O'Neill Paul A, Willis Sarah C, Jones Alison
Medical Undergraduate Studies, Faculty of Medicine, Dentistry, and Nursing, University of Manchester, United Kingdom.
Acad Med. 2002 Jun;77(6):552-61. doi: 10.1097/00001888-200206000-00015.
In 1994, the medical school at the University of Manchester introduced a new integrated course that uses problem-based learning (PBL) throughout the clinical clerkships as the major approach for delivery of the core curriculum. This study explored how students linked PBL and clinical experiences.
All third- and fourth-year students were asked to respond to an open-ended question on the end-of-module course evaluation. Their responses were analyzed and grouped into themes. The authors also conducted three focus groups of third-year students and a further three focus groups of fourth-year students to explore how students viewed the links between PBL and clinical experiences. The discussions were taped and subsequently analyzed by the researchers independently.
The authors found that the students used clinical experience as a means of elaborating their knowledge either at the time of encountering an appropriate patient (outside the group) or by bringing their experiences back to the PBL group for discussion (inside the group). Major facilitators of elaboration were the match between the clinical clerkship and the content of the PBL case, the role of the tutor, and the self-directedness of the student. A theoretical model of how students linked PBL with their clinical experience was derived based on a cognitive psychological approach to learning.
The model will be of benefit as the authors try to improve the course for those students who were unable to use their clinical experiences to achieve the goals of their PBL discussions.
1994年，曼彻斯特大学医学院推出了一门新的综合课程，该课程在整个临床实习期间采用基于问题的学习（PBL）作为核心课程的主要授课方式。本研究探讨了学生如何将PBL与临床经验联系起来。
所有三年级和四年级学生都被要求在模块课程结束时的评估中回答一个开放式问题。对他们的回答进行分析并归纳为不同主题。作者还组织了三组三年级学生和另外三组四年级学生进行焦点小组讨论，以探讨学生如何看待PBL与临床经验之间的联系。讨论过程进行了录音，随后由研究人员独立进行分析。
作者发现，学生们将临床经验作为一种在遇到合适患者时（小组之外）深化知识的方式，或者将自己的经验带回PBL小组进行讨论（小组内部）。深化知识的主要促进因素包括临床实习与PBL案例内容的匹配度、导师的作用以及学生的自主学习能力。基于认知心理学的学习方法，得出了一个关于学生如何将PBL与临床经验联系起来的理论模型。
当作者试图改进该课程，帮助那些无法利用临床经验实现PBL讨论目标的学生时，这个模型将有所帮助。
