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1、非预防医学专业医学统计学教学中案例式教学法初探马洪林 王良君 詹志鹏 （辽宁医学院，辽宁锦州，121001）摘要：案例式教学法(Case Method)是一种利用案例作为教学媒介的教学方法，这种教学方法已在欧美高等医学教育中广泛使用。本文就案例式教学法的含义，优点及具体应用做了初步的探讨。关键词：非预防医学专业；医学统计学；案例式教学；初探作者简介：马洪林（1963），男，辽宁抚顺人，辽宁医学院公共卫生管理学院院长，教授，硕士生导师，研究方向：预防医学教育、健康管理。The First exploration for Case Method in non-prevent medical sci
2、ence specialty, Medical Science Statistics teachingMa Honglin, Wang Liangjun, Zhan Zhipeng(Liaoning Medical University, Jinzhou, Liaoning, 121001)Abstract:Case Method is one kind of teaching method which using case as teaching medium, this kind of teaching method is already widely used in the Higher
3、 Medical Education of the Occident. This paper makes a preliminary discussion on the meaning of Case Method, its advantages and specific applications.Keywords:Non-prevent medical science specialty, Medical Science Statistics, Case Method, First explorationAuthor brief introduction:Ma Honglin, born i
4、n 1963, male, birth place: Liaoning Fushun, president of Public health management institute of Liaoning Medical University, professor, postgraduate advisor. Research Area:prevent medical science education, health management.医学统计学是依据概率论和数理统计的基本原理与方法研究居民健康状况以及卫生服务领域中数据的收集、整理和分析的一门基础应用性学科。1，2对非预防医学专业的学
5、生而言，医学统计学概念多，概念之间又有较强的联系，内容抽象、难懂，而且认为它与临床工作没有什么联系，因此重视程度不够。然而，据对国内5种权威临床医学杂志统计学应用状况调查发现，统计描述指标缺陷率为21%，统计推断缺陷率为62%，对照应用率为68%，随机化应用率为60% 3 。这些说明传统的医学统计学教学方式并不适合非预防医学专业的学生，不能让他们将理论知识与临床实际有机结合起来，因此非预防医学专业医学统计学教学方法改革势在必行。通过两年多的教学改革实践，我们发现案例式教学法在非预防医学专业的医学统计学教学中的应用对解决上述问题有很好的效果。一、案例式教学法的含义案例式教学是通过模拟真实的事例，
6、让学生在特定的情景中进行体验、分析、决策、从而培养他们独立思考能力和解决具体问题能力的一种教学模式4。与讲授法不同，案例式教学法是一种参与型的学习方法，它是在教师的精心策划和指导下，在学生已经掌握了有关基本知识、理论和方法的基础上，让学生以决策者的身份来发现问题和分析问题，通过学生的独立思考和集体协作，寻求解决问题的思路和方案。二、案例式教学法的优点案例式教学法应用的优点已被多位学者证实，对于非预防医学专业医学统计学教学来说，应用案例式教学有如下优点：1.启发性。案例式教学可采用各种正确和错误的案例启发学生思考，培养学生批判性和分析性的思维能力，从根本上改变了传统死记硬背、理论与实践相脱离的学
7、习过程、激发学生学习兴趣、发挥主观能动性、充分发挥教学互动的优点，使原本枯燥的医学统计学内容变得易于理解和掌握5。2.实用性。通过案例分析，加强实践能力，减小理论与实际应用差距。传统教学模式常脱离实际问题，如医学生学习统计学后科研设计仍然不够严谨，面对自己的实验数据，仍然不知道该如何选择合适的统计分析方法，最终导致医学论文中的统计分析与结论错误较多。而案例式样教学采用大量的医学科研实例，有针对性的提出问题，组织学生进行讨论、分析和总结，有助于学生理论联系实际，避免将来犯类似错误5。我院对参加大学生创新科研活动的学生进行了案例式教学的科研培训，就收到了很好的效果，在对培训后的调查中发现，有96%
8、的学生认为案例式教学理论联系实际性强，非常具有实用性。3. 有助于培养学生创新精神。传统的教学模式以教师为主体，强调教师讲授和学生倾听，强调教师教给学生哪些知识，忽视对学生创新精神的培养；在长期的传统教育模式下，学生缺乏主动发现问题，解决问题的积极性，总是等着通过教师的教授来直接获取信息和答案，这种现象已非常普遍。而案例式教学法则不同，它非常重视学生的主观能动性、主体性和参与性，学生通过典型案例分析，积极动脑思考，激发创造性思维，在这过程中学会搜集、整理、分析和查阅相关文献资料并最终找到解决问题的办法。4. 有助于培养学生团队合作精神。案例式教学要求学生在课堂上以小组形式就问题自由讨论、交流，
9、通过合作分析共同解决问题。案例教学是一种群体活动，通常要经过小组、大组合作思维的撞击，在合作中互相沟通，在沟通中增进合作6。在查阅资料时，就要求小组内要做好分工；在参与讨论时，就要求学会取长补短，集思广益，不仅要正确看待别人的观点，也要正确评价自己的表现。这些在无形中就培养了学生的团队合作精神。5. 有助于培养学生自主学习能力。学会自主学习是学习型社会对人们能力的基本要求。传统教学模式教给学生的是运用概念知识解决现成问题，学生获得的是背诵、机械记忆、按标准答案答题的知识。而案例式教学告诉学生，“答案不止一个”，答案是开放的、发展的6。在案例教学中，教师通过有意识的引导，让学生自己去查资料，通过
10、团队合作的方式进行分析和判断，积极寻找多种答案，鼓励学生通过多个途径和多种方法解决同一个问题，并对学生的努力和表现给予充分肯定和认可。这样经过多次的案例分析讨论后，学生就会获得自主学习的方法，并在自主学习中获取知识和快乐，使自主学习成为现实。三、案例式教学法在医学统计学教学中的具体应用在案例式教学中，我们对传统的医学统计学教学内容进行调整：对于公式，只要求学生了解其直观意义、用途和应用条件，而不要求掌握具体的数学推导。教学内容的重点放在统计学基本原理和统计分析方法的应用上，而不是统计方法的计算过程或数学算法讲解上。课堂上以学生为中心，通过临床典型案例，开展讨论，既可激发学生的学习热情，又可提高
11、学生的学习效率，充分锻炼学生的分析问题、解决问题的能力。以医学统计学中均数估计与假设检验一章为例：课上首先给学生两组数据，其中一组为铅作业工人的血铅值，另一组为非铅作业工人的血铅值，让学生分别计算均数，发现铅作业工人与非铅作业工人的血铅值均数不同。由此可以引导学生思考并讨论两组均数间的差异究竟是抽样误差引起的还是铅作业工人与非铅作业工人的血铅值本身就存在实质性差异？讨论之后再给学生导入假设检验的概念、步骤及种类。之后再以“不同的假设检验方法适用于不同的资料类型，该如何选择呢？”作为问题引出t检验及u检验的原理、意义并举例阐述不同假设检验方法的适用条件。再以秩和检验一章为例：课上首先举一个具体案
12、例然后让学生分析讨论该案例是否符合参数检验的条件，讨论之后再由教师引出非参数检验的适用条件及秩和检验的概念、方法等。以上两个例子就是案例式教学在医学统计学中的具体应用，与传统灌输式讲授教学相比，学生对医学统计学的原理及应用有了更加深刻的理解，这对于他们今后从事科研工作奠定了坚实的基础。综上所述，案例式教学法作为对医学统计学课程传统教学模式的改革，因其具有启发性、实用性优点；在实施过程了有助于培养学生创新精神和团队合作精神，有助于培养学生自主学习这种终生学习能力等优势；因其在具体应用过程中紧密结合实际，针对性和可操作性强，使学生分析和解决实际问题能力得到提高，这些都为培养高素质、创新型、实用型医
13、学人才奠定了良好的基础，所以案例式教学是一种较好的教学方法，值得推广应用。参考文献1 方积乾. 医学统计学. 北京: 人民卫生出版社, 2004, 52 倪宗瓒. 医学统计学. 北京: 高等教育出版社, 2003, 13 原建慧. 非预防医学专业医学统计学教学改革.中国高等医学教育, 2006,(3):60,824 苏金玲, 姜希娟, 马东明等.案例式教学在病理学教学中的应用初探. 中国高等医学教育, 2011(2):91-925 罗家洪, 毛勇, 李晓梅等.案例教学法在医学统计学秩和检验中的应用和探索.昆明医学院学报, 2009(3B):306-3096 郑淑芬.案例教学法的作用、实施环节及
14、需要注意的问题.教育探索,2008(4):56-57基金项目：辽宁医学院2010年度教育科学规划课题“案例式教学法在非预防医学专业医学统计学教学中探索与实践”（2010ZD0012）作者简介：马洪林（1963），男，辽宁抚顺人，辽宁医学院公共卫生管理学院院长，教授，硕士生导师，研究方向：预防医学教育、健康管理。电话：13904169476 邮箱：mahonglin666作者单位：辽宁锦州，121001,辽宁医学院公共卫生管理学院预防医学教研室（马洪林，王良君，詹志鹏）Editors note: Judson Jones is a meteorologist, journalist and ph
15、otographer. He has freelanced with CNN for four years, covering severe weather from tornadoes to typhoons. Follow him on Twitter: jnjonesjr (CNN) - I will always wonder what it was like to huddle around a shortwave radio and through the crackling static from space hear the faint beeps of the worlds
16、first satellite - Sputnik. I also missed watching Neil Armstrong step foot on the moon and the first space shuttle take off for the stars. Those events were way before my time.As a kid, I was fascinated with what goes on in the sky, and when NASA pulled the plug on the shuttle program I was heartbro
17、ken. Yet the privatized space race has renewed my childhood dreams to reach for the stars.As a meteorologist, Ive still seen many important weather and space events, but right now, if you were sitting next to me, youd hear my foot tapping rapidly under my desk. Im anxious for the next one: a space c
18、apsule hanging from a crane in the New Mexico desert.Its like the set for a George Lucas movie floating to the edge of space.You and I will have the chance to watch a man take a leap into an unimaginable free fall from the edge of space - live.The (lack of) air up there 待添加的隐藏文字内容1Watch man jump fro
19、m 96,000 feet Tuesday, I sat at work glued to the live stream of the Red Bull Stratos Mission. I watched the balloons positioned at different altitudes in the sky to test the winds, knowing that if they would just line up in a vertical straight line we would be go for launch.I feel this mission was
20、created for me because I am also a journalist and a photographer, but above all I live for taking a leap of faith - the feeling of pushing the envelope into uncharted territory.The guy who is going to do this, Felix Baumgartner, must have that same feeling, at a level I will never reach. However, it
21、 did not stop me from feeling his pain when a gust of swirling wind kicked up and twisted the partially filled balloon that would take him to the upper end of our atmosphere. As soon as the 40-acre balloon, with skin no thicker than a dry cleaning bag, scraped the ground I knew it was over.How claus
22、trophobia almost grounded supersonic skydiverWith each twist, you could see the wrinkles of disappointment on the face of the current record holder and capcom (capsule communications), Col. Joe Kittinger. He hung his head low in mission control as he told Baumgartner the disappointing news: Mission
23、aborted.The supersonic descent could happen as early as Sunday.The weather plays an important role in this mission. Starting at the ground, conditions have to be very calm - winds less than 2 mph, with no precipitation or humidity and limited cloud cover. The balloon, with capsule attached, will mov
24、e through the lower level of the atmosphere (the troposphere) where our day-to-day weather lives. It will climb higher than the tip of Mount Everest (5.5 miles/8.85 kilometers), drifting even higher than the cruising altitude of commercial airliners (5.6 miles/9.17 kilometers) and into the stratosph
25、ere. As he crosses the boundary layer (called the tropopause), he can expect a lot of turbulence.The balloon will slowly drift to the edge of space at 120,000 feet (22.7 miles/36.53 kilometers). Here, Fearless Felix will unclip. He will roll back the door.Then, I would assume, he will slowly step ou
26、t onto something resembling an Olympic diving platform.Below, the Earth becomes the concrete bottom of a swimming pool that he wants to land on, but not too hard. Still, hell be traveling fast, so despite the distance, it will not be like diving into the deep end of a pool. It will be like he is div
27、ing into the shallow end.Skydiver preps for the big jumpWhen he jumps, he is expected to reach the speed of sound - 690 mph (1,110 kph) - in less than 40 seconds. Like hitting the top of the water, he will begin to slow as he approaches the more dense air closer to Earth. But this will not be enough
28、 to stop him completely.If he goes too fast or spins out of control, he has a stabilization parachute that can be deployed to slow him down. His team hopes its not needed. Instead, he plans to deploy his 270-square-foot (25-square-meter) main chute at an altitude of around 5,000 feet (1,524 meters).
29、In order to deploy this chute successfully, he will have to slow to 172 mph (277 kph). He will have a reserve parachute that will open automatically if he loses consciousness at mach speeds.Even if everything goes as planned, it wont. Baumgartner still will free fall at a speed that would cause you
30、and me to pass out, and no parachute is guaranteed to work higher than 25,000 feet (7,620 meters).It might not be the moon, but Kittinger free fell from 102,800 feet in 1960 - at the dawn of an infamous space race that captured the hearts of many. Baumgartner will attempt to break that record, a feat that boggles the mind. This is one of those monumental moments I will always remember, because there is no way Id miss this.
