CAJ | 학술논문

目的：探讨医学模拟教学（simulation based medical education，SBME）在重症医学以问题为基础的学习（problem-based learning，PBL）中的效果。方法选择2012至2013年在我院参与重症医学PBL教学的上海交通大学医学院临床医学专业五年制学生46名为研究对象，分为2组。24名2009级学生为PBL组，22名2010级学生为医学模拟-PBL组（SBME-PBL组）。教学结束后，采用问卷调查、理论知识考核、直接观察操作技能（direct observation of procedural skills， DOPS）和迷你临床评估训练（mini-clinical evaluation exercise，Mini-CEX）等评分系统进行教学效果的评估。数据采用SPSS 17.0软件进行统计分析，问卷调查数据用百分比表示，考核成绩用x±s表示，分别采用χ2和t检验进行统计分析，P<0.05为差异有统计学意义。结果①问卷调查显示：在学习兴趣（P=0.665，0.937，0.746）和学习能力（P=0.937，0.665）方面2组差异无统计学意义，但在协作能力方面SBME-PBL组要明显高于PBL组，2组差异有统计学意义（P=0.019，0.038，0.024）。②在理论知识考核中2组差异无统计学意义（P=0.743）。③临床基本操作技能的DOPS评估显示：SBME-PBL组的各项操作技能评分均明显高于PBL组（P 心肺复苏=0.000，P 气管插管=0.023，P 电除颤=0.002， P 中心静脉穿刺=0.047）。④Mini-CEX评估显示：相对于PBL组，SBME-PBL组在体格检查（χ2=0.790）、临床判断（P=0.426）方面2组差异无统计学意义，但是在医疗面谈、人文关怀、沟通技能、组织效能和整体临床能力方面有提高，P值分别为0.002、0.001、0.017、0.029、0.024。结论 SBME能够提高重症医学PBL教学中医学生的团队协作能力、临床基本操作技能、临床综合处理能力。
목적：탐토의학모의교학（simulation based medical education，SBME）재중증의학이문제위기출적학습（problem-based learning，PBL）중적효과。방법선택2012지2013년재아원삼여중증의학PBL교학적상해교통대학의학원림상의학전업오년제학생46명위연구대상，분위2조。24명2009급학생위PBL조，22명2010급학생위의학모의-PBL조（SBME-PBL조）。교학결속후，채용문권조사、이론지식고핵、직접관찰조작기능（direct observation of procedural skills， DOPS）화미니림상평고훈련（mini-clinical evaluation exercise，Mini-CEX）등평분계통진행교학효과적평고。수거채용SPSS 17.0연건진행통계분석，문권조사수거용백분비표시，고핵성적용x±s표시，분별채용χ2화t검험진행통계분석，P<0.05위차이유통계학의의。결과①문권조사현시：재학습흥취（P=0.665，0.937，0.746）화학습능력（P=0.937，0.665）방면2조차이무통계학의의，단재협작능력방면SBME-PBL조요명현고우PBL조，2조차이유통계학의의（P=0.019，0.038，0.024）。②재이론지식고핵중2조차이무통계학의의（P=0.743）。③림상기본조작기능적DOPS평고현시：SBME-PBL조적각항조작기능평분균명현고우PBL조（P 심폐복소=0.000，P 기관삽관=0.023，P 전제전=0.002， P 중심정맥천자=0.047）。④Mini-CEX평고현시：상대우PBL조，SBME-PBL조재체격검사（χ2=0.790）、림상판단（P=0.426）방면2조차이무통계학의의，단시재의료면담、인문관부、구통기능、조직효능화정체림상능력방면유제고，P치분별위0.002、0.001、0.017、0.029、0.024。결론 SBME능구제고중증의학PBL교학중의학생적단대협작능력、림상기본조작기능、림상종합처리능력。
Objective To evaluate the effectiveness of applying simulation based medical education (SBME) in critical care medicine PBL teaching. Methods Totally 46 undergraduates in medical college of Shanghai JiaoTong University , who participated in critical care medicine PBL teaching in our Hospital from 2012 to 2013 were chosen as research objects. These students were divided into two groups: PBL group (2009 grade, n=24) and SBME-PBL group (2010 grade, n=22). The teaching effectiveness was evaluated by questionnaire survey, theoretical exam, direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (Mini-CEX). Data were analyzed by SPSS 17.0 software. The data of questionnaire survey were expressed as percentage and the assessment results were expressed as x±s. Chi-square and t test were used to do statistical analysis. P<0.05 signi-fies for statistically significant differences . Results ①The results of questionnaire survey showed that:there was no significant difference between two groups in study interests(P=0.665, 0.937, 0.746) and study ability(P=0.937, 0.665). But regarding collaboration ability, SBME-PBL group performed better than PBL group (P=0.019, 0.038, 0.024). ②These was no significant difference in the theo-retical knowledge exam between PBL and SBME-PBL group(P=0.743). But the DOPS scores of car-diopulmonary resuscitation (P=0.000), endotracheal intubation (P=0.023), defibrillation (P=0.002) and central venous catheterization(P=0.047) were all significantly higher in SBME-PBL group than in PBL group. ③In Mini-CEX, there was no statistical difference in physical examination skills (P=0.790) and clinic judgment(P=0.426) between the two groups. However, SBME-PBL group performed better in medical interviewing capacity(P=0.002), humanistic care (P=0.001), counseling skills(P=0.017), organization efficiency(P=0.029) and overall clinical competence(P=0.024) than PBL group. Conclusions SBME can promote the students' team work spirit, basic clinical skills and comprehen-sive clinical capacity in critical care medicine PBL teaching and can improve the teaching quality of critical care medicine.