Kaufman David M., Mann Karen V.
Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada B3H 4H7.
Adv Health Sci Educ Theory Pract. 1999;4(3):245-260. doi: 10.1023/A:1009829831978.
This study compared student performance in problem-based (PBL) and conventional curricula on: 1) basic science knowledge following two preclinical years; 2) the Medical Council of Canada Qualifying Examination (MCC) Part I, written upon completion of the four year MD, and 3) Part II of the MCC Qualifying Examination, an assessment of clinical performance after 17 months of postgraduate education. Students in the conventional class of 1995 (n = 81) and the PBL classes of 1996 (n = 84) and 1997 (n = 78) participated. The 1995 conventional class scored significantly higher on the knowledge test than did the 1996 PBL class. The 1997 PBL class performed similarly to the 1995 class. The MCC Part I total examination scores of the three classes were similar. However, the PBL classes of 1996 and 1997 outperformed the class of 1995 in Psychiatry (p = 0.01); also, the PBL class of 1997 outscored the classes of 1995 and 1996 in Preventive Medicine and Community Health (p = 0.001). Two classes have completed the Part II examination. The 1995 and 1996 classes scored similarly in data-gathering, problem-solving and overall. The 1995 class scored significantly higher in communication skills (p = 0.01). We conclude that the performance of PBL and conventional classes is equivalent after medical school, and during postgraduate education, and that knowledge differences found in the first PBL class after two preclinical years have disappeared at the end of fourth year. Basic science knowledge may continue to grow throughout the clinical experience. Differences in communication skills, which favoured the conventional class, require further study.
本研究比较了基于问题式学习(PBL)课程和传统课程的学生在以下方面的表现:1)经过两年临床前学习后的基础科学知识;2)四年医学博士课程结束时所进行的加拿大医学委员会资格考试(MCC)第一部分笔试;3)MCC资格考试第二部分,即研究生教育17个月后的临床能力评估。1995年传统课程班的学生(n = 81)以及1996年(n = 84)和1997年(n = 78)的PBL课程班的学生参与了研究。1995年传统课程班在知识测试中的得分显著高于1996年PBL课程班。1997年PBL课程班的表现与1995年课程班相似。三个班级的MCC第一部分考试总成绩相近。然而,1996年和1997年的PBL课程班在精神病学方面的表现优于1995年课程班(p = 0.01);此外,1997年PBL课程班在预防医学与社区卫生方面的得分高于1995年和1996年课程班(p = 0.001)。有两个班级完成了第二部分考试。1995年和1996年课程班在数据收集、问题解决及整体表现方面得分相近。1995年课程班在沟通技巧方面得分显著更高(p = 0.01)。我们得出结论,医学院校毕业后及研究生教育期间,PBL课程班和传统课程班的表现相当,且在临床前两年后首个PBL课程班中发现的知识差异在第四年结束时已消失。基础科学知识可能会在整个临床经验中持续增长。有利于传统课程班的沟通技巧差异需要进一步研究。