本文關(guān)鍵詞： PBL教學(xué)法 診斷學(xué) 實(shí)驗(yàn)教學(xué) 效果評(píng)價(jià)　出處：《山東大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景《診斷學(xué)》是研究如何運(yùn)用診斷疾病的基礎(chǔ)理論、基本知識(shí)和基本技能對(duì)患者提出正確診斷,及對(duì)醫(yī)學(xué)生進(jìn)行臨床診斷性思維培養(yǎng)的一門(mén)學(xué)科,它是基礎(chǔ)醫(yī)學(xué)向臨床醫(yī)學(xué)過(guò)渡的重要橋梁課程之一,也是臨床各科的基礎(chǔ)課程,在醫(yī)學(xué)生整個(gè)醫(yī)學(xué)教育過(guò)程中發(fā)揮重要作用。《診斷學(xué)》是一門(mén)實(shí)踐性較強(qiáng)的課程,診斷學(xué)實(shí)驗(yàn)教學(xué)在整個(gè)教學(xué)過(guò)程中占有重要地位,因此教學(xué)時(shí)間的安排明顯傾向于實(shí)驗(yàn)教學(xué)。理論教學(xué)時(shí)間和實(shí)驗(yàn)教學(xué)時(shí)間課時(shí)的安排通常是1：1,每學(xué)期的課時(shí)分別為36學(xué)時(shí)。另外實(shí)驗(yàn)教學(xué)還大量利用周末、晚上及自習(xí)課等業(yè)余時(shí)間來(lái)開(kāi)放實(shí)驗(yàn)室,開(kāi)放實(shí)驗(yàn)室的時(shí)間每學(xué)期大約為18學(xué)時(shí),這樣每學(xué)期理論為36學(xué)時(shí),實(shí)驗(yàn)為54學(xué)時(shí),實(shí)驗(yàn)教學(xué)時(shí)間已遠(yuǎn)遠(yuǎn)超過(guò)理論授課時(shí)間。診斷學(xué)實(shí)驗(yàn)教學(xué)任務(wù)既要培養(yǎng)學(xué)生牢固地掌握臨床各項(xiàng)基本技能,還要培養(yǎng)學(xué)生的診斷性思維,教會(huì)學(xué)生如何通過(guò)問(wèn)診和體格檢查真實(shí)客觀(guān)地獲得第一手資料,并能將以前所學(xué)的解剖、生理、病理生理等基礎(chǔ)課與診斷學(xué)進(jìn)行有機(jī)結(jié)合并融會(huì)貫通,全面培養(yǎng)醫(yī)學(xué)生臨床職業(yè)的綜合素質(zhì)。這些素質(zhì)的培養(yǎng)不但對(duì)于后期開(kāi)設(shè)的臨床課程的學(xué)習(xí),是否完成臨床見(jiàn)習(xí)、實(shí)習(xí)的順利過(guò)渡,以至于將來(lái)走向工作崗位后的臨床工作水平和質(zhì)量都有著至關(guān)重要的影響。但是《診斷學(xué)》作為一門(mén)橋梁課,學(xué)科涉及范圍廣,幾乎涉及到了醫(yī)學(xué)所有的基礎(chǔ)醫(yī)學(xué)課程和和臨床醫(yī)學(xué)課程。其概念、操作標(biāo)準(zhǔn)及規(guī)范、生理指標(biāo)的正常值、異常值等內(nèi)容較多,而且大都瑣碎、枯燥無(wú)味,有些內(nèi)容還模糊、抽象,單純死記硬背很難激起學(xué)生的學(xué)習(xí)興趣,學(xué)習(xí)的熱情很難維持太久。而傳統(tǒng)的實(shí)驗(yàn)教學(xué)方法也只是將這些技能的操作方法機(jī)械地傳授給學(xué)生,記住大量的正常參考值及其異常時(shí)的臨床意義,忽略了學(xué)生綜合利用通過(guò)檢查而獲取的信息進(jìn)行處理的能力培養(yǎng),阻礙了學(xué)生臨床綜合分析思維的發(fā)展和提高,由于學(xué)習(xí)缺乏目的性,學(xué)生學(xué)習(xí)的主動(dòng)性、積極性差,學(xué)習(xí)效果欠佳,不能完全達(dá)到預(yù)期的教學(xué)目標(biāo),也就不能很好地完成由學(xué)校學(xué)習(xí)進(jìn)入臨床學(xué)習(xí)的順利過(guò)渡。研究目的“基于問(wèn)題的學(xué)習(xí)”(Problem-Based Learning,PBL)是以問(wèn)題為基礎(chǔ),以學(xué)生為主體,以小組討論為形式,在老師的參與下,圍繞某一專(zhuān)題或具體病例的診治等問(wèn)題進(jìn)行探討的一種學(xué)習(xí)方法。該法最早起源于20世紀(jì)50年代美國(guó)西余大學(xué)醫(yī)學(xué)院的綜合課程教育,目前已成為國(guó)際上較為流行的一種教學(xué)方法。國(guó)內(nèi)、外專(zhuān)家研究PBL教學(xué)可使學(xué)生通過(guò)主動(dòng)學(xué)習(xí),小組內(nèi)學(xué)生的充分交流與溝通,小組成員的協(xié)作與團(tuán)隊(duì)的集體智慧,解決學(xué)習(xí)過(guò)程中一個(gè)又一個(gè)問(wèn)題,使學(xué)生不僅學(xué)習(xí)到了知識(shí),而且更重要的是培養(yǎng)了學(xué)生的自主學(xué)習(xí)能力、臨床思維能力、解決問(wèn)題能力、溝通交流能力和團(tuán)隊(duì)協(xié)作精神。在PBL實(shí)驗(yàn)教學(xué)過(guò)程中,圍繞典型病例展開(kāi)的學(xué)習(xí),不但集知識(shí)獲取與能力培養(yǎng)于一體,且能夠有效地強(qiáng)化學(xué)生對(duì)理論知識(shí)的理解,并能促進(jìn)知識(shí)的實(shí)踐與遷移,從而實(shí)現(xiàn)理論知識(shí)與實(shí)踐能力的同步構(gòu)建。但PBL這種行之有效的教學(xué)方法在醫(yī)學(xué)理論的授課中應(yīng)用較多,都取得了較好的教學(xué)效果。PBL教學(xué)法在《診斷學(xué)》實(shí)驗(yàn)教學(xué)過(guò)程中應(yīng)用的研究尚未見(jiàn)報(bào)道。所以我們針對(duì)目前診斷學(xué)實(shí)驗(yàn)教學(xué)的現(xiàn)狀,在實(shí)驗(yàn)教學(xué)過(guò)程中嘗試部分開(kāi)展PBL教學(xué),目的是探索PBL教學(xué)法在《診斷學(xué)》實(shí)驗(yàn)教學(xué)過(guò)程中的可行性和優(yōu)越性；同時(shí)了解一下這種新的教學(xué)方法在開(kāi)展的過(guò)程會(huì)存在哪些困難,存在的困難可以通過(guò)什么措施進(jìn)行解決,也可以結(jié)合學(xué)校實(shí)際,大膽嘗試,希望發(fā)揮PBL先進(jìn)教學(xué)模式優(yōu)越性的同時(shí),也為更順利地推進(jìn)實(shí)驗(yàn)教學(xué)工作的開(kāi)展。研究方法以整群隨機(jī)抽樣的方法,從2011級(jí)臨床醫(yī)學(xué)專(zhuān)業(yè)20個(gè)班內(nèi)隨機(jī)抽取6個(gè)班,然后將6個(gè)班隨機(jī)分成A組和B組。然后分別在A(yíng)組和B組內(nèi)再采用二階段抽樣的方法,從每個(gè)班隨機(jī)抽取2/3的學(xué)生組成實(shí)驗(yàn)組和對(duì)照組。實(shí)驗(yàn)組和對(duì)照組學(xué)生分別為109人,研究對(duì)象共計(jì)218人。為消除由不同教師授課帶來(lái)的偏差,固定一名教師作為研究對(duì)象的實(shí)驗(yàn)帶教老師。實(shí)驗(yàn)組采用PBL教學(xué)法,對(duì)照組采用傳統(tǒng)教學(xué)法。課程開(kāi)始前、課程結(jié)束后,發(fā)放調(diào)查問(wèn)卷,收集兩組學(xué)生的階段性實(shí)驗(yàn)考試成績(jī)、調(diào)查問(wèn)卷結(jié)果,將所得資料建立數(shù)據(jù)庫(kù),利用EXCEL和SPSS17.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,定量資料采用均數(shù)±標(biāo)準(zhǔn)差表示,問(wèn)卷1、2：將‘"A"、"B"、"C"、"D"、"E"選項(xiàng)分別賦值“1”、“2”、“3”、“4”及“5”分,組間比較采用兩獨(dú)立樣本的t檢驗(yàn)、x2檢驗(yàn),問(wèn)卷3：將“A”、“B”、“C”選項(xiàng)分別賦值為“1”、“2”、“3”分,組間比較采用兩獨(dú)立樣本的χ2檢驗(yàn)。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果經(jīng)研究發(fā)現(xiàn),在診斷實(shí)驗(yàn)課程開(kāi)始前,實(shí)驗(yàn)組和對(duì)照組的學(xué)生在學(xué)習(xí)習(xí)慣、專(zhuān)業(yè)思想態(tài)度方面并沒(méi)有明顯差異(P0.05)。在診斷學(xué)實(shí)驗(yàn)課程開(kāi)始后,使用PBL教學(xué)法的實(shí)驗(yàn)組學(xué)生與使用傳統(tǒng)教學(xué)方法的對(duì)照組學(xué)生相比,實(shí)驗(yàn)組學(xué)生能夠積極開(kāi)動(dòng)腦筋,提出問(wèn)題,分析問(wèn)題,最后解決問(wèn)題。在學(xué)習(xí)習(xí)慣的改善、專(zhuān)業(yè)思想態(tài)度加強(qiáng)、臨床診斷性思維的培養(yǎng)、學(xué)習(xí)積極性主動(dòng)性提高、人際交流能力的提高等方面,實(shí)驗(yàn)組明顯高于對(duì)照組(P0.05),在實(shí)施PBL教學(xué)的整個(gè)過(guò)程中,培養(yǎng)了醫(yī)學(xué)生多方面的能力,同時(shí)實(shí)驗(yàn)階段性操作考試成績(jī)實(shí)驗(yàn)組和對(duì)照組也存在明顯差異,其中實(shí)驗(yàn)組心肺聽(tīng)診平均得分7.27+1.14分、體格檢查平均得分8.10±0.88分、病歷書(shū)寫(xiě)平均得分8.39±1.11分、實(shí)驗(yàn)考試總分為23.75±2.22。而對(duì)照組心肺聽(tīng)診平均得分7.18±1.07分、體格檢查平均得分7.78±0.73分、病歷書(shū)寫(xiě)平均得分7.95+0.76分、實(shí)驗(yàn)考試總分為22.91±1.61。除心肺聽(tīng)診實(shí)驗(yàn)成績(jī)差異無(wú)統(tǒng)計(jì)學(xué)意義差異(P0.05)外,其余幾項(xiàng)成績(jī)實(shí)驗(yàn)組均高于對(duì)照組(P0.05)。結(jié)論與建議PBL教學(xué)法同樣適用于《診斷學(xué)》實(shí)驗(yàn)教學(xué),在實(shí)驗(yàn)教學(xué)中相對(duì)于傳統(tǒng)教學(xué)方法具有明顯的優(yōu)越性。在實(shí)施的過(guò)程中我們結(jié)合教學(xué)實(shí)際情況給予適當(dāng)改進(jìn)是可行的、有效的。PBL教學(xué)法是順應(yīng)當(dāng)今醫(yī)學(xué)教育形勢(shì)發(fā)展的一種教學(xué)方法。盡管目前在《診斷學(xué)》實(shí)驗(yàn)教學(xué)中全面實(shí)施PBL教學(xué)法還存在著一些困難,但不能因?yàn)樵趯?shí)施過(guò)程中存在的困難就否定該種教學(xué)方法的優(yōu)越性,我們應(yīng)契合當(dāng)今醫(yī)學(xué)教育發(fā)展的有力條件,整合各種教學(xué)資源,充分調(diào)動(dòng)師生的工作學(xué)習(xí)積極性,培養(yǎng)適合時(shí)代發(fā)展的高素質(zhì)醫(yī)學(xué)人才
[Abstract]:< > background diagnostics is the basic theoretical research on how to use the diagnosis of diseases, basic knowledge and basic skills of correct diagnosis of patients, and for medical students in clinical diagnostic thinking of a subject, it is one of the important bridge course of basic medicine to clinical medicine and clinical departments of transition, basic course, play in the process of medical students in the whole medical education plays an important role in diagnosis. < > is a practical course of diagnostics teaching occupies an important position in the whole process of teaching, so the teaching schedule was inclined to experiment teaching. The theory of teaching time and the time of experiment teaching arrangement is usually 1:1, each semester hour was 36 hours. The other experimental teaching but also a large number of the weekend, and evening self-study class of spare time to open laboratory, open laboratory time per term About 18 hours per semester, this theory is 36 hours, the experiment for 54 hours, the time of experiment teaching has been far more than the theory of teaching time. Diagnostics teaching task is to train the students to master the basic skills of clinical firmly, but also cultivate the diagnosis of thinking of students, teach students how to inquiry and physical examination objectively to obtain first-hand information, and the previous study of anatomy, physiology, pathophysiology and other basic courses and diagnostics are combined and mastery, all-round development of clinical medical students occupation. The quality of training not only for clinical courses later opened learning, whether the completion of clinical probation, the smooth transition of practice and that future work after the clinical work level and quality are important influence. But < diagnostics > as a bridge class, subject area Broad, involving almost all medical courses in Basic Medical Sciences and clinical medicine courses. Its concept, operation standards and norms, physiological indexes of normal, abnormal value more content, and most of them are trivial, some content is still vague, dull as ditch water, abstract, Dan Chunsi rote is difficult to arouse students' interest in learning, learning passion is difficult to maintain for a long time. And the traditional experiment teaching method is the method of operation of these mechanical skills to teach their students, remember the normal reference a large number of values and clinical significance of abnormal, neglected to cultivate students' ability of comprehensive utilization of the information obtained through the examination process, hinders the development of students' clinical comprehensive analysis of thinking and improve, because of the lack of purpose of learning, students' learning initiative, enthusiasm, learning effect is poor, can not fully achieve the desired teaching goal, also cannot Well done by the school for a smooth transition into clinical learning. The purpose of the study of "problem based learning" (Problem-Based Learning PBL) is a problem based, student-centered, group discussion to form in the teacher's participation, a method of learning a subject or problem on specific cases diagnosis and treatment are discussed. The method of integrated curriculum originated in the United States in 1950s more than the West University School of medicine and education, has become a kind of teaching method is more popular in the world. Domestic and foreign experts on PBL teaching can make students through active learning, full exchange and communication within the group of students, cooperation and collective wisdom the team members of the learning process, to solve a problem, so that students not only learn knowledge, but more important is to cultivate students' autonomous learning ability and clinical thinking ability To solve the problem, ability, communication skills and teamwork spirit. In the PBL experiment teaching process, focus on typical cases of learning, not only in knowledge acquisition and ability training in one, and can effectively enhance the students' understanding of theoretical knowledge, and can promote the transfer of knowledge and practice, so as to realize the synchronous construction of theoretical knowledge and practice ability. But the effective teaching method of PBL in medical theory teaching in the application of more, have achieved good teaching effect of.PBL teaching method in the diagnosis of < Application > in the process of experiment teaching has not yet been reported. So we aimed at the status of the diagnosis of experimental teaching, try to carry out the teaching part in PBL in the process of experimental teaching, the aim is to explore the teaching method of PBL in the diagnosis of "the feasibility and superiority of science" in the course of experimental teaching; at the same time learn about this new teaching method in To carry out the process there will be difficulties, difficulties can be solved by what measures can also be combined with the actual school, a bold attempt, I hope to play the superiority of the PBL advanced teaching mode at the same time, also to more successfully promote experimental teaching work. The research method using a cluster random sampling method from 6. Class 2011 randomly selected 20 classes of the clinical medicine, then 6 classes were randomly divided into A group and B group. Then respectively in A group and B group with two stage sampling, randomly selected from each class of 2/3 students in the experimental group and control group. The experimental group and control group students 109 people were the object of study, a total of 218 people. In order to eliminate the bias caused by different teachers, fixed a teacher as the research object of the experiment teachers. The experimental group adopted PBL teaching method, the control group used the traditional teaching method. The course before the start ,璇劇▼緇撴潫鍚，

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