CBL联合临床路径在胸外科实习教学中的应用

目的 探讨以案例为基础的学习（case-based learning，CBL）联合临床路径在胸外科实习带教中的可行性和应用价值。方法 筛选2018年1月至2018年8月实习的临床专业本科学生30名，按照随机数字表法分为传统组和研究组。传统组以传统教学模式带教，研究组以CBL联合临床路径教学。对比两组学生的出科理论成绩、实践技能成绩和病例分析能力等。另外通过匿名调查问卷的方式观察两组教师和学生对教学效果的评价。采用 SPSS 21.0 进行t 检验和卡方检验。结果 研究组学生出科各项成绩均优于传统组，其中理论成绩（88.20±4.02） vs. （80.76±4.62），P<0.001]、实践技能成绩（90.80±2.16） vs. （84.80±3.07），P<0.001]和病例分析能力成绩（89.80±3.34） vs. （81.86±4.31），P<0.001]，差异均有统计学意义。同时调查问卷显示，研究组在提高学生的学习兴趣、临床技能、病例分析能力、临床沟通能力，加深对理论知识的理解及培养临床思维能力方面均优于传统组，差异有统计学意义（P<0.05）；而在学生对带教教师的满意度方面，两组差异无统计学意义（P=0.083）。结论 CBL联合临床路径教学法可提高胸外科实习带教效果，值得推广使用。

Application of CBL combined with clinical pathway in thoracic surgery practice teaching

Objective To explore the feasibility and application value of case-based learning (CBL) combined with clinical pathway in thoracic surgery practice teaching.Methods A total of 30 clinical undergraduate students who practiced from January 2018 to August 2018 were selected and randomly divided into the traditional group and the research group. The traditional group used traditional teaching mode, while the research group adopted the CBL combined with clinical pathway teaching. The scores of theoretical examination and practice skills assessment and the case analysis ability of the two groups were compared at the time of department. In addition, the evaluation of the teaching effect of the two groups of teachers and students was observed through anonymous questionnaires. SPSS 21.0 was used for t-test and Chi-square test.Results The scores of the students in the research group were better than those in the traditional group, including score of theoretical examination (88.20±4.02) vs. (80.76±4.62), P<0.001], score of practice skills assessment (90.80±2.16) vs. (84.80±3.07), P<0.001] and case analysis ability (89.80±3.34) vs. (81.86±4.31), P<0.001]. The differences were statistically significant. At the same time, the questionnaire showed that the research group was superior to the traditional group in improving students'' learning interest, clinical skills, case analysis ability, clinical communication ability, theoretical knowledge understanding and clinical thinking ability, with a statistically significant difference (P<0.05). While the two groups had no statistically significant difference in students'' satisfaction with teachers (P=0.083).Conclusion The CBL method combined with clinical pathway teaching method can improve the teaching effect of thoracic surgery practice, which is worth popularizing.