Aylward Michael, Nixon James, Gladding Sophia
Dr. Aylward is assistant professor of medicine and pediatrics and program director, Internal Medicine and Pediatric Residency Program, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Nixon is associate professor of medicine and pediatrics and vice chair of education, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Gladding is assistant professor of medicine and director of educational research and development, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Acad Med. 2014 Oct;89(10):1335-40. doi: 10.1097/ACM.0000000000000317.
Medical education is moving toward assessment of educational outcomes rather than educational processes. The American Board of Internal Medicine and American Board of Pediatrics milestones and the concept of entrustable professional activities (EPA)--skills essential to the practice of medicine that educators progressively entrust learners to perform--provide new approaches to assessing outcomes. Although some defined EPAs exist for internal medicine and pediatrics, the continued development and implementation of EPAs remains challenging. As residency programs are expected to begin reporting milestone-based performance, however, they will need examples of how to overcome these challenges. The authors describe a model for the development and implementation of an EPA using the resident handoff as an example. The model includes nine steps: selecting the EPA, determining where skills are practiced and assessed, addressing barriers to assessment, determining components of the EPA, determining needed assessment tools, developing new assessments if needed, determining criteria for advancement through entrustment levels, mapping milestones to the EPA, and faculty development. Following implementation, 78% of interns at the University of Minnesota Medical School were observed giving handoffs and provided feedback. The authors suggest that this model of EPA development--which includes engaging stakeholders, an iterative process to describing the behavioral characteristics of each domain at each level of entrustment, and the development of specific assessment tools that support both formative feedback and summative decisions about entrustment--can serve as a model for EPA development for other clinical skills and specialty areas.
医学教育正朝着评估教育成果而非教育过程的方向发展。美国内科医学委员会和美国儿科学会的里程碑以及可托付专业活动（EPA）的概念——即教育工作者逐步托付学习者去执行的医学实践所需技能——为评估成果提供了新方法。尽管内科医学和儿科学已有一些明确的EPA，但EPA的持续发展和实施仍具有挑战性。然而，随着住院医师培训项目预计开始报告基于里程碑的表现，它们将需要如何克服这些挑战的示例。作者以住院医师交接班为例，描述了一个EPA开发与实施的模型。该模型包括九个步骤：选择EPA、确定技能的实践和评估地点、解决评估障碍、确定EPA的组成部分、确定所需评估工具、必要时开发新评估、确定通过托付级别进阶的标准、将里程碑映射到EPA以及教师发展。实施后，明尼苏达大学医学院78%的实习生进行了交接班并提供了反馈。作者建议，这种EPA开发模型——包括让利益相关者参与、一个迭代过程来描述每个托付级别各领域的行为特征以及开发支持形成性反馈和关于托付的总结性决策的特定评估工具——可以作为其他临床技能和专业领域EPA开发的模型。
