目的 探讨基于问题学习(problem-based learning,PBL)结合基于人体模型的医学模拟教学在住院医师创面修复教学中的应用效果。 方法 本研究采用试验对照方法。2022年1至12月,以解放军总医院第一医学中心接受住院医师规范化培训的60名学员为研究对象,采用随机数字表法将其平均分为试验组和对照组。试验组学员采用PBL结合基于人体模型的医学模拟教学方法,对照组学员采用传统课堂讲授结合基于人体模型的医学模拟教学方法。在为期2个月的创面修复教学结束后,通过两组学员考核成绩和问卷调查结果评价各自教学效果,采用χ²检验和t检验分析相关数据。 结果 两组学员应用皮瓣修复创面的理论考试成绩比较,其差异无统计学意义[(88.3±5.1)分比(87.9±4.7)分,P=0.726];试验组学员的实践考试成绩高于对照组学员,其差异具有统计学意义[(92.6±5.1)分比(80.4±6.2)分,P=0.012]。问卷调查结果显示,PBL结合基于人体模型的医学模拟教学在激发学员的学习兴趣,提高其自学能力、皮瓣设计的临床应用能力和创新能力培养等方面,试验组学员赞成的比例均高于对照组学员[86.7%(26/30)比60.0%(18/30),90.0%(27/30)比50.0%(15/30),96.7%(29/30)比63.3%(19/30),90.0%(27/30)比50.0%(15/30)],其差异均具有统计学意义(均P＜0.05)。 结论 PBL结合基于人体模型的医学模拟教学有助于提高学员在短时间内应用皮瓣的临床实践能力,并得到住培学员的认可,实现了迅速提高学员应用皮瓣修复创面能力的培养目标。

Objective To explore the effect of applying problem-based learning (PBL) combined with medical simulation teaching based on human models in the teaching of wound repair for resident physicians. Methods The experimental control method was used. From January to December 2022, 60 trainees undergoing standardized residency training at the First Medical Center of the People′s Liberation Army General Hospital were enrolled. They were randomly divided into an experimental group and a control group using a random number table method. The experimental group used PBL combined with simulation teaching method based on human body model, while the control group used traditional teaching combined with simulation teaching method based on human body model. After a 2-month wound repair teaching, the teaching effectiveness was evaluated based on assessment scores and questionnaire survey results, and relevant data was analyzed using a chi square test and t-test. Results There was no statistically significant difference in the theoretical exam scores of the two groups of trainees using skin flaps to repair wounds [(88.3 ± 5.1) vs. (87.9 ± 4.7), P=0.726]. The practical exam scores of the experimental group were higher than those of the control group, and the difference was statistically significant [(92.6 ± 5.1) vs. (80.4 ± 6.2), P=0.012]. The results of the questionnaire survey showed that the combination of PBL and simulation teaching based on human models was able to stimulate trainees′ learning interest, improve their self-learning ability, enhance their clinical application ability of skin flap design, master clinical skills, and cultivate innovation ability. The proportion of trainees in the experimental group who agree with it were higher than those of the control group [86.7% (26/30) vs.60.0% (18/30),90.0% (27/30 ) vs.50.0% (15/30),96.7% (29/30) vs.63.3% (19/30),90.0% (27/30) vs.50.0% (15/30) ], and the differences were statistically significant (all P<0.05). Conclusions The combination of PBL and medical simulation teaching based on human models helped improve the clinical practice ability of students to apply skin flaps in a short period of time, and was recognized by resident trainees, achieving the training goal of rapidly improving students′ ability to use skin flaps to repair wounds.