关键词: 基于问题学习; 授课式学习; 脑血管病; 教学; 荟萃分析

Abstract: Objective To systematically evaluate the efficacy of problem-based learning (PBL) and traditional lecture-based learning (LBL) in cerebrovascular disease clinical teaching in China. Methods Randomized controlled trials (RCTs) of PBL and LBL in cerebrovascular disease clinical teaching were retrieved from Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Information Chinese Journal Service Platform) from inception to May 2021. Revman 5.4 and Stata 15.0 were used for meta analysis and publication

bias detection. By using standard mean difference (SMD) or RR and 95%CI , the teaching efficacy

of PBL and LBL were compared through examination scores (theoretical knowledge, case analysis and skill operation), questionnaire scoring items (medical knowledge development, doctor-patient communication ability, clinical practice ability, clinical thinking ability, team cooperation ability, autonomous learning ability) and teaching satisfaction. Results A total of 25 RCTs involving 1493 participants were included, of them, 747 in PBL group and 746 in LBL group. The examination scores of theoretical knowledge (SMD 1.41, 95%CI 0.79- 2.02, P <0.001), case analysis (SMD 1.74, 95%CI 0.84-2.64, P <0.001) and skill operation (SMD 3.35, 95%CI 1.09-5.60, P =0.004) in PBL group were superior to those in LBL group (P <0.001). The questionnaire scores of medical knowledge development (SMD 1.08, 95%CI 0.53-1.62, P <0.001), doctor-patient communication ability (SMD 3.07, 95%CI 2.07-4.07, P <0.001), clinical practice ability (SMD 2.55, 95%CI 1.33-3.78, P <0.001), clinical thinking ability (SMD 3.02, 95%CI 0.99- 5.06, P =0.004), team cooperation ability (SMD 1.64, 95%CI 1.19-2.08, P <0.001), autonomous learning ability (SMD 2.35, 95%CI 1.20-3.50, P <0.001) in PBL group were superior to that in LBL group. The teaching satisfaction (RR 1.18, 95%CI 1.10-1.26, P <0.001) in PBL group was also superior to that in LBL model. Except for the homogeneity of teaching satisfaction (P =0.23, I 2=29%), the other outcome indicators were heterogeneous (P ≤0.1 or I 2≥50%). There was no statistical significance of publication bias for theoretical knowledge score, case analysis score, skill operation score, teaching satisfaction and questionnaire score of medical knowledge development, while there was statistical significance of publication bias for other outcome indicators. Conclusions Based on the existing evidence, PBL method was more effective than LBL method in cerebrovascular diseases clinical teaching in China. However, the risk of bias and heterogeneity of included studies should not be ignored, and more higher quality multicenter studies are needed to further confirm the above conclusions.

Key words: Problem-based learning; Lecture-based learning ; Cerebrovascular disease; Clinical teaching; Meta analysis