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目的：研究以案例为基础的学习（CBL）教学法结合以问题为基础的学习（PBL）教学法在肝胆外科教学中的应用，为临床教学提供依据。方法：选取2014 年1月到2015 年6 月我院肝胆外科实习生270 例为研究对象，按照随机数字表法将实习生分为I组、 II 组和III组，每组90 例，I 组给予PBL联合CBL 教学法，II组给予PBL 教学法，III组给予传统学习(LBL)教学法，比较三组教学效果。结果：I组和II组学习兴趣、自主学习能力以及课堂氛围评分显著高于III组，I组知识理解评分显著高于II组和III组，II组显著高于III组，比较差异具有统计学意义（P＜0.05）；I 组基础知识分显著高于II组和III组，I组和II组临床技能评分显著高于III 组，比较差异具有统计学意义（P＜0.05）；I 组和II组调查满意度显著高于III 组，且I 组显著高于II 组，比较差异具有统计学意义（P＜0.05）。结论：PBL联合CBL教学法用于肝胆外科教学中能显著提高实习生的知识理解能力和满意度。

英文摘要:

To study the application of case based learning (CBL) teaching method combined with problem based learning (PBL) teaching method in hepatobiliary surgery teaching, and to provide the basis for clinical teaching. A total of 270 surgical interns, who practised in the department of hepatobiliary surgery of the First Affiliated Hospital of Guangzhou Medical University from January 2014 to June 2015, were selected and randomly divided into group I(n=90), group II(n=90) and group III(n=90). Group I was given PBL combined with CBL teaching method; group II , PBL teaching method; group III, the lecture-based learning (LBL) teaching method. The teaching effects of the three groups were compared. Learning interest, self learning ability and classroom atmosphere scores of group I and II were significantly higher than those of group III.The score of knowledge in group I was significantly higher than those in group II and III; the score of knowledge in group II was significantly higher than that in group III, the differences were statistically significant(P<0.05). The basic knowledge score of group I was significantly higher than group II and III; the scores of clinical skills in group I and II were significantly higher than that in group III,the differences were statistically significant(P<0. 05). The satisfaction degrees of group I and II were significantly higher than that of group III,and the satisfaction degree of group I was significantly higher than that of group II, the differences were statistically significant (P<0.05). PBL combined with CBL teaching method can increase the ability of understanding and satisfaction degree of students in the department of hepatobiliary surgery teaching.

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