Carraccio Carol, Englander Robert, Gilhooly Joseph, Mink Richard, Hofkosh Dena, Barone Michael A, Holmboe Eric S
C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina. R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC, at the time this article was written. J. Gilhooly is adjunct professor of pediatrics, Oregon Health & Science University, Portland, Oregon. R. Mink is chief, Division of Pediatric Critical Care Medicine, and director, pediatric critical care fellowship, Harbor-UCLA Medical Center, Torrance, California, and professor of pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California. D. Hofkosh is professor of pediatrics and associate dean for faculty affairs, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and president, Association of Pediatric Program Directors, McLean, Virginia. M.A. Barone is associate professor of pediatrics and director of medical student education, Johns Hopkins University School of Medicine, Baltimore, Maryland. E.S. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.
Acad Med. 2017 Mar;92(3):324-330. doi: 10.1097/ACM.0000000000001141.
The transition to competency-based medical education (CBME) and adoption of the foundational domains of competence by the Accreditation Council for Graduate Medical Education, Association of American Medical Colleges (AAMC), and American Board of Medical Specialties' certification and maintenance of certification (MOC) programs provided an unprecedented opportunity for the pediatrics community to create a model of learning and assessment across the continuum. Two frameworks for assessment in CBME have been promoted: (1) entrustable professional activities (EPAs) and (2) milestones that define a developmental trajectory for individual competencies. EPAs are observable and measureable units of work that can be mapped to competencies and milestones critical to performing them safely and effectively.The pediatrics community integrated the two frameworks to create a potential pathway of learning and assessment across the continuum from undergraduate medical education (UME) to graduate medical education (GME) and from GME to practice. The authors briefly describe the evolution of the Pediatrics Milestone Project and the process for identifying EPAs for the specialty and subspecialties of pediatrics. The method of integrating EPAs with competencies and milestones through a mapping process is discussed, and an example is provided. The authors illustrate the alignment of the AAMC's Core EPAs for Entering Residency with the general pediatrics EPAs and, in turn, the alignment of the latter with the subspecialty EPAs, thus helping build the bridge between UME and GME. The authors propose how assessment in GME, based on EPAs and milestones, can guide MOC to complete the bridge across the education continuum.
向基于胜任力的医学教育（CBME）的转变，以及研究生医学教育认证委员会、美国医学院协会（AAMC）和美国医学专业委员会的认证及认证维持（MOC）项目对胜任力基础领域的采用，为儿科学领域创造一个贯穿整个连续过程的学习与评估模式提供了前所未有的机遇。CBME中有两种评估框架得到了推广：（1）可托付专业活动（EPA）和（2）为个体胜任力定义发展轨迹的里程碑。EPA是可观察和可测量的工作单元，可映射到对安全有效地执行这些工作至关重要的胜任力和里程碑。儿科学领域整合了这两种框架，以创建一条从本科医学教育（UME）到研究生医学教育（GME），以及从GME到实践的贯穿整个连续过程的潜在学习与评估途径。作者简要描述了儿科学里程碑项目的演变，以及确定儿科学专业及亚专业EPA的过程。讨论了通过映射过程将EPA与胜任力和里程碑整合的方法，并给出了一个示例。作者阐述了美国医学院协会（AAMC）的住院医师入职核心EPA与普通儿科学EPA的一致性，进而阐述了后者与亚专业EPA的一致性，从而有助于搭建UME和GME之间的桥梁。作者提出基于EPA和里程碑的GME评估如何能够指导MOC完成教育连续过程中的桥梁搭建。
