摘要目的:探讨基于产出导向法（production-oriented approach，POA）理论的以问题为基础的学习（problem-based learning，PBL）在手足外科临床实习教学中的应用价值。方法:将在济宁医学院附属医院手足外科2019年1月至2020年10月实习的112名本科生按照简单随机数字表法分为对照组和观察组，每组各56名。对照组采用PBL教学，观察组采用基于POA理论下的PBL教学。比较两组实习生对教学效果的评估、实践考核错误率统计、自主学习能力测评量表评分、职业成熟度量表评分与实习生对带教教师的满意度。采用SPSS 25.0进行卡方检验和 t检验。 结果:观察组的教学效果、实习生对带教教师的满意度（除了师德、管理能力外）均优于对照组（ P<0.05）。观察组的查体不熟练错误率、无菌清创观念较差错误率均降低（ P<0.05）；两组的病历书写不规范错误率、病史采集欠缺错误率、沟通交流差错误率比较，差异无统计学意义（ P>0.05）。教学后观察组的自主学习能力测评量表评分、职业成熟度量表评分均高于对照组（ P<0.05）。 结论:基于POA理论的PBL教学在手足外科临床实习教学中具有良好的效果，值得进一步推广。

abstractsObjective:To explore the application value of problem-based learning (PBL) based on production-oriented approach (POA) theory in clinical practice teaching in department of hand and foot surgery.Methods:A total of 112 interns from the Department of Hand and Foot Surgery in Affiliated Hospital of Jining Medical University from January 2019 to October 2020 were randomly divided into control group and observation group, with 56 interns in each group. The control group was taught by PBL teaching, and the observation group was taught by PBL teaching based on POA theory. The two groups of interns were compared in terms of the evaluation of teaching effect, the statistics of errors in practice assessment, the assessment scale of independent learning ability, the career maturity inventory attitude scale, and the satisfaction of interns with their teachers. SPSS 25.0 was used for Chi-test and t-test. Results:The teaching effect and the satisfaction of interns with the teacher in the observation group were better than those of the control group ( P<0.05); the error rate of unskilled physical examination and the error rate of poor aseptic debridement concept in the observation group were all lower ( P<0.05); there was no significant difference in the error rate of irregular writing of medical records, the error rate of lack of medical history collection, and the error rate of communication errors between the two groups ( P>0.05). After teaching, the scores of independent learning ability and career maturity inventory attitude scale in the observation group were higher than those in the control group ( P<0.05). Conclusion:The PBL teaching based on POA theory has a good effect in the clinical practice teaching in the department of hand and foot surgery, and it is worthy of further promotion.