医学领域多元化以问题为基础学习教学模式的比较与思考

以问题为基础学习(problem-based learning,PBL)教学模式自产生以来,就沿着不同方向发展、并向不同领域渗透,逐渐形成了多元化PBL教学模式.本文主要介绍了不同地域、不同文化背景下医学教育领域中的3种PBL教学模式:加拿大麦克马斯特大学模式、丹麦奥尔堡大学模式和中国医科大学模式.通过多元化PBL教学模式的比较与讨论,促进交流PBL教学,达到提高医学生能力的目的.     

具有临床特色的以问题为基础学习实习模式初探

北京大学人民医院肝胆外科分析了以问题为基础学习(problem-based learning,PBL)教学方法的优势与不足,提出了具有临床特色的新型PBL实习模式的教学理念,评价了实习模式的实施效果,同时对完善实习模式进行了思考.

Abstract：

This paper summarized advantages and disadvantages of PBL,introduced concept and implementing measures of a new pattern of PBL clinical practice model with characteristics of clinical medicine in interns education in Department of Hepatobiliary Surgery of Peking University People' s Hospital, then explored and discussed it in detail.     

PBL教学法在英国曼彻斯特大学的应用及思考

在英国,问题导向学习(Problem-based learning,PBL)最早由曼彻斯特大学于1994年引入英国医学教育系统,现已成为除牛津和剑桥两个医学院之外英国各大医学院的主流教育方法.在此将简要介绍PBL教学法在英国曼彻斯特大学医学教育中的应用现状,并探讨在医学教育实践中运用PBL时应关注的几个问题.

Abstract：

University of Manchester who first introduced Problem based learning(PBL)to the UK medical education,and adopted this new curriculum in 1994.Notably,Cambridge and Oxford have always had a high proportion of student-centred and self-directed learning,and have therefore not introduced PBL.Other medical schools have followed the example of Manchester,now PBL has become the mainstream curriculum in British medical edacation.First,this article is going to introduce how PBL curriculum is structured at Manchester medical school,and then reflect and give some thoughts on its current practice.     

以问题为基础学习为导向的要点形象化教学在斜弱视教学中的应用

本文分析了在眼科斜弱视教学中实施以问题为基础学习(problem-based learning,PBL)为导向的要点形象化教学的意义,介绍了该教学方法的具体内容,即教学内容整合重组、利用影像资源将教学要点形象化、创建特色教学形式,以及教学的具体实施过程,激发学生的学习兴趣与欲望,提高学生的学习主动性,达到理解性学习、运用所学知识解决临床实际问题的目的.

Abstract：

This article analyzed the necessity and advantages of practice of key point visualization teaching oriented by problem-based learning(PBL) in strabismus and amblyopia courses,introduced the specific contents of the teaching procedure,including reorganization of the contents, visualization of learning key point,creating a distinctive teaching style.All the efforts helped inspiring the students'interest and desire in learning,improving their initiative in learning,developing their ability to synthesize and achieve the purpose of comprehension-based learning and to resolve the strabismus and amblyopic problem in real clinic practices.     

Effect of Bushenyisui Formula on brain tissue apoptosis and Bcl-2 in beta-amyloid protein-induced Alzheimer’s disease rat models

OBJECTIVE:To investigate the effect of Bushenyisui Formula on cell apoptosis and positive B cell lymphoma(Bcl-2) in the Brain of rat models of Alzheimer’s disease(AD) induced by beta-amyloid protein(Aβ) and the mechanism underlying the effect.METHODS:Total of 40 SD rats,20 females and 20 males,were randomly assigned to 4 groups,controlled group(A),model group(B),conventional treatment group(C) and Bushenyisui Formula treatment(BYFT) group(D),10 rats in each group.Aβ 1-42 was injected into the bilateral hippocampus of the rats in group B,C and D to create the models of AD.Sham operation was performed on the rats of group A in the same way by injecting equal volume of 0.9% sodium chloride solution into their bilateral hippocampus.5 days after operation,Bushenyisui Formula was intraperitoneally administered at a dose of 450 mg/kg to the rats of group D(QD) for 20 days.Equalvolumeof0.9%sodiumchloridesolution wasintraperitoneallyinjectedintotheratsofgroupB withthesameprocedure.C suspension(20 mg/mL) was intraperitoneally injected into the rats of group B with the same procedure.The number of apoptotic cells in Brain and the positive Bcl-2 were counted.The changes of learning and memory abilities were evaluated usingY-maze.RESULTS:Right after the establishment of the models,group B,C and D compared to group A respectively,the outcomes of Y-maze were significantly different from that of group A,which suggested obvious learning and memory disorder in those groups(P<0.01).After treatment,the times of electronic shocks of group C and D were significantly less than that of group B(P<0.05),and the numbers of apoptotic cells and positive Bcl-2 were significantly different from those of group B,apoptotic sells’ number of group C and D smaller than that of group B and the number of positive Bcl-2 greater than that of group B.CONCLUSION:Bushenyisui Formula could increase the number of Bcl-2 in brain,which improved the function of nervous system pertaining to learning and memory abilities.     

Electro-acupuncture combined with transcranial magnetic stimulation improves learning and memory function of rats with cerebral infarction by inhibiting neuron cell apoptosis

This study examined the effect of electro-acupuncture (EA) combined with transcranial magnetic stimulation (TMS) therapy at different time windows on learning and memory ability of rats with cerebral infarction and the underlying mechanism.Two hundred SD rats were randomly divided into four groups:normal group,sham-operated group,model group and EA+TMS group,and each group was then divided into five sub-groups in terms of the different time to start treatment post operation:6,12,24,48 and 72 h.Cerebral infarction models were established in the model and the EA+TMS groups by left middle cerebral artery occlusion/reperfusion (MCAO/R).After treatment for 14 d,the Morris water maze test was applied to examine the spatial learning and memory abilities of rats.In infarcted area,the expression of caspase-3 was immunohistochemically detected,and real-time fluorescent quantitative PCR was used to measure the expression of Bcl-2 mRNA.The results showed that in EA+TMS group compared with model group at the same treatment time windows,the escape latency was substantially shortened,the expression of caspase-3 was considerably decreased and the expression level of Bcl-2 mRNA significantly increased (P<0.05).In the EA+TMS sub-groups,the escape latency was shortest,the expression level of caspase-3 lowest,and the expression level of Bcl-2 mRNA highest at the treatment time window of 24 h.It was concluded that EA combined with TMS can promote neurological function of rats with cerebral infarction by increasing the expression level of Bcl-2 mRNA and decreasing the expression of caspase-3.The best time window is 24 h after perfusion treatment to ischemia.     

医学教育网络式PBL教学模式的实施与案例分析

由于受到具有我国高校特殊情况的主客观条件制约,PBL教学模式在我国医学教育中至今未能广泛展开[1].广州医学院在教学改革实践中,将经典的PBL教育理念与校情相结合,提出了一种新的教学模式--网络式PBL教学模式(以下简称WPBL),并在临床医学专业双语班学生中进行了实施.实践结果显示,WPBL有效克服了经典PBL在我国开展所遇到的困难,不仅较好地实现了教学目的,而且由于网络技术的介入,大大提高了学习效率和教学资源的使用率.

Abstract：

Due to the subjective and objective constraints of universities in China,PBL Teaching Mode failed to gain its popularity in China's medical education.In its teaching reform,Guangzhou Medical University put forward a new teaching model--Web-based PBL Teaching Mode(hereinafter referred to as WPBL).by integrating the classical concept of PBL education with the real situation of the university and carried it out among students in bilingual classes of Clinical Medicine.The resuIts showed that by effectively overcoming the difficulties during the implementation of classical PBL teaching,Web-based PBL Teaching Mode not only succeeded in achieving the teaching objectives,but also improved the learning efficiency and utilization of teaching resources greatly by means of network technology.     

以问题为基础学习教学方法在护理学专业健康评估课程中的应用

目的 探讨以问题为基础学习(problem-based learning,PBL)教学方法在护理学专业健康评估课程中的应用效果.方法 采取整群抽样的方法,对某大学护理学本科专业33名学生的健康评估课程实施PBL教学方法,课后进行问卷调查.结果 学生对PBL教学方法的各项评价指标中,"有利于评判性思维的培养"、"有助于充分调动小组学生参与的积极性"两个项目的中位数为4,其余各项目的中位数均为5.学生对导师的评价中,认为导师"只有在恰当的时候才进行干预"、"在学生讨论中给予了足够的指导"以及"对小组每一名学生都给予了关注"三个项目的中位数为4,其余各项目的中位数均为5.结论 PBL教学方法有助于学生对健康评估课程相关知识的学习,有助于学生评判性思维能力以及团队精神的培养.

Abstract：

Objective To evaluate the effects of problem-based learning(PBL) in the health assessment course. Methods Cluster sampling was used to select 33 nursing students and PBL method was employed in the health assessment course. Results Among the evaluation for PBL teaching, the media in favor of the critical thinking and the enthusiasm of the students are 4, other items are 5. Among the evaluation of the teacher, the media of the optimal timing intervene and enough teaching are 4, and other items are 5. Conclusions PBL is favor of knowledge learning and critical thinking for students.     

以病例讨论为主导的教学模式在病理生理学教学中的应用

根据病理生理学的特点,实施以病例讨论为主导的教学模式,包括以病例为基础、问题为引导的理论授课,以心力衰竭为专题的问题导向式学习,网上病例分析和临床专家的专题讲座,激发了学生的学习兴趣,提高了学生分析和解决问题的能力,培养了学生自主学习和终身学习的能力,有助于学生素质的全面提高.

Abstract：

Based on the characteristics of pathophysiology, various forms of case discussion teaching reform were carried out, including case-based and problem-oriented theory teaching, problem-based learning (PBL) on the topic of heart failure, online case analysis, and seminars instructed by clinical experts. All these reforms provoked students' interests in learning, promoted their abilities to analyze and solve problem, cultivated their independent and lifelong learning abilities, and raised their overall quality.     

神经病学见习中以问题为基础学习与床边学习两种教学方法的比较研究

目的 比较以问题为基础学习(problem-based learning,PBL)和床边学习(bedsidebased learning,BBL)两种教学方法在神经病学见习中培养医学生临床思维能力的效果.方法 选择2009年9月~2009年10月在广州医学院第一附属医院见习神经病学并由专人带教的2006级临床医学专业70名本科学生为研究对象,将其随机分为PBL组(34人)和BBL组(36人),分别采用PBL教学方法和BBL教学方法进行带教,并在1个月后进行临床思维能力和理论知识的考核.结果 PBL组和BBL组学生见习时答题正确率的差异无统计学意义;见习1个月后,PBL组学生临床思维能力考核成绩(t=2.346,P=0.022)及总成绩(t:2.329,P=0.023)均高于BBL组学生,其差异均具有统计学意义;两组学生理论考试成绩之间的差异无统计学意义(t=1.164,P=0.248).结论 本研究发现,PBL教学方法对于学生神经病学临床思维能力培养的效果优于BBL教学方法,能够从多方面提高学生的素质,是一种值得推广的教学方法.

Abstract：

Objective To compare the effect of clinical neurologic thinking training between the problem-based learning (PBL) and the bedside-based learning (BBL) during neurologic probation. Methods From September 2009 to October 2009, 70 forth-year medical probation undergraduates of Guangzhou Medical College undergoing the neruologic teaching of a special doctor were randomly divided into PBL group (34 students) and BBL group (36 students). The PBL and BBL approachs were respectively used to teach the students. A month later, the clinical and theoretic examinations were performed to compare the effect Results No statistically significance about the answers' accuracy was found during probation between PBL and BBL groups. A month after probation, both clinical exam record and total record of PBL group were higher than those of BBL group. However, no statistically difference was found in the theoretic examinartion record between PBL and BBL groups. Conclusions Our study suggests that the effect of clinical neurologic thinking training of PBL approach is more effective than that of BBL approach during neurologic probation. The PBL approach can also improve the students' quality in many aspects, and deserves to be popularized.     

PBL教学法在妇产科临床实习教学中的应用探索

目的:探讨PBL教学法在妇产科学临床实习中的应用效果。方法:在妇产科临床实习课中,将72名学生随机分为PBL教学法组和传统教学法组,比较其考试成绩,调查学生对PBL教学法的评价。结果:PBL教学法组与传统教学法组学生的考试总成绩分别为(88.64±3.90)分与(80.78±4.76)分,两者差异有统计学意义(P<0.01)。问卷调查显示,多数学生认为PBL教学有利于多种能力的提高。PBL教学法组教学效果显著优于传统教学法组。结论:PBL教学法在妇产科临床实习教学中具有较明显优势,能提高实习教学质量。     

以问题为基础学习教学模式授课效果评价研究

目的对以问题为基础学习（problem—basedlearning，PBL）教学模式授课效果进行分析和评价，探讨PBL教学模式授课的优点和不足，为进一步提高PBL教学效果提供理论和技术上的支持。方法本研究采用间接询问调查法对参与PBL教学的学生进行问卷调查，利用Visual FoxPro6．0软件建立数据库，采用SPSS13．0统计分析软件进行效度和信度分析、聚类分析、卡方检验，并对PBL教学效果进行评价和分析。结果学生对PBL教学总体的满意率达到85％以上，在总体情况、小组学习情况与强化教学能力、教师教学水平、教学优势方面，学生对PBL临床医学课程和基础医学课程的看法有所不同，其差异具有显著性统计学意义（P〈0．01）。结论学生对PBL教学模式持肯定态度，临床医学课程PBL教学效果优于基础医学课程，提示针对不同学科应当采取不同的PBL教学模式。     

医学物理学PBL教学模式探索

PBL教学法是西方医学教育的主流模式之一，本文根据医学物理学的特点，结合PBL教学法的优势，对医学物理学PBL教学模式进行了探讨，为PBL教学模式在医学物理学教学中的广泛应用提供了参考。     

学科整合型PBL课程的构建与实施

在深入探究PBL教学理念、比较国内外不同PBL教 学模式的实施效果的基础上,复旦大学上海医学院尝试将学科整合式PBL教学模式引入八年制医学教育.初步的实践取得了良好的效果,积累了宝贵的经验,为进一步拓展医学教育改革思路做出了有益的探索.     

日本医学院校几种主要的基于问题学习的教学模式特色分析

为培养适应社会需要的高质量的医师,各国医学教育都在进行相应的改革,其中,PBL教学模式的引入与实施成为当前研究的热点课题。本文就日本医学院校PBL教学模式的特色进行介绍并加以分析,寻找引入实施新教学模式的办法和规律,为我国医学院校的教学改革提供有用的参考。     

PBL在口腔颌面外科教学中的应用

基于问题的学习（Problem-based learning,PBL）是被广泛接受的以临床病例为先导、问题为基础、学生为主体的自学讨论式教学方法。在现行教学模式和课程体系下,进行PBL教学的探索,并通过教案编写、指导教师培训、学生的组织、教学评价及实施,形成了可行、有效的实施方法和过程,然而这种教学模式在临床医学教学中并未普及。本文介绍PBL教学的组成、特点及其在口腔颌面外科教学中的应用,为各高校开展PBL教学提供参考。     

PBL教学模式在医学消毒学教学中的应用

为了探讨PBL教学模式在医学消毒学教学中的应用,选取了化学消毒法内容在2003级卫生检验专业学生中进行尝试,并与采取传统教学模式的2001级和2002级同专业的学生比较,期末成绩两者并无明显差异,但有关化学消毒法内容的得分两者存在显著性差异;同时对教学效果的调查显示,这种方法受到学生的欢迎,学习的积极性、主动性大为提高。此次探索性的尝试,为医学消毒学全面实施PBL教学奠定了基础。     

PBL教学法教学效果的影响因素分析

PBL教学法是一种比较先进的教学模式和理念,自2003级口腔本科学生开始在临床专业课教学过程中实施PBL教学法,通过四个年级的口腔本科生PBL教学效果研究,认为影响PBL教学效果的因素主要有四个方面：问题设计、教师素质、学生因素、学习资源。     

常规PBL教学模式与改进型小案例PBL教学模式的比较

目的:比较常规PBL教学模式和改进的PBL教学模式在医学信息检索教学中的效果。方法:用DREEM量表比较分析医学信息检索教学改进后的PBL教学模式和常规的PBL教学模式的教学效果。结果:改进的PBL教学模式分值大多数高于常规的PBL教学模式的分值。结论:改进的PBL教学模式比常规的PBL教学模式更能提高学生的学习积极性和综合能力,教学效果更好。