学生标准化病人在以问题为基础的学习中的应用

目的 探讨医学生作为标准化病人（student as standardized patients,SSP）在外科学见习中开展以问题为基础的学习（problem-based learning,PBL）的教学效果.方法 选取2008级本科临床医学专业161名学生为研究对象,按自然班随机分为PBL组和以授课为基础的学习（lecture-based learning,LBL）组.PBL组（81人）引入SSP开展PBL教学,LBL组（80人）按LBL进行见习.见习结束时对2组学生进行理论考核,并对PBL组学生进行问卷调查;数据录入SPSS13.0软件进行统计分析,比较2组差异,计量资料采用t检验,计数资料用频数与构成比描述.结果 理论考核结果显示PBL组病案分析平均成绩为（37.35±5.95）分,明显高于LBL组的（33.25±4.89）分（P=0.001）;PBL组总评成绩为（71.20±8.67）分,亦高于LBL组的（67.79±9.87）分（P=0.018）;2组选择题平均成绩分别为（33.85±5.05）、（34.24±6.87）分,两者比较差异无统计学意义（P=0.658）.问卷调查的10个条目,回答为“好”的比例均超过75％,其中SSP的配合程度、SSP无暗示性语言或动作、能激发学习兴趣3个条目,回答为“好”的比例超过90％.结论 引入SSP开展PBL教学能明显提高学生临床分析、解决问题的能力,但对于学生的基础理论知识掌握度影响不明显;SSP可以替代职业标准化病人进行PBL教学.

Application of taking medical students as standardized patients in PBL teaching

Objective To investigate the effect of taking medical students as standardized patients（SSP） on problem based leaming（PBL） teaching in clerkship.Methods Totally 161 students （grade 2008） selected from clinical medical department was divided into PBL group（n=81） and lecture-based learning（LBL） group（n=80）.SSP was introduced into PBL teaching and LBL group was taught by LBL.After the clerkship,theory test was conducted in two groups and questionnaire was given to LBL group.Statistical analyses were conducted by SPSS 13.0,measurement data were analyzed by t test and enumeration data were described by frequency and constituent ratio.Results Theory test results showed that the average score of medical record analysis was （37.35 ± 5.95） in PBL group,much higher than （33.25 ± 4.89） in LBL group（P=0.001） ;the total score was （71.20 ± 8.67） in PBL group,much higher than that of （67.79 ± 9.87） in LBL group（P=0.018） as well.The average scores of choice question in 2 groups were （33.85 ± 5.05） and （34.24 ± 6.87）,without significant differences（P=0.658）.The constituent ratio of answer ‘OK＇ regarding 10 entries in questionnaire was more than 75%.The constituent ratio of answer ‘OK＇ regarding 3 entries（SSP matching degree,SSP without implied language or action,stimulating the learning interest） was more than 90%.Conclusions Introducing SSP PBL teaching can improve students＇ ability of clinical analysis and problem solving but not so effective for the basic theoretical knowledge grasp.SSP could replace standardized patients in PBL teaching.