以案例为基础的整合式学习在医学生思维培养中的应用

Application of Case-Based Integrated Learning in the Cultivation of Medical Students’ Clinical Thinking

摘要: 传统讲授式教学(LBL)在知识爆炸与临床实践复杂化的双重挑战下，难以满足培养卓越医学人才的需求。以学生为中心的案例教学(CBL)、问题教学(PBL)及团队教学(TBL)虽各具优势，但存在局限性；联合教学虽部分弥补单一模式的不足，但仍面临局部整合欠佳、师资要求高等问题。以案例为基础的整合式学习(CBCL)并非CBL、PBL、TBL的简单叠加，而是在建构主义理论指导下，通过课前准备、课堂协作讨论与课后巩固的完整学习循环，系统培养医学生的临床推理能力、批判性思维及知识整合能力。CBCL能有效提升学生学习兴趣、参与度及综合能力，尤其在智慧教育技术赋能下展现出广阔应用前景。然而，该模式在高质量案例开发、师资转型、学生适应性及评价体系重构等方面仍面临挑战。未来需进一步探索个性化学习路径与多维度评价机制，推动CBCL在医学教育中的深化应用。本文对以案例为基础的整合式学习在医学生思维培养中的应用进展作一综述。

Abstract: Traditional lecture-based learning (LBL) faces significant challenges in cultivating outstanding medical talents due to the dual pressures of knowledge explosion and increasing complexity in clinical practice. Although student-centered approaches such as case-based learning (CBL), problem-based learning (PBL), and team-based learning (TBL) each have their own advantages, they also possess limitations. While combined teaching methods partially address the shortcomings of single models, they still face issues such as suboptimal local integration and high demands on faculty. Case based collaborative learning (CBCL) is not a simple superposition of CBL, PBL, and TBL. Guided by constructivist theory, it establishes a complete learning cycle consisting of pre-class preparation, in-class collaborative discussion, and post-class consolidation, systematically cultivating medical students’ clinical reasoning skills, critical thinking, and knowledge integration abilities. CBCL effectively enhances students’ learning interest, engagement, and comprehensive competencies, demonstrating broad application prospects, particularly when empowered by smart education technologies. Nevertheless, challenges remain in the development of high-quality cases, faculty transformation, student adaptability, and reconstruction of evaluation systems. Future efforts should further explore personalized learning pathways and multidimensional evaluation mechanisms to promote the deeper application of CBCL in medical education. This paper reviews the progress in the application of CBCL to the development of medical students’ thinking.