Carrero E, Gomar C, Penzo W, Rull M
University of Barcelona, Hospital Clínic, Department of Anaesthesiology, Barcelona, Spain.
Eur J Anaesthesiol. 2007 Dec;24(12):1008-15. doi: 10.1017/S0265021506002304. Epub 2007 Jan 30.
The case/problem-based learning discussion method was recently introduced into the theory-based training program for residents run by the Catalan Society of Anaesthesiology. This study was designed to assess and compare its effectiveness with that of the lecture-based approach for teaching pre-anaesthetic assessment, applying an objective tool for knowledge evaluation before and after teaching.
A prospective randomized study of two consecutive year groups of first year anaesthesiology residents was conducted. Twenty-nine residents attended a lecture, and 25, a case/problem-based learning discussion session. Their knowledge of pre-anaesthetic assessment was assessed before and after the teaching session with tests on four different clinical cases measuring six fields: (1) 'recognizing clinical data with anaesthetic implications'; (2) 'reasoning clinical data with anaesthetic implications'; (3) 'ASA class'; (4) 'Mallampati class'; (5) 'choice of anaesthetic technique'; (6) 'reasoning choice of anaesthetic technique'.
Before the teaching session, the lecture group scored significantly higher on field 1 (P = 0.006). Both teaching methods improved scores on fields 1, 2 and 4. The case/problem group also improved on fields 3 and 6. After the teaching session, the field 1 score was still significantly higher in the lecture group (P = 0.005), and the field 3 score was significantly higher in the case/problem group (P = 0.044).
The effectiveness of lecture and case/problem-based learning discussion differed little in terms of improving participants' immediate knowledge of 'pre-anaesthetic assessment'.
基于案例/问题的学习讨论方法最近被引入加泰罗尼亚麻醉学会为住院医师开展的理论培训项目中。本研究旨在评估该方法与基于讲座的教学方法在麻醉前评估教学中的有效性,并在教学前后应用客观工具进行知识评估。
对连续两年的一年级麻醉科住院医师进行前瞻性随机研究。29名住院医师参加了讲座,25名参加了基于案例/问题的学习讨论课程。在教学课程前后,通过对四个不同临床病例的测试评估他们对麻醉前评估的知识,测试涵盖六个领域:(1)“识别具有麻醉意义的临床数据”;(2)“推理具有麻醉意义的临床数据”;(3)“美国麻醉医师协会(ASA)分级”;(4)“马兰帕蒂分级”;(5)“麻醉技术选择”;(6)“推理麻醉技术选择”。
在教学课程前,讲座组在领域1的得分显著更高(P = 0.006)。两种教学方法均提高了领域1、2和4的得分。基于案例/问题的学习组在领域3和6也有所提高。教学课程后,讲座组在领域1的得分仍显著更高(P = 0.005),基于案例/问题的学习组在领域3的得分显著更高(P = 0.044)。
在提高参与者对“麻醉前评估”的即时知识方面,讲座和基于案例/问题的学习讨论的有效性差异不大。