目的 探索基于移动教学平台开展的以问题为基础的教学法(problem-based learning,PBL)联合以团队为基础的教学法(team-based learning,TBL)在病理学理论教学中的应用效果.方法 选取 2021 年 3-7 月在山西大同大学医学院就读的 160 名 2019 级临床医学专业本科生作为研究对象,随机分为两组,试验组实施PBL联合TBL教学法,对照组采用常规教学.通过对两组学生的平时考核成绩、期末试卷成绩进行比较,综合评估教学效果.结果 试验组的平时成绩、试卷成绩和总成绩均明显高于对照组,差异有统计学意义(P＜0.05).除出勤外,试验组平时成绩的各项分值均高于对照组,差异有统计学意义(P＜0.05).在试卷成绩中,试验组客观题与主观题成绩优于对照组,差异有统计学意义(P＜0.05).结论 信息化教学背景下,基于学习通平台开展的PBL联合TBL教学法可以激发学生的学习兴趣,提高医学生的自主学习能力、临床思维能力及病理诊断能力,有助于提升病理学理论课的教学效果.

目的 以超星学习通为例探讨基于互联网教学平台开展的以案例为基础的教学法(CBL)联合以团队为基础的教学法(TBL)在病理学实验教学中的应用效果.方法 选取山西大同大学医学院 2019 级临床医学专业本科生 164 名为研究对象,随机分为两组,试验组学生实施基于超星学习通平台的CBL联合TBL教学法,对照组学生采用传统教学模式,研究时间为 2021 年 3-7 月,通过比较两组学生理论课与实习课的平时成绩及期末考试成绩评价教学效果.结果 试验组实习课的平时成绩、试卷成绩和总成绩明显高于对照组,差异有统计学意义(P＜0.05).在平时成绩中,试验组的单元测验成绩优于对照组,差异有统计学意义(P＜0.05).在理论课期末测试中,试验组的主观题成绩优于对照组,差异有统计学意义(P＜0.05).结论 在病理学实验教学中,基于网络平台开展CBL+TBL教学法有助于提升病理学的教学效果,提高学生的积极性,激发学习兴趣,培养学生自主学习、独立思考、临床思维和病理诊断等多项能力.

目的 探讨CBL、TBL和LBL多元化教学法在本科临床医学专业病理学实验线上教学中的实施效果.方法 以参与病理学实验线上教学的临床本科生为研究对象,实验组采用CBL、TBL和LBL多元化教学法,对照组采用LBL教学法,通过平时考核、期末考试以及问卷调查综合评价教学效果.结果 实验组期末成绩和总成绩显著高于对照组,教学满意度、学习兴趣、主动学习能力、整合知识能力、临床推理能力、小组合作能力、语言表达能力以及病理诊断能力也显著高于对照组.结论 CBL、TBL和LBL多元化教学法在病理学实验线上教学中实施效果较好,值得推广.

目的 探索学生自主学习在过程性评价中的影响.方法 选择 2021 年 3-7 月山西大同大学 2019 级三个中医专业班级的学生作为研究对象,首先对其学情进行分析,之后针对病理学课程的特点,设置了过程性评价模块,最后比较不同班级的过程性评价的实施效果,分析学生自主学习在过程性评价中不同模块中的权重.结果 无论是过程性评价还是期末成绩,中医一班和三班的学生成绩对比均差异无统计学意义(P＞0.05),但是中医二班的成绩显著低于中医一班和中医三班,差异有统计学意义(P＜0.05);学情调查结果显示:在"为了自己的前途学习"和"每周上自习 5 次及以上"方面,中医一班(82.0％和 58.0％)和三班(90.4％和 32.7％)的学生占比均高于中医二班(70.6％和 23.5％);过程性评价中,在课堂互动和章节测验模块,中医一班的成绩均显著高于中医二班和三班,差异有统计学意义(P＜0.05);在学习次数模块中,中医一班和中医三班显著高于中医二班,差异有统计学意义(P＜0.05).结论 具有明确的学习目标及良好的自主学习习惯,能够有效提高中医专业学生病理学课程的过程性和终结性评价成绩;过程性考核设置课间互动、章节测验和学习次数统计,可有效对学生进行过程性评价.

Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.

病理学为基础医学和临床医学之间的桥梁课程,主要研究了疾病的病因,发病机制,病理变化和临床病理联系,学好病理学对于医学生步入临床岗位进行临床诊治工作非常重要.目前,传统教学模式在病理学授课中仍处于主导地位,但由于其方式过于单一,不能与学生的实际需求相结合,学生通常缺乏学习的积极性和主动性.在"互联网+"背景下,各大网络教学平台纷纷涌现,为提高学生对病理学课程的学习热情,增加课堂趣味,本教研室充分利用现有网络资源进行线上教学方法探索.本文以我院2018级中医本科生病理学课程教学为例,介绍线上教学模式的设计方案、具体实施过程和教学思考,为以后课程改革和教学创新提供借鉴.

Driven by the illegal purpose,attackers often exploit the vulnerability of the classifier to make the malicious samples free of detection in adversarial learning.At present,adversarial learning has been widely used in computer network intrusion detection,spam filtering,biometrics identification and other fields.Many researchers only apply the existing ensemble methods in adversarial learning,and prove that multiple classi-fiers are more robust than single classifier.However,priori information about the attacker has a great influence on the robustness of the classifier in adversarial learning.Based on this situation,by simulating different strength of attack in learning process and increasing the weight of the misclassified sample,the robustness of the multiple classifiers can be improved with maintaining the accuracy.The experimental results show that the ensemble algorithm against evasion attack with different strength of attack is more robust than Bagging.Finally,the convergence of the algorithm and the influence of parameter on the algorithm were analyzed.