Zhang Yanqi, Zhou Liang, Liu Xiaoyu, Liu Ling, Wu Yazhou, Zhao Zengwei, Yi Dali, Yi Dong
Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, China.
PLoS One. 2015 Mar 30;10(3):e0120884. doi: 10.1371/journal.pone.0120884. eCollection 2015.
Although the problem-based learning (PBL) emerged in 1969 and was soon widely applied internationally, the rapid development in China only occurred in the last 10 years. This study aims to compare the effect of PBL and lecture-based learning (LBL) on student course examination results for introductory Chinese undergraduate medical courses.
Randomized and nonrandomized controlled trial studies on PBL use in Chinese undergraduate medical education were retrieved through PubMed, the Excerpta Medica Database (EMBASE), Chinese National Knowledge Infrastructure (CNKI) and VIP China Science and Technology Journal Database (VIP-CSTJ) with publication dates from 1st January 1966 till 31 August 2014. The pass rate, excellence rate and examination scores of course examination were collected. Methodological quality was evaluated based on the modified Jadad scale. The I-square statistic and Chi-square test of heterogeneity were used to assess the statistical heterogeneity. Overall RRs or SMDs with their 95% CIs were calculated in meta-analysis. Meta-regression and subgroup meta-analyses were also performed based on comparators and other confounding factors. Funnel plots and Egger's tests were performed to assess degrees of publication bias.
The meta-analysis included 31studies and 4,699 subjects. Fourteen studies were of high quality with modified Jadad scores of 4 to 6, and 17 studies were of low quality with scores of 1 to 3. Relative to the LBL model, the PBL model yielded higher course examination pass rates [RR = 1.09, 95%CI (1.03, 1.17)], excellence rates [RR = 1.66, 95%CI (1.33, 2.06)] and examination scores [SMD = 0.82, 95%CI (0.63, 1.01)]. The meta-regression results show that course type was the significant confounding factor that caused heterogeneity in the examination-score meta-analysis (t = 0.410, P<0.001). The examination score SMD in "laboratory course" subgroup [SMD = 2.01, 95% CI: (1.50, 2.52)] was higher than that in "theory course" subgroup [SMD = 0.72, 95% CI: (0.56, 0.89)].
PBL teaching model application in introductory undergraduate medical courses can increase course examination excellence rates and scores in Chinese medical education system. It is more effective when applied to laboratory courses than to theory-based courses.
尽管基于问题的学习（PBL）于1969年出现并很快在国际上得到广泛应用，但在中国的快速发展仅发生在过去10年。本研究旨在比较PBL和基于讲座的学习（LBL）对中国本科医学基础课程学生课程考试成绩的影响。
通过PubMed、医学文摘数据库（EMBASE）、中国知网（CNKI）和维普中国科技期刊数据库（VIP-CSTJ）检索1966年1月1日至2014年8月31日发表的关于PBL在中国本科医学教育中应用的随机和非随机对照试验研究。收集课程考试的及格率、优秀率和考试成绩。基于改良的Jadad量表评估方法学质量。使用I²统计量和异质性卡方检验评估统计异质性。在荟萃分析中计算总体RRs或SMDs及其95%CI。还基于比较器和其他混杂因素进行了元回归和亚组荟萃分析。进行漏斗图和Egger检验以评估发表偏倚程度。
荟萃分析纳入31项研究和4699名受试者。14项研究质量高，改良Jadad评分为4至6分，17项研究质量低，评分为1至3分。相对于LBL模式，PBL模式产生更高的课程考试及格率[RR = 1.09，95%CI（1.03，1.17）]、优秀率[RR = 1.66，95%CI（1.33，2.06）]和考试成绩[SMD = 0.82，95%CI（0.63，1.01）]。元回归结果表明课程类型是导致考试成绩荟萃分析中异质性的显著混杂因素（t = 0.410，P<0.001）。“实验课程”亚组的考试成绩SMD[SMD = 2.01，95%CI：（1.50，2.52）]高于“理论课程”亚组[SMD = 0.72，95%CI：（0.56，0.89）]。
PBL教学模式在中国医学教育体系本科基础课程中的应用可以提高课程考试优秀率和成绩。应用于实验课程比应用于理论课程更有效。
