Research on the application of a method combining progressive case study and fishbone diagram in general surgery intern teaching

Huang Simin; Wei Yuxuan; Yang Weibang; Wang Qiwen; Jiang Xiaofeng

doi:10.3760/cma.j.cn116021-20240710-02053

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Research on the application of a method combining progressive case study and fishbone diagram in general surgery intern teaching

Clinical Teaching | 更新时间：2025-07-01

- Research on the application of a method combining progressive case study and fishbone diagram in general surgery intern teaching
- Chinese Journal of Medical Education Research Vol. 24, Issue 6, Pages: 814-818(2025)
- 作者机构：
  
  1.广州医科大学附属第二医院肝胆外科，广州 510260
  2.广州医科大学附属第二医院外科实验室，广州 510260
- 作者简介：
  
  Jiang Xiaofeng, Email: jiangxiaofeng008@163.com
- 基金信息：
  
  Undergraduate Teaching Quality and Teaching Reform Engineering Construction Project of Guangzhou Medical University(2023ZLGC026)
- DOI：10.3760/cma.j.cn116021-20240710-02053
  CLC： R-05
- Received：10 July 2024，
  
  Published：20 June 2025
- 稿件说明：
移动端阅览
黄思敏, 魏宇轩, 杨伟帮, 等. 进展性案例结合鱼骨图教学在普外科实习教学中的应用研究[J]. 中华医学教育探索杂志, 2025, 24(6): 814-818.

Huang Simin, Wei Yuxuan, Yang Weibang, et al. Research on the application of a method combining progressive case study and fishbone diagram in general surgery intern teaching[J]. Chinese journal of medical education research, 2025, 24(6): 814-818.
黄思敏, 魏宇轩, 杨伟帮, 等. 进展性案例结合鱼骨图教学在普外科实习教学中的应用研究[J]. 中华医学教育探索杂志, 2025, 24(6): 814-818. DOI： 10.3760/cma.j.cn116021-20240710-02053.

Huang Simin, Wei Yuxuan, Yang Weibang, et al. Research on the application of a method combining progressive case study and fishbone diagram in general surgery intern teaching[J]. Chinese journal of medical education research, 2025, 24(6): 814-818. DOI： 10.3760/cma.j.cn116021-20240710-02053.

摘要

目的

探讨进展性案例结合鱼骨图教学在普外科临床实习教学中的应用效果，评估其对医学生理论知识掌握、临床实践能力及系统性思维培养的影响。

方法

选取2022年7月至2023年12月在普外科实习的60名临床医学本科生为研究对象，随机分为对照组（

=30）和观察组（

=30）。对照组采用传统案例教学，通过集中授课、小组讨论和总结答疑完成教学。观察组实施进展性案例结合鱼骨图整合教学，通过设计进展性案例、鱼骨图实施教学。采用理论考核、实践考核和教学满意度对教学进行评价。采用SPSS 22.0进行

检验和卡方检验。

结果

观察组实习生理论考核总分高于对照组[（86.97±4.60） vs. （66.06±5.96），

=-17.79，

0.001

]

，其中诊疗规范[（17.03±1.82） vs. （14.07±2.35）

]

和鉴别诊断[（12.85±1.42） vs. （8.92±2.37）

]

得分差异尤为明显。实践考核中，观察组实习生总分[（90.19±5.04） vs. （68.63±4.30，

=-17.82，

0.001）

]

及各分项成绩均优于对照组，特别是在急腹症评估[（18.23±1.72） vs. （14.37±2.05）

]

、腹腔镜空间定位[（8.83±0.95） vs. （5.92±1.38）

]

和术中突发情况处理[（8.95±0.97） vs. （6.05±1.23）

]

方面表现突出。观察组实习生各项满意度评分均高于对照组（

0.001），其中临床思维提升[（4.65±0.61） vs. （3.10±0.71）

]

和师生互动质量[（4.72±0.53） vs. （3.11±0.63）

]

的提升幅度最大。

结论

进展性案例结合鱼骨图教学通过动态呈现病例演变过程和结构化分析工具的应用，显著提高了实习生的理论成绩、实践操作能力和临床决策水平，且教学满意度更高。

Abstract

Objective

To explore the application effects of a method combining progressive case study and fishbone diagram in clinical teaching of interns in general surgery

and evaluate its impact on medical students' theoretical knowledge mastery

clinical practice ability development

and systematic thinking cultivation.

Methods

Sixty u

ndergraduate clinical medicine students who interned in the Department of General Surgery from July 2022 to December 2023 were selected as the research subjects and randomly divided into a control group (

=30) and an observation group (

=30). The control group received traditional case-based teaching through centralized lectures

group discussions

and review/Q

A sessions. The observation group received an integrated teaching approach combining progressive case study and fishbone diagram through the design of progressive cases and fishbone diagrams. Teaching effectiveness was evaluated through theoretical assessment

practical assessment

and teaching satisfaction survey. SPSS 22.0 was used for

-test and

test.

Results

The total score of theoretical assessments for the observation group interns was higher than that of the control group [(86.97±4.60) vs. (66.06±5.96)

=-17.79

0.001

]

. The differences in scores of diagnosis and treatment standards [(17.03±1.82) vs. (14.07±2.35)

]

and differential diagnosis [(12.85±1.42) vs. (8.92±2.37)

]

were particularly significant. In the practical assessments

the total score of the observation group interns [(90.19±5.04) vs. (68.63±4.30)

=-17.82

0.001

]

and their scores in individual assessments were higher than those of the control group

especially in acute abdomen evaluation [(18.23±1.72) vs. (14.37±2.05)

]

laparoscopic spatial positioning [(8.83±0.95) vs. (5.92±1.38)

]

and intraoperative emergency management [(8.95±0.97) vs. (6.05±1.23)

]

. The satisfaction scores of the observation group interns were higher than those of the control group (

0.001)

with the greatest improvement in clinical thinking [(4.65±0.61) vs. (3.10±0.71)

]

and teacher-student interaction quality [(4.72±0.53) vs. (3.11±0.63)

]

Conclusions

The teaching method combining progressive case study and fishbone diagram significantly improved interns' theoretical assessment scores

practical operation ability

and clinical decision-making level through the dynamic presentation of case evolution processes and the application of structured analysis tools

and also enhanced the teaching satisfaction.

关键词

Keywords

references

左可盈，李菁，杨思维，等 . 我国公众院前急救普及现状和培训新模式的策略研究 [J ] . 保健医学研究与实践， 2023 ， 20 （ 2 ）： 187 - 191 . DOI: 10.11986/j.issn.1673-873X.2023.02.042 http://dx.doi.org/10.11986/j.issn.1673-873X.2023.02.042 .

潘华洋，吴佳明，汪桐，等 . 基于在线平台PBL联合CBL教学在普外科临床实习中的应用 [J ] . 中国病案， 2021 ， 22 （ 5 ）： 78 - 81 . DOI: 10.3969/j.issn.1672-2566.2021.05.029 http://dx.doi.org/10.3969/j.issn.1672-2566.2021.05.029 .

侯毅芳，肖明，周诩川 . 进展性案例结合标准化病人在手术室模拟教学中的应用 [J ] . 全科护理， 2021 ， 19 （ 22 ）： 3143 - 3146 . DOI: 10.12104/j.issn.1674-4748.2021.22.031 http://dx.doi.org/10.12104/j.issn.1674-4748.2021.22.031 .

刘凤春，宋晓萌，李翠景，等 . 进展性案例结合思维导图教学法在神经内科低年资护士培训中的应用效果 [J ] . 护理研究， 2021 ， 35 （ 22 ）： 4093 - 4096 . DOI: 10.12102/j.issn.1009-6493.2021.22.029 http://dx.doi.org/10.12102/j.issn.1009-6493.2021.22.029 .

陈晓英，陈飞，钱锦钰，等 . 基于核心胜任力的进展性案例教学法在护士规范化培训中的应用 [J ] . 中华医学教育探索杂志， 2023 ， 22 （ 7 ）： 1088 - 1093 . DOI: 10.3760/cma.j.cn116021-20221212-01361 http://dx.doi.org/10.3760/cma.j.cn116021-20221212-01361 .

王文倩，袁媛，韩捷 . 中医经典鱼骨图教学法研究 [J ] . 中国中医药现代远程教育， 2021 ， 19 （ 11 ）： 17 - 19 . DOI: 10.3969/j.issn.1672-2779.2021.11.007 http://dx.doi.org/10.3969/j.issn.1672-2779.2021.11.007 .

吴雪华，袁媛，韩捷 . 鱼骨图分析教学法在中医内科学肠病专业硕士研究生的应用 [J ] . 中国中医药现代远程教育， 2021 ， 19 （ 12 ）： 43 - 45 . DOI: 10.3969/j.issn.1672-2779.2021.12.016 http://dx.doi.org/10.3969/j.issn.1672-2779.2021.12.016 .

支楠，姚小英，郦忆，等 . 翻转课堂联合案例式教学法在神经系统体格检查教学中的应用及评价 [J ] . 诊断学理论与实践， 2024 ， 23 （ 5 ）： 557 - 560 . DOI: 10.16150/j.1671-2870.2024.05.014 http://dx.doi.org/10.16150/j.1671-2870.2024.05.014 .

尹红燕，顾涛颖，张一帆，等 . 多模态教学在临床核医学教学中的应用探讨 [J ] . 诊断学理论与实践， 2024 ， 23 （ 2 ）： 214 - 218 . DOI: 10.16150/j.1671-2870.2024.02.017 http://dx.doi.org/10.16150/j.1671-2870.2024.02.017 .

桑旭，王照东，张超，等 . 整合式问题驱动教学法对医学本科生临床思维的影响 [J ] . 中华全科医学， 2024 ， 22 （ 7 ）： 1230 - 1233 . DOI: 10.16766/j.cnki.issn.1674-4152.003606 http://dx.doi.org/10.16766/j.cnki.issn.1674-4152.003606 .

朱姬莹，励杨晟，朱湘文，等 . SPARK影像教学案例库在医学影像学专业本科生实习中的应用 [J ] . 中华全科医学， 2024 ， 22 （ 8 ）： 1416 - 1419 . DOI: 10.16766/j.cnki.issn.1674-4152.003649 http://dx.doi.org/10.16766/j.cnki.issn.1674-4152.003649 .

罗希，周桦，黄秀桃，等 . 基于网络平台的PAL在妇产科技能模拟教学中的应用 [J ] . 保健医学研究与实践， 2023 ， 20 （ 4 ）： 142 - 145 . DOI: 10.11986/j.issn.1673-873X.2023.04.032 http://dx.doi.org/10.11986/j.issn.1673-873X.2023.04.032 .

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