Patel V L, Arocha J F, Leccisi M S
Department of Medical Informatics and Psychiatry, Columbia University New York, NY 10032, USA.
J Dent Educ. 2001 Nov;65(11):1199-218.
This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used data-driven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found this pattern to be true for medical students trained in two different curriculum formats. Although all housestaff generated equal numbers of diagnostic hypotheses during the reasoning process, housestaff from the conventional curriculum generated a greater number of accurate hypotheses than residents in PBLC. These results are discussed in relation to assumptions in health professional curricula about the adequacy of hypothetico-deductive methods of reasoning as teaching mechanisms and the need for clinical and biomedical knowledge integration.
本文报道了一项关于比较在传统医学院校或基于问题的医学院校接受本科医学培训的住院医师解决问题能力的研究。在阅读两个临床病例后，住院医师需要写出鉴别诊断和病理生理学解释。确定所使用的生物医学和临床知识以及推理策略。结果表明，住院医师的表现受教学性质的影响。在传统课程（CC）中接受培训的住院医师关注患者信息，将生物医学知识与临床知识分开，并使用数据驱动策略。来自基于问题学习课程（PBLC）的住院医师围绕生成的推理组织他们的知识，整合生物医学和临床知识，并使用假设驱动策略。在PBLC中，数据驱动推理似乎受到阻碍，这表明PBLC的学生在获取问题模式方面存在困难。先前的调查也发现，对于在两种不同课程形式下接受培训的医学生来说，这种模式也是如此。尽管所有住院医师在推理过程中产生的诊断假设数量相同，但传统课程的住院医师比PBLC的住院医师产生的准确假设数量更多。本文结合健康专业课程中关于假设演绎推理方法作为教学机制的充分性以及临床和生物医学知识整合需求的假设对这些结果进行了讨论。
