LBL结合 PBL在层进式孕前优生风险教学中的效果分析

目的：探索如何有效结合以授课为基础的教学（ LBL）模式和以问题为基础的教学（ PBL）模式，层进式改善孕前优生风险教学的效果，促进优生知识和技能的全面掌握及应用。方法2012年－2015年，每年进行2轮教学，每年度平均进行2次临床督导。2013年之前全部教学均单独使用LBL教学模块。2013年采用整群抽样进行分组试验，LBL＋PBL教学模块组（ LBL教学模块与PBL教学模块联合教学）共纳入研究对象21人，分为3组，每组7人；LBL教学模块组共纳入研究对象35人。比较LBL＋PBL组与LBL组在施教前后的近期教学效果及满意度。2013年之后全部教学均采用LBL＋PBL教学模块进行逐年连续层进式教学干预。每年度收集单位时间内的转诊人次和诊断准确率评估教学的远期效果。结果教学前，LBL＋PBL组和 LBL组的总成绩以及优生理论知识、优生检查技能、优生风险评估及转诊、实际病例分析四部分成绩，均无显著性差异（t值分别为0．663、0．399、0．571、0．430、1．074，均P＞0．05）。教学后，虽然两组学员的总成绩都比各自教学前明显升高（ LBL＋PBL组：91．8±6．1 vs．60．0±15．7，t＝8．601，P＜0．05；LBL组：82．9±10．1 vs．57．1±14．8，t＝8．472，P＜0．05），但是教学后LBL＋PBL组学员的总成绩以及各部分成绩均显著高于教学后的LBL组（t值分别为3．613、2．320、3．512、3．053、3．904，均P＜0．05），LBL＋PBL组对优生检查技能、优生风险评估及转诊、实际病例分析这些实践技能和能力分值的提升上，效果更突出（均P＜0．01），而且LBL＋PBL组学员对教学的总满意度显著高于LBL组（85．7％vs 57．1％，χ2＝10．539，P＜0．05）。层进式教学循环干预下，优生高风险转诊人次逐年递增，4年的总增长率达到383．3％，2014年全面采用LBL＋PBL教学模块干预后，该年度高风险转诊的环比增长率达到历年最高（104．8％），且该年度的诊断准确率达到70．0％，显著高于其它年度（χ2＝23．437，P＜0．05）。结论 LBL＋PBL的教学模式既兼顾了系统知识的学习，又提高了实践技能和问题解决能力；以解决问题为中心的层进式教学循环，稳定巩固了临床实践技能。建议推广应用于各类继续医学教育及医学生的临床培训。

Effect analysis of step-by-step teaching cycle of lecture-based learning combined with problem-based learning module in eugenic risk education

Objective To explore lecture-based learning (LBL) module combined with problem-based learning (PBL) module in teaching cycle for improving the effect of eugenic risk education step by step , so as to promote the overall mastering and application of eugenic knowledge and skills .Methods Two cycles of teaching annually and average twice a year clinical supervision were conducted from 2012 to 2015.Only LBL teaching module was applied in classes before 2013.In 2013, grouped tests were carried out by cluster sampling .There were 21 subjects included in LBL +PBL teaching module group ( LBL combined with PBL modules for teaching ) .They were divided into three groups and seven subjects in each .There were 35 subjects included in LBL teaching module group .The recent effect and satisfaction of teaching were compared between LBL +PBL group and LBL group before and after the class .After 2013, LBL+PBL teaching module was applied in all classes for continuous teaching intervention step by step .The long-term effect of teaching was evaluated by collecting referral times and diagnostic accuracy rate during unit time annually .Results Comparing LBL+PBL group to LBL group before teaching , there were no significant differences in the total score and four part scores of eugenic theories , eugenics examination skills , eugenics risk assessment and referral, case analysis (t value was 0.663, 0.399, 0.571, 0.430 and 1.074, respectively, all P >0.05).After teaching, the total score was significantly higher in two groups respectively (LBL+PBL group:91.8 ±6.1 vs 60.0 ±15.7,t=8.601, P<0.05;LBL group:82.9 ±10.1 vs 57.1 ±14.8, t=8.472, P<0.05), but the total score and four part scores of LBL +PBL group were significantly higher than those of LBL group (t value was 3.613, 2.320, 3.512, 3.053 and 3.904, respectively, all P<0.05).And for promoting the scores of practical skills and abilities ( such as eugenics examination skills , eugenics risk assessment and referral , case analysis), it was more effective in LBL +PBL group ( all P <0.01).Overall satisfaction rate of teaching in LBL +PBL group was significantly higher than that in LBL group (85.7%vs 57.1%,χ2 =10.539,P<0.05).Under the intervention of step-by-step teaching cycle, the referral times of eugenic high risk increased annually , and the total growth rate approached to 383.3%during 4 years.In 2014, when LBL+PBL teaching module interventions were applied for all classes , the chain growth rate of high-risk referral rate reached the highest level (104.8%).And the diagnostic accuracy rate in this year reached 70.0%, which was significantly higher than that in other years (χ2 =23.437, P<0.05).Conclusion Teaching model of LBL +PBL is not only beneficial to systematic knowledge learning , but also beneficial to improving the abilities of practical skills and problem solving skills .The step-by-step teaching cycle focusing on problem solving could make the clinical practice skills stability and consolidation .It is suggested and recommended to apply in all kinds of continuing medical education and clinical training of medical students .