【摘要】 目的 评价基于智慧教室的PBL教学法在肾内科临床教学中的应用效果，并探讨该模式对提升临床科室带教同质化水平的潜在价值。方法 选取2023年9月—2024年10月在江苏大学附属医院肾内科轮转的临床医学专业学生及住院医师规范化培训学员共80名为研究对象，采用区组随机化方法分为实验组和对照组，每组40名。实验组在智慧教室环境中实施PBL教学，对照组采用传统讲授法。两组课堂学时完全一致（每周2次，每次2学时，共16学时），但实验组课前预习与课后拓展为自愿完成，未对课外学习时间进行量化记录。通过理论考核、临床技能评估、模拟临床演练评估及问卷调查评价教学效果。结果 Mini-CEX评估显示，实验组在临床判断（7.65±0.78 vs 6.82±0.85，P<0.001）和沟通技能（7.80±0.72 vs 6.95±0.88，P<0.001）维度改善最为明显，均从达标水平（4~6分）跨越至优秀水平（7~9分）；临床技能考核中腹膜透析置管术成绩实验组（45.82±1.45分）高于对照组（42.15±2.03分）（t=9.24，P<0.001，Cohen's d=2.08）。实验组理论考核成绩（89.45±3.12）分高于对照组（84.23±4.56）分（t=5.89，P<0.001, Cohen's d=1.32），临床技能考核成绩（45.82±1.45）分高于对照组（42.15±2.03）分（t=9.24, P<0.001, Cohen's d=2.08）。实验组在学习动机、课堂互动性和学习效率方面自评优于对照组（P<0.05），但团队合作能力培养两组差异无统计学意义（62.5% vs 52.5%, P=0.340）。结论 该联合模式能有效促进规培生临床核心胜任力的转化，可为临床科室高仿真技能带教提供实操路径。

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．

目的 探讨PBL联合SOAP门诊药历在提高门诊药师药学服务质量的效果。方法 开展SOAP门诊药历工作,并围绕实践中的典型案例开展PBL培训,由学员发现案例中的问题进行提问、分析、讨论,培训药师给予适当指导,并及时对问题解答与讨论过程中的问题进行总结。结果 PBL联合SOAP门诊药历提高了门诊药师的处方审核与处方干预水平,促进门诊药学服务工作顺利开展。结论 PBL联合SOAP门诊药历有利于培养药师独立思考和解决具体问题的临床思维能力,让门诊药师在临床实践中逐渐成长,在医院门诊药师向临床转型的实践中有良好的应用前景。

Objective To discuss the effects over the method of combining PBL with SOAP outpatient medicine records to improve the quality of pharmaceutical service of outpatient pharmacists. Methods We put the SOAP outpatient medicine records into practice and carry out the PBL training based on the typical cases in practice. In this process, the trainees can ask questions, analyze and discuss the problems in the cases, while the trainers should give some guidance, answer the questions immediately and conclude what were discussed. Results The method of combining PBL with SOAP outpatient medicine records has improved the outpatient pharmacists' level of prescription audit and intervention, it is helping to smoothly carry out the outpatient pharmaceutical service. Conclusion Combining PBL with SOAP outpatient medicine records will be helpful for pharmacists to develop their independent clinical thinking which may solve the specific problems, making them much more expert in the clinical practice. It is promising in the practice of outpatient pharmacists transforming to be clinical ones.

目的 针对以问题为导向教学法（PBL教学法）联合以案例为基础教学法（CM教学法）在手术室实习生带教中的应用进行探讨。方法 选取我院2016年9月—2017年6月期间手术室实习生100名,根据双盲分组法分为联合组和常规组,常规组实习生实施传统教学模式,联合组实习生实施PBL联合CM教学法,对比分析两组实习生的考核成绩、教学评估效果及带教满意度。结果 在考核成绩对比中,联合组实习生在理论成绩和实践成绩等考核成绩均高于常规组,组间对比有差异（P<0.05）;在教学评估效果对比中,联合组实习生在自主学习、护理知识掌握、主动参与、团队合作、临床护理实践等教学评估效果中均优于常规组（P<0.05）;在带教满意度对比中,联合组实习生总满意率高于常规组,经统计学对比分析有意义（P<0.05）。结论 PBL联合CM教学法能够有效提高手术室实习生的学习效果和临床护理实践能力,应在临床护理工作中予以推广并应用。