探讨多学科协作诊治模式(MDT)联合以案例为基础的学习-以问题为基础的学习(CBL-PBL)教学模式及形成性评价在心血管内科住院医师规范化培训中的应用效果。

选择2023年3月至2023年5月在西安交通大学第二附属医院心血管内科进行住院医师规范化培训的30名住培生，设为试验组，采用MDT联合CBL和PBL教学模式，通过带教老师带领住培生以临床典型病例为基础，从实际问题出发，通过多学科讨论，分步骤对心血管内科专业知识进行系统整合学习，每一步骤做形成性评价反馈。同时选择2022年12月至2023年2月在西安交大第二附属医院心血管内科进行住院医师规范化培训的30名住培生，设为对照组，采用传统教学模式。对两组住培生的考试成绩、教学满意度进行比较，试验组住培生做形成性评价反馈。

试验组住培生理论成绩、病例分析成绩、技能操作成绩、总成绩[(87.30±3.58)分，(83.13±3.19)分，(87.77±2.96)分，(86.98±2.93)分]高于对照组成绩[(84.40±3.51)分，(81.10±3.03)分，(84.23±2.83)分，(84.04±2.67)分]，均差异有统计学意义(t＝3.39，2.37，4.72，4.06；均P<0.05)。试验组总教学满意度(27/30，90.00%)明显高于对照组(19/30，63.33%)，差异具有统计学意义(χ²＝6.26，P<0.05)。试验组对教学做形成性评价反馈显示，MDT联合CBL和PBL教学模式能明显提高住培生独立思考能力、学习积极性、自主学习能力和临床实践及思维能力，满意度均为100.00%；但激发学习兴趣和提高、发现及解决问题能力仍需进一步完善，满意度分别为[29/30(96.67%)，27/30(90.00%)]。

MDT联合CBL和PBL教学模式融合形成性评价在心血管内科住院医师规范化培训中教学效果显著，能够充分发挥住培生的主观能动性及团队协作能力，提高住培生理论知识和临床思维能力，在教学中值得推广。

To explore the effect of multi-disciplinary treatment (MDT) combined with case-based learning (CBL) and problem-based learning (PBL) teaching model and formative assessment in standardized training of cardiology residents.

The experimental group consisted of 30 students who underwent standardized training at the Department of Cardiovascular Medicine, the Second Affiliated Hospital of Xi′an Jiaotong University, from March to May 2023. They were exposed to the MDT in conjunction with CBL and PBL teaching approaches, as well as formative evaluation integration. Teachers used the resident clinical cases as the basis, then guided the physicians to systematically integrate and learn the professional knowledge of cardiovascular medicine through multidisciplinary discussions and step-by-step learning, and provided formative assessment comments at each step. At the same time, 30 students who received standardized training of residents in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Xi′an Jiaotong University from December 2022 to February 2023 were chosen as the control group, who were taught using traditional methods. The two groups′ test results and teaching satisfaction were compared, and the experimental group provided formative comments feedback.

The experimental group′s theoretical scores, case analysis scores, skill operation scores and total scores [(87.30±3.58)points, (83.13±3.19)points, (87.77±2.96)points, (86.98±2.93)points] were higher than those of the control group [(84.40±3.51)points. (81.10±3.03)points, (84.23±2.83)points, (84.04±2.67)points], the differences were statistically significant (t=3.39, 2.37, 4.72, 4.06, all P<0.05). The overall teaching satisfaction rate was significantly higher in the experimental group (27/30, 90.00%) than that in the control group (19/30, 63.33%), and this difference was statistically significant (χ²=6.26, P<0.05). The experimental group′s formative evaluation feedback revealed that MDT combined with CBL and PBL could significantly improve the standardized resident training students′ independent thinking ability, learning enthusiasm, independent learning ability, clinical practice and thinking ability, the satisfaction rates were all 100.00%. However, there was still room for improvement in stimulating learning interest, and enhancing the ability to discover and solve problems, the satisfaction rates were 96.67% (29/30) and 90.00% (27/30) respectively.

The integrated formative evaluation of MDT combined with CBL and PBL teaching models has a significant teaching effect in the standardized training of cardiovascular internal medicine residents, which can fully exploit resident physicians′ subjective initiative and teamwork ability, improve their theoretical knowledge and clinical thinking ability, and is worth promoting in teaching.