The impact of case-based learning combined with scenario-based simulation on clinical competence of pediatric interns: The moderating effect of prior simulation experience
CBL联合情景模拟教学对儿科实习生临床综合能力的影响： 前期模拟经历的调节效应

摘要

目的 评估基于案例的学习（CBL）联合情景模拟教学对儿科实习生临床综合能力的影响，并检验前期模拟教学经历的调节作用。方法 采用分层随机对照设计，将224名儿科实习生按学校分层后随机分入试验组（n=112，CBL联合情景模拟教学）和对照组（n=112，传统教学），干预12周。以迷你临床演练评估（mini-CEX）量表评定临床综合能力，采用分层多元线性回归检验教学方式、前期模拟经历及二者交互项对mini-CEX总分的影响，并进行简单斜率检验。结果 试验组mini-CEX总分高于对照组［（49.6±3.0）分 vs.（45.8±3.3）分，P<0.001，Cohen's d=1.2］。教学方式与前期模拟经历的交互项有统计学意义（b=1.24，P=0.011），有前期模拟经历者从联合教学中获益更大（边际效应4.8分，95%CI 3.66.0），无经历者获益3.5分（95%CI 2.64.4）。学校背景亦有独立效应，厦门医学院学生得分高于其他院校（b=2.10，P<0.001）。结论 CBL联合情景模拟教学可有效提升儿科实习生临床综合能力，前期模拟经历对此效应起正向调节作用。建议在医学教育早期系统引入模拟训练，构建阶梯式培养路径。

Abstract

Objective This study evaluated whether case-based learning (CBL) combined with scenario-based simulation teaching improves the clinical competence of pediatric interns and examined whether prior simulation experience moderates this effect.
Methods In this stratified randomized controlled trial, 224 pediatric interns were assigned by school strata to an experimental group (n=112, CBL plus simulation) or a control group (n=112, traditional teaching) for 12 weeks. Clinical competence was assessed using the Mini-Clinical Evaluation Exercise (mini-CEX). Hierarchical multiple linear regression was used to test the effects of teaching method, prior simulation experience, and their interaction on mini-CEX total scores, followed by simple slope analysis.
Results The experimental group scored higher than the control group on the mini-CEX total score [(49.6±3.0) vs. (45.8±3.3), P<0.001, Cohen's d=1.2]. The interaction between teaching method and prior simulation experience was statistically significant (b=1.24, P=0.011). Interns with prior experience benefited more from the combined teaching (marginal effect 4.8 points, 95%CI 3.6~6.0) than those without (3.5 points, 95%CI 2.6~4.4). School background also had an independent effect, with students from Xiamen Medical College scoring higher than those from other institutions (b=2.10, P<0.001).
Conclusion   The CBL-simulation combination effectively enhances clinical competence among pediatric interns, and prior simulation experience positively moderates this effect. These findings support the early and systematic introduction of simulation-based training in medical education to build a stepwise development pathway for clinical skills.