目的 探讨理论授课后续以问题为基础的学习（PBL）的阶梯教学法在临床技能混合教学中的效果。方法 选择福建医科大学附属南平第一医院2019级临床医学专业58名见习生为研究对象,将其通过单双号抽签的方式分为两组,即研究组与对照组各29例,研究组基于理论授课后续PBL的阶梯教学法,以“一对一”方式进行线上线下混合教学,对照组开展常规线下教学,对两组见习生教学效果进行比较。结果 研究组见习生参与消毒铺巾、气管插管、胸腔穿刺、腰椎穿刺及小儿腰椎穿刺等5项临床技能考核分别为（95.23±3.18）（95.19±3.26）（95.15±3.35）（95.28±3.17）（95.11±3.45）分,优于对照组（88.23±4.01）（87.89±4.59）（86.23±3.78）（87.22±3.89）（86.23±3.67）分（t=7.366、6.983、9.510、8.650、9.494,P<0.05）;研究组见习生综合能力提升情况优于对照组（χ²=6.444,5.497、5.497、6.444、7.733,P<0.05）;从教师培训态度（7项）、培训方法（15项）、培训时间（3项）、培训效果（11项）等方面进行评价,研究组临床技能培训教学效果各项评分及总分分别为（6.67±0.35）（12.23±2.23）（2.44±0.29）（9.23±2.56）（30.34±4.45）分,高于对照组的（4.12±1.45）（10.12±2.17）（9.23±2.56）（1.68±0.56）（7.23±2.12）分（24.34±3.45）分,（t=9.206、3.652、6.490、3.240、5.738,P<0.05）。结论 基于理论授课后续PBL的阶梯教学法,以“一对一”线上线下混合教学建立医学生临床技能的培训方法,见习生的综合能力明显提升,教学效果更好。

Objective To explore the effect of Problen-Based Learning（PBL）step-by-step teaching method in the online and offline mixed teaching of clinical skills for medical students. Methods Fifty-eight interns majoring in clinical medicine of grade 2019 in Nanping First Hospital affiliated to Fujian Medical University were selected as the research object,they were divided into two groups by drawing lots with even and odd numbers,namely,the study group and the control group,with 29 cases in each group．The study group conducted online and offline mixed teaching in a “one-on-one” way based on the step-by-step PBL teaching method after theoretical teaching,while the control group received regular offline teaching,and the teaching effects of the two groups were compared. Results The students of the study group participated in 5 clinical skills assessment,including disinfection towel（95.23±3.18）,tracheal intubation（95.19±3.26）,chest puncture（95.15±3.35）,lumbar puncture（95.28±3.17）and pediatric lumbar puncture（95.11±3.45）,were significantly better than those of control group（88.23±4.01）,（87.89±4.59）,（86.23±3.78）,（87.22±3.89）,（86.23±3.67）（t=7.366,6.983,9.510,8.650,9.494,P<0.05）．The comprehensive ability improvement of students in study group was better than that in control group（χ²=6.444,5.497,5.497,6.444,7.733,P<0.05）．The evaluation was made from the aspects of teacher training attitude（7 items）,training method（15 items）,training time（3 items）and training effect（11 items）．The clinical skill training teaching effect scores of study group（6.67±0.35）,（12.23±2.23）,（2.44±0.29）,（9.23±2.56）,（30.34±4.45）were significantly higher than those of control group（4.12±1.45）,（10.12±2.17）,（9.23±2.56）,（1.68±0.56）,（7.23±2.12）,（24.34±3.45）（t=9.206,3.652,6.490,3.240,5.738,P<0.05）. Conclusions Based on PBL step-by-step teaching method after theoretical teaching,the training method of clinical skills for medical students is established by “one-to-one” online and offline mixed teaching,can improve the clinical skills and comprehensive ability of interns and get high evaluation from students．