摘要
1概述
高等医学院校临床教学质量受各教学环节多种因素的影响,而临床兼职教师素质和水平是关键的因素之一。临床兼职教师对学生的影响是通过其从事带教活动时表现出来的各种行为方式来实现的。对当前高等医学院校临床兼职教师教学行为的现状进行调查,分析不同类型临床兼职教师的教学行为特征,研究教学行为对教学质量的影响,对改善临床兼职教师教学行为和提升临床教学质量具有重要的理论和现实意义。
本研究在进行大量文献查阅、专家和学生咨询以及预调查的基础上,以某医科大学临床教学一线的兼职教师作为研究对象,以临床兼职教师教学行为现状及其对教学质量影响的研究为切入点,将行为流行病学现场调查、病例对照研究方法在教育管理研究中的运用进行了初步实践和探索。以临床兼职教师教学质量的结果作为应变量,影响教学质量的教学行为因素为自变量进行Logistic回归分析,进行了多组病例对照研究,对不同教学质量水平临床兼职教师的教学行为进行了比较研究,成功筛选出影响临床教学质量的关键行为因素。并结合当前教学的实际情况,提出了主要的干预措施,供相关教师及教学管理(服务)部门今后工作的参考。
2研究目的
2.1通过课题研究,建立一套科学、有效、可操作性强的评价指标体系,实现对临床兼职教师教学行为质量的适时评价。
2.2从学生和教师两个角度对高等医学院校临床兼职教师教学行为进行研究,科学描述高等医学院校临床兼职教师教学行为的现状,研究教学优秀、教学不良和教学普通教师的行为特征。
2.3为高校临床教学管理部门进行教学管理反思、推动临床兼职教师开展教学反思、探索和建立一套可行的高等医学院校临床兼职教师教学行为干预方案提供决策理论依据。
3研究对象
本研究以某高等医学院校参与一线教学的临床兼职教师为研究对象。为避免该院校临床兼职教师的人员变动、参与临床教学的次数等混杂因素的干扰,客观反映临床兼职教师教学行为与教学质量的关系,本研究对调查对象设定了如下入选条件:①近3年稳定在本科临床教学一线的兼职教师(至少参与一年以上教学);②教学质量同时被学生和科教科进行过3次以上评估的兼职教师。根据近3年来的兼职教师临床教学工作统计和评价情况,符合要求的教师共有1000名。
4研究方法
4.1临床兼职教师教学行为质量评价指标体系的构建研究
运用系统分析法、文献研究法、Delphi法、层次分析法,构建临床兼职教师教学质量学生评价和专家评价指标体系,经过实测、统计分析和改进,进一步完善和确立指标体系。
4.2临床兼职教师教学行为及现状对教学质量影响的研究
4.2.1调查表的设计
根据流行病学描述性研究和病例对照研究的理论和方法,围绕课题研究目的,在文献复习基础上,通过会议研讨、问卷咨询等形式开展专家咨询,制定调查问卷,在预调查的基础上,对问卷的信度、效度进行实测,改进和确定调查问卷内容和格式。通过预测试、主成分分析和因子分析等方法对问卷的信度、效度进行检测和改进。
4.2.2调查方法
运用研制的调查问卷,按一人一卷实行现场调查。在问卷内容不涉及个人隐私的前提下,为提高问卷应答质量,在调查中对署名问题采用了回避方法:问卷调查采取不署名的形式,但在问卷的页码处标注调查对象的识别信息。为维护调查对象的信息不外泄给课题研究人员以外的其他人,将问卷和一个空白信封放入标有调查对象姓名的大信封中,提示问卷填写者用空白信封将填写后的问卷密封后交回。由教务处实践教学科牵头、各教学医院科教科负责人共同参与,组成30人的调查小组。在对调查组成员进行详细说明和培训后,由各调查组成员将问卷在同一时间逐一发到本单位的调查对象手上,并在3天内将问卷收回。各调查组成员同时作为问卷填写的咨询人员,解答有关填写问题,调查组设立和公布了热线咨询联系人、电话、电子邮箱,随时解答有关问题。
4.2.3数据录入和整理
由研究者本人带领3位录入员组成数据录入小组,录入小组在5天内运用SPSS12.0软件完成录入和核对工作,根据课题研究的需要对数据进行遴选分类、标注和整理,建立数据库。录入完成后,对数据进行两次总体核对,一次抽样核对。
4.2.4统计学方法
所有的数据运用SPSS12.0软件录入,建立了《临床兼职教师教学行为及现状对教学质量影响研究》的数据库,运用x~2检验和秩和检验对临床教学质量和教学行为的分布进行统计学分析和描述;运用Logistic回归分析方法对病例组和对照组进行研究。
4.2.5病例对照研究
临床兼职教师的教学质量评价结果采用学生、专家评分的加权总分,能比较准确地反馈临床兼职教师的教学质量。将加权总分折算为百分等级分数,取前32%为教学优秀;后32%为教学不良;中间人群为教学普通。运用流行病学病例对照研究方法,对影响临床教学质量的相关行为因素进行Logistic回归分析,开展多组病例对照研究,对不同特征临床兼职教师人群的教学行为进行比较研究,从中寻找影响临床教学质量的“危险行为因素”。
5研究结果
5.1建立了一个科学、有效、可操作性强的临床教学质量评价指标体系
本研究通过专家咨询、统计学分析测试,建立了一个科学、有效、可操作性强的临床教学质量评价指标体系,在临床教学管理实践中有序地开展并取得了良好的效果,解决了对临床兼职教师教学质量进行量化评价的关键问题,也为本课题的开展奠定了基础。
5.2临床教学质量在不同教学行为特征人群中的分布有统计学差异
课题研究发现,临床教学质量的分布在第一学历、担任教学组长或秘书等2类人群中有统计学差异。
临床教学质量在27种不同教学行为表现的教师人群中的分布有统计学差异。分别是:语言表达能力、沟通交流能力、注重仪表、重视常见病教学、组织教学查房、组织小讲课、注重思维能力培养、教学工作重视程度、教学工作努力程度、时间精力投入教学情况、对病人爱护程度、做好教学努力程度、感受学校激励程度、教学评估影响程度、鼓励学生努力学习、激励和肯定学生、注重教学方法、鼓励学生提问、与学生探讨式学习、对待学生回答问题方式、阅读教育学书籍、知识量的掌握、师生关系、参加校外教学培训、参加学校教学培训、对个人表现满意度、带教对教学促进程度等。
5.3探索了行为流行病学现场调查、病例对照研究方法在教育管理研究中的运用
课题以临床兼职教师教学行为现状及其对教学质量影响的研究为切入点,将行为流行病学现场调查、病例对照研究方法在教育管理研究中的运用进行了初步实践和探索。
6研究结论
6.1结论一:横断面调查揭示临床教学质量在不同教学行为特征人群中的分布有统计学差异。
6.2结论二:临床教学质量受多种教学行为因素的共同影响。
6.3结论三:行为流行病学理论和方法能够成功运用于教育管理研究。探索流行病学与教育管理学的结合,有良好的研究和运用前景,也具有非常重要的现实和理论意义。
6.4结论四:对临床兼职教师教学行为进行干预的关键策略和方向有三点:一是有效开展临床兼职教师培训与指导;二是加强对临床兼职教师的督导、监控与考核;三是建立科学的临床兼职教师教学行为激励机制。
1. Introduction
The clinical teaching quality of higher education institutions is collectively influenced by various factors in teaching segments, with part-time clinical teachers' quality and level as one of the most crucial factors. The influence of part-time clinical teachers in higher education institutions on students is exerted through various behavior manners in their teaching activities. It is of both theoretical and practical significance to the improvement on part-time clinical teachers' teaching behaviors and the enhancement in their teaching quality to investigate the status quo of teaching behaviors, to analyze the features of teaching behaviors of diversified types of teachers, to study the influence on teaching quality.
This research is undertaken on the practical teachers in a certain key medical university on the basis of a vast amount of literature review, consultation with experts and students, and a preliminary investigation. It takes the study of status quo of part-time clinical teachers' teaching behaviors and the effect of the behaviors on teaching quality as the breakthrough point to preliminarily explore the practical application of prevalence survey and case-control study to the research of educational management. Many case-control studies are conducted in accordance with logistic regression models, both of which have factors in teaching behaviors that influence teaching quality. Teachers' teaching behaviors are analyzed from the multivariate perspective due to the adoption of logistic analysis in case-control study. It conducts comparative study on teaching behaviors of teachers with different levels, successfully picks out the crucial behavioral factors that influence teaching quality. In connection with the teaching and the actual situation, key intervention measures for teachers and teaching related to management (services) sector future reference.
2. Objectives
To establish a set of scientific, effective and practical assessment indexes system and supervision management mechanism for the timing assessment and supervision on the quality of part-time clinical teachers' teaching behaviors.
To study the teaching behaviors of part-time clinical teachers in the medical university from both students' and teachers' angles, and to scientifically depict status quo of teaching behaviors of part-time clinical teachers in the medical university for the study on distinct behavioral features of teachers who teach excellently, badly, and ordinarily.
To provide theoretical foundations for the self-reflection of teaching management sections in higher education institutions on teaching management, for the self-reflection of part-time clinical teachers on teaching , and for the decision-making to explore the establishment of a set of practical supervision programme on teaching behaviors of part-time clinical teachers in the medical university.
3. Subjects
The subjects of this research are the practical part-time clinical teachers in a certain medical university. In order to eliminate the interference of the confounding factors, such as the changing of part-time clinical teachers, and the frequency of teaching, and to objectively reflect the relation between part-time clinical teachers' teaching behaviors and their teaching quality, the criteria for the selection of research subjects are as follows:
①The part-time clinical teachers who have been steadily teaching college students in recent 3 years (at least more than one year);
②The part-time clinical teachers whose teaching quality has already been assessed by both students and experts.
There are altogether 1000 teachers who fulfill both of the two criteria according to the statistics on part-time clinical teachers' teaching and its assessment in recent 3 years.
4. Methods
The study on the establishment of the assessment indexes system on the quality of part-time clinical teachers' teaching behavior
Both student and expert assessment indexes systems on part-time clinical teachers' teaching quality are established by applying systematic analysis method, literature study method, Delphi method, and AHP method, and the indexes systems are further optimized through actual measurement, statistics analysis and improvement.
The practical study on status quo of part-time clinical teachers' teaching behaviors and the effect of the behaviors on teaching quality
The design of the questionnaires
The questionnaires centered on research objectives are designed on the basis of literature review and in line with both the theories and methods in the epidemiological descriptive study and case-control study by consulting experts through seminars and questionnaires. The reliability and validity of the questionnaires are actually measured, and the content and the format of the questionnaires are improved and determined on the basis of a preliminary investigation. Finally, the reliability and validity of the questionnaires are tested and improved through the means of a preliminary test, principal components analysis, and factor analysis.
Investigation methods
Each teacher is investigated with the questionnaire on the spot. In order to enhance the quality of replies, the questionnaires without any private questions are answered anonymously, but identity information is indicated at the page number. In order to keep the information of the research subjects secret from anyone except the researcher, the questionnaire and a blank envelop are put into a large envelop with the name of the research subject on it, and the questionnaire is returned inside the sealed blank envelop. An investigation group of 30 people is formed by the directors of education branch and scientific research office under the lead of practice teaching office. Questionnaires are distributed one by one to the research subjects by members of the investigation group from the same working unit who have been explained with details and trained, and the questionnaires are returned in 3 days. The members of the investigation group also are the consultants on the fill-in of the questionnaires, explaining releva nt questions. Furthermore, the ways of contacting the group members, such as their telephone numbers and email addresses, are known to the teachers for the sake of giving immediate explanations.
The input and sorting out of data
A data input group is formed by 3 college students of health service management, who are familiar with Excel, with the lead of the researcher. The data input staffs are trained for 5 days with simulation drill. The input and the checking of the data are finished within 5 days with the help of the software SPSS12.0. Data are selected, marked and sorted out in the light of the demand of the research, and a database is created. After the input, two general checking and one sample checking are conducted.
Statistical methods
All the data are input via the software SPSS12.0, and an open database of the study on status quo of teaching behaviors of part-time clinical teachers and the effect of the behaviors on teaching quality is created. Statistical analysis and description are conducted on the distribution of teaching quality and teaching behaviors by adopting X2 test and rank sum test. Case-control study is conducted by adopting logistic analysis.
Case-control study
The outcomes of the assessment of part-time clinical teachers' teaching quality are measured by the weighted sum of both student grading and expert grading, which enables the exact reflection of part-time clinical teachers' teaching quality. The outcomes are ranked with percentage, with the first 32% as teaching excellence, the last 32% as teaching badness, and the rest as teaching ordinary.The logistic analysis are conducted on the behavioral factors that influence clinical teaching quality by adopting the method of epidemiological case-control study. The risk behavioral factors that influence teaching quality are looked for through many case-control studies and the comparative study on behavioral features of diversified types of teachers.
5. Findings
The establishment of a scientific, effective and practical evaluation system on clinical teaching quality
By consultation with experts and statistical analysis tests, this research establishes a scientific, effective and practical evaluation system on clinical teaching quality. It develops with favorable effect in the practice of clinical teaching management, solves the crucial problem of quantitative assessment of part-time clinical teachers' teaching quality, and also lays the foundation for this research.
The statistical differences in the distribution of teaching quality of teachers withdistinct teaching behavioral features
This research finds out that statistical differences in the distribution of teaching quality come from the following 2 factors—different first qualifications and heads or secretaries of the teaching groups.
This research finds out that statistical differences in the distribution of teaching quality also come from the following 27 factors in teaching behaviors—language competence, communication skills, focus on instrumentation, common attention to teaching, organizations teaching rounds, organization stresses small classes, focus on thinking ability, degree of importance that teachers attach to their teaching, degree of endeavor for teaching, time and energy into teaching situation, the extent of the patient care, degree of endeavor for teaching, degree of inspiration from the university, teaching impact assessment, encouragement for students' studiousness, giving credit to and stimulating students, focus on teaching methods, encouragement for students to raise questions, with the students on learning, handling with students' ways of answering questions, reading of pedagogical books, knowledge of the master, student-teacher relationship, participate in extracurricular teaching training, Participate in college training teaching, satisfaction with the performance of individuals, with the promotion of the teaching degree.
The exploration of the application of prevalence survey and case-control study to the research of educational management
It takes the study on status quo of part-time clinical teachers' teaching behaviors and the effect of the behaviors on teaching quality as the breakthrough point to preliminarily explore the practical application of prevalence survey, cause disease and causal inference, and case-control study to the research of educational management.
6. Conclusions
Cross-sectional survey reveals the existence of statistical differences in the distribution of clinical teaching quality of teachers with distinct teaching behavioral features.
Clinical teaching quality is collectively affected by numerous factors in teaching behaviors.
Epidemiological theories and methods are able to be successfully applied to the research of educational management. The exploration of the combination of epidemiology and educational management has promising research and application future, and is of great practical and theoretical significance as well.
The three key strategies to supervise part-time clinical teachers' teaching behaviors are as follows: to conduct effective part-time clinical teachers trainings, to strengthen the supervision of part-time teachers and monitoring, and to establish scientific motivation mechanism on part-time clinical teachers' behaviors.
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