基于多学科协作的CBL教学法对提高全科医师临床应诊能力的影响研究

doi:10.12114/j.issn.1007-9572.2023.0796

中国全科医学 ›› 2024, Vol. 27 ›› Issue (31): 3941-3945.DOI: 10.12114/j.issn.1007-9572.2023.0796

• 论著·全科医学教育研究 • 上一篇下一篇

基于多学科协作的CBL教学法对提高全科医师临床应诊能力的影响研究

杨士芳¹, 姬路鹏², 李晓明³, 陈雪莹², 赵满芝¹, 黄国华¹, 崔景华¹, 陈炼³^,^*(), 李静¹^,^*()

1．510080　广东省广州市，南方医科大学附属广东省人民医院（广东省医学科学院）呼吸与危重症医学科
2．519055　广东省珠海市第五人民医院呼吸与危重症医学科
3．510080　广东省广州市，南方医科大学附属广东省人民医院（广东省医学科学院）全科医学二科

收稿日期:2023-12-10 修回日期:2024-06-11 出版日期:2024-11-05 发布日期:2024-08-16
通讯作者: 陈炼, 李静
作者贡献：
杨士芳、姬路鹏负责提出研究思路、设计研究方案、研究的实施和撰写论文；李晓明、陈雪莹、黄国华、崔景华负责研究的实施、数据收集与整理；赵满芝负责统计学分析、表的绘制与展示；陈炼、李静负责文章的修订、质量控制与审查，对文章整体负责。

The Impact of MDT-based CBL Education Mode on Improving Clinical Practice Skills of General Practitioners

YANG Shifang¹, JI Lupeng², LI Xiaoming³, CHEN Xueying², ZHAO Manzhi¹, HUANG Guohua¹, CUI Jinghua¹, CHEN Lian³^,^*(), LI Jing¹^,^*()

1. Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
2. Department of Pulmonary and Critical Care Medicine, the Fifth People's Hospital of Zhuhai, Zhuhai 519055, China
3. Department of General Practice 2, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China

Received:2023-12-10 Revised:2024-06-11 Published:2024-11-05 Online:2024-08-16
Contact: CHEN Lian, LI Jing

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摘要/Abstract

摘要： 背景培养高质量的全科医学人才是维护人民群众身体健康的核心，但我国现有的全科医生培养方式仍存在不足，致使全科医生在基层医疗服务中岗位胜任力不足，故如何提高全科医生的岗位胜任力是目前全科医学教学的重中之重。目的探索基于多学科协作（MDT）的CBL教学法对提高全科医师临床应诊能力的影响。方法选取2020年7月—2023年7月在呼吸与危重症医学科培训的26名全科医生为研究对象，按批次分为三组：传统教学组、CBL教学组和MDT+CBL教学组，同一批次教学方法相同。采用莱斯特评估套件（LAP）对学员临床应诊能力进行评价，并采用自主设计的匿名调查问卷进行教学满意度调查。结果理论考核成绩：MDT+CBL教学组考试成绩优于传统教学组和CBL教学组（P<0.05）。临床应诊能力考核：MDT+CBL教学组LAP总分高于传统教学组和CBL教学组（P<0.05），MDT+CBL教学组在接诊和病史采集、患者管理、解决问题、医生行为和与患者的关系及预防性治疗方面的得分均高于传统教学组和CBL教学组（P<0.05）。教学效果的满意度：三种教学模式中MDT+CBL教学模式总体满意度得分高于CBL教学组和传统教学组（P<0.05），且MDT+CBL教学组学员的知识外延能力、指导健康生活方式能力、处理合并症能力、指导患者康复能力和社区合理用药能力得分更高（P<0.05）。结论基于多学科协作的CBL教学法有助于提高全科医师的临床应诊能力和岗位胜任力，是全科医学教学新模式。

关键词: 全科医师, 岗位胜任力, 多学科协作, CBL教学法, 临床应诊能力

Abstract:

Background

The development of excellent general practitioners is essential to preserving people's health. Unfortunately, the general practitioner training model in place today is insufficient, which leaves them unqualified to provide primary medical services. Consequently, enhancing clinical competency should be the main goal of general practitioners' training.

Objective

To investigate how general practitioners' clinical practice abilities are affected by MDT-based CBL education.

Methods

From July 2020 to July 2023, 26 trainee general practitioners received training at the department of pulmonary and critical care medicine as part of their residency programme. As research subjects, they were divided three groups and trained with different model: traditional model, CBL model and MDT-based CBL model, respectively. Leicester Assessment Package (LAP) was used to assess their clinical practice skills by the end. Self-designed questionnaire was used for satisfaction survey anonymously. The results were analyzed statistically.

Results

The MDT-based CBL teaching group outperformed the traditional teaching group and the CBL teaching group in the theoretical examination (P<0.05). The MDT-based CBL teaching group had a significantly higher total LAP score (P<0.05) in comparison to either the conventional teaching group or CBL teaching group. Further investigation revealed that the MDT-based CBL teaching group performed better (P<0.05) in the part of patient admissions, collecting medical histories, patient management, problem solving, physician behavior, patient relationship, and preventive therapy. The students from the MDT-based CBL model had the best overall satisfaction, with a significant difference comparing the students from the CBL and traditional teaching groups (P<0.05). Additionally, the MDT-based CBL teaching group showed a significant improvement in their capacity to guide healthy lifestyle, deal with commodities, guide patient recovery, and use medications after discharge (P<0.05) .

Conclusion

A novel training approach for general practitioner, the MDT-based CBL teaching mode may enhance the clinical practice abilities and competency of general practitioners.

Key words: General practitioners, Job competency, Multi-disciplinary treatment, Cases-based learning, Clinical practice skill

中图分类号:

R 192.3

杨士芳,姬路鹏,李晓明,等. 基于多学科协作的CBL教学法对提高全科医师临床应诊能力的影响研究[J]. 中国全科医学, 2024, 27(31): 3941-3945. DOI: 10.12114/j.issn.1007-9572.2023.0796.
YANG Shifang,JI Lupeng,LI Xiaoming, et al. The Impact of MDT-based CBL Education Mode on Improving Clinical Practice Skills of General Practitioners[J]. Chinese General Practice, 2024, 27(31): 3941-3945. DOI: 10.12114/j.issn.1007-9572.2023.0796.

图/表 3

参考文献 18

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组别	例数	理论知识考核成绩
传统教学组	8	80.73±5.94
CBL教学组	9	85.88±5.76
MDT+CBL教学组	9	92.45±4.98^ab
F值		9.518
P值		0.001

组别	例数	理论知识考核成绩
传统教学组	8	80.73±5.94
CBL教学组	9	85.88±5.76
MDT+CBL教学组	9	92.45±4.98^ab
F值		9.518
P值		0.001

组别	例数	接诊和病史采集	体格检查	患者管理	解决问题	医生行为和与患者的关系	预防性治疗	病史记录	总分
传统教学组	8	14.72±0.71	6.63±0.72	15.04±1.58	14.22±1.52	7.12±0.62	6.82±0.72	8.22±0.74	72.77±6.66
CBL教学组	9	15.44±0.82	7.44±0.62^a	15.68±1.78	16.19±1.67^a	7.29±0.45	7.24±0.62	8.42±0.86	77.70±6.84
MDT+CBL教学组	9	16.44±0.91^ab	7.67±0.78^a	17.72±1.13^ab	17.77±1.27^ab	8.02±0.64^ab	8.13±1.02^ab	8.67±0.62	85.42±6.36^ab
F值		9.435	4.946	7.339	11.960	6.037	5.899	0.777	7.939
P值		0.001	0.016	0.003	<0.001	0.008	0.009	0.472	0.002

组别	例数	接诊和病史采集	体格检查	患者管理	解决问题	医生行为和与患者的关系	预防性治疗	病史记录	总分
传统教学组	8	14.72±0.71	6.63±0.72	15.04±1.58	14.22±1.52	7.12±0.62	6.82±0.72	8.22±0.74	72.77±6.66
CBL教学组	9	15.44±0.82	7.44±0.62^a	15.68±1.78	16.19±1.67^a	7.29±0.45	7.24±0.62	8.42±0.86	77.70±6.84
MDT+CBL教学组	9	16.44±0.91^ab	7.67±0.78^a	17.72±1.13^ab	17.77±1.27^ab	8.02±0.64^ab	8.13±1.02^ab	8.67±0.62	85.42±6.36^ab
F值		9.435	4.946	7.339	11.960	6.037	5.899	0.777	7.939
P值		0.001	0.016	0.003	<0.001	0.008	0.009	0.472	0.002

组别	例数	学习兴趣的激发	学习的主观能动性	知识外延能力	临床思维能力提高	指导健康生活方式能力	处理合并症能力
传统教学组	8	7.09±0.82	7.61±0.71	7.94±0.68	7.23±0.72	7.33±0.65	8.03±0.75
CBL教学组	9	8.45±0.66^a	8.79±0.76^a	8.07±0.64	8.27±0.77^a	7.53±0.68	8.26±0.67
MDT+CBL教学组	9	8.72±0.79^a	9.02±0.72^a	8.79±0.61^ab	9.11±0.72^ab	8.72±0.75^ab	8.97±0.52^ab
F值		11.080	8.909	4.438	13.760	10.180	4.941
P值		<0.001	0.001	0.023	<0.001	<0.001	0.016
组别	指导患者康复能力	社区合理用药能力	团队协作意识	愿意继续接受这种教学方式	总分
传统教学组	6.89±0.75	7.42±0.88	7.44±0.82	7.01±0.65	73.86±7.33
CBL教学组	7.31±0.68	7.78±0.78	8.77±0.67^a	8.06±0.76^a	81.26±6.12^a
MDT+CBL教学组	8.59±0.65^ab	8.66±0.56^ab	8.85±0.72^a	8.93±0.54^ab	88.42±6.68^ab
F值	14.190	6.317	9.632	18.120	10.000
P值	<0.001	0.007	0.001	<0.001	0.001

基于多学科协作的CBL教学法对提高全科医师临床应诊能力的影响研究

The Impact of MDT-based CBL Education Mode on Improving Clinical Practice Skills of General Practitioners

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