Application of flipped classroom combined with case-based learning in cultivating clinical reasoning skills for chest pain diagnosis
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摘要:
目的 胸痛病因复杂，临床诊断极具挑战性，传统教学模式在培养医学生临床推理能力方面存在不足。本研究旨在评估案例学习（CBL）联合翻转课堂（FC）的教学模式能否有效提升医学生对胸痛的临床推理能力。 方法 纳入2023年9月—2024年3月在蚌埠医科大学第一附属医院实习的122名临床医学本科生，采用随机数字表法分为实验组（CBL+FC组，61名）和对照组（传统教学组，61名）。实验组通过课前观看胸痛多模态案例视频并在课堂分组讨论，对照组采用传统教材授课。评估指标包括诊断思维量表评分、诊断准确性、自主学习能力及教学满意度评分。 结果 实验组在诊断思维量表评分、诊断正确率、自主学习能力评分及教学满意度评分均高于对照组（160.3±17.3 vs. 149.4±10.9，P < 0.001；91.8% vs. 75.4%，P=0.014；79.7±5.6 vs. 69.3±6.0，P < 0.001；86.1±7.2 vs. 83.6±6.7，P=0.042）。 结论 CBL联合FC的教学模式能显著提高医学生对胸痛的临床推理能力与诊断效率，增强自主学习意识，并有效提升课堂时间的利用效率。 Abstract:Objective Chest pain has complex etiologies and poses significant diagnostic challenges. Traditional teaching methods often fall short in developing clinical reasoning skills in medical students. This study aimed to evaluate whether a teaching model combining case-based learning (CBL) with flipped classroom (FC) could effectively improve medical students' clinical reasoning skills in chest pain diagnosis. Methods A single-center randomized controlled trial was conducted at the First Affiliated Hospital of Bengbu Medical University from September 2023 to March 2024. A total of 122 clinical medicine undergraduates were randomly allocated using a random number table into an experimental group (CBL+FC, n=61) and a control group [traditional lecture-based learning (LBL), n=61]. The experimental group watched multimodal case videos on chest pain before class and participated in group discussions during class; the control group received traditional textbook-based lectures. Assessment metrics included the diagnostic thinking inventory (DTI) score, diagnostic accuracy, self-directed learning ability, and teaching satisfaction score. Results The experimental group scored higher than the control group in the DTI (160.3±17.3 vs. 149.4±10.9, P < 0.001), diagnostic accuracy (91.8% vs. 75.4%, P=0.014), self-directed learning ability (79.7±5.6 vs. 69.3±6.0, P < 0.001), and teaching satisfaction (86.1±7.2 vs. 83.6±6.7, P=0.042). Conclusion The teaching model combining CBL and FC can significantly enhance medical students' clinical reasoning ability and diagnostic efficiency for chest pain, strengthen their self-directed learning awareness, and effectively improve classroom time utilization. -
Key words:
- Chest pain /
- Case-based learning /
- Flipped classroom /
- Clinical reasoning /
- Medical education
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表 1 2组学生基线特征比较
Table 1. Comparison of baseline characteristics between the two groups of students
组别 例数 年龄(x±s，岁) 性别[人(%)] 诊断思维评分(x±s，分) 男性 女性 实验组 61 21.1±1.3 28(45.9) 33(54.1) 74.7±9.1 对照组 61 21.0±1.2 34(55.7) 27(44.3) 72.2±8.4 统计量 0.512a 1.181b 1.541a P值 0.610 0.277 0.126 注：a为t值，b为χ2值。 
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表 2 2组学生教学效果比较
Table 2. Comparison of teaching effects between two groups of students
组别 例数 诊断思维得分(x±s，分) 诊断准确性[人(%)] 自主学习(x±s，分) 满意度(x±s，分) 正确 错误 实验组 61 160.3±17.3 56(91.8) 5(8.2) 79.7±5.6 86.1±7.2 对照组 61 149.4±10.9 46(75.4) 15(24.6) 69.3±6.0 83.6±6.7 统计量 4.143a 5.980b 9.890a 2.056a P值 ＜0.001 0.014 ＜0.001 0.042 注：a为t值，b为χ2值。
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