肺复苏 | 17.3 ± 2.4 | 15.6 ± 1.9 | 3.5992 | 0.00056 |
| 诊疗计划 | 16.4 ± 2.6 | 13.9 ± 2.4 | 4.5789 | 0.00002 |
表2. 两组培训学员出科考核成绩比较
两组培训学员共84名，出科前均参与了满意度问卷调查，有效问卷率100%，结果提示，试验组培训学员对带教的主观满意度明显高于对照组培训学员，差异具有统计学意义(P < 0.05)，详见表3。
| 满意(例) | 比较满意(例) | 不满意(例) | 满意度[例(%)] | |
|---|---|---|---|---|
| 试验组(n = 42) | 36 | 4 | 2 | 40(95) |
| 对照组(n = 42) | 24 | 8 | 10 | 32(90) |
| t值 | 8.447 | 7.101 | 6.222 | 0. |
| P值 | 0.007 | 0.003 | 0.013 | 0.012 |
表3. 两组培训学员主观满意度评价比较
医学临床教学目前多采用传统教学法的教学模式。传统教学法主要以带教教师授课为主，重点传授课本临床理论知识，使得学生掌握教材知识点，对于学生的临床实践技能及理论实践转化方面欠缺 [
陕西省人民医院是一家大型综合的三级甲等公立医院，作为国家全科医师培训基地、国家住院医师规范化培训基地。急性心肌梗死是住院医师规范化培训在心血管内科学习期间必须掌握的一种常见的急危重症疾病。如何让住院医师培训学员在学习期间对急性心肌梗死理论知识及临床实践能力快速提升，是我们带教老师需要思考的问题。因此，为了让住院医师规范化培训学员在学习理论知识的基础上，能更重视临床实践能力临床思维能力，我们结合科室专业特色，临床教学过程中，我们将传统教学法联合CBL教学法，从而使得住院医师培训学员不仅能准确地掌握急性心肌梗死的理论知识和诊治流程，而且可以大大提升住院医师规范化培训的质量，进一步学员的临床综合实践能、临床思维及自主学习能力均得到了提高。
本次研究我们将传统教学法联合CBL教学法，应用于住院医师规范化培训学员的临床带教中，取得了一定的效果。研究结果显示，试验组培训学员的理论考核和临床实践技能考核成绩均高于对照组，同时培训学员满意度也明显优于对照组，结果均提示传统教学法联合CBL教学法优于传统教学法。传统教学法联合CBL教学法的应用，使得培训学员对急性心肌梗死的理论知识得以巩固加强，同时学员熟练掌握了急性心肌梗死的诊疗流程，降低住院费且缩短了平均住院时间，诊疗行为也得到了规范化，进一步节约了卫生资源。与此同时，本研究更新了带教教师的传统教学理念方法，从书本到书本，从理论到理论的传统教学方法，已不再适用；更多需要的是学生在临床实践中更充分的理解掌握疾病的理论知识，同时调动了学生的兴趣和主动积极性。传统教学法联合CBL教学法，亦强调老师和学生之间的频繁讨论交流。但是，传统教学法联合CBL教学法是一种新的教学模式的尝试，仍需要不断的完善 [
综上所述，传统教学法联合CBL教学法在心血管内科住院医师规范化培训的临床教学中具有一定的实施性，能够使得培训学员的临床实践及临床思维能力得到提升，同时培训学员可以全面、快速地学习临床知识并积累临床经验，值得进一步推广应用。
陕西省人民医院科技人才支持计划项目(2023JY-06)，陕西省教育厅科学研究计划项目(22JS035)，陕西中医药大学陕西省中西医结合心血管病防治重点实验室开放课题(2022XXG-QN-001)，陕西省人民医院科技发展孵化基金项目(2021YJY-29)。
马美娟,黄晓燕,刘延梅,王淑霞,杨 静,唐怀滨,王玉娟,刘富强,张国安. 传统教学法联合CBL教学法在心血管内科住院医师急性心肌梗死临床教学中的应用 Application of Traditional Teaching Method Combined with CBL Teaching Method in Clinical Teaching of Acute Myocardial Infarction among Resident Cardiovascular Physicians[J]. 亚洲急诊医学病例研究, 2024, 12(01): 17-22. https://doi.org/10.12677/ACREM.2024.121003
https://doi.org/10.5688/ajpe7044