中医诊断学是一门中医学专业的主干课程, 也是连接基础理论与临床实践的桥梁课程,其知识点繁杂、实践性强导致学生感觉枯燥无味, 教师教学质量欠佳。随着“互联网+教育”的高速发展, 混合式教学作为一种创新型教学模式,有诸多优势, 但也存在一些不足。文章从多元化教学方法、思政教育、多元化评价三个方面出发, 研究创新混合教学模式措施, 以期提升教学效果,提高学生的中医思维能力和临床水平, 培养学生的医德医风,实现知识传授与价值引领, 为社会输送德才兼备的中医药人才。文章研究了中医诊断学课程混合教学模式的教学现状和实践探索, 以进一步提高教学质量, 可为各大中医院校混合教学模式的开展提供借鉴。

Traditional Chinese medicine（TCM）diagnostics is a main course of TCM specialty, and it is also a bridge course connecting basic theory and clinical practice．Its complex knowledge and strong practicability lead to students feeling bored and poor teaching quality．With the rapid development of “Internet + Education”, blended teaching, as an innovative teaching mode,has many advantages, but it also has some shortcomings．This paper starts from three aspects of diversified teaching methods, civic education and diversified evaluation to study the measures of innovative mixed teaching mode, with a view to enhancing the teaching effect, improving the students’ thinking ability and clinical level of Chinese medicine, cultivating the students’ medical ethics and medical style,realizing the knowledge pass on and value leadership, and delivering both moral and talented talents in traditional Chinese medicine for the society．This paper studies the teaching status and practical exploration of the mixed teaching mode of TCM diagnostics curriculum in order to further improve the teaching quality and provide reference for the development of the mixed teaching mode in major TCM colleges．

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．