临床本科血管外科教学探索：团队学习(TBL)与案例导学(CBD)的融合应用研究

Teaching Exploration of Clinical Undergraduate Vascular Surgery: Research on the Integration and Application of Team Learning (TBL) and Case Tutorial (CBD)

摘要: 目的：对临床本科血管外科教学中实施团队学习(TBL)与案例导学(CBD)创新融合模式的应用及效果进行分析，为医学教育改革提供实证依据。方法：采用前瞻性随机对照试验设计，选取内蒙古医科大学临床医学专业90名本科生为研究对象，按1:1分配至实验组(TBL + CBD融合教学组，n = 45)与对照组(传统讲授组，n = 45)。实验组以血管外科典型病例(如主动脉夹层、下肢动脉硬化闭塞症)为主线，实施“课前病例分析→课中团队协作诊疗→课后反思总结”闭环教学，强化教学设计的“病例驱动”与“团队协作”。对照组沿用“理论授课 + 床旁教学”的常规教学模式。教学任务完成后，进行基础知识闭卷考试，采用OSCE四站点考核(含标准化病人、血管超声模拟操作)进行临床技能考核；采用自制《教学考察问卷》评估两组教学满意度；同时采用批判性思维倾向问卷(CTDI-CV)对教学过程中临床思维能力进行追踪评价。结果：两组学生基础知识考试成绩及OSCE临床技能考核成绩(四站点)的差异均有统计学意义(均P < 0.001)，实验组学生两项成绩均高于对照组；教学考察问卷调查显示，实验组学生在五项调查维度中的“团队协作频率、重难点掌握效果”两方面的满意度显著高于对照组，差异有统计学意义(P < 0.05)；实验组与对照组CTDI-CV临床思维能力总分为(229.75 ± 20.04)分vs (186.33 ± 19.25)分，实验组优势显著(P < 0.001)。结论：TBL与CBD融合教学通过构建“病例驱动–团队协作–实践强化”闭环，有效促进临床本科生从知识记忆向能力转化的跨越，对提升其知识整合能力、临床思维能力效果显著，该教学模式在血管外科教学中兼具创新性与可操作性，可有效助力教学需求。

Abstract: Objective: To analyze the application and effect of the innovative integration model of team learning (TBL) and case guidance (CBD) in the teaching of clinical undergraduate vascular surgery, so as to provide an empirical basis for the reform of medical education. Methods: A prospective randomized controlled trial was used to select 90 undergraduates majoring in clinical medicine from Inner Mongolia Medical University as the research subjects, and they were assigned to the experimental group (TBL CBD fusion teaching group, n = 45) and the control group (traditional teaching group, n = 45) according to 1:1. The experimental group took typical cases of vascular surgery (such as aortic dissection and lower extremity arteriosclerosis occlusion) as the main line, and implemented the closed-loop teaching of “pre-class case analysis → teamwork diagnosis and treatment during class → and after-class reflection and summary”, and strengthened the “case-driven” and “teamwork” of teaching design. The control group followed the conventional teaching mode of “theoretical teaching and bedside teaching”. After the completion of the teaching task, a closed-book examination of basic knowledge was conducted, and the OSCE four-site assessment (including standardized patient and vascular ultrasound simulation operation) was used for clinical skill assessment. The self-made Teaching Investigation Questionnaire was used to evaluate the teaching satisfaction of the two groups. At the same time, the Critical Thinking Tendency Questionnaire (CTDI-CV) was used to track and evaluate clinical thinking ability in the teaching process. Results: There were statistically significant differences in the basic knowledge test scores and OSCE clinical skills assessment scores (four sites) between the two groups (all P < 0.001), and the two scores of the experimental group were higher than those of the control group. The results of the teaching survey showed that the satisfaction of the students in the experimental group was significantly higher than that of the control group in the five survey dimensions, and the difference was statistically significant (P < 0.05). The total score of CTDI-CV clinical thinking ability in the experimental group and the control group was (229.75 ± 20.04) vs (186.33 ± 19.25), and the experimental group had a significant advantage (P < 0.001). Conclusion: The integrated teaching of TBL and CBD can effectively promote the leap from knowledge memory to ability transformation of clinical undergraduates by constructing a closed loop of “case-driven-teamwork-practice reinforcement”, and has a significant effect on improving their knowledge integration ability and clinical thinking ability.