建立教学案例库联合CBL教学法在急性心肌梗死临床实习生教学中的应用

Application of a Teaching Case Library Combined with Case-Based Learning in Clinical Internship Teaching of Acute Myocardial Infarction

摘要: 目的：构建标准化急性心肌梗死教学案例库，并评价其联合案例教学法在临床实习教学中的应用效果，以提升学生的临床推理、急诊决策及综合处置能力。方法：选取2025年1月至2026年1月在济宁医学院附属医院心血管内科实习的100名医学生作为研究对象。采用随机数字表法分为观察组和对照组，每组50名。对照组采用传统讲授式教学，观察组在相同教学目标、教学内容和教学时长基础上，采用标准化急性心肌梗死教学案例库联合案例教学法(CBL)。教学案例来源于真实临床病例，经脱敏、标准化整理及专家审核后形成。教学结束后，采用统一理论考试、临床技能考核、病例分析考核及匿名教学满意度问卷评价教学效果，并比较两组差异。结果：观察组理论考试、临床技能及病例分析成绩分别为(85.07 ± 4.89)分、(84.12 ± 5.29)分和(85.86 ± 5.93)分，均高于对照组的(77.94 ± 5.31)分、(77.55 ± 5.71)分和(73.32 ± 5.04)分，差异均有统计学意义(均P < 0.05)。观察组在学习兴趣、自主学习能力、课堂参与度、临床思维能力及教学满意度方面的评分亦高于对照组(均P < 0.05)。结论：急性心肌梗死教学案例库联合CBL可提高临床实习生的理论知识、临床技能和病例分析能力，增强学习主动性及教学满意度，为心血管急危重症临床教学提供标准化、情境化和能力导向的教学模式，具有推广应用价值。

Abstract: Objective: To develop a standardized teaching case library for acute myocardial infarction (AMI) and evaluate the effectiveness of combining this library with case-based learning (CBL) in clinical internship education, with the aim of improving students’ clinical reasoning, emergency decision-making, and comprehensive management abilities. Methods: A total of 100 medical students who completed their clinical rotations in the Department of Cardiology at the Affiliated Hospital of Jining Medical University from January 2025 to January 2026 were selected as study participants. Using a random number table, the participants were divided into an observation group and a control group, with 50 students in each group. The control group received traditional lecture-based instruction, while the observation group, based on the same teaching objectives, content, and duration, utilized a standardized acute myocardial infarction case database combined with case-based learning (CBL). The teaching cases were derived from real clinical cases and were developed after anonymization, standardization, and expert review. Following the completion of the instruction, teaching effectiveness was evaluated using a standardized theoretical exam, clinical skills assessment, case analysis assessment, and an anonymous teaching satisfaction questionnaire, and differences between the two groups were compared. Results: The scores for theoretical knowledge, clinical skills, and case analysis in the observation group were 85.07 ± 4.89, 84.12 ± 5.29, and 85.86 ± 5.93, respectively, which were significantly higher than those in the control group (77.94 ± 5.31, 77.55 ± 5.71, and 73.32 ± 5.04, respectively; all P < 0.05). The observation group also achieved significantly higher scores for learning interest, self-directed learning ability, classroom participation, clinical reasoning ability, and teaching satisfaction (all P < 0.05). Conclusion: The integration of an AMI teaching case library with CBL may improve clinical interns’ theoretical knowledge, clinical skills, and case analysis abilities while enhancing learning initiative and teaching satisfaction. This approach provides a standardized, context-based, and competency-oriented model for clinical education in cardiovascular emergencies and has potential for broader application.