傅瑜　樊东升　鲁明　宋红松

[摘要] 目的 探索教师标准化患者（TSP）+病例导引教学（CBL）模式解决短暂性脑缺血发作（TIA）课临床教学“老大难”问题的可行性。 方法 分别对八年制临床医学系2012级（38人）和2011级（38人）的TIA课采用TSP+CBL教学法和单纯TSP教学法。学习结束时，比较分析两组教学课堂考核成绩和教学效果调查问卷自评分。用t检验评价2种方法的教学效果。 结果 TSP+CBL组学生课堂考核平均分达（88.76±3.48）分，显著高于TSP 组的（85.27±3.01）分（P < 0.05）。TSP+CBL组尤在临床思维、与人合作和解决问题能力方面成绩明显高于TSP组（P < 0.01）。TSP+CBL组对教学效果调查问卷的平均自评分为（92.29±1.56）分，显著高于TSP组的（85.27±3.01）分（P < 0.01）。TSP+CBL组在“对教材内容理解掌握程度”、“对新教学法满意程度”、“有利理论与临床实践结合”3个方面显著高于TSP组（均P < 0.01）。 结论 以TSP+CBL的教学模式值得推广，对此类发作-间歇型疾病的临床教学具有普遍性意义。

[关键词] 教师标准化患者；病例导引教学；短暂性脑缺血发作

[中图分类号] R193 [文献标识码] A [文章编号] 1673-7210（2016）03（a）-0165-04

Application of teacher as standardized patient combined with case-based learning mode in transient ischemic attack teaching

FU Yu FAN Dongsheng▲ LU Ming SONG Hongsong

Department of Neurology， Peking University Third Hospital， Beijing 100191， China

[Abstract] Objective To evaluate the feasibility of teacher as standardized patient （TSP） combined with case based learning （CBL） teaching mode to solve clinical teaching "persistent" problem of the transient ischemic attack （TIA）. Methods TSP combined with CBL was used in 38 eight-year medical students of grade 2012， while TSP was used in 38 eight-year medical students of grade 2011. At the end of the study， teaching effect was assessed by the final examination and questionnaires. The data were processed by t test. Results The average test score in the TSP combined with CBL group was （88.76±3.48） scores， which was significantly higher than that in the TSP group （85.27±3.01） scores （P < 0.05）. Scores of clinical thinking， cooperating with others and solving problems in TSP combined with CBL group were significantly higher than those in TSP group （P < 0.01）. The score of the questionnaire in the TSP combined with CBL group was （92.29±1.56） scores， which was significantly higher than （85.27±3.01） scores in TSP group （P < 0.01）. Scores of “understanding of teaching materials”， “satisfaction with new teaching method”， “combination of favorable theory and clinical practice” in the TSP combined with CBL group were better than those of TSP group. Conclusion The TSP combined with CBL can be a valuable strategy， which has universal significance in clinical teaching to such attacks-intermittent disease.

[Key words] Teacher as standardized patient； Case-based learning； Tansient ischemic attack

短暫性脑缺血发作（transient ischemic attack，TIA）是神经内科教学中的重要课程。TIA为发作性疾病，患者多于间歇期就诊，无临床体征，诊断主要靠问诊[1]，故成为教学中的难点。单纯依赖老师“填鸭”式灌输、学生“死记硬背”的传统授课模式[2]，已无法满足现代医学生的教学需求。

当今医学领域教学模式主要有教师标准化患者（teacher as standardized patient，TSP）教学法[3-4]、问题导引教学法[5]、病例导引教学（case based learning，CBL）法[6]、團队为基础教学法[7]等，实践证实各有千秋。为适应新医学教育模式转变，符合“培养全面素质人才”的高等教育理念，本教研组在教学中结合国情进行探索。从2014年4月起选择TSP+CBL模式TIA课教学法，经过2年多的与单纯TSP模式对照评估，发现此模式对TIA课教学效果有显著性提高，现报道如下：

1 对象与方法

1.1 研究对象

选取北京大学第三医院八年制临床医学系2011、2012级各38人为研究对象。前者采用单纯TSP教学法（TSP组），后者用TSP与CBL结合模式（TSP+CBL组）。两组TSP、带教老师相同，两组教学研究前平均学习成绩、年龄及性别构成比较差异无统计学意义（P > 0.05），具有可比性。