目的 探讨基于问题学习(problem-based learning, PBL)结合学生标准化病人(student as standardized patients, SSP)的教学方法在医学生临床实践能力培养中的教学效果。 方法 选取山西医科大学2014级五年制临床医学专业3个班183名学生为研究对象,以1班62名学生为实验组,采用PBL结合SSP教学方法;以2班60名学生为对照1组,采用PBL教学方法;以3班61人为对照2组,采用基于讲授的学习(lecture-based learning,LBL),3组学生分别通过理论及实践操作考试和问卷调查进行教学效果评价。结果 实验组学生理论和实践操作考试成绩分别为(86.1±8.9)分和(80.3±11.9)分;对照1组学生理论和实践操作考试成绩分别为(81.7±8.7)分和(75.7±10.4)分;对照2组学生理论和实践操作考试成绩分别为(79.7±11.8)分和(74.7±8.3)分。实验组学生理论和实践操作考试成绩均优于对照1组和对照2组,差异均具有统计学意义(均P＜0.05)。在提高学习兴趣、提高自主学习能力、培养临床思维能力和提高医患沟通能力方面,实验组学生认同的比例分别为91.9%(57/62),91.9%(57/62),90.3%(56/62),88.7%(55/62);对照1组学生认同比例分别为76.7%(46/60),78.3%(47/60),71.7%(43/60),53.3%(32/60);对照2组学生认同比例分别为75.4%(46/61),73.8%(45/61),67.2%(41/61),50.8%(31/61)。实验组学生认同比例高于对照1组和对照2组学生,差异均具有统计学意义(均P＜0.05)。结论 与LBL和PBL教学比较,PBL结合SSP的教学方法能够更好地提高学生的临床实践能力。

Objective To explore the teaching effect of problem-based learning (PBL) combined with students as standardized patients (SSP) in clinical skill training. Methods The total 183 students of five-year clinical medicine in Shanxi Medical University were selected as research subjects. A group of 62 students in class 1 was used as experimental group with PBL combined with SSP, A group of 60 students in class 2 was used as control group 1 with PBL, A group of 61 students in class 3 was used as control group 2 with lecture-based learning (LBL) according to their routine classes. The students in the three groups were evaluated on learning outcomes through theoretical and practical test scores and questionnaires. Results The scores of theoretical examination and practical operation in experimental group are (86.1±8.9) and (80.3±11.9); which in control group 1 are (81.7±8.7) and (75.7±10.4); which in control group 2 are (79.7±11.8) and (74.7±8.3).The scores of theoretical and practical examination in experimental group is significantly better than those of control group 1 and control group 2 (all P＜0.05). The teaching method combined with PBL and SSP can improve medical students' interest in learning and students' autonomous learning and students' clinical thinking ability and doctor-patient communication ability. The identification ratio of experinmental group are91.9%(57/62),91.9%(57/62),90.3%(56/62),88.7%(55/62); which in control group 1 are76.7%(46/60),78.3%(47/60),71.7%(43/60),53.3%(32/60); which in control group 2 are75.4%(46/61),73.8%(45/61),67.2%(41/61),50.8%(31/61). There was statistical difference (all P＜0.05). Conclusions Compared with LBL teaching method and PBL teaching method, the teaching method combining PBL with SSP can better improve students' clinical practice ability.