ten Cate Olle, Scheele Fedde
Center for Research and Development of Education, University Medical Center, Utrecht, The Netherlands.
Acad Med. 2007 Jun;82(6):542-7. doi: 10.1097/ACM.0b013e31805559c7.
The introduction of competency-based postgraduate medical training, as recently stimulated by national governing bodies in Canada, the United States, the United Kingdom, The Netherlands, and other countries, is a major advancement, but at the same time it evokes critical issues of curricular implementation. A source of concern is the translation of general competencies into the practice of clinical teaching. The authors observe confusion around the term competency, which may have adverse effects when a teaching and assessment program is to be designed. This article aims to clarify the competency terminology. To connect the ideas behind a competency framework with the work environment of patient care, the authors propose to analyze the critical activities of professional practice and relate these to predetermined competencies. The use of entrustable professional activities (EPAs) and statements of awarded responsibility (STARs) may bridge a potential gap between the theory of competency-based education and clinical practice. EPAs reflect those activities that together constitute the profession. Carrying out most of these EPAs requires the possession of several competencies. The authors propose not to go to great lengths to assess competencies as such, in the way they are abstractly defined in competency frameworks but, instead, to focus on the observation of concrete critical clinical activities and to infer the presence of multiple competencies from several observed activities. Residents may then be awarded responsibility for EPAs. This can serve to move toward competency-based training, in which a flexible length of training is possible and the outcome of training becomes more important than its length.
加拿大、美国、英国、荷兰及其他国家的国家管理机构最近推动了基于胜任力的研究生医学培训的引入，这是一项重大进步，但同时也引发了课程实施方面的关键问题。一个令人担忧的问题是将一般胜任力转化为临床教学实践。作者观察到围绕胜任力这一术语存在混淆，这在设计教学和评估计划时可能会产生不利影响。本文旨在澄清胜任力术语。为了将胜任力框架背后的理念与患者护理的工作环境联系起来，作者建议分析专业实践的关键活动，并将这些活动与预先确定的胜任力联系起来。使用可托付专业活动（EPA）和授予责任声明（STAR）可能会弥合基于胜任力教育理论与临床实践之间的潜在差距。EPA反映了那些共同构成该专业的活动。开展大多数这些EPA需要具备多种胜任力。作者建议不要像在胜任力框架中抽象定义的那样，不遗余力地去评估胜任力本身，而是专注于观察具体的关键临床活动，并从若干观察到的活动中推断多种胜任力的存在。然后可以授予住院医师对EPA的责任。这有助于迈向基于胜任力的培训，在这种培训中，培训时长可以灵活安排，培训结果比培训时长更重要。
