PBL、CBL及LBL三法融合在内分泌科临床见习带教中的应用

目的 探讨以问题为基础的学习(problem based learning，PBL)教学法与案例教学法(case-based learning，CBL)及传统教学法(lecture based learning，LBL)三者融合对内分泌临床见习教学的影响与效果。 方法 将先后在内分泌科临床见习的68名学生随机分为实验组和对照组。实验组采用PBL、CBL及LBL (简称PCL)三者融合的教学法教学，对照组采用CBL及LBL (简称CL)教学法教学，并以问卷形式评价教学效果。 结果 PCL组学生学习时气氛活跃，互动性强，能够积极发言和讨论，课堂气氛明显好于CL组。问卷调查结果显示，在满意度测评方面，PCL组36名学生，满意34人，不满意2人，满意度为94.4%，明显优于CL组(71.8%)。自我评价结果分析显示，除在“提高临床学习的兴趣、增强解决问题的能力及拓宽知识面”3个项目差异无统计学意义(P＞0.05)，PCL组学生在对“是否有助于临床思维模式的建立(肯定度77.7%)、加强临床理论理解(肯定度66.6%)、提高自主学习能力(肯定度91.6%)、提高表达能力(肯定度80.5%)、提高沟通能力(肯定度75.0%)”5个项目的评价上均明显优于CL组(依次为:50.0%、40.6%、56.2%、40.6%、37.5%)，差异均具有统计学意义(P均＜0.05)。 结论 PBL、CBL及LBL三者融合教学优于仅用案例和传统教学法教学，是内分泌临床见习带教非常有效的教学方法，值得推广。 

Application of PBL combined with CBL and LBL in clinical probation in endocrinology department

Objective To assess the teaching effects of the competitive teaching methods that Problem Based Learning(PBL) combined with Case Based Learning(CBL) and Lecture Based Learning(LBL) on students undergoing clinical probation of endocrinology. Methods Sixty-eight students in the endocrinology department were allocated randomly to experimental and control.The experimental group received PBL,CBL and LBL teaching(PCL),whereas the controls were given CBL and LBL teaching(CL).The teaching effects were assessed by written questionnaire basis at the end of the tasks in the two groups. Results The classroom atmosphere was better in PCL group than that in CL group,which including better interaction,positively speaking and discussion.Questionnaire survey results show that students in the PCL groups had a higher satisfaction(94.4%) with the teaching than that in CL group(71.8%),P<0.05.On self-evaluation in students its self,the performance from the PCL group were significantly better than CL group on ability acquisition of the establishment of clinical thinking mode (positive rate 77.7% vs. 50.0%),to strengthen the understanding of clinical theory (positive rate 66.6% vs. 40.6%),improving of the ability in autonomous learning (positive rate 91.6% vs. 56.2%),improving of expression ability (positive rate 80.5% vs. 40.6%),communication skills improving (positive rate 75.0% vs. 37.5%),All P<0.05.However,there was no significant difference between the two groups in the three items about the clinical interest in learning,the ability of solving problems and the expansion of knowledge. Conclusion The teaching effectiveness of PCL(PBL,CBL and LBL) teaching methods is better than that in LBL only combined with CBL teaching methods.It was deserve popularizing in clinical probation teaching.