Reich Lawrence M, David Rand A
Department of Ambulatory Care, Elmhurst Hospital Center, NY 11373, USA.
Mt Sinai J Med. 2005 Sep;72(5):300-6.
The focus of competency-based training is on outcomes, specifically well-trained residents. Our goal is to help move resident assessment away from content- and process-based factors and towards measures of mastery of practice. Doing so requires reorganizing and reprioritizing elements of the training program. We describe our attempt to shift the priorities of our program (the primary care internal medicine residency of the Mount Sinai School of Medicine [Elmhurst] Program) towards the desired outcomes of the medical resident, faculty, institution, and program as a whole. These outcomes are based on the six core competencies of graduate medical education (medical knowledge, patient care, interpersonal and communication skills, professionalism, systems-based practice, and practice-based learning and improvement). We call this process "comprehensive educational performance improvement" (CEPI).
We began by identifying each individual learning element of the program and classifying it into a clinical, didactic or evaluative "domain." We thus identified 40 clinical learning elements (specific outpatient and inpatient clinical settings), 25 didactic learning elements (specific lecture formats, workshops, conferences, etc.), and 11 evaluative elements (evaluation formats and contexts). Then we developed a set of questions intended to define and evaluate each element. Finally, we established criteria for prioritizing these questions, by asking relevant faculty, staff, and residents to assign priority scores for each.
By this process, we generated 2-6 questions for each learning element, resulting in a total of 301 questions. This constituted a comprehensive plan for the assessment of both the program and the competency of the medical residents who have completed the program. Examples of the application of this process are described.
The CEPI process has a number of strengths. It allows for the concurrent assessment of each learning element with its intended outcomes, enabling us to simultaneously assess its outcome and its programmatic value. It effectively integrates the cognitive aspects of a program element with its clinical aspects, along with the input of evaluators at various levels. Finally, it helps train faculty members in an evidence-based approach to the curriculum.
基于胜任力的培训重点在于结果，特别是训练有素的住院医师。我们的目标是帮助将住院医师评估从基于内容和过程的因素转向对实践掌握程度的衡量。要做到这一点，需要重新组织培训计划的要素并重新确定其优先级。我们描述了我们试图将我们项目（西奈山医学院[埃尔姆赫斯特]项目的初级保健内科住院医师项目）的优先级转向医学住院医师、教员、机构以及整个项目的期望结果。这些结果基于毕业后医学教育的六项核心胜任力（医学知识、患者护理、人际沟通技能、职业素养、基于系统的实践以及基于实践的学习与改进）。我们将这个过程称为“全面教育绩效改进”（CEPI）。
我们首先确定项目的每个单独学习要素，并将其分类到临床、教学或评估“领域”。我们由此确定了40个临床学习要素（特定的门诊和住院临床环境）、25个教学学习要素（特定的讲座形式、研讨会、会议等）以及11个评估要素（评估形式和背景）。然后我们制定了一组旨在定义和评估每个要素的问题。最后，我们通过要求相关教员、工作人员和住院医师为每个问题分配优先级分数来确定这些问题的优先级标准。
通过这个过程，我们为每个学习要素生成了2 - 6个问题，总共产生了301个问题。这构成了一个评估项目以及完成该项目的医学住院医师胜任力的全面计划。描述了该过程应用的示例。
CEPI过程有许多优点。它允许同时评估每个学习要素及其预期结果，使我们能够同时评估其结果及其项目价值。它有效地将项目要素的认知方面与其临床方面以及各级评估者的意见整合在一起。最后，它有助于以基于证据的方法培训教员制定课程。
