Dijkstra Ids S, Pols Jan, Remmelts Pine, Rietzschel Eric F, Cohen-Schotanus Janke, Brand Paul L P
Wenckebach Institute, University Medical Center Groningen, University of Groningen, FC 10, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.
Perspect Med Educ. 2015 Dec;4(6):300-307. doi: 10.1007/s40037-015-0219-3.
Many training programmes in postgraduate medical education (PGME) have introduced competency frameworks, but the effects of this change on preparedness for practice are unknown. Therefore, we explored how elements of competency-based programmes in PGME (educational innovations, attention to competencies and learning environment) were related to perceived preparedness for practice among new consultants.
A questionnaire was distributed among 330 new consultants. Respondents rated how well their PGME training programme prepared them for practice, the extent to which educational innovations (portfolio, Mini-CEX) were implemented, and how much attention was paid to CanMEDS competencies during feedback and coaching, and they answered questions on the learning environment and general self-efficacy. Multiple regression and mediation analyses were used to analyze data.
The response rate was 43 % (143/330). Controlling for self-efficacy and gender, the learning environment was the strongest predictor of preparedness for practice (B = 0.42, p < 0.001), followed by attention to competencies (B = 0.29, p < 0.01). Educational innovations were not directly related to preparedness for practice. The overall model explained 52 % of the variance in preparedness for practice. Attention to competencies mediated the relationship between educational innovations and preparedness for practice. This mediation became stronger at higher learning environment values.
The learning environment plays a key role in determining the degree to which competency-based PGME prepares trainees for independent practice.
许多研究生医学教育（PGME）培训项目都引入了能力框架，但这一变化对实践准备的影响尚不清楚。因此，我们探讨了PGME中基于能力的项目要素（教育创新、对能力的关注和学习环境）与新入职顾问对实践准备的认知之间的关系。
向330名新入职顾问发放了问卷。受访者对他们的PGME培训项目使他们为实践做好准备的程度、教育创新（档案袋、迷你临床评估练习）的实施程度、在反馈和辅导过程中对加拿大医学教育方向与角色设定（CanMEDS）能力的关注程度进行了评分，并回答了关于学习环境和一般自我效能感的问题。采用多元回归和中介分析来分析数据。
回复率为43%（143/330）。在控制自我效能感和性别后，学习环境是实践准备的最强预测因素（B = 0.42，p < 0.001），其次是对能力的关注（B = 0.29，p < 0.01）。教育创新与实践准备没有直接关系。总体模型解释了实践准备差异的52%。对能力的关注在教育创新与实践准备之间起到了中介作用。在较高的学习环境值下，这种中介作用更强。
学习环境在确定基于能力的PGME使受训者为独立实践做好准备的程度方面起着关键作用。
