目的 探讨基于建构主义与ISO15189的GROW模型教学在医学检验实习教学中的实践与评估。方法 采用试验对照研究。选择2022年6月至2024年5月在汕头大学医学院附属深圳儿童医院检验科实习的医学检验技术专业36名本科学生为研究对象,在ISO15189质量认可前选择18名学生作为对照组,认可后选择18名学生作为试验组。试验组学生采用基于建构主义与ISO15189的GROW模型教学,对照组学生采用传统实习教学。采用柯氏四级评估模型对教学效果进行反应层、学习层、行为层和结果层评价。采用独立样本t检验、 χ2检验处理相关数据。结果 (1)反应层:试验组学生教学方法满意度评分为(4.39±0.61)分,高于对照组学生的(3.89±0.58)分,差异具有统计学意义(P=0.017)。(2)学习层:试验组学生ISO15189质量管理体系知识考试成绩为(87.67±5.37)分,高于对照组学生的(83.89±4.68)分,差异具有统计学意义(P=0.031),试验组学生技能操作和模拟情景化应答考核、职业积极态度和自信心评分均高于对照组,差异均具有统计学意义(均P<0.05);而专业理论知识考核成绩差异无统计学意义(P>0.05)。教学前,两组学生批判性思维能力测量表和个人成长主动性量表评分差异均无统计学意义(均P>0.05);教学后,试验组学生前述2项量表评分高于对照组,差异均具有统计学意义(均P<0.05)。(3)行为层:试验组学生在带教教师监督下现场操作检验临床标本、对临床真实病例进行报告解读和沟通能力的总分为(82.33±1.50)分,高于对照组的(79.11±2.74)分,差异具有统计学意义(P<0.001)。(4)结果层:实习结束后6个月,两组学生毕业后的研究生录取率和就业率差异均无统计学意义(均P>0.05);用人单位对试验组学生专业技能、职业素养、管理能力、个人综合素质等岗位胜任力评价的总分为(89.20±10.40)分,高于对照组的(80.30±7.80)分,差异具有统计学意义(P<0.001)。结论 基于建构主义与ISO15189的GROW模型教学从多层次提升了学生的实习教学成效,有助于培养高质量医学检验技术人才。
Objective To explore the practice and evaluation of GROW model teaching based on constructivism and ISO15189 in the internship teaching of clinical laboratory technology. Methods A controlled experimental study was conducted. A total of 36 undergraduate students majoring in clinical laboratory technology who interned in the Laboratory Department of Affiliated Shenzhen Children's Hospital of Shantou University Medical College from June 2022 to May 2024 were selected as research subjects. Eighteen students who interned before ISO15189 accreditation were assigned to the control group, and 18 students who interned after accreditation were assigned to the experimental group. The experimental group received GROW model teaching based on constructivism and ISO15189, while the control group received traditional internship teaching. The Kirkpatrick Four-Level Evaluation Model was used to assess teaching effectiveness at the reaction level, learning level, behavior level, and result level. Data were analyzed using independent sample t-test and chi-square test. Results (1) Reaction level: The satisfaction score for the teaching method in the experimental group (4.39±0.61) was higher than that in the control group (3.89±0.58), P=0.017. (2) Learning level: The exam score on the ISO15189 quality management system in the experimental group (87.67±5.37) was higher than that in the control group (83.89±4.68), P=0.031. The experimental group also achieved higher scores in skill operation and simulated scenario response assessments, as well as in professional positive attitude and self-confidence (all P<0.05). However, there was no significant difference between the two groups in the theoretical knowledge exam score (P>0.05). Before teaching, there were no significant differences between the two groups in the scores of the Critical Thinking Disposition Inventory and the Personal Growth Initiative Scale (both P>0.05). After teaching, the experimental group scored significantly higher than the control group on both scales (both P<0.05). (3) Behavior level: The total score for hands-on clinical specimen operation under teacher supervision, clinical real-case report interpretation, and communication ability in the experimental group (82.33±1.50) was higher than that in the control group (79.11±2.74), P<0.001.(4) Result level: Six months after the internship, there were no significant differences between the two groups in the postgraduate admission rate or employment rate (both P>0.05). However, employers' evaluation scores for job competencies, including professional skills, professional quality, management ability, and overall personal comprehensive quality, were higher in the experimental group (89.20±10.40) than in the control group (80.30±7.80), P<0.001. Conclusions The GROW model teaching based on constructivism and ISO15189 improves students' internship teaching effectiveness at multiple levels and helps cultivate high-quality clinical laboratory technology professionals.
[1] Vanstapel F, Orth M, Streichert T, et al. ISO 15189 is a sufficient instrument to guarantee high-quality manufacture of laboratory developed tests for in-house-use conform requirements of the European In-Vitro-Diagnostics Regulation[J]. Clin Chem Lab Med, 2023,61(4):608-626. DOI: 10.1515/cclm-2023-0045.
[2] ISO 15189: 2022 Medical laboratories-requirements for quality and competence[S/OL].(2022-12-06)[2025-05-30].https://www.iso.org/standard/76677.html.
[3] 广西医科大学附属民族医院.接轨国际标准！我院检验科通过ISO15189认证[EB/OL].(2025-03-26)[2025-05-30].https://gxmzyy.gxrb.com.cn/xwzx/yyxw/396290.html.
[4] 蚌埠医科大学检验医学院.检验医学院举办检验医学教育领域专题讲座[EB/OL].(2025-05-15)[2025-05-30].https://jyx.bbmu.edu.cn/info/1050/6924.htm.
[5] Consorti F, Familiari G, Lotti A, et al. Medical education in Italy: challenges and opportunities[J]. Med Teach, 2021,43(11):1242-1248. DOI: 10.1080/0142159X.2021.1959024.
[6] 戴芳, 朱冬敏, 黄冬梅, 等. 病例教学法在医学检验技术专业实习教学中的应用[J].检验医学与临床,2023,20(21):3253-3256. DOI: 10.3969/j.issn.1672-9455.2023.21.038.
[7] 李宗清, 王敏, 潘峰. 基于ISO 15189质量管理体系的PBL+CBL双轨教学模式在检验科实习生带教中的应用[J].中国高等医学教育,2023(3):49-50. DOI: 10.3969/j.issn.1002-1701.2023.03.020.
[8] 赵婧, 袁静波, 赵洋, 等. 将ISO15189质量管理体系融入医学检验技术专业本科实习的教学模式探讨[J].铜陵职业技术学院学报,2024,23(1):55-59. DOI: 10.16789/j.cnki.1671-752x.2024.01.011.
[9] Clark KR. Learning theories: constructivism[J]. Radiol Technol, 2018,90(2):180-182.
[10] Thampinathan S. The application of the constructivism learning theory to physician assistant students in primary care[J]. Educ Health (Abingdon), 2022,35(1):26-30. DOI: 10.4103/efh.EfH_333_20.
[11] 聂伟进,汪卫平. 基于柯氏模型的高职教师培训评价体系构建[J]. 教师教育研究,2021,33(2):31-37. DOI:10.13445/j.cnki.t.e.r.2021.02.005.
[12] 王璐, 徐阳婷, 李沛迪, 等. 某高校医学本科生批判性思维能力的现状和提升策略[J].中华医学教育杂志,2024,44(4):246-250. DOI: 10.3760/cma.j.cn115259-20230321-00292.
[13] 王伊萌. 大学生正念与个人成长主动性对智慧推理的影响以及反思视角的调节作用[D].南京:南京师范大学,2020. DOI:10.27245/d.cnki.gnjsu.2020.002283.
[14] 邱模昌, 吴剑, 黄丹, 等. 基层医疗机构临床检验技师岗位胜任力评价指标体系的构建[J].职业教育,2023,22(26):47-50. DOI: 10.3969/j.issn.2095-4530.2023.26.011.
[15] 王传新. 新时代检验医学发展定位与思考[J].中华检验医学杂志,2022,45(1):1-4. DOI: 10.3760/cma.j.cn114452-20211209-00762.
[16] Melvin A, Patel RS. Applying educational theory to medical education research[J]. Clin Exp Dermatol, 2022,47(12):2085-2089. DOI: 10.1111/ced.15287.
[17] Suwannaphisit S, Anusitviwat C, Hongnaparak T, et al. Expectations on online orthopedic course using constructivism theory: A cross-sectional study among medical students[J]. Ann Med Surg(Lond), 2021,67:102493. DOI: 10.1016/j.amsu.2021.102493.
[18] Mitchell S, Sehlbach C, Franssen G, et al. Taxonomy of teaching methods and their use in health professions education: a scoping review protocol[J]. BMJ Open, 2024,14(1):e077282. DOI: 10.1136/bmjopen-2023-077282.
[19] 侯晓静, 李卫宁, 冯骏. 医学院校《健康教育学》课程教学模式构建与实施[J].中华医学教育探索杂志,2025,24(4):506-511. DOI: 10.3760/cma.j.cn116021-20231222-01954.
[20] Jagpal S, Fant A, Bianchi R, et al. Teaching quality improvement: the use of education theories across the medical education spectrum[J]. Cureus, 2022,14(7):e26625. DOI: 10.7759/cureus.26625.
[21] 马翠萍, 谢劲波, 郑少兵, 等. 建构主义理论教考联动模式用于机器人辅助手术护理带教对教学质量的影响[J].机器人外科学杂志(中英文),2025,6(2):300-304. DOI:10.12180/j.issn.2096-7721.2025.02.020.
[22] Shaughnessy AF, Erlich DR. The science of education: using learning theory to solve teaching problems in medical education[J]. Educ Prim Care, 2022,33(4):194-198. DOI: 10.1080/14739879.2022.2053344.
[23] 王嫣, 王智彪, 李发琪, 等. 基于OBE线上线下混合式医学专业和人文精神融合的课程设计和实践[J].中华医学教育探索杂志,2025,24(4):535-539. DOI: 10.3760/cma.j.cn116021-20231112-02000.
[24] Kang KI, Lee N, Joung J. Nursing students' experience of online peer tutoring based on the grow model: a qualitative study[J]. Nurse Educ Today, 2021,107:105131. DOI: 10.1016/j.nedt.2021.105131.
[25] Bandura A.Toward a psychology of human agency: pathways and reflections[J]. Perspect Psychol Sci, 2018,13(2):130-136. DOI: 10.1177/1745691617699280.
[26] 王薇, 王治国, 刘佳丽. ISO15189:2022标准对室内质量控制要求实施的再思考[J].中华检验医学杂志,2024,47(5):493-497. DOI: 10.3760/cma.j.cn114452-20231020-00226.
[27] Thornhill-Miller B, Camarda A, Mercier M, et al. Creativity, critical thinking, communication, and collaboration: assessment, certification, and promotion of 21st century skills for the future of work and education[J]. J Intell, 2023,11(3):54. DOI: 10.3390/jintelligence11030054.
