Sutyak J P, Lebeau R B, Spotnitz A J, O'Donnell A M, Mehne P R
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, USA.
Am J Surg. 1996 Sep;172(3):286-90. doi: 10.1016/S0002-9610(96)00108-0.
As case-based methods replaced lectures in a surgical clerkship, the influences of case structure and prior experience on learning were investigated.
Early and late third-year students randomly received different cases. "Structured" cases had data presented and summarized. "Unstructured" cases required questions to faculty for information. Multiple choice tests and differential diagnosis activities were administered. An attitudinal questionnaire gauged student perceptions.
In both multiple choice and differential diagnosis activities, the late rotation, "unstructured" group scored higher than the "structured" group. Conversely, the early rotation, "unstructured" group scored lower than the "structured" group. Combined, rotation, and structure significantly affected both multiple choice and differential diagnosis activities (ANOVA, P < or = 0.02). Early rotation, "unstructured" students described a more enjoyable experience, despite lower evaluation scores.
Surgical clerkship case-based learning is profoundly affected by case structure and prior clinical experience. Case-based curriculum should be tailored to accommodate these interactions.
随着基于病例的教学方法在外科实习中取代讲座式教学，人们对外科病例结构和既往经验对学习的影响进行了研究。
三年级的早期和晚期学生被随机分配到不同的病例组。“结构化”病例会呈现并总结数据。“非结构化”病例需要向教员提问以获取信息。进行了多项选择题测试和鉴别诊断活动。通过态度问卷来评估学生的看法。
在多项选择题测试和鉴别诊断活动中，晚期实习的“非结构化”组得分均高于“结构化”组。相反，早期实习的“非结构化”组得分低于“结构化”组。轮转时间、病例结构共同对多项选择题测试和鉴别诊断活动均有显著影响（方差分析，P≤0.02）。早期实习的“非结构化”学生虽然评估得分较低，但他们描述了更愉快的体验。
外科实习中的基于病例的学习受到病例结构和既往临床经验的深刻影响。基于病例的课程应进行调整以适应这些相互作用。
