Tekian Ara, Hodges Brian D, Roberts Trudie E, Schuwirth Lambert, Norcini John
University of Illinois at Chicago , USA .
Med Teach. 2015 Apr;37(4):399-402. doi: 10.3109/0142159X.2014.993954. Epub 2014 Dec 19.
This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence.
本文介绍了围绕使用里程碑来评估基于结果的医学教育中的能力的观点和争议。讨论了全球视角（加拿大、欧洲和美国）及其背后的发展依据。在加拿大，正从基于时间来概念化能力的做法大幅转向展示特定能力。这一转变的成功可能需要反映学生在复杂性和情境中进步的复杂（而非简化主义）里程碑，以及一种叙述其历程的方法。欧洲国家（英国、法国和德国）强调了时间和里程碑对于医学生真正实现能力的复杂性。为满足医学不断变化的需求，他们认为时间实际上为学生提供了实现各种里程碑所需的知识和接触机会。在美国，里程碑基于在整个专业发展过程中的抽样，以启动终身学习。然而，使用里程碑可能并不意味着具备整体能力（简化主义）。里程碑必须与基于结果的课程一起，在教师和能力委员会的参与下制定。本文概述的观点凸显了实施基于结果的医学教育所面临的新挑战，并呼吁对能力进行新的概念化。
