SPOC-PBL融合教学模式在关节骨科见习中的构建与实践：一项提升临床思维能力的随机对照研究

Construction and Practice of SPOC-PBL Integrated Teaching Model in Joint Orthopedics Clerkship: A Randomized Controlled Study to Improve Clinical Thinking Skills

摘要: 研究目的：通过随机对照研究，客观评价小规模限制性在线课程与基于问题的学习(Small Private Online Course and Problem-Based Learning, SPOC-PBL)融合教学模式在关节骨科见习应用中提升临床思维能力的效果。研究方法：本研究采用前瞻性、随机对照试验，纳入2024年11月至2025年7月于眉山市中医医院见习且符合纳排标准的医学生，入组后通过随机数字表法按照1:1分为试验组和对照组，试验组采用SPOC-PBL融合教学模式进行干预，对照组采用传统讲授式教学法(Lecture-Based Learning, LBL)进行干预。结果：最终共50例参与者被随机分配，整个干预过程无学生脱落。各组年龄、性别等一般资料差异无统计学意义(P > 0.05)，同时两组学生在见习课程大纲所要求的学习病种、教学课件及教学时数等方面均相同；出科成绩方面，试验组考核成绩(87.2 ± 3.5)分，对照组(72.1 ± 5.8)分，提升约20.9%，差异具有显著性(P < 0.001)，同时对两组见习生理论、实操以及病历分析成绩进行了分析对比，结果显示三类成绩试验组均高于对照组，差异具有显著性(P < 0.05)；教学满意度调查方面，结果显示试验组非常满意的人数占比远高于对照组，差异具有显著性(P < 0.01)。结论：SPOC-PBL融合教学模式相较于传统的LBL教学模式可系统提升见习医生在关节骨科中的临床思维与实操能力。

Abstract: Objective: To objectively evaluate the effect of a combined teaching model of Small Private Online Course and Problem-Based Learning (SPOC-PBL) on improving clinical thinking skills during joint orthopedics clerkship through a randomized controlled trial. Methods: This prospective, randomized controlled trial included medical students who completed their clinical rotations at Meishan Traditional Chinese Medicine Hospital from November 2024 to July 2025 and met the inclusion and exclusion criteria. After enrollment, students were randomly assigned to the experimental group and the control group at a 1:1 ratio using a random number table. The experimental group received the SPOC-PBL combined teaching model, while the control group received the traditional lecture-based learning (LBL) model. Results: A total of 50 participants were randomly assigned, and there was no dropout during the entire intervention process. There were no statistically significant differences in general characteristics such as age and gender among the groups (P > 0.05). Furthermore, the two groups had identical diseases covered, teaching courseware, and teaching hours, as required by the clerkship syllabus. Regarding exit grades, the experimental group scored (87.2 ± 3.5) points, while the control group scored (72.1 ± 5.8) points, representing an improvement of approximately 20.9%, a significant difference (P < 0.001). Analysis of the two groups’ scores in theory, practical skills, and case analysis showed that the experimental group outperformed the control group in all three areas, with significant differences (P < 0.05). In terms of teaching satisfaction, the percentage of highly satisfied students in the experimental group was significantly higher than that in the control group (P < 0.01). Conclusion: The SPOC-PBL integrated teaching model, compared to the traditional LBL teaching model, can systematically improve the clinical thinking and practical skills of medical students undertaking clerkship in joint orthopedics.