Choe John H, Knight Christopher L, Stiling Rebekah, Corning Kelli, Lock Keli, Steinberg Kenneth P
J.H. Choe is assistant professor, Department of Medicine, and associate program director, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington. C.L. Knight is associate professor, Department of Medicine, and associate program director, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington. R. Stiling was program operations specialist, Internal Medicine Residency Program, University of Washington, Seattle, Washington, at the time this article was written. K. Corning is associate director, Internal Medicine Residency Program, University of Washington, Seattle, Washington. K. Lock is program operations specialist, Internal Medicine Residency Program, University of Washington, Seattle, Washington. K.P. Steinberg is professor, Department of Medicine, and program director, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle Washington.
Acad Med. 2016 Jul;91(7):943-50. doi: 10.1097/ACM.0000000000001161.
The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.
新的认证系统要求内科培训项目每半年向毕业后医学教育认证委员会（ACGME）提供每位住院医师在22个亚能力领域的进展情况。与基于能力通常进展预期的评估相比，对住院医师在可托付专业活动（EPA）中的“可信度”进行评估可能会提供一种更切实的评估架构。然而，将基于EPA的评估结果转化为ACGME的里程碑进展报告已被证明具有挑战性，因为这两个系统的基础架构不同。作者描述了一个过程，以弥合基于特定轮转的EPA评估与ACGME里程碑报告之间的差距。该方法于2012年和2013年在华盛顿大学开发，涉及将基于EPA的评估回复映射到“里程碑要素”，即22个内科亚能力各栏中的叙述性描述。当教员完成基于EPA的评估时，映射的里程碑要素会自动标记为“已确认”。项目可以维护一个数据库，统计每位住院医师每个里程碑要素被确认的次数；这些数据可用于生成住院医师在内科里程碑方面进展的图形展示。通过对里程碑要素进行计数，项目能够弥合教员基于特定轮转观察到的活动对住院医师的评估与基于内科里程碑的ACGME半年期报告之间的差距。尽管该方法可能对所有项目都有用，但对于大型项目尤其有益，因为在大型项目中临床能力委员会成员可能没有机会直接观察所有住院医师。
