PBL+CBL+CP教学在肝胆外科住院医师规范化培训中的应用

目的 探讨以问题为基础的学习（problem-based learning，PBL）、以案例为基础的学习（case-based learning，CBL）和临床路径（clinical pathway，CP）相结合应用于肝胆外科住院医师规范化培训中的效果。方法 以2018年7月至2019年7月在陕西省人民医院肝胆外科接受规范化培训的64名住院医师为研究对象，分为观察组和对照组。其中对照组运用PBL+CBL教学，观察组运用PBL+CBL+CP教学。对比两组住培医师出科考试成绩和教学认可度评分。采用SPSS 15.0进行t检验和卡方检验。结果 对比两组住培医师的出科考试成绩，在专业理论、病例分析、操作技能方面，观察组均高于对照组，差异有统计学意义（t=6.98、7.85、7.01，P<0.05）。在对教学的认可度方面，观察组高于对照组，差异有统计学意义（t=9.14，P<0.05）。结论 PBL+CBL+CP教学有利于住培医师全面、系统地掌握知识，并快速建立科学的临床思维，具有很强的科学性和系统性，值得推广。

Application of PBL combined with CBL and CP teaching methods in standardized residency training in the department of hepatobiliary surgery

Objective To analyze the effect of problem-based learning (PBL) combined with case-based learning (CBL) and clinical pathway (CP) teaching methods in standardized residency training in department of hepatobiliary surgery.Methods A total of 64 residents who received the standardized residency training in the Department of Hepatobiliary Surgery in Shaanxi Provincial People''s Hospital from July 2018 to July 2019 were selected and divided into the observation group and the control group. The control group used PBL + CBL teaching methods, while the observation group adopted PBL + CBL + CP teaching methods. The after-department examination scores and the teaching cognition scores of the two groups were compared. SPSS 15.0 was used for t-test and Chi-square test.Results The after-department examination scores of the two groups were compared. Compared with the control group, the examination scores of professional theories, case analysis and operation skills in the observation group were significantly higher, and the difference was statistically significant (t = 6.98, 7.85, 7.01, P < 0.05). In terms of recognition of teaching, the observation group was significantly higher than the control group, and the difference was statistically significant (t = 9.14, P < 0.05).Conclusion The PBL + CBL + CP teaching is conducive to the comprehensive and systematic mastery of knowledge and the rapid establishment of scientific clinical thinking. It has a strong scientific and systematic nature and is worthy of promotion.