具备独立执业能力：利用儿科住院医师培训里程碑评估准备情况。
Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness.
作者信息
Li Su-Ting T, Tancredi Daniel J, Schwartz Alan, Guillot Ann P, Burke Ann E, Trimm R Franklin, Guralnick Susan, Mahan John D, Gifford Kimberly A
机构信息
S.-T.T. Li is associate professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, Sacramento, California. D.J. Tancredi is associate professor, Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, and director of research, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois. A.P. Guillot is professor, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont. A.E. Burke is professor and pediatric program director, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio. R.F. Trimm is professor, vice chair, and pediatric program director, Department of Pediatrics, University of South Alabama, Mobile, Alabama. S. Guralnick is associate professor, director of graduate medical education, and designated institutional officer, Office of Academic Affairs, Winthrop University Hospital, Mineola, New York. J.D. Mahan is professor, vice chair, and pediatric and pediatric nephrology fellowship program director, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio. K.A. Gifford is assistant professor and pediatric program director, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
出版信息
Acad Med. 2017 Mar;92(3):385-393. doi: 10.1097/ACM.0000000000001322.
PURPOSE
To describe clinical skills progression during pediatric residency using the distribution of pediatric milestone assessments by subcompetency and year of training and to determine reasonable milestone expectations at time of graduation.
METHOD
Multi-institutional cohort study of the milestones reported to the Accreditation Council for Graduate Medical Education for all 21 pediatric subcompetencies. Most subcompetencies were measured using five milestone levels (1 = novice, 2 = advanced beginner, 3 = competent, 4 = proficient, 5 = master); 3 subcompetencies had only four levels defined.
RESULTS
Milestone assessments for 2,030 pediatric residents in 47 programs during academic year 2013-2014 were obtained. There was significant variation in end-of-year milestone ratings for residents within each level of training, which decreased as training level increased. Most (78.9%; 434/550) graduating third-year pediatric residents received a milestone rating of ≥ 3 in all 21 subcompetencies; fewer (21.1%; 116/550) received a rating of ≥ 4 in all subcompetencies. Across all training levels, professionalism and interpersonal communication skills were rated highest; quality improvement was rated lowest.
CONCLUSIONS
Trainees entered residency with a wide range of skills. As they advanced, skill variability within a training level decreased. Most graduating pediatric residents were still advancing on the milestone continuum toward proficiency and mastery, and an expectation of milestone ratings ≥ 4 in all categories upon graduation is unrealistic; milestone ratings ≥ 3 upon graduation may be more realistic. Understanding current pediatric residents' and graduates' skills can help to identify key areas that should be specifically targeted during training.
目的
通过按亚能力和培训年份划分的儿科里程碑评估分布情况来描述儿科住院医师培训期间临床技能的进展，并确定毕业时合理的里程碑期望。
方法
对向毕业后医学教育认证委员会报告的所有21项儿科亚能力的里程碑进行多机构队列研究。大多数亚能力使用五个里程碑水平进行衡量（1 = 新手，2 = 高级初学者，3 = 胜任，4 = 熟练，5 = 精通）；3项亚能力仅定义了四个水平。
结果
获得了2013 - 2014学年47个项目中2030名儿科住院医师的里程碑评估。每个培训水平内住院医师的年终里程碑评分存在显著差异，且随着培训水平的提高而降低。大多数（78.9%；434/550）即将毕业的三年级儿科住院医师在所有21项亚能力中获得的里程碑评分为≥3；较少（21.1%；116/550）在所有亚能力中获得的评分为≥4。在所有培训水平中，专业精神和人际沟通技能的评分最高；质量改进的评分最低。
结论
学员进入住院医师培训时技能水平差异很大。随着他们的进步，同一培训水平内的技能差异减小。大多数即将毕业的儿科住院医师仍在朝着熟练和精通的里程碑连续体前进，期望毕业时在所有类别中里程碑评分为≥4是不现实的；毕业时里程碑评分为≥3可能更现实。了解当前儿科住院医师和毕业生的技能有助于确定培训期间应特别针对的关键领域。
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