基于EBM理念的PBL在骨科临床实习教学中的应用评价

目的 探讨以问题为基础的学习（problem-based learning，PBL）结合循证医学（evidence-based medicine，EBM）理念在骨科临床实习教学工作中的应用效果。方法 将2017年6月至2018年6月进入本科室的48名实习生随机分为试验组（PBL结合EBM理念教学组24人）和对照组（传统教学组24人）。试验组由带教教师选取典型病例并设计具有一定灵活性和复杂性的问题，围绕实际问题组织学生查阅文献、分组讨论、汇报总结。对照组授课时根据带教教师的临床经验采用传统教学。教学效果评价分为问卷调查、理论试卷考试、临床技能考核3部分。采用SPSS 16.0进行t检验和卡方检验。结果 问卷调查显示，试验组学生对自身接受的教学方法在提高理论知识理解能力、综合分析能力、团队协作意识、文献检索和语言表达能力，激发学习动机，增强科研思维创新能力方面的评价均优于对照组，差异有统计学意义（P<0.05）。理论试卷考试成绩显示，试验组平均得分（92.42±2.55）高于对照组（86.17±3.36），差异有统计学意义（P<0.05）。临床技能考核成绩显示，试验组平均得分（85.79±3.15）高于对照组（78.88±3.41），差异有统计学意义（P<0.05）。结论 在骨科实习中采用PBL教学，并将EBM理念贯穿整个教学过程，取得了良好的效果，能改善骨科临床教学质量，提高临床医学生的综合素质，激发其主动学习的积极性，培养其思维创新、构建问题、综合分析、文献检索、沟通交流等方面的能力。

Application evaluation of evidence-based medicine concept-based problem-based learning teaching mode in the clinical practice teaching of an orthopedic department

Objective To investigate the effect of application of problem-based learning (PBL) combined with evidence-based medicine (EBM) in clinical practice teaching of an orthopedic department.Methods A total of 48 interns who entered Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China from June 2017 to June 2018 were randomly divided into experimental group (the PBL combined with EBM concept teaching group, n = 24) and control group (the traditional teaching group, n = 24). In the experimental group, teachers selected typical cases, designed questions with certain flexibility and complexity, and organized the students to consult the literature, discuss in groups, and report and summarize around the practical problems. In the control group, traditional indoctrination teaching was adopted according to the clinical experience of the teachers. The teaching effect was assessed by a questionnaire survey, a theoretical examination, and a clinical skill examination. The results were analyzed by t-test and Chi-square test using SPSS 16.0 software.Results The questionnaire survey showed that compared with the control group, the experimental group gave a significantly better evaluation of the teaching methods they received in terms of improving their theoretical knowledge comprehension ability, comprehensive analysis ability, team collaboration awareness, document retrieval and language expression ability, stimulating their learning motivation, and enhancing their scientific thinking and innovation ability (P < 0.05). Furthermore, compared with the control group, the experimental group had significantly higher mean scores for both the theoretical test (92.42±2.55 vs. 86.17±3.36, P < 0.05) and the clinical skill test (85.79±3.15 vs. 78.88±3.41, P < 0.05).Conclusion The application of PBL teaching in orthopedic practice, with the concept of EBM throughout the teaching process, has obtained a good effect. It can improve the clinical teaching quality in orthopedics, improve the comprehensive quality of clinical medical students, inspire their active learning enthusiasm, and cultivate their creative thinking, problem construction, comprehensive analysis, literature retrieval, and communication ability.