Participants
This is a non-randomized controlled trial. A total of 66 resident doctors participated in standardized training at the Second Affiliated Hospital of Shandong First Medical University.36 residents who received standardized training in the department of anesthesiology in 2021 were selected as the Rain Classroom combined with TBL group(Experimental group), and 30 residents who received standardized training in the department of anesthesiology in 2022 were selected as the LBL group(Control group).
Experimental group: Clinical teaching strives to achieve the transformation from "teacher-centered" to "resident-centered". The teaching with residents as the main body enhances the participation of residents, stimulates their enthusiasm for learning, cultivates innovative ability and personalized development, so as to achieve the purpose of improving the effect of clinical teaching.Rain Classroom combined with TBL realizes interactive communication between teachers and students through the combination of online and offline. The specific teaching practice is as follow
(1) The first stage (self-study stage) : 3 days in advance, the contents of the cases to be discussed was sent to residents through the Rain Classroom to encourage them to think about the case and cultivated self-learning ability.
(2) The second stage (Team-based learning stage) : At this stage, a resident reported the case in the form of PPT. Before the discussion, teachers assessed the residents' self-learning ability and the attainment of knowledge objectives through the "Rain Classroom" test.Teachers organized residents to discuss clinical cases in groups within the prescribed time (30 minutes) (5-6 people/group, group leader and secretary).During the discussion, the theoretical knowledge of the case and related clinical problems were fully explored, and the clinical logical thinking of the residents was trained.The secretary recorded the comments of the group members, and the group leader summarized the speech.
(3) The third stage (reflection and summary stage) : The third stage (reflective summary stage) : Residents summarize the contents discussed in this case by means of knowledge frame diagram or mind map, which is helpful to integrate what they have learned, internalize knowledge and improve clinical logical thinking ability.According to the students' performance, the instructor further improved the teaching content and form.
Control group: The LBL was adopted. At a fixed time and place, the resident reported the cases, and the instructor presided over the case discussion and asked to speak by name.
Assessment methods
The teaching effect was evaluated by theoretical knowledge, clinical ability test and questionnaire survey.
Theoretical knowledge assessment
The full score of theoretical knowledge assessment was 100 points, including theoretical knowledge (50 points) and case analysis (50 points).
Clinical Competency Tests
- The modified Mini-Clinical Evaluation Scale (Mini-CEX)[12] includes eight aspects: preoperative interview, communication skills, anesthesia planning, preoper- ative preparation, anesthesia operation, intraoperative anesthesia management focus, clinical competence, and overall satisfaction.
Clinical thinking ability: According to the evaluation index system of clinical thinking proposed by Song Junyan [13], the research group designed an evaluation scale of clinical thinking ability, which includes 15 items in three dimensions, critical thinking ability, systematic thinking ability and evidence-based thinking ability. The dimensions of critical thinking ability include Finding the truth,Analysis and judgment of problem and Clinical disposal ability. The dimensions of systematic thinking ability included Mastery of knowledge, disease observation, Evaluation before anesthesia,disease judgment, summary and collation of information, communication skill, and health education.The dimensions of evidence-based thinking ability include knowledge of evidence-based medicine, problem sorting and solving, retrieve information and evidence, assessment of data quality, and integration of data.
Questionnaire survey
A questionnaire survey was conducted among the residents in the two groups, and the recovery rate was 100%.The contents of the questionnaire included active atmosphere, learning enthusiasm, knowledge mastery and application, verbal expression ability, team spirit, the ability to analyze and solve problems, ability to use knowledge and clinical thinking ability.
Statistical analysis
The measurement data in accordance with normal distribution were expressed as mean ± standard deviation, and the count data were expressed as frequency. SPSS 26.0(SPSS, Inc.Chicago, IL) software was used for statistical analysis.The test scores and teaching satisfaction were analyzed by t test, and the rank sum test was used to analyze the clinical ability levels. P<0.05 was considered statistically significant.