CAJ | 학술논문

目的：探讨基于临床路径的教学方法在血液科临床带教中的实施效果．方法将在血液科实习的本科生按照来科实习顺序非随机分组，实验组在教学过程中加入特发性血小板减少性紫癜（idiopathic thrombocy-topenic purpura，ITP）临床路径作为教学工具，对照组以内科学第七版本科教材为基础进行教学，每组学生实习2周后出科时进行口头考试，并设计调查问卷进行现场调查．结果本研究中接受ITP临床路径培训的实验组共纳入32名实习医生，以内科学第七版教材为基础的对照组共纳入38名实习医生．2组间实习同学对ITP“病史询问要点、诊断标准和鉴别诊断的把握、实验室检查项目的选择”差异有统计学意义（＜0.01），实验组得分优于对照组；2组间关于“首选治疗方案问题”方面差异无统计学意义（＞0.05）；但是对于“首选激素治疗2周内血小板计数仍低于20×109/L的患者下一步治疗”方面，对照组得分优于实验组（＝0.0003）．调查问卷的结果显示临床路径组实习学生对于ITP临床教学方法的接纳程度为93.8%，开放式问题调查显示临床路径教学更为直观简洁，有利于实现标准化教学．结论将临床路径作为血液科实习医生的教学工具之一有利于学生更为清楚地理解该病种的诊治，具有可操作性，但需要结合教材进行深入讲解．
목적：탐토기우림상로경적교학방법재혈액과림상대교중적실시효과．방법장재혈액과실습적본과생안조래과실습순서비수궤분조，실험조재교학과정중가입특발성혈소판감소성자전（idiopathic thrombocy-topenic purpura，ITP）림상로경작위교학공구，대조조이내과학제칠판본과교재위기출진행교학，매조학생실습2주후출과시진행구두고시，병설계조사문권진행현장조사．결과본연구중접수ITP림상로경배훈적실험조공납입32명실습의생，이내과학제칠판교재위기출적대조조공납입38명실습의생．2조간실습동학대ITP“병사순문요점、진단표준화감별진단적파악、실험실검사항목적선택”차이유통계학의의（＜0.01），실험조득분우우대조조；2조간관우“수선치료방안문제”방면차이무통계학의의（＞0.05）；단시대우“수선격소치료2주내혈소판계수잉저우20×109/L적환자하일보치료”방면，대조조득분우우실험조（＝0.0003）．조사문권적결과현시림상로경조실습학생대우ITP림상교학방법적접납정도위93.8%，개방식문제조사현시림상로경교학경위직관간길，유리우실현표준화교학．결론장림상로경작위혈액과실습의생적교학공구지일유리우학생경위청초지리해해병충적진치，구유가조작성，단수요결합교재진행심입강해．
Objective To investigate the effects of clinical pathway-based teaching methods in clinical teaching of hematology. Methods Interns, which studied in department of hematology, were classified non-randomized into two groups. The interns in experimental group received idiopathic thrombocytopenic purpura (ITP) clinical pathway-based teaching. And the interns in the control group received the seventh edition textbook of medicine-based traditional teaching. All interns were oral tested when they finished two weeks period clinical studied of hematology. Meanwhile, a questionnaire designed for clinical pathway-based teaching was included in this test only for the experimental group. Results There were 32 interns recruited in the group of clinical pathway-based teaching and 38 interns in the control group of traditional teaching. There were statistically significant differences between the two groups in the fields of the key points about history of diseases ( = 0.0017), assessment of diagnostic criteria and differential diagnosis ( =0.0074), selection of laboratory examination items ( <0.0001) for ITP. The group of clinical pathway-based teaching achieved higher scores than the control group. However, there was no statistically significant difference between the two groups in the field of selection of first-line treatment measure of ITP ( = 0.1155) . Moreover, the control group achieved higher scores than the group of clinical pathway-based teaching in the field of how to treat ITP patients with first-line treatment failure ( =0.0003) . In addition,there were 93.8%interns in the experimental group accepted the new clinical pathway-based teaching tool in the survey. The open-ended question survey showed the clinical pathway teaching method was more simple, intuitive and standardizing than the traditional one. Conclusion The ITP clinical pathway, as an interns teaching tool of hematology, is helpful for understanding more clearly the diagnosis and treatment of ITP. However, an in-depth explanation is necessary combination with textbook of medicine study in the clinical teaching of ITP.