Sutyak J P, Lebeau R B, O'Donnell A M
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, 08903-0019, USA.
Am J Surg. 1998 Jun;175(6):503-7. doi: 10.1016/s0002-9610(98)00076-2.
The impact of instructional method on students with opposing surgical career orientations was investigated in a prospective study.
Students were randomly assigned to structured or unstructured case-based discussions. Clinical reasoning (OSCE and a diagnosis exercise), subject knowledge (multiple choice test [MCT]), method preference, and pre-third year career preference were compared.
Twenty-two students listed a surgical career high (Surgical) and 20 low (Primary). Surgical MCT scores were higher than Primary regardless of instructional method. Surgical diagnosis exercise scores were higher than Primary with the structured method (22.0+/-2.3 versus 15.1+/-3.0, P <0.08). Unstructured scores on this exercise were similar (19.7+/-1.8 Surgical versus 20.3+/-3.5 Primary). Analysis of variance suggested an interaction on the diagnosis exercise between method and career (P = 0.16). Students preferred the unstructured method.
The improved diagnosis exercise performance implies that unstructured cases positively influence surgical domain specific reasoning for nonsurgical career students. These method effects increase our understanding of case-based methods in surgical education.
在一项前瞻性研究中，调查了教学方法对具有相反外科职业倾向的学生的影响。
学生被随机分配到结构化或非结构化的基于案例的讨论中。比较了临床推理（客观结构化临床考试和诊断练习）、学科知识（多项选择题测试[MCT]）、方法偏好和三年级前的职业偏好。
22名学生将外科职业列为高偏好（外科组），20名学生列为低偏好（初级组）。无论教学方法如何，外科组的MCT分数均高于初级组。采用结构化方法时，外科组的诊断练习分数高于初级组（22.0±2.3对15.1±3.0，P<0.08）。该练习的非结构化分数相似（外科组19.7±1.8对初级组20.3±3.5）。方差分析表明，方法和职业在诊断练习上存在交互作用（P=0.16）。学生更喜欢非结构化方法。
诊断练习表现的改善意味着非结构化案例对非外科职业学生的外科领域特定推理有积极影响。这些方法效果增进了我们对外科教育中基于案例方法的理解。
