目的 编制具有科学性、实用性的医学生死亡教育体验式学习需求评估工具,并检验其信度和效度。 方法 2023年1至2月,基于前期质性研究和文献研究结果形成评估工具条目池,采用目的抽样法对14名专家进行德尔菲专家函询。2023年2至4月,采用便利抽样法,选取16个省级行政区、23所院校的1 108名医学生进行问卷调查,以分析条目并进行信度和效度检验。 结果 构建出的医学生死亡教育体验式学习需求评估工具,包括“希望学习到的死亡教育内容”和“感兴趣的死亡教育教学方式”2个部分,共有14个维度53个条目,2个部分的累积方差贡献率分别为87.52%和85.52%, χ2和自由度之比(χ2/DF)分别为5.452和4.627,近似误差均方根(RMSEA)分别为0.069和0.062,拟合优度指数(GFI)分别为0.860和0.927,比较拟合优质指数(CFI)分别为0.957和0.972、规范拟合指数(NFI)分别为0.948和0.964、增值拟合指数(IFI)分别为0.957和0.972、非标准拟合指数(TLI)分别为0.950和0.965。总评估工具的克朗巴赫系数为0.985,重测信度系数为0.712。结论 医学生死亡教育体验式学习需求评估工具具有较好的信度和效度,可以作为调查医学生对死亡教育体验式学习需求的可靠工具。
Objective To develop an assessment tool on experiential learning needs for death education in medical students with scientificity and practicality, and to test its reliability and validity. Methods Between January and February 2023, an item pool for the assessment tool was developed based on findings from prior qualitative research and literature review. Using purposive sampling, a Delphi consultation was conducted with 14 experts. From February to April 2023, a convenience sampling strategy was employed to survey 1 108 medical students from 23 institutions across 16 provinces and municipalities. The survey data were used for item analysis as well as reliability and validity testing. Results The experiential learning needs assessment tool for medical students in death education was developed to include 2 sections: ″desired content in death education″ and ″preferred teaching methods″, comprising 14 dimensions and 53 items. The cumulative variance contribution rates for the two sections were 87.52% and 85.52%, respectively. The ratio of χ2 and degrees of freedom (χ2/DF) were 5.452 and 4.627, the root mean square error of approximation (RMSEA) were 0.069 and 0.062, the goodness of fit indices (GFI) were 0.860 and 0.927, the comparative fit quality indices (CFI) were 0.957 and 0.972, the normative fit indices (NFI) were 0.948 and 0.964, the incremental fit indices (IFI) were 0.957 and 0.972; and the non-normed fit index (TLI) were 0.950 and 0.965. The overall Cronbach′s α coefficient of the tool was 0.985, and the test-retest reliability coefficient was 0.712. Conclusions The assessment tool on experiential learning needs for death education in medical students demonstrated good reliability and validity, which can be used as a reliable tool to investigate the needs of medical students for experiential learning in death education in the future.
[1] 王云岭. 死亡教育纳入国民教育体系探究[J].科学与社会,2020,10(3):1-13,65. DOI: 10.19524/j.cnki.10-1009/g3.2020.03.001.
[2] 韩小玉, 张猛. 中国传统生命哲学与临终关怀的几点思考[J].医学与哲学,2019,40(7):37-39.
[3] 吴利平, 陈利平, 徐晔. 医学生死亡焦虑及生命意义感问题调研及对策研究[J].中国卫生事业管理,2022,39(6):467-470.
[4] 陈兴强.职业院校医学实习生临床接触死亡事件与临终关怀态度现状及其相关研究[J].卫生职业教育,2021,39(4):66-68.
[5] 许丽杰, 岳鹏, 肖瑶, 等. 生命关怀与死亡教育社会实践课程的设计及教学实践研究[J].中华护理教育,2025,22(1):55-60. DOI: 10.3761/j.issn.1672-9234.2025.01.009.
[6] 孙瑜. 体验式学习理论及其在成人培训中的运用[D].上海: 华东师范大学,2007.
[7] Hwang HL, Lin HS, Chen WT. Evaluation of life and death studies course on attitudes toward life and death among nursing students[J]. Kaohsiung J Med Sci, 2005,21(12):552-560. DOI: 10.1016/S1607-551X(09)70207-4.
[8] 宋莉娟, 杜苗, 朱爱勇, 等. 本科生死教育课程中濒死期照护的教学方案设计与实践[J].中华护理教育,2024,21(6):700-705. DOI: 10.3761/j.issn.1672-9234.2024.06.010.
[9] 岳鹏, 许丽杰, 高丽, 等. 医学生“生命关怀与死亡教育”课程的设计与实施[J].中国护理管理,2024,24(2):161-164. DOI: 10.3969/j.issn.1672-1756.2024.02.001.
[10] Kolb DA. Experiential learning: experience as the source of learning and development[M]. 2nd ed.New Jersey: Pearson FT Press, 2015:1-23.
[11] 吕林海. 解读康德建构主义思想的缘起、内涵及当代教育启示[J].现代远程教育研究,2012(5):9-16. DOI: 10.3969/j.issn.1009-5195.2012.05.002.
[12] Tang Q, Xu T, Li Z, et al. Bereavement and professional competencies: exploring the personal experience of death among nursing students-a qualitative study[J]. Omega (Westport), 2025,91(4):1984-2006. DOI: 10.1177/00302228231167495.
[13] 唐倩倩. 生死与共——基于生命经历的护理专业死亡教育体验式学习的需求研究[D].北京:首都医科大学,2023.
[14] 曾光. 现代流行病学方法与应用[M].北京:北京医科大学、中国协和医科大学联合出版社,1994:250-270.
[15] 吴明隆. 问卷统计分析实务:SPSS 操作与应用[M].重庆:重庆大学出版社,2010:166-183.
[16] 孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京:人民卫生出版社,2014:485-492.
[17] 邱皓政. 量化研究与统计分析SPSS中文视窗版数据分析范例解析[M].重庆:重庆大学出版社,2009:299-301
[18] 吴明隆. 结构方程模型:AMOS的操作与应用[M]. 2版. 重庆:重庆大学出版社,2010:42-53.
[19] 王静爱, 余瀚.中国地理区域划[EB/OL]. (2001-12-19)[2023-11-21].https://www.zgbk.com/ecph/words?SiteID=1&ID=552840&Type=bkzyb&SubID=234808.
[20] Andersen HE, Larsen KV. Sculpting with people-an experiential learning technique[J]. Nurse Educ Pract,2015,15(6):556-560. DOI: 10.1016/j.nepr.2015.07.014.
[21] Mallory JL. The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students[J]. J Prof Nurs, 2003,19(5):305-312. DOI: 10.1016/s8755-7223(03)00094-2.
[22] 黄丽群, 倪娜, 张黎, 等. 医学院校开展死亡教育模式初探[J]. 护理研究, 2017, 31(10): 1256-1259.
[23] 陈玲玲. 护理专业学生死亡焦虑及死亡教育需求的调查研究[J].中华护理教育,2018,15(6):444-448. DOI: 10.3761/j.issn.1672-9234.2018.06.011.
[24] 胡少芬, 刘晓英, 桑美丽, 等. 高等医学院校护理生命教育课程实施现状分析[J].护理学杂志,2013,28(20):88-89. DOI: 10.3870/hlxzz.2013.20.088.
[25] 刘宇. 护理学专业死亡教育课程知识体系构建研究[D]. 延吉: 延边大学, 2019.
[26] 周涵冰, 李鑫雅, 陈颖, 等. 医学生对开展死亡教育的需求与实施途径研究——以昆明医科大学为例[J]. 文化创新比较研究, 2020, 4(14): 30-32.
