以问题为基础的学习在病理生理学教学中的应用

目的： 与传统的教学方法进行比较，探讨在本科生病理生理学教学中开展以问题为基础的学习（PBL）的必要性，并进一步探索在我国开展PBL教学的可能方法和途径。 方法： 在大学三年级本科生中抽取1个大班作为试验班，其余3个大班作为对照班，在试验班中采用全程PBL教学，将病理生理学教材内容重新整合并划分为6个单元，分别由3位指导教师承担不同单元的教学。每个单元相互独立，但又相互联系、交叉，均以1-2个病历为主要内容，每个病历中均隐藏着所涉及的学习要点的全部内容，学生通过小班讨论、自学、小组讨论、大班讨论以及教师总结等几个环节，归纳、总结出该单元的学习要点，以备进一步学习。在课程结束之后，在学生中进行问卷调查，同时采用PBL教学试验班和对照班期末考试考同一份卷的方法比较PBL教学和传统教学方式的主要差别。 结果： 采用PBL教学方式能够更好地调动学生的学习积极性，启发学生自主学习，并且在提高学生分析问题和解决问题的能力方面相对于传统的教学方式具有明显的优势。     

Curriculum design for problem-based learning on a volunteer basis: a Yonsei approach

Innovative new medical programs such as Problem Based Learning (PBL) are being developed worldwide. An increasing number of medical schools are starting to introduce these programs into or even to replace the existing curriculum. At Yonsei University College of Medicine (YUCM), we developed our own PBL curriculum and evaluation method. In order to develop a program suitable for our school, we suggest that for trial purposes, a small number of student and teacher volunteers should be selected and that the tutors involved in the program be given adequate training.     

PBL教学模式在普通外科临床见习教学中的应用

PBL(prob lem-based learn ing)教学模式,即“以问题为基础的学习”,其核心在于临床前期课或临床课中,以问题为基础、学员为主体、教员为导向的小组讨论式教学方法,打破学科界限,围绕问题,以塑造学员的独立性,培养创新力、有效运用知识解决问题的能力为教学目标[1]。医学生见习阶段是由纯粹的理论学习向临床实践过渡的学习阶段,在这一阶段,如何使学员尽快将所学的各科理论知识综合应用,分析解决问题以及提高独立思考、自行寻找问题答案的能力,是带教教员应着重解决的问题。近3年来,我们对普通外科临床见习学员大胆尝试了PBL教学模式,取得…     

PBL教学法在胸心外科教学中的应用

PBL（problem-based learning,PBL）教学法即＂基于问题式学习＂,是以临床实践问题为出发点,以学生为主体、教师为主导,围绕某一临床病例的诊治等专题,通过小组讨论的形式进行研究性学习[1]。胸心外科专业性、实践性强,根据我校人才培养方案和课程标准,其教学时间较短、内容少,导致学生对胸     

PBL在脑血管介入教学中的探索和实践

以问题为导向的教学方法即PBL教学法（problem-basedlearning,PBL）是一种以学生为中心,以教师为导向,以小组为单位,围绕实际问题进行讨论的启发式教学形式[1]。我科自2004年以来将PBL教学法应用于脑血管介入的教学实践,取得了显著的教学效果,现总结报道如下。     

Mechanistic case diagramming: a tool for problem-based learning.

Without appropriate learning tools to guide the application of knowledge to clinical situations, medical students in a problem-based learning (PBL) curriculum may revert to traditional modes of learning and hence deprive themselves of PBL's educational benefits. The author describes a technique involving the stepwise diagramming of pathophysiologic mechanisms leading from underlying causes to the symptoms and findings presented in a PBL case. This technique can guide clinical reasoning during an initial problem encounter, the identification of pertinent learning issues, and the subsequent integration of knowledge as relevant to the patient's case. The author suggests that training students and tutors to use this technique may allow the former to fully realize the benefits of PBL, including the ability to organize information for use in clinical contexts and the ability to critically reflect upon their own learning.     

A Bayesian approach to generating tutorial hints in a collaborative medical problem-based learning system

OBJECTIVES: Today a great many medical schools have turned to a problem-based learning (PBL) approach to teaching. While PBL has many strengths, effective PBL requires the tutor to provide a high degree of personal attention to the students, which is difficult in the current academic environment of increasing demands on faculty time. This paper describes intelligent tutoring in a collaborative medical tutor for PBL. The main contribution of our work is the development of representational techniques and algorithms for generating tutoring hints in PBL group problem solving, as well as the implementation of these techniques in a collaborative intelligent tutoring system, COMET. The system combines concepts from computer-supported collaborative learning with those from intelligent tutoring systems. METHODS AND MATERIALS: The system uses Bayesian networks to model individual student clinical reasoning, as well as that of the group. The prototype system incorporates substantial domain knowledge in the areas of head injury, stroke and heart attack. Tutoring in PBL is particularly challenging since the tutor should provide as little guidance as possible while at the same time not allowing the students to get lost. From studies of PBL sessions at a local medical school, we have identified and implemented eight commonly used hinting strategies. In order to evaluate the appropriateness and quality of the hints generated by our system, we compared the tutoring hints generated by COMET with those of experienced human tutors. We also compared the focus of group activity chosen by COMET with that chosen by human tutors. RESULTS: On average, 74.17% of the human tutors used the same hint as COMET. The most similar human tutor agreed with COMET 83% of the time and the least similar tutor agreed 62% of the time. Our results show that COMET's hints agree with the hints of the majority of the human tutors with a high degree of statistical agreement (McNemar test, p=0.652, kappa=0.773). The focus of group activity chosen by COMET agrees with that chosen by the majority of the human tutors with a high degree of statistical agreement (McNemar test, p=0.774, kappa=0.823). CONCLUSION: Bayesian network clinical reasoning models can be combined with generic tutoring strategies to successfully emulate human tutor hints in group medical PBL.     

融合微课的PBL教学法在局部解剖学教学中的应用

<正>基于问题为基础教学方法(problem based learning,PBL),在培养学生学习积极性、探索能力、解决问题能力等方面显示出独特优势~([1])。微课具有内容简洁、生动有趣味、可重复等优点~([2])。为了能优化教学资源,达到提高教学效果的目的,我们尝试将微课与PBL 2种教学方法有机融合进行局部解剖学教学,并对教学效果进行探索。     

A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine

Background

Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.

Methods

A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the ‘Assessing Competency in EBM’ (ACE) tool. Students’ self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.

Results

A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=?0.68, (95% CI–1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.

Conclusions

BL is no more effective than DL at increasing medical students’ knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.

     

PBL在泌尿外科教学查房中的应用

以问题教学为基础的教学(Prob lem-Based Learn ing,PBL)是将整个教学过程纳入到真实的临床问题中,并围绕若干问题,在教师的指导下完成教学的方式[1-2]。长期以来在我国的高等教育中,一直采用“填鸭式”教学,它往往缺乏活力,缺乏时代的气息,教材内容重复,知识成旧,忽视因材施教     

A multi-institutional randomized controlled trial of adjuvant Web-based teaching to medical students.

PURPOSE: To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations. METHOD: From April 2003 to May 2004, 351 students completing clinical rotations in surgery-urology at four U.S. medical schools were invited to volunteer for the study. Web-based teaching cases were developed covering four core urologic topics. Students were block randomized to receive Web-based teaching on two of the four topics. Before and after a designated duration at each institution (ranging one to three weeks), students completed a validated 28-item Web-based test (Cronbach's alpha = .76) covering all four topics. The test was also administered to a subset of students at one school at the conclusion of their third-year to measure long-term learning. RESULTS: Eighty-one percent of all eligible students (286/351) volunteered to participate in the study, 73% of whom (210/286) completed the Web-based program. Compared to controls, Web-based teaching significantly increased test scores in the four topics at each medical school (p < .001, mixed analysis of variance), corresponding to a Cohen's d effect size of 1.52 (95% confidence interval [CI], 1.23-1.80). Learning efficiency was increased three-fold by Web-based teaching (Cohen's d effect size 1.16; 95% CI 1.13-1.19). Students who were tested a median of 4.8 months later demonstrated significantly higher scores for Web-based teaching compared to non-Web-based teaching (p = .007, paired t-test). Limited learning was noted in the absence of Web-based teaching. CONCLUSIONS: This randomized controlled trial provides Class I evidence that Web-based teaching as an adjunct to clinical experiences can significantly and durably improve medical students' learning.     

Web-based learning in residents' continuity clinics: a randomized, controlled trial.

PURPOSE: To determine whether internal medicine residents prefer learning from Web-based (WB) modules or printed material, and to compare the effect of these teaching formats on knowledge. METHOD: The authors conducted a randomized, controlled, crossover study in the internal medicine resident continuity clinics of the Mayo School of Graduate Medical Education during the 2002-03 academic year. Participants studied two topics of ambulatory medicine using WB modules and two topics using paper practice guidelines in randomly assigned sequences. Primary outcomes were format preference (assessed by an end-of-course questionnaire) and score changes from pre- to postintervention tests of knowledge. RESULTS: A total of 109 consented and 75 (69%) completed the postintervention test. Fifty-seven of 73 (78% [95% CI, 67-86%]) preferred the WB format (p < .001). Test scores improved for both formats (67.7% to 75.0% for WB, 66.0% to 73.3% for paper), but score change was not different between formats both before (p = .718) and after (p = .080) adjusting for topic, clinic site, study group, postgraduate year, and gender. Residents spent less time on WB modules (mean = 47 +/- 26 minutes) than paper (mean = 59 +/- 35, p = .024). Difficulties with passwords limited their use of WB modules for 71% (59-80%) of residents. CONCLUSION: No difference was found between WB and paper-based formats in knowledge-test score change, but residents preferred learning with WB modules and spent less time doing so. Passwords appeared to impede use of WB modules. WB learning is effective, well accepted, and efficient. Research should focus on aspects of WB instruction that will enhance its power as a learning tool and better define its role in specific settings.     

From case-based reasoning to problem-based learning.

Many medical schools today are questioning whether they should implement a problem-based learning (PBL) curriculum. Educators have raised serious questions regarding the efficiency of PBL and therefore recommend learning more about the cognitive processes developed by PBL before implementing it broadly. In addition, it is important to determine whether PBL best matches the human reasoning process. The authors' theoretical discussion examines the relationship between the case-based reasoning (CBR) model and the PBL model. CBR indicates that the knowledge source one uses while solving a new problem includes not only generalized rules or general cases, but often a memory of stored cases recording specific prior episodes. CBR enables the reasoner to recommend solutions to problems quickly and to propose solutions in domains that are not completely understood, such as medicine. The authors' analysis reveals a strong association between the CBR and PBL models, and thus it can be argued that PBL is a successful teaching method that should be encouraged by medical schools.     

PBL教学法在门诊慢性创面处置教学中的实践和探索

医学作为一门实践性学科,最终需要学生独立操作和实践。让学员参与整个教学,尤其是带着问题进行学习才是21世纪培养创新开拓型医学人才的方式。以问题为导向的PBL教学法（problem-based learning,PBL）是在老师引导下建立学生讨论小组,根据不同的临床情况进行具体讨论的一种教学模式。