Kuyambira mliri wa COVID-19, dzikolo layamba kuyang'ana kwambiri ntchito yophunzitsa zachipatala m'zipatala zamayunivesite.Kulimbikitsa kuphatikizika kwamankhwala ndi maphunziro ndikuwongolera bwino komanso kuchita bwino kwa maphunziro azachipatala ndizovuta zazikulu zomwe maphunziro azachipatala akukumana nazo.Kuvuta kwa kuphunzitsa mafupa agona pamitundu yosiyanasiyana ya matenda, ukatswiri wapamwamba komanso mawonekedwe osamveka bwino, omwe amakhudza mayendedwe, changu komanso mphamvu ya kuphunzitsa kwa ophunzira azachipatala.Kafukufukuyu adapanga dongosolo lophunzitsira la m'kalasi losinthika motengera lingaliro la CDIO (Concept-Design-Implement-Operate) ndikuligwiritsa ntchito mu maphunziro a anamwino a mafupa kuti apititse patsogolo luso la kuphunzira ndikuthandiza aphunzitsi kuzindikira kusintha tsogolo la maphunziro a unamwino komanso ngakhale maphunziro azachipatala.Kuphunzira m'kalasi kudzakhala kogwira mtima komanso kolunjika.
Ophunzira 50 azachipatala omwe adamaliza maphunziro awo ku dipatimenti ya mafupa pachipatala chapamwamba mu June 2017 adaphatikizidwa mu gulu lowongolera, ndipo ophunzira 50 a unamwino omwe adamaliza maphunziro awo mu dipatimentiyi mu June 2018 adaphatikizidwa mugulu lothandizira.Gulu lothandizira lidatengera lingaliro la CDIO la mtundu wophunzitsira wopindika m'kalasi, pomwe gulu lowongolera lidatengera njira yophunzitsira yachikhalidwe.Atamaliza ntchito zothandiza za dipatimentiyi, magulu awiri a ophunzira adawunikidwa pa chiphunzitso, maluso ogwirira ntchito, luso la kuphunzira paokha komanso luso loganiza bwino.Magulu awiri a aphunzitsi adamaliza miyeso isanu ndi itatu yowunika momwe angagwiritsire ntchito zachipatala, kuphatikiza njira zinayi za unamwino, kuthekera kwa unamwino waumunthu, komanso kuwunika momwe akuphunzitsira zachipatala.
Pambuyo pa maphunziro, luso lazochita zamankhwala, luso loganiza bwino, luso lophunzirira lodziimira, zongopeka ndi zogwirira ntchito, komanso maphunziro apamwamba a zachipatala a gulu lothandizira anali apamwamba kwambiri kuposa a gulu lolamulira (zonse P <0.05).
Njira yophunzitsira yozikidwa pa CDIO imatha kulimbikitsa kuphunzira paokha kwa anamwino ndi luso loganiza bwino, kulimbikitsa kuphatikiza kwamalingaliro ndi machitidwe, kukulitsa luso lawo logwiritsa ntchito mokwanira chidziwitso chaukadaulo kusanthula ndi kuthetsa mavuto othandiza, ndikuwongolera momwe amaphunzirira.
Maphunziro azachipatala ndi gawo lofunikira kwambiri la maphunziro a unamwino ndipo limakhudza kusintha kuchokera ku chidziwitso chaukadaulo kupita kukuchita.Kuphunzira bwino zachipatala kungathandize anamwino kukhala ndi luso laukatswiri, kulimbitsa chidziwitso chaukadaulo, komanso kukulitsa luso lawo lochita unamwino.Ilinso gawo lomaliza la kusintha kwa ntchito kwa ophunzira azachipatala [1].M'zaka zaposachedwa, ofufuza ambiri azachipatala achita kafukufuku wokhudzana ndi njira zophunzitsira monga kuphunzira motengera zovuta (PBL), kuphunzira motengera milandu (CBL), kuphunzira kwamagulu (TBL), kuphunzira kwanthawi zonse komanso kuyerekezera zochitika pakuphunzitsa kwachipatala. ..Komabe, njira zosiyanasiyana zophunzitsira zili ndi ubwino ndi kuipa kwake potengera zotsatira za kuphunzira kwa kulumikizana kothandiza, koma sizimakwaniritsa kuphatikizika kwa chiphunzitso ndi machitidwe [2].
"Kalasi yopindika" imatanthawuza njira yophunzirira yatsopano yomwe ophunzira amagwiritsa ntchito nsanja yodziwikiratu kuti aphunzire mozama zida zosiyanasiyana zamaphunziro asanaphunzire ndi kumaliza homuweki mwanjira ya "maphunziro ogwirizana" m'kalasi pomwe aphunzitsi amawongolera ophunzira.Yankhani mafunso ndikupereka chithandizo chaumwini[3].American New Media Alliance idawona kuti kalasi yosinthika imasintha nthawi mkati ndi kunja kwa kalasi ndikusamutsa zisankho za ophunzira kuchokera kwa aphunzitsi kupita kwa ophunzira [4].Nthawi yamtengo wapatali yogwiritsidwa ntchito m'kalasi mu chitsanzo chophunzirira ichi imalola ophunzira kuti aganizire kwambiri maphunziro okhudzidwa, okhudzana ndi mavuto.Deshpande [5] adachita kafukufuku pamaphunziro osinthira azachipatala ndi kuphunzitsa ndipo adatsimikiza kuti kalasi yosinthika imatha kupititsa patsogolo chidwi cha ophunzira ndikuchita bwino pamaphunziro ndikuchepetsa nthawi yakalasi.Khe Fung HEW ndi Chung Kwan LO [6] adawunika zotsatira za kafukufuku wa zolemba zofananira za kalasi yotembenuzidwa ndikufotokozera mwachidule momwe njira yophunzitsira yosinthira m'kalasi mwa kusanthula meta, kuwonetsa kuti poyerekeza ndi njira zophunzitsira zachikhalidwe, njira yophunzitsira yopindika m'kalasi. m'maphunziro azaumoyo waukatswiri ndiabwino kwambiri komanso amathandizira kuphunzira kwa ophunzira.Zhong Jie [7] anayerekezera zotsatira za kalasi yopindika komanso kusinthasintha kwa maphunziro a m'kalasi pakupeza chidziwitso cha ophunzira, ndipo adapeza kuti panthawi yophunzirira mophatikizana m'kalasi yosinthika ya histology, kuwongolera maphunziro a pa intaneti kumatha kupititsa patsogolo kukhutitsidwa kwa ophunzira komanso chidziwitso.gwirani.Kutengera zotsatira za kafukufukuyu, pankhani ya maphunziro a unamwino, akatswiri ambiri amaphunzira momwe kalasi yosinthira m'kalasi imakhudzidwira ndi luso la kuphunzitsa m'kalasi ndipo amakhulupirira kuti kuphunzitsa m'kalasi kungathandize anamwino kuti azichita bwino m'maphunziro, luso la kuphunzira paokha, komanso kukhutira m'kalasi.
Chifukwa chake, pakufunika mwachangu kufufuza ndikupanga njira yatsopano yophunzitsira yomwe ingathandize ophunzira unamwino kuyamwa ndikukhazikitsa chidziwitso chaukadaulo ndikuwongolera luso lawo lazachipatala komanso luso lawo lonse.CDIO (Concept-Design-Implement-Operate) ndi chitsanzo cha maphunziro a uinjiniya chomwe chinapangidwa mu 2000 ndi mayunivesite anayi, kuphatikiza Massachusetts Institute of Technology ndi Royal Institute of Technology ku Sweden.Ndi chitsanzo chapamwamba cha maphunziro a uinjiniya omwe amalola ophunzira anamwino kuti aphunzire ndikukhala ndi luso lachangu, logwira ntchito, komanso lachilengedwe [8, 9].Pankhani ya maphunziro apakatikati, chitsanzochi chikugogomezera "kukhazikika kwa ophunzira," kulola ophunzira kutenga nawo mbali pakupanga, kupanga, kukhazikitsa, ndi kuyendetsa ntchito, ndikusintha chidziwitso chophunzitsidwa bwino kukhala zida zothetsera mavuto.Kafukufuku wambiri wasonyeza kuti njira yophunzitsira ya CDIO imathandizira kupititsa patsogolo luso lazochita zamankhwala komanso kuwongolera bwino kwa ophunzira azachipatala, kuwongolera kulumikizana kwa aphunzitsi ndi ophunzira, kupititsa patsogolo luso la kuphunzitsa, komanso kumathandizira kulimbikitsa kusintha kwa chidziwitso ndikuwongolera njira zophunzitsira.Amagwiritsidwa ntchito kwambiri pophunzitsa talente [10].
Ndi kusintha kwa chitsanzo chachipatala padziko lonse, zofuna za anthu za thanzi zikuwonjezeka, zomwe zachititsanso kuti udindo wa ogwira ntchito zachipatala uwonjezeke.Mphamvu ndi khalidwe la anamwino zimagwirizana mwachindunji ndi chisamaliro chachipatala ndi chitetezo cha odwala.M'zaka zaposachedwa, kakulidwe ndi kuwunika kwa kuthekera kwachipatala kwa ogwira ntchito ya unamwino kwakhala nkhani yovuta kwambiri pankhani ya unamwino [11].Chifukwa chake, njira yowunikira, yokwanira, yodalirika, komanso yovomerezeka ndiyofunikira pakufufuza kwamaphunziro azachipatala.Mini-clinical evaluation Exercise (mini-CEX) ndi njira yowunikira luso lachipatala la ophunzira azachipatala ndipo imagwiritsidwa ntchito kwambiri pankhani yamaphunziro azachipatala amitundumitundu kunyumba ndi kunja.Zinawonekera pang'onopang'ono m'munda wa unamwino [12, 13].
Maphunziro ambiri achitika pakugwiritsa ntchito mtundu wa CDIO, kalasi yopindika, ndi mini-CEX pamaphunziro a unamwino.Wang Bei [14] adakambirana za momwe CDIO imathandizira pakuwongolera maphunziro a namwino pazosowa za anamwino a COVID-19.Zotsatirazi zikusonyeza kuti kugwiritsa ntchito chitsanzo cha CDIO popereka maphunziro apadera a unamwino pa COVID-19 kudzathandiza ogwira ntchito ya unamwino kukhala ndi luso lapadera lophunzitsira unamwino ndi chidziwitso chokhudzana ndi izi, ndikuwongolera bwino luso lawo la unamwino.Akatswiri monga Liu Mei [15] adakambilana za kagwiritsidwe ntchito ka njira yophunzitsira yamagulu kuphatikiza ndi m'kalasi yopindika pophunzitsa anamwino a mafupa.Zotsatira zinasonyeza kuti chitsanzo chophunzitsirachi chikhoza kupititsa patsogolo luso la anamwino a mafupa monga kumvetsetsa.ndi kugwiritsa ntchito chidziwitso chaukadaulo, kugwirira ntchito limodzi, kulingalira mozama, ndi kafukufuku wasayansi.Li Ruyue et al.[16] anaphunzira zotsatira za kugwiritsa ntchito bwino Nursing Mini-CEX mu maphunziro ovomerezeka a anamwino atsopano opaleshoni ndipo adapeza kuti aphunzitsi angagwiritse ntchito Nursing Mini-CEX kuti ayese kuyesa konse ndi machitidwe a ntchito pakuphunzitsa zachipatala kapena maulalo a work.weak mu iye.anamwino ndi kupereka ndemanga zenizeni zenizeni.Kupyolera mukudziyang'anira nokha ndikudziwonetsera nokha, mfundo zazikuluzikulu zowunikira ntchito ya unamwino zimaphunziridwa, maphunziro amasinthidwa, kaphunzitsidwe kachipatala kamakhala bwino, luso la unamwino la anamwino lachipatala limapangidwa bwino, ndipo kusinthasintha kuphatikiza m'kalasi kutengera lingaliro la CDIO kumayesedwa, koma pakadali pano palibe lipoti la kafukufuku.Kugwiritsa ntchito njira yowunika ya mini-CEX pamaphunziro a unamwino kwa ophunzira a mafupa.Wolembayo adagwiritsa ntchito chitsanzo cha CDIO popanga maphunziro a anamwino a mafupa, adamanga kalasi yosinthika molingana ndi lingaliro la CDIO, ndikuphatikizidwa ndi chitsanzo cha mini-CEX chowunikira kuti agwiritse ntchito njira yophunzirira ya atatu-imodzi ndi yabwino.chidziwitso ndi luso, komanso zinathandizira kuwongolera luso la kuphunzitsa.Kuwongolera kosalekeza kumapereka maziko ophunzirira mokhazikika m'zipatala zophunzitsira.
Pofuna kupititsa patsogolo kukhazikitsidwa kwa maphunzirowa, njira yosavuta yochitira zitsanzo idagwiritsidwa ntchito ngati maphunziro ophunzirira anamwino a unamwino kuyambira 2017 ndi 2018 omwe amagwira ntchito mu dipatimenti ya mafupa pachipatala chapamwamba.Popeza pali ophunzitsidwa 52 pamlingo uliwonse, kukula kwachitsanzo kudzakhala 104. Ophunzira anayi sanachite nawo ntchito zonse zachipatala.Gulu loyang'anira linaphatikizapo anamwino a 50 omwe anamaliza maphunziro awo mu dipatimenti ya mafupa a chipatala chapamwamba mu June 2017, omwe amuna a 6 ndi amayi a 44 a zaka zapakati pa 20 mpaka 22 (21.30 ± 0.60) zaka, omwe anamaliza maphunziro awo pa dipatimenti yomweyo. mu June 2018. Gulu lothandizira linaphatikizapo ophunzira a zachipatala a 50, kuphatikizapo amuna a 8 ndi akazi a 42 a zaka 21 mpaka 22 (21.45 ± 0.37) zaka.Maphunziro onse adapereka chilolezo chodziwitsidwa.Zofunika Zophatikizira: (1) Ophunzira azachipatala a Orthopedic omwe ali ndi digiri ya bachelor.(2) Chilolezo chodziwitsidwa ndi kutenga nawo mbali modzifunira mu phunziroli.Njira zochotsera: Anthu omwe sangathe kutenga nawo mbali mokwanira pazachipatala.Palibe kusiyana kwakukulu pazidziwitso zamagulu awiri a ophunzira azachipatala (p> 0.05) ndipo amafanana.
Magulu onsewa adamaliza maphunziro achipatala a 4-sabata, ndi maphunziro onse omwe adamalizidwa mu dipatimenti ya Orthopedics.Panthawi yowonera, panali magulu a 10 a ophunzira azachipatala, ophunzira a 5 pagulu lililonse.Maphunziro amachitika molingana ndi pulogalamu ya internship kwa ophunzira anamwino, kuphatikiza magawo aukadaulo ndiukadaulo.Aphunzitsi m’magulu onsewa ali ndi ziyeneretso zofanana, ndipo mphunzitsi wa namwino ali ndi udindo woyang’anira kaphunzitsidwe kabwino.
Gulu loyang'anira limagwiritsa ntchito njira zophunzitsira zakale.M’mlungu woyamba wa sukulu, makalasi amayamba Lolemba.Aphunzitsi amaphunzitsa chiphunzitso Lachiwiri ndi Lachitatu, ndipo amayang'ana kwambiri maphunziro ogwirira ntchito Lachinayi ndi Lachisanu.Kuyambira sabata yachiwiri mpaka yachinayi, membala wa faculty aliyense ali ndi udindo wa wophunzira zachipatala wopereka maphunziro a apo ndi apo mu dipatimentiyo.Mu sabata yachinayi, kuwunika kudzamalizidwa masiku atatu maphunzirowo asanathe.
Monga tanena kale, wolemba amatengera njira yophunzitsira ya m'kalasi yosinthika kutengera lingaliro la CDIO, monga tafotokozera pansipa.
Mlungu woyamba wa maphunziro ndi wofanana ndi gulu lolamulira;Milungu yachiwiri mpaka inayi ya maphunziro a mafupa a mafupa amagwiritsira ntchito ndondomeko yophunzitsira ya m'kalasi motsatira lingaliro la CDIO kwa maola 36.Gawo lamalingaliro ndi kapangidwe limamalizidwa sabata yachiwiri ndipo gawo lokhazikitsidwa limamalizidwa sabata yachitatu.Opaleshoni inamalizidwa mu sabata lachinayi, ndipo kuunika ndi kuunika kunamalizidwa masiku atatu asanatulutsidwe.Onani Table 1 kuti mugawane nthawi yamagulu.
Gulu lophunzitsa lokhala ndi namwino wamkulu wa 1, gulu la mafupa 8 ndi katswiri wa unamwino wopanda mafupa a CDIO adakhazikitsidwa.Namwino Wamkulu amapatsa mamembala a gulu lophunzitsa maphunziro ndi luso la maphunziro ndi miyezo ya CDIO, buku la zokambirana za CDIO ndi malingaliro ena okhudzana ndi njira zogwirira ntchito (osachepera maola 20), ndipo amakambirana ndi akatswiri nthawi zonse pa nkhani zovuta zophunzitsira. .Aphunzitsi amaika zolinga zophunzirira, kuyang'anira maphunziro, ndikukonzekera maphunziro m'njira yogwirizana ndi zofunikira za unamwino wamkulu ndi pulogalamu yokhalamo.
Malinga ndi pulogalamu ya internship, ponena za pulogalamu yophunzitsira talente ya CDIO ndi miyezo [17] komanso kuphatikiza ndi machitidwe ophunzitsira a namwino wazamisala, zolinga zophunzirira za anamwino amaphunzitsidwa m'magulu atatu, omwe ndi: zolinga za chidziwitso (kuzindikira zoyambira). chidziwitso), chidziwitso chaukadaulo ndi njira zofananira zamakina, ndi zina), zolinga zamaluso (kupititsa patsogolo luso laukadaulo, luso loganiza bwino komanso luso lophunzirira lodziyimira pawokha, ndi zina zambiri) ndi zolinga zabwino (kumanga zikhalidwe zaukadaulo komanso mzimu wosamalira anthu komanso etc.)..).Zolinga zachidziwitso zimayenderana ndi chidziwitso chaukadaulo ndi kulingalira kwamaphunziro a CDIO, kuthekera kwamunthu, luso laukadaulo ndi maubale a maphunziro a CDIO, ndi zolinga zabwino zimagwirizana ndi luso lofewa la maphunziro a CDIO: kugwira ntchito limodzi ndi kulumikizana.
Pambuyo pamisonkhano iwiri, gulu lophunzitsa lidakambirana za dongosolo lophunzitsira unamwino m'kalasi yosinthika motengera lingaliro la CDIO, adagawa maphunzirowo m'magawo anayi, ndikutsimikiza zolinga ndi kapangidwe kake, monga momwe tawonetsera mu Gulu 1.
Atatha kusanthula ntchito ya unamwino pa matenda a mafupa, mphunzitsiyo adazindikira matenda odziwika komanso odziwika bwino a mafupa.Tiyeni titenge ndondomeko ya chithandizo cha odwala omwe ali ndi lumbar disc herniation monga chitsanzo: Wodwala Zhang Moumou (wamwamuna, zaka 73, kutalika kwa 177 cm, kulemera kwa 80 kg) anadandaula za "kupweteka kwa m'munsi komwe kumayendera limodzi ndi dzanzi ndi kupweteka kumanzere kumanzere 2 months” ndipo adagonekedwa m’chipatala chachipatala chakunja.Monga wodwala Namwino Wodalirika: (1) Chonde funsani mwadongosolo mbiri ya wodwalayo kutengera chidziwitso chomwe mwapeza ndikuzindikira zomwe zikuchitika kwa wodwalayo;(2) Sankhani mwadongosolo kafukufuku ndi njira zowunikira akatswiri malinga ndi momwe zinthu zilili ndikuwonetsa mafunso ofufuza omwe amafunikira kuunikanso;(3) Pangani matenda a unamwino.Pankhaniyi, ndikofunikira kuphatikiza nkhokwe yakusaka kwamilandu;lembani njira zothandizira unamwino zokhudzana ndi wodwalayo;(4) Kambiranani za mavuto omwe alipo pakudzisamalira okha, komanso njira zamakono komanso zomwe zili pakutsatira kwa odwala pakutha.Lembani nkhani za ophunzira ndi mndandanda wa ntchito masiku awiri musanayambe maphunziro.Mndandanda wa ntchito za nkhaniyi ndi motere: (1) Unikaninso ndi kulimbikitsa chidziwitso cha chiphunzitso cha etiology ndi mawonetseredwe azachipatala a lumbar intervertebral disc herniation;(2) Konzani ndondomeko yosamalira chisamaliro;(3) Konzani nkhaniyi potengera ntchito yachipatala ndikukhazikitsa chisamaliro chachipatala ndi pambuyo pa opaleshoni ndizochitika ziwiri zazikulu zophunzitsira fanizo la polojekiti.Ophunzira a unamwino paokha kuwunika zomwe zili mu maphunzirowa ndi mafunso oyeserera, funsani zolemba ndi nkhokwe zofunika, ndi kumaliza ntchito zodziwerengera polowa mu gulu la WeChat.
Ophunzira amapanga magulu mwaufulu, ndipo gulu limasankha mtsogoleri wa gulu yemwe ali ndi udindo wogawanitsa anthu ogwira ntchito ndikuwongolera ntchitoyo.Mtsogoleri wa gulu lokonzekera ali ndi udindo wofalitsa nkhani zinayi: kufotokozera nkhani, kukhazikitsa ndondomeko ya unamwino, maphunziro a zaumoyo, ndi chidziwitso chokhudzana ndi matenda kwa membala aliyense wa gulu.Pa nthawi ya internship, ophunzira amagwiritsa ntchito nthawi yawo yaulere kuti afufuze mbiri yakale kapena zida zothetsera mavuto, kuchita zokambirana zamagulu, ndi kukonza mapulani enaake.Pachitukuko cha pulojekiti, mphunzitsi amathandiza mtsogoleri wa gulu pogawa mamembala a gulu kuti akonzekere chidziwitso choyenera, kupanga ndi kupanga mapulojekiti, kusonyeza ndi kusintha mapangidwe, ndikuthandizira ophunzira a unamwino kuti aphatikize chidziwitso chokhudzana ndi ntchito pakupanga ndi kupanga.Dziwani zambiri za gawo lililonse.Zovuta ndi mfundo zazikulu za gulu lofufuzirali zidawunikidwa ndikupangidwa, ndipo ndondomeko yoyendetsera zochitika za gulu la kafukufukuyu inakhazikitsidwa.Panthawi imeneyi, aphunzitsi adakonzanso ziwonetsero za unamwino.
Ophunzira amagwira ntchito m'magulu ang'onoang'ono kuti awonetse ntchito.Pambuyo pa lipotili, mamembala ena amgulu ndi aphunzitsi adakambirana ndikuyankhapo pagulu lopereka malipoti kuti apititse patsogolo dongosolo la chisamaliro cha unamwino.Mtsogoleri wa gulu amalimbikitsa mamembala a gulu kuti ayese ndondomeko yonse ya chisamaliro, ndipo mphunzitsi amathandiza ophunzira kufufuza kusintha kwakukulu kwa matenda pogwiritsa ntchito machitidwe ofananitsa, kukulitsa kumvetsetsa kwawo ndi kumanga chidziwitso cha chiphunzitso, ndikukhala ndi luso loganiza bwino.Zonse zomwe ziyenera kumalizidwa mu chitukuko cha matenda apadera zimatsirizidwa motsogozedwa ndi aphunzitsi.Aphunzitsi amathirira ndemanga ndikuwatsogolera anamwino kuti azichita mchitidwe wapafupi ndi bedi kuti akwaniritse chidziwitso chophatikizana komanso machitidwe azachipatala.
Atatha kuunika gulu lirilonse, mlangizi adapereka ndemanga ndikuwona mphamvu ndi zofooka za membala aliyense pagulu lomwe ali nalo komanso luso lake kuti apititse patsogolo kumvetsetsa kwa anamwino pazomwe akuphunzira.Aphunzitsi amasanthula khalidwe la kuphunzitsa ndikukonza maphunziro motengera kuwunika kwa anamwino ndi kuwunika kwa kaphunzitsidwe.
Ophunzira a unamwino amatenga mayeso ongoganizira komanso othandiza akamaliza maphunziro othandiza.Mafunso okhudzana ndi kulowererapo amafunsidwa ndi mphunzitsi.Mapepala othandizira amagawidwa m'magulu awiri (A ndi B), ndipo gulu limodzi limasankhidwa mwachisawawa kuti lilowererepo.Mafunso olowera nawo agawidwa m'magawo awiri: chidziwitso chaukadaulo chaukadaulo ndi kusanthula kwamilandu, iliyonse ili ndi mfundo 50 pamlingo wokwanira 100.Ophunzira, poyesa luso la unamwino, adzasankha mwachisawawa chimodzi mwa zotsatirazi, kuphatikizapo njira ya axial inversion, njira yabwino yoikira miyendo kwa odwala omwe ali ndi vuto la msana, kugwiritsa ntchito njira yothandizira pneumatic, njira yogwiritsira ntchito makina ogwirizanitsa a CPM, ndi zina zotero. chigoli ndi 100 points.
Mu sabata yachinayi, Independent Learning Assessment Scale idzayesedwa masiku atatu maphunzirowo asanathe.Mulingo wodziyimira wodziyimira pawokha wa luso la kuphunzira lopangidwa ndi Zhang Xiyan [18] adagwiritsidwa ntchito, kuphatikiza zolimbikitsa kuphunzira (zinthu 8), kudziletsa (zinthu 11), kuthekera kogwirizana pophunzira (zinthu 5), komanso kudziwa zambiri (zinthu 6) .Chinthu chilichonse chimayikidwa pamlingo wa 5-point Likert kuchokera ku "zosagwirizana konse" mpaka "zosagwirizana kwathunthu," ndi ziwerengero zochokera ku 1 mpaka 5. Chiwerengero chonse ndi 150. Kupambana kwapamwamba, kumapangitsa kuti athe kuphunzira paokha. .Cronbach's alpha coefficient of the sikelo ndi 0.822.
Mu sabata yachinayi, mphamvu yoganiza mozama idawunikidwa masiku atatu isanatulutsidwe.Baibulo lachi China la Critical Thinking Ability Assessment Scale lomasuliridwa ndi Mercy Corps [19] linagwiritsidwa ntchito.Lili ndi miyeso isanu ndi iwiri: kutulukira chowonadi, kuganiza momasuka, luso losanthula ndi luso lokonzekera, ndi zinthu 10 mugawo lililonse.Sikelo ya 6-point imagwiritsidwa ntchito kuyambira "kusagwirizana kwambiri" mpaka "kuvomereza mwamphamvu" kuchokera ku 1 mpaka 6, motsatana.Mawu olakwika ndi otsutsana, omwe ali ndi chiwerengero chochokera ku 70 mpaka 420. Chiwerengero chonse cha ≤210 chimasonyeza ntchito yolakwika, 211-279 imasonyeza kusalowerera ndale, 280-349 imasonyeza ntchito zabwino, ndipo ≥350 imasonyeza luso loganiza bwino.Cronbach's alpha coefficient of the sikelo ndi 0.90.
Mu sabata yachinayi, kuyesa kwachipatala kudzachitika masiku atatu asanatulutsidwe.Sikelo ya mini-CEX yomwe idagwiritsidwa ntchito mu kafukufukuyu idasinthidwa kuchokera ku Medical Classic [20] kutengera mini-CEX, ndipo kulephera kudachokera pa 1 mpaka 3 mfundo.Imakwaniritsa zofunikira, mfundo 4-6 pazofunikira, 7-9 mfundo zabwino.Ophunzira azachipatala amamaliza maphunziro awo akamaliza maphunziro apadera.The Cronbach's alpha coefficient of this sikelo ndi 0.780 ndipo gawo lodalirika la theka ndi 0.842, kusonyeza kudalirika kwabwino.
M’sabata yachinayi, kutatsala tsiku limodzi kuti achoke m’dipatimentiyi, panachitika nkhani yosiyirana ya aphunzitsi ndi ana asukulu komanso kuunika kwa kaphunzitsidwe kabwino.Fomu yowunikira luso la kuphunzitsa idapangidwa ndi Zhou Tong [21] ndipo ili ndi mbali zisanu: malingaliro ophunzitsira, zomwe zikuphunzitsa, ndi kuphunzitsa.Njira, zotsatira za maphunziro ndi makhalidwe a maphunziro.Sikelo ya 5-point Likert idagwiritsidwa ntchito.Kuchuluka kwa magole, kumapangitsanso luso la kuphunzitsa.Anamalizidwa atamaliza maphunziro apadera.Mafunsowo ali ndi kudalirika kwabwino, ndi alpha ya Cronbach ya sikelo kukhala 0.85.
Deta idawunikidwa pogwiritsa ntchito pulogalamu yowerengera ya SPSS 21.0.Deta yoyezera imawonetsedwa ngati ± kupatuka kokhazikika (\(\strike X \pm S\)) ndipo gulu lothandizira t limagwiritsidwa ntchito poyerekeza pakati pamagulu.Deta yowerengera idawonetsedwa ngati kuchuluka kwa milandu (%) ndikuyerekeza kugwiritsa ntchito chi-square kapena kulowererapo ndendende kwa Fisher.Mtengo wa p <0.05 umasonyeza kusiyana kwakukulu.
Kuyerekeza kwa zochitika zamaganizo ndi zogwirira ntchito zamagulu awiri a namwino ogwira ntchito akuwonetsedwa mu Table 2.
Kuyerekeza kwa maphunziro odziyimira pawokha komanso luso loganiza bwino la magulu awiri a namwino omwe amaphunzira nawo zikuwonetsedwa mu Gulu 3.
Kuyerekeza kwa kuwunika kwa luso lachipatala pakati pa magulu awiri a namwino intern.Kuthekera kwa unamwino wachipatala kwa ophunzira mu gulu lothandizira kunali bwino kwambiri kuposa gulu lolamulira, ndipo kusiyana kwake kunali kofunikira kwambiri (p <0.05) monga momwe tawonetsera mu Table 4.
Zotsatira za kuyesa khalidwe la maphunziro a magulu awiriwa zinasonyeza kuti chiwerengero cha maphunziro apamwamba cha gulu lolamulira chinali 90.08 ± 2.34 mfundo, ndipo chiwerengero chonse cha maphunziro a gulu lothandizira chinali 96.34 ± 2.16 mfundo.Kusiyanaku kunali kofunikira powerengera.(t = - 13.900, p <0.001).
Kukula ndi kupita patsogolo kwa mankhwala kumafuna kudzikundikira kokwanira kwa talente yachipatala.Ngakhale njira zambiri zophunzitsira zoyeserera komanso zoyeserera zilipo, sizingalowe m'malo mwa machitidwe azachipatala, omwe amagwirizana mwachindunji ndi luso lachipatala lamtsogolo pochiza matenda ndikupulumutsa miyoyo.Kuyambira mliri wa COVID-19, dzikolo lapereka chidwi kwambiri pantchito yophunzitsa zachipatala m'zipatala zaku yunivesite [22].Kulimbikitsa kuphatikizika kwamankhwala ndi maphunziro ndikuwongolera bwino komanso kuchita bwino kwa maphunziro azachipatala ndizovuta zazikulu zomwe maphunziro azachipatala akukumana nazo.Kuvuta kwa kuphunzitsa mafupa kumagona pamitundu yambiri ya matenda, ukatswiri wapamwamba komanso mawonekedwe osamveka, omwe amakhudza mayendedwe, chidwi komanso luso la ophunzira azachipatala [23].
Njira yophunzitsira ya m'kalasi yosinthika mkati mwa lingaliro la kuphunzitsa la CDIO imaphatikiza zophunzirira ndi njira yophunzitsira, kuphunzira ndi kuchita.Izi zimasintha kapangidwe ka makalasi ndikuyika ophunzira unamwino pachimake cha kuphunzitsa.Pa nthawi ya maphunziro, aphunzitsi amathandiza anamwino anamwino kuti adziŵe zofunikira pazochitika za unamwino zovuta nthawi zonse [24].Kafukufuku akuwonetsa kuti CDIO imaphatikizapo chitukuko cha ntchito ndi ntchito zophunzitsira zachipatala.Pulojekitiyi imapereka chitsogozo chatsatanetsatane, imaphatikizanso kuphatikizika kwa chidziwitso chaukadaulo ndi chitukuko cha luso lantchito, ndikuzindikira zovuta pakuyerekeza, zomwe zimakhala zothandiza kwa ophunzira a unamwino pakuwongolera kuphunzira kwawo paokha komanso luso loganiza mozama, komanso kuwongolera panthawi yodziyimira pawokha. kuphunzira.-maphunziro.Zotsatira za phunziroli zikuwonetsa kuti pambuyo pa masabata a 4 a maphunziro, maphunziro odziimira okha ndi luso loganiza bwino la anamwino omwe ali mu gulu lothandizira anali apamwamba kwambiri kuposa omwe ali mu gulu lolamulira (onse p <0.001).Izi zikugwirizana ndi zotsatira za kafukufuku wa Fan Xiaoying pa zotsatira za CDIO pamodzi ndi njira yophunzitsira ya CBL pa maphunziro a unamwino [25].Njira yophunzitsira iyi ingathandize kwambiri ophunzira kuganiza mozama komanso luso la kuphunzira paokha.Pa nthawi ya malingaliro, mphunzitsi amagawana mfundo zovuta ndi ophunzira anamwino m'kalasi.Ophunzira anamwino adaphunzira pawokha mfundo zofunikira kudzera m'mavidiyo amaphunziro ang'onoang'ono ndikufunafuna zida zoyenera kuti apititse patsogolo kumvetsetsa kwawo ntchito yaunamwino ya mafupa.Panthawi yokonza mapulani, ophunzira a unamwino adagwiritsa ntchito limodzi ndi luso loganiza mozama pokambirana m'magulu, motsogozedwa ndi aphunzitsi ndikugwiritsa ntchito maphunziro a zochitika.Pa gawo lokhazikitsa, ophunzitsa amawona chisamaliro cha perioperative cha matenda enieni ngati mwayi ndikugwiritsa ntchito njira zophunzitsira zoyeserera kuti aphunzitse ophunzira unamwino kuti azichita zochitika mumagulu amagulu kuti adziwe bwino ndikupeza zovuta pantchito yaunamwino.Panthaŵi imodzimodziyo, mwa kuphunzitsa zochitika zenizeni, ophunzira unamwino angaphunzire mfundo zazikulu za chisamaliro chachipatala ndi pambuyo pa opaleshoni kotero kuti amvetse bwino kuti mbali zonse za chisamaliro cha perioperative ndizofunika kwambiri pakuchira kwa wodwalayo.M'malo ogwirira ntchito, aphunzitsi amathandizira ophunzira azachipatala kudziwa bwino malingaliro ndi luso muzochita.Pochita zimenezi, amaphunzira kuona kusintha kwa mikhalidwe muzochitika zenizeni, kulingalira za zovuta zomwe zingatheke, komanso kusaloweza njira zosiyanasiyana za unamwino kuti athandize ophunzira azachipatala.Njira yomanga ndi kukhazikitsa organically imaphatikiza zomwe zili mu maphunziro.Munjira yophunzirira yogwirizana, yolumikizana komanso yokumana nayo, luso la ophunzira la unamwino pawokha komanso chidwi cha kuphunzira zimayendetsedwa bwino ndipo luso lawo loganiza bwino limawongoleredwa.Ofufuza adagwiritsa ntchito Design Thinking (DT) -Conceive-Design-Implement-Operate (CDIO)) kuti ayambitse njira yopangira uinjiniya m'maphunziro operekedwa pa intaneti kuti apititse patsogolo luso la ophunzira komanso luso loganiza (CT), ndipo zotsatira zake zikuwonetsa kuti. Kuchita bwino kwa ophunzira pamaphunziro ndi luso loganiza mophatikizira limakula bwino [26].
Phunziroli limathandiza ophunzira a unamwino kutenga nawo mbali pazochitika zonse molingana ndi ndondomeko ya Questioning-Concept-Design-Implementation-Operation-Debriefing.Zochitika zachipatala zapangidwa.Cholinga chake chimakhala pa mgwirizano wamagulu ndi kulingalira paokha, kuwonjezeredwa ndi mphunzitsi kuyankha mafunso, ophunzira kupereka njira zothetsera mavuto, kusonkhanitsa deta, zochitika zolimbitsa thupi, ndipo pamapeto pake masewero olimbitsa thupi.Zotsatira za phunziroli zinasonyeza kuti ophunzira ambiri a zachipatala mu gulu lothandizira pa kafukufuku wa chidziwitso cha chidziwitso ndi luso la ntchito anali bwino kuposa ophunzira omwe ali mu gulu lolamulira, ndipo kusiyana kunali kofunikira kwambiri (p <0.001).Izi zikugwirizana ndi mfundo yakuti ophunzira azachipatala mu gulu lothandizira anali ndi zotsatira zabwino pakuwunika kwa chidziwitso cha chiphunzitso ndi luso la ntchito.Poyerekeza ndi gulu lolamulira, kusiyana kwake kunali kofunikira kwambiri (p <0.001).Kuphatikizidwa ndi zotsatira zoyenera za kafukufuku [27, 28].Chifukwa cha kusanthula ndi chakuti chitsanzo cha CDIO choyamba chimasankha mfundo za chidziwitso cha matenda omwe ali ndi chiwerengero chapamwamba, ndipo kachiwiri, zovuta za makonzedwe a polojekiti zimagwirizana ndi zoyambira.Muchitsanzo ichi, ophunzira akamaliza zomwe zachitika, amamaliza buku la polojekiti ngati pakufunika kutero, amawunikanso zomwe zili zoyenera, ndikukambirana ndi mamembala amagulu kuti agayire ndikuyika zomwe akuphunzira ndikuphatikiza chidziwitso chatsopano ndi kuphunzira.Chidziwitso chakale m'njira yatsopano.Kuphatikizidwa kwa chidziwitso kumawonjezeka.
Kafukufukuyu akuwonetsa kuti pogwiritsa ntchito njira yophunzirira zachipatala ya CDIO, ophunzira a unamwino omwe ali mgulu lothandizira anali bwino kuposa ophunzira a unamwino omwe ali mgulu lowongolera pochita zofunsa za unamwino, kuyezetsa thupi, kudziwa matenda a unamwino, kukhazikitsa njira zothandizira unamwino, komanso chisamaliro cha unamwino.zotsatira.ndi chisamaliro chaumunthu.Kuphatikiza apo, panali kusiyana kwakukulu pamagawo aliwonse pakati pa magulu awiriwa (p <0.05), zomwe zinali zofanana ndi zotsatira za Hongyun [29].Zhou Tong [21] adaphunzira momwe angagwiritsire ntchito chitsanzo chophunzitsira cha Concept-Design-Implement-Operate (CDIO) pophunzitsa unamwino wamtima ndi mtima, ndipo adapeza kuti ophunzira m'gulu loyesera amagwiritsa ntchito CDIO chipatala .Njira yophunzitsira mu unamwino, umunthu Magawo asanu ndi atatu, monga luso la unamwino ndi chikumbumtima, ndi abwino kwambiri kuposa a anamwino omwe amagwiritsa ntchito njira zophunzitsira zachikhalidwe.Izi zitha kukhala chifukwa pophunzira, ophunzira unamwino savomerezanso chidziwitso, koma amagwiritsa ntchito luso lawo.kupeza chidziwitso m'njira zosiyanasiyana.Mamembala amgulu amamasula mzimu wawo wamagulu, amaphatikiza zida zophunzirira, ndikupereka lipoti mobwerezabwereza, kuyeseza, kusanthula, ndikukambirana za unamwino wachipatala.Chidziwitso chawo chimakula kuchokera kumtunda kupita kukuya, kumapereka chidwi kwambiri pazomwe zili mu kufufuza chifukwa.mavuto azaumoyo, kupanga zolinga za unamwino ndi kuthekera kwa njira zothandizira unamwino.Aphunzitsi amapereka chitsogozo ndi ziwonetsero pazokambirana kuti apange chilimbikitso chokhazikika cha kuyankha, kuthandizira ophunzira unamwino kumaliza maphunziro atanthauzo, kupititsa patsogolo luso la anamwino pazachipatala, kupititsa patsogolo chidwi cha kuphunzira ndi kuchita bwino, ndikupitiriza kupititsa patsogolo ntchito zachipatala za ophunzira - anamwino ..luso.Kutha kuphunzira kuchokera ku chiphunzitso kuti muzichita, kumaliza kutengera chidziwitso.
Kukhazikitsa mapulogalamu amaphunziro azachipatala opangidwa ndi CDIO kumapangitsa kuti maphunziro azachipatala akhale abwino.Zotsatira za kafukufuku wa Ding Jinxia [30] ndi ena zimasonyeza kuti pali mgwirizano pakati pa zinthu zosiyanasiyana monga kulimbikitsa kuphunzira, luso la kuphunzira paokha, ndi khalidwe lophunzitsira bwino la aphunzitsi azachipatala.Mu phunziroli, ndikukula kwa kuphunzitsa kwachipatala kwa CDIO, aphunzitsi azachipatala adalandira maphunziro apamwamba, malingaliro osinthidwa, komanso luso lophunzitsira.Kachiwiri, imalimbikitsa zitsanzo zamaphunziro azachipatala komanso maphunziro a unamwino wamtima, imawonetsa dongosolo ndi magwiridwe antchito a kaphunzitsidwe kake, ndikulimbikitsa kumvetsetsa kwa ophunzira ndikusunga zomwe zili mumaphunzirowa.Ndemanga pambuyo pa phunziro lililonse limalimbikitsa kudzidziwitsa okha kwa aphunzitsi azachipatala, kulimbikitsa aphunzitsi a zachipatala kuti aganizire za luso lawo, msinkhu waukatswiri ndi makhalidwe aumunthu, kuzindikiradi kuphunzira kwa anzawo, ndi kupititsa patsogolo maphunziro a zachipatala.Zotsatirazo zinasonyeza kuti khalidwe la kuphunzitsa kwa aphunzitsi a zachipatala mu gulu lothandizira linali labwino kuposa la gulu lolamulira, lomwe linali lofanana ndi zotsatira za phunziro la Xiong Haiyang [31].
Ngakhale kuti zotsatira za phunziroli ndizofunika kwambiri pakuphunzitsa zachipatala, phunziro lathu lidakali ndi malire angapo.Choyamba, kugwiritsa ntchito sampuli zosavuta kungachepetse kuchuluka kwa zomwe zapezazi, ndipo chitsanzo chathu chinali chochepa ku chipatala chimodzi chapamwamba.Kachiwiri, nthawi yophunzitsira ndi masabata 4 okha, ndipo namwino omwe amaphunzira nawo amafunikira nthawi yochulukirapo kuti apange luso loganiza bwino.Chachitatu, mu phunziroli, odwala omwe amagwiritsidwa ntchito mu Mini-CEX anali odwala enieni opanda maphunziro, ndipo khalidwe la maphunziro a anamwino ophunzitsidwa likhoza kusiyana ndi odwala.Izi ndizovuta zomwe zimalepheretsa zotsatira za kafukufukuyu.Kafukufuku wam'tsogolo ayenera kukulitsa kukula kwa zitsanzo, kuonjezera maphunziro a aphunzitsi azachipatala, ndi kugwirizanitsa miyezo yopangira maphunziro a zochitika.Kufufuza kwanthawi yayitali kumafunikanso kuti mufufuze ngati kalasi yosinthika motengera lingaliro la CDIO itha kukulitsa luso la ophunzira azachipatala pakapita nthawi.
Kafukufukuyu adapanga chitsanzo cha CDIO pamapangidwe a anamwino a mafupa, adapanga kalasi yosinthika motengera lingaliro la CDIO, ndikuliphatikiza ndi njira yowunika ya mini-CEX.Zotsatira zikuwonetsa kuti kalasi yopindika yotengera lingaliro la CDIO sikuti imangopititsa patsogolo luso la kaphunzitsidwe kachipatala, komanso imapangitsanso luso la ophunzira pakuphunzira paokha, kuganiza mozama, komanso luso lachipatala.Njira yophunzitsira iyi ndi yodalirika komanso yothandiza kuposa nkhani zachikhalidwe.Tinganene kuti zotsatira zake zingakhale ndi zotsatira za maphunziro a zachipatala.Kalasi yotembenuzidwa, yotengera lingaliro la CDIO, imayang'ana kwambiri pa kuphunzitsa, kuphunzira ndi zochitika zothandiza komanso kuphatikiza kwambiri kuphatikiza kwa chidziwitso chaukadaulo ndi chitukuko cha luso lothandizira kukonzekeretsa ophunzira ntchito zachipatala.Poganizira kufunikira kopatsa ophunzira mwayi wotenga nawo mbali pakuphunzira ndi kuchita, ndikuganizira mbali zonse, akuti njira yophunzirira zamankhwala yozikidwa pa CDIO igwiritsidwe ntchito pamaphunziro azachipatala.Njirayi ingathenso kulangizidwa ngati njira yatsopano, yokhudzana ndi ophunzira pakuphunzitsa zachipatala.Kuonjezera apo, zomwe zapezazi zidzakhala zothandiza kwambiri kwa olemba ndondomeko ndi asayansi popanga njira zowonjezera maphunziro a zachipatala.
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Nthawi yotumiza: Feb-24-2024