目的 探讨虚拟病人联合案例教学法(case-based learning，CBL)的教学效果，并研究其对提升学生临床思维能力的作用。方法 将2021年7月至2022年12月在上海交通大学医学院附属第六人民医院内科实习的71名学生随机分为3组:虚拟病人教学组(24人)，予以虚拟病人教学;CBL教学组(23人)，予以CBL教学;混合教学组(24人)，予以虚拟病人教学+CBL教学。教学结束后，对所有学生进行技能考试，并进行了教学效果满意度调查。数据分析采用SPSS 24。0软件进行，多组均数的比较采用方差分析(analysis of variance，ANOVA)，而3组之间的两两比较则采用最小显著差异法(least-significant difference，LSD)进行。结果 在3组学生技能考试成绩的比较中，"问诊思路"项目上，3组学生成绩[(82。04±3。76)vs。(79。00±4。93)vs。(78。61±4。56)]差异有统计学意义(P=0。018)，混合教学组成绩优于虚拟病人教学组和CBL教学组。3组学生的"总分"成绩差异也有统计学意义[(81。33±5。02)vs。(80。65±5。67)vs。(79。76±5。15)](P=0。046)。两两比较发现，混合教学组在总分上明显优于CBL教学组(P=0。013)。教学效果满意度调查显示，在"提高学习积极性和主动性"方面，混合教学组和虚拟病人教学组均优于CBL教学组;在"提升分析问题的能力"方面，混合教学组和CBL教学组优于虚拟病人教学组;在"加深对知识的理解"方面，混合教学组优于虚拟病人教学组;而在"提高创新的能力"方面，混合教学组则优于CBL教学组。总体而言，混合教学组学生的满意度最高。结论 虚拟病人与CBL相结合的教学方法能够更有效地提升学生的临床思维能力，促进学生自主学习，并提升教学满意度，为临床思维教学提供了一种全新的教学模式。
Practice and exploration of the teaching mode of virtual patients combined with case-based learning in teaching internal medicine
Objective To explore the teaching effect of virtual patient combined with case-based learning(CBL)and investigate its impact on improving students'clinical thinking ability.Methods From July 2021 to December 2022,71 students practicing in the Department of Internal Medicine at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were randomly divided into three groups:virtual patient teaching group(24 students),CBL teaching group(23 students),and mixed teaching group(24 students,virtual patient+CBL).After the teaching,a skill test and a teaching satisfaction survey were conducted.The data analysis was conducted using SPSS 24.0 software.The comparison of means among multiple groups was performed using analysis of variance.The pairwise comparisons between the three groups were performed using the least significant difference method.Results In comparison of the scores of the three groups of students in skill test,there was a statistically significant difference in"consultation ideas"among the three groups of students[(82.04±3.76)vs.(79.00±4.93)vs.(78.61±4.56),P=0.018)],and the mixed teaching group performed better than the virtual patient teaching group and CBL teaching group.There was a significant difference in"total score"among the three groups of students[(81.33±5.02)vs.(80.65±5.67)vs.(79.76±5.15),P=0.046].Pairwise comparisons showed that the mixed teaching group was significantly better than the CBL teaching group in"total score"(P=0.013).The survey on teaching satisfaction showed that the scores of"improving learning motivation and initiative"were higher in the mixed teaching group and the virtual patient teaching group than in the CBL teaching group.The scores of"enhancing the ability to analyze problems"were higher in the mixed teaching group and CBL teaching group than in the virtual patient teaching group.The score of"deepening understanding of knowledge"was higher in the mixed teaching group than in the virtual patient teaching group.The score of"improving innovation ability"was higher in the mixed teaching group than in the CBL teaching group.Overall,students in the mixed teaching group showed the highest satisfaction.Conclusions The teaching method combining virtual patient and CBL can more effectively enhance students'clinical thinking ability,promote self-learning,and improve teaching satisfaction,providing a new mode for teaching clinical thinking.
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