Evaluate The Implementation Effect Of PBL In China Medical University Applying OSCE Primarily

IntroductionAiming at the disadvantage that traditional education methods simply attach importance to knowledge imparting and ignore cultivating diversified skills, problem-based learning (PBL) mode comes into being. Education researchers all over the world identify with it generally. However, people now still apply traditional evaluation means based on fact recalling and questionnaires to evaluate PBL. In this study, we used objective structured clinical examination (OSCE) which is the best way to evaluate clinical ability at present and questionnaires assisted to evaluate the medium-term implementation effect of the first round PBL reform in China Medical University (CMU) primarily.Material and Methods483 students of China Medical University were included, among whom there were 117 students from 2002 grade of five-year program, 185 from 2001 grade of six-year program and 201 from 2002 grade of seven-year program. The students from five-year and seven-year program all attended PBL, as for six-year program, there were 80 students attended. Questionnaire survey was done during OSCE, and we gather the grades of the examination after OSCE. The PBL students from six-year program were divided into three groups according to their attitudes toward PBL (approval, neutralism, dislike) and together with other non-PBL students they were divided into four groups in all. We analyzed their corresponding grades of OSCE in four aspects: general implementation effect of PBL, collecting case history ability, medical examination ability and clinical thinking ability. The attitudes of the students from five-year and six-year program and from seven-year program in the questionnaires were analyzed, which reflected the self-assessment of general implementation effect of PBL. Then the students from five-year and six-year program and from seven-year program were divided into several groups according to questionnaires result respectively. We compared the total grades of OSCE of each group and analyzed the influence on the implementation effect of PBL that different course organizations had. SPSS 13.0 was used for data analysis.ResultsOn the aspect of general implementation effect of PBL, 90 percent of students from five-year and six-year program and from seven-year program didn't object to it, in them 50 percent also approve, 40 percent also remain neutral and less than 10 percent dislike this method. The total grades of OSCE of dislike group from six-year program were significantly lower than approval group (P<0.05) and likewise non-PBL group (P<0.01) .On the aspect of different clinical abilities comparison, in collecting case history ability, there was no significant difference in the grades of content of inquisition (P>0.05) and the grades of skill of inquisition and content add skill of inquisition of dislike group were significantly lower than that of non-PBL group (P<0.05) .In medical examination ability, the grades of contents of medical examination and content add skill of medical examination of dislike group were significantly lower than approval and neutralism group (P<0.05 )and lower than non-PBL group (P<0.01) ;the grades of skill of medical examination of dislike group were significantly lower than those of approval group (P<0.05) and non-PBL group (P<0.01) .In clinical thinking ability, the grades of computer-based case of simulation exam of dislike group were significantly lower than those of the other three groups (P<0.05) ; the grades of short station of approval group were significantly higher than that of non-PBL group (P<0.05) ; as for the grades of written examination in standard patient station there was no significant difference in the four group (P>0.05) .On the aspect of comparison of different course organizations, the total grades of OSCE in the group less than 6 students were higher then that of 6～10 students (P<0.01 )from seven-year program, as for five-year and six-year program, the number of students in study group didn't influence the total grades of OSCE(P>0.05). The total grades of OSCE of the students who took charge of the groups in discussion were higher than those who hadn't that experience (P<0.01) and there was no significant difference in seven-year program (P>0.05) . The total grades of OSCE of the students who had 4 or above PBL courses were higher than that of the students who had 1～3 courses(P<0.001 )and there was just opposite in seven-year program(P<0.001). There was no influence on total grades of OSCE that the percentage of group study in total course had (P>0.05) .DiscussionFrom the questionnaires we could see that the students from five-year and six-year program and seven-year program all consent to PBL mode in certain degree. But we havn't found obvious advantages applying the grades of OSCE to evaluate the implementation effect of PBL from six-year program in total and single clinical abilities except the clinical thinking ability, in which there is improvement in approval PBL students over non-PBL. To analyze the above result, students, teachers, teaching materials, environment and so on all influence the implementation effect and speed of PBL in China.Due to their relatively better background, students of seven-year program show better in adaptability and receptivity of PBL as compared with those of five-year and six-year program. So their clinical abilities are different when the number of students in groups is different and the clinical abilities of the groups less than 6 students are best. The clinical abilities of the students from five-year and six-year program who take charge of the groups in discussion are better than those who havn't that experience and due to the relatively better background of the students from seven-year program who have better study abilities, their clinical abilities aren't different whether they take charge of the group in discussion or not. The much more PBL courses the students have, the better clinical abilities are cultivated and reinforced. The fact that clinical abilities of the students who have 4 or above PBL courses are better than the students who have 1～3 just prove it. On the contrary, owing to student's limited vigor overfull PBL courses affect the implementation effect of PBL. So there is just opposite in seven-year program. Although the total grades of OSCE from five-year and six-year program and from seven-year program increase following the percentage of group study time in whole course, there is no statistically significance.ConclusionAlthough the self-assessment of students is relatively satisfactory, we have not found obvious advantages applying the grades of OSCE to evaluate the medium-term implementation effect of PBL in CMU. Different course organizations have influence on the implementation effect of PBL. In that, the study group that has less than 6 students is more effective in the implementation effect of PBL; the student who takes charge of the group in discussion is more effective in the implementation effect of PBL. While we can't make sure that the number of PBL course has effect on the implementation effect of PBL and there is also no influence on it the percentage of group study time in whole course has.