康复治疗师继续教育病例库联合案例学习法的设计与运用效果

doi:10.3969/j.issn.1006-9771.2026.03.001

摘要/Abstract

摘要：

目的调查案例学习法(CBL)联合教学病例库在康复治疗师继续教育课程中的需求，并探索其应用成效。

方法采用聚敛式混合方法研究，纳入2022年10月至2024年10月在北京大学第三医院康复医学科接受进修培训的康复治疗师51名及其授课教师31名。通过自编问卷收集师生对CBL及教学病例库的需求情况；运用医学课程学生评教问卷、课堂参与量表和Flanders互动分析系统，对比CBL联合教学病例库与传统教学法在学生评价、课堂参与度和互动等方面的差异；借助半结构化访谈获取师生对其的评价与态度。

结果问卷调查显示，91.4%受访师生支持在教学中使用CBL；其中82.7%主张病例库纳入典型病例。师生在病例教学方式选择上存在显著性差异(χ² = 17.597, P < 0.01)。应用效果比较显示，CBL联合教学病例库在学生预习、课堂互动及学习效果等方面明显优于传统教学法(|Z| ≥ 2.646, P < 0.01)；Flanders互动分析显示，CBL在学生话语权、自主学习动机等方面优于传统教学法。质性研究提炼出4个正向主题(培养临床思维、贴近临床实际、加深知识理解、提升教学水平)和3个负向主题(增加备课负担、软硬件要求高、对学生挑战大)。

结论相较于传统教学法，CBL联合教学病例库紧密联系临床实践，有利于培养康复临床思维、提升教学效果与满意度，契合康复治疗师继续教育目标和需求，在师生中认可度较高。

关键词: 康复治疗师, 继续教育, 病例库, 案例学习法

Abstract:

Objective To investigate the demand and the application outcomes of case-based learning (CBL) combined with teaching case library in continuing education courses for rehabilitation therapists.

Methods A convergent mixed-methods research design was adopted, involving 51 rehabilitation therapists and 31 instructors who participated in the advanced training program at the Department of Rehabilitation Medicine, Peking University Third Hospital between October, 2022 and October, 2024. Self-developed questionnaires were used to collect data on the perceived needs of teachers and students regarding CBL and teaching case library. Differences between CBL + teaching case library and traditional lecturing in student evaluations, classroom participation and interaction were compared using Student Evaluation of Teaching in Medical Lectures, Classroom Participation Scale and Flanders Interaction Analysis System. Semi-structured interviews were conducted to obtain evaluations and attitudes towards this method from both instructors and students' perspectives.

Results The survey showed that 91.4% of participating teachers and students supported the use of CBL in the courses, and 82.7% advocated that the teaching case library should include typical cases. Significant differences were observed in teaching preference between teachers and students (χ² = 17.597, P < 0.01). Application effects demonstrated that CBL+teaching library significantly outperformed traditional teaching methods in student previewing behaviors, classroom interaction and learning outcomes (|Z| ≥ 2.646, P < 0.01). Flanders Interaction Analysis indicated that CBL+teaching library was superior to traditional teaching in terms of students' motivation to speak and autonomous learning. Qualitative Research generated four positive themes including cultivating clinical reasoning, being close to clinical practice, deepening knowledge understanding and improving teaching quality; and three negative themes including increasing teaching burden, high software and hardware requirements and posing great challenges to students were generated.

Conclusion Compared with traditional teaching methods, CBL combined with teaching case library is closely linked to clinical practice, facilitating students' clinical reasoning, enhancing teaching effectiveness and satisfaction, and therefore aligning with the goals and needs of continuing education for rehabilitation therapists, which is highly recognized by both instructors and students.

Key words: rehabilitation therapists, continuing education, case library, case-based learning

中图分类号:

R49-4

钱李果, 吴同绚, 张巧云, 邢剑, 杨延砚. 康复治疗师继续教育病例库联合案例学习法的设计与运用效果[J]. 《中国康复理论与实践》, 2026, 32(3): 249-257.

QIAN Liguo, WU Tongxuan, ZHANG Qiaoyun, XING Jian, YANG Yanyan. Design and application effect of continuing education case library combined with case-based learning for rehabilitation therapists[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 249-257.

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参考文献 26

[1]	陈健尔, 曹缦婷, 梁康. 中国康复医学教育现状分析及其发展对策[J]. 中华物理医学与康复杂志, 2024, 46(4): 356-358.
[2]	PETERSON S, WEIBLE K, HALPERT B, et al. Continuing education courses for orthopedic and sports physical therapists in the United States often lack supporting evidence: a review of available intervention courses[J]. Phys Ther, 2022, 102(6): pzac031.
[3]	谢凌锋, 许涛, 刘雅丽, 等. 国内康复治疗教育现状的研究[J]. 中国康复, 2019, 34(10): 557-560.
[4]	邱卓英, 郭键勋, 孙宏伟, 等. 世界卫生组织康复胜任力架构及其在康复领域的系统应用:理论架构、方法和应用领域[J]. 中国康复理论与实践, 2022, 28(3): 265-274. doi: 10.3969/j.issn.1006-9771.2022.03.002
	QIU Z Y, KWOK J K F, SUN H W, et al. Systematic implementation of World Health Organization rehabilitation competency framework in rehabilitation: conceptual framework, approaches and application[J]. Chin J Rehabil Theory Pract, 2022, 28(3): 265-274.
[5]	国家卫生健康委办公厅. 康复治疗专业人员培训大纲(2023年版) [EB/OL]. (2023-10-27)[2025-04-15]. https://www.gov.cn/zhengce/zhengceku/202311/content_6915265.htm.
[6]	DEMETRI L, DONNELLEY C A, TOOGOOD P. Comparison of case-based learning and traditional lectures in an orthopedic residency anatomy course[J]. J Surg Educ, 2021, 78(78): 679-685. doi: 10.1016/j.jsurg.2020.08.026
[7]	覃霞, 梁贞文, 毕霞, 等. 案例联合情景模拟教学法在康复实践技能课程中的应用[J]. 中国继续医学教育, 2023, 15(1): 96-100.
	QIN X, LIANG Z W, BI X, et al. Application of case-based learning combined with scenario simulation teaching method in rehabilitation practical skills course[J]. Chin Contin Med Educ, 2023, 15(1): 96-100.
[8]	王美芳, 赵俊英, 李邻峰, 等. 以临床病例库为基础的案例教学法在皮肤科本科带教中的应用[J]. 中国医刊, 2022, 57(11): 1273-1276.
[9]	杨晓龙, 戴甜, 王启明, 等. 基于"案例基础+问题导向"«骨科康复学»课程转化能力培养教学实践[J]. 中华医学教育探索杂志, 2024, 23(10): 1369-1373.
	YANG X L, DAI T, WANG Q M, et al. Teaching practice of transformation ability cultivation in the "orthopedic rehabilitation" course based on "case-based+problem-oriented" method[J]. Chin J Med Educ Res, 2024, 23(10): 1369-1373.
[10]	黄红拾, 王懿, 张思, 等. 基于病例分析以问题为基础的学习法在运动康复继续教育中的应用[J]. 中国康复医学杂志, 2022, 37(8): 1098-1101.
[11]	MÜLLER T, MONTANO D, POINSTINGL H, et al. Evaluation of large-group lectures in medicine: development of the SETMED-L (Student Evaluation of Teaching in Medical Lectures) questionnaire[J]. Bmc Med Educ, 2017, 17(1): 137. doi: 10.1186/s12909-017-0970-8
[12]	张旭. 大学生课堂参与的现状及影响因素研究[D]. 苏州: 苏州大学, 2014.
	ZHANG X. The study on status quo and influence factors of university students' class participation[D]. Suzhou: Soochow University, 2014.
[13]	方海光, 高辰柱, 陈佳. 改进型弗兰德斯互动分析系统及其应用[J]. 中国电化教育, 2012(10): 109-113.
[14]	师嘉阳, 陈宗涛. 基于弗兰德斯互动分析法在«健康管理»课程说课比赛中师生语言互动行为效果研究[J]. 中华医学教育探索杂志, 2024, 23(4): 460-464.
	SHI J Y, CHEN Z T. Effect of language interaction between teachers and students in presentation of a teaching plan for Health Management courses based on Flanders interaction analysis[J]. Chin J Med Educ Res, 2024, 23(4): 460-464.
[15]	刘京宇, 杨延砚, 周谋望, 等. 国家康复医学专业医疗服务与质量安全报告(2020年)[J]. 中华物理医学与康复杂志, 2022, 44(10): 950-960.
[16]	吴鸣, 刘沙鑫, 燕铁斌, 等. 中国康复治疗师毕业后规范化培训专家共识[J]. 中国康复医学杂志, 2021, 36(11): 1347-1350.
[17]	郭思园, 陈淑英, 尹莹. 公立医院高质量发展背景下进修医师培训需求调查与分析[J]. 中国继续医学教育, 2022, 14(20): 97-102.
	GUO S Y, CHEN S Y, YIN Y. Investigation and analysis on the demand for training of refresher physicians under the background of high quality development of public hospitals[J]. Chin Contin Med Educ, 2022, 14(20): 97-102.
[18]	王慧慧. 病例库及病例导入法在生殖医学教学中的应用[J]. 继续医学教育, 2021, 35(11): 42-44.
[19]	CEN X, HUA Y, NIU S, et al. Application of case-based learning in medical student education: a meta-analysis[J]. Eur Rev Med Pharmacol Sci, 2021, 25(8): 3173-3181.
[20]	赵彦, 林爱翠. 案例情景模拟法对康复治疗专业教学效果的影响[J]. 中国康复医学杂志, 2020, 35(8): 972-975.
[21]	孔渝菡, 田贵华, 杜丽, 等. ICF引导的案例教学法在康复治疗实习教学中的应用[J]. 中华医学教育探索杂志, 2021, 20(3): 304-307.
	KONG Y H, TIAN G H, DU L, et al. Application of case-based learning guided by ICF in rehabilitation practice teaching[J]. Chin J Med Educ Res, 2021, 20(3): 304-307.
[22]	张晶, 吕曼曼, 吕小林, 等. 基于"互联网+"的案例教学法联合OSCE在肾内科护生带教中的应用[J]. 中华医学教育探索杂志, 2024, 23(5): 717-720.
	ZHANG J, LÜ M M, LÜ X L, et al. Application of "Internet +" based case teaching method combined with OSCE teaching method in the teaching of nursing students in the department of nephrology[J]. Chin J Med Educ Res, 2024, 23(5): 717-720.
[23]	王小蕊, 蔺丽慧, 白萍, 等. 基于工作流程的CBL教学在血液检验本科实习带教中的应用与思考[J]. 中华医学教育探索杂志, 2021, 20(9): 1001-1003.
	WANG X R, LIN L H, BAI P, et al. Application and thinking of working-process based CBL teaching method for undergraduate practice teaching in clinical laboratory of hematology[J]. Chin J Med Educ Res, 2021, 20(9): 1001-1003.
[24]	陈琦, 王夜明, 袁超, 等. 基于SP的CBL联合TBL教学在重症医学科临床教学中的应用[J]. 中华医学教育探索杂志, 2023, 22(1): 91-94.
	CHEN Q, WANG Y M, YUAN C, et al. Application of the CBL combined with TBL based on SP teaching method in clinical teaching of department of intensive care medicine[J]. Chin J Med Educ Res, 2023, 22(1): 91-94.
[25]	杨琼, 郎宁, 袁慧书. PBL/CBL/RBL教学模式结合PACS/RIS/HIS系统用于三甲医院影像教学[J]. 继续医学教育, 2019, 33(2): 41-43.
[26]	YUAN W, LI Z, HAN J, et al. Improving the resident assessment process: application of App-based e-training platform and lean thinking[J]. BMC Med Educ, 2023, 23(1): 134. doi: 10.1186/s12909-023-04118-2 pmid: 36855113

教师访谈	学生访谈
1.您对在教学中使用CBL体验如何?持什么态度?	1.您对接受CBL体验如何，持什么态度?
2.您认为在教学中使用CBL的促进/阻碍因素分别有哪些?	2.您希望以哪种方式接受CBL?
3.您认为该如何在教学中使用CBL?	3.您认为好的康复教学病例库应具备哪些特点?
4.您认为康复病例库能对您的教学带来哪些影响?	4.您认为康复教学病例库能为您现阶段的学习带来哪些影响?
5.您理想中的康复教学病例库应该具备哪些特点?	5.您期望以什么方式在学习过程中使用病例库?

受访对象			n(%)
学生(n = 51)	学历	大学专科	1(2.00)
		大学本科	36(70.60)
		研究生	14(27.50)
	工作年限	< 1年	21(41.20)
		1~2年	9(17.70)
		3~5年	5(9.80)
		> 5年	16(31.40)
教师(n = 30)	身份	康复医师	9(30.00)
		康复治疗师	18(60.00)
		康复护士	3(10.00)
	职称	初级	5(16.67)
		中级	22(73.33)
		副高级	3(10.00)
	教龄	< 1年	4(13.33)
		1~2年	5(16.67)
		3~5年	5(16.67)
		> 5年	16(53.33)

项目		应用效果评价 (学生，n = 18)	质性访谈
项目		应用效果评价 (学生，n = 18)	受访学生(n = 8)	受访教师(n = 6)
学历	大学专科	1(5.6)	0	0
	大学本科	12(66.7)	5(62.5)	2(33.3)
	研究生	5(27.8)	3(37.5)	4(66.7)
工作年限/教龄	< 1年	5(27.8)	3(37.5)	0
	1~2年	3(16.7)	1(12.5)	0
	3~5年	2(11.1)	1(12.5)	1(16.7)
	> 5年	8(44.4)	3(37.5)	5(83.3)
职称	中级			5(83.3)
	副高级			1(16.7)

病例库使用方式	学生(n = 51)	教师(n = 30)
病例讨论	24(47.1)	12(40.0)
模拟临床诊疗演练	14(27.5)	2(6.7)
理论课学习	9(17.7)	8(26.7)
线上自主学习	4(7.8)	1(3.3)
综合使用	0	7(23.3)

教学方式	n	1	2	3	4	5	6	7	8	9
传统教学	18	4(4, 5)	4(4, 4)	4(4, 5)	4(4, 4)	4(4, 4.3)	4(4, 4)	4(4, 5)	4(4, 5)	4(4, 4)
CBL	18	4(4, 5)	4(4, 5)	5(4, 5)	5(4, 5)	5(4, 5)	4.5(4, 5)	5(4.8, 5)	5(5, 5)	5(4.8, 5)
Z值		0.000	-0.687	-1.446	-2.771	-2.963	-2.442	-2.081	-2.395	-3.641
P值		1.000	0.492	0.148	0.006	0.003	0.015	0.037	0.017	< 0.001
教学方式	n	10	11	12	13	14	课程部分总分	教师部分总分	整体满意度 (0~10分)
传统教学	18	4(3, 5)	4(3, 5)	4(4, 5)	4(4, 5)	4(4, 5)	31.0(28.8, 33)	34.0(30.8, 36.5)	8(8, 9)
CBL	18	5(4, 5)	5(4, 5)	5(4, 5)	5(4, 5)	5(4.8, 5)	36.5(34.8, 39.3)	38.0(36.8, 40.0)	10(9, 10)
Z值		-2.690	-2.471	-1.418	-1.217	-2.646	-4.448	-3.022	-3.528
P值		0.007	0.013	0.156	0.224	0.008	< 0.001	0.003	< 0.001