The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio.
The Ohio State University College of Medicine, Department of Emergency Anesthesiology, Columbus, Ohio.
West J Emerg Med. 2017 Jan;18(1):35-42. doi: 10.5811/westjem.2016.10.31479. Epub 2016 Dec 5.
Medical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10.
First, we wrote five emergent patient case-scenarios that a medical trainee would likely confront in an acute care setting. Furthermore, we developed high-fidelity simulations to realistically portray these patient case scenarios. Finally, we designed a performance assessment instrument to evaluate the medical student's performance on executing critical actions related to EPA-10 competencies. Critical actions included the following: triage skills, mustering the medical team, identifying causes of patient decompensation, and initiating care. Up to four students were involved with each case scenario; however, only the team leader was evaluated using the assessment instruments developed for each case.
A total of 114 students participated in the EPA-10 assessment during their final year of medical school. Most students demonstrated competence in recognizing unstable vital signs (97%), engaging the team (93%), and making appropriate dispositions (92%). Almost 87% of the students were rated as having reached entrustment to manage the care of an emergent patient (99 of 114). Inter-rater reliability varied by case scenario, ranging from moderate to near-perfect agreement. Three of five case-scenario assessment instruments contained items that were internally consistent at measuring student performance. Additionally, the individual item scores for these case scenarios were highly correlated with the global entrustment decision.
High-fidelity simulation showed good potential for effective assessment of medical student entrustment of caring for the emergent patient. Preliminary evidence from this pilot project suggests content validity of most cases and associated checklist items. The assessments also demonstrated moderately strong faculty inter-rater reliability.
美国的医学院校被鼓励在学生毕业前，准备并认证学生承担 13 项核心可委托专业活动（EPAs）的能力。委托是指对学习者有能力自主执行特定患者护理活动的知情信任。核心 EPA-10 是委托毕业生照顾紧急患者。本项目旨在设计一种现实的绩效评估方法，以评估四年级医学生在 EPA-10 方面的表现。
首先，我们编写了五个可能在急性护理环境中遇到的紧急患者病例情景。此外，我们开发了高保真模拟来真实地描绘这些患者病例情景。最后，我们设计了一种绩效评估工具，以评估医学生在执行与 EPA-10 能力相关的关键行动方面的表现。关键行动包括以下内容：分诊技能、召集医疗团队、确定患者失代偿的原因以及启动护理。每个病例情景涉及多达四名学生，但只有团队负责人使用为每个病例开发的评估工具进行评估。
共有 114 名学生在医学院的最后一年参加了 EPA-10 评估。大多数学生在识别不稳定生命体征（97%）、参与团队（93%）和做出适当处置（92%）方面表现出了能力。近 87%的学生被评为达到委托管理紧急患者护理的能力（114 人中的 99 人）。案例情景的评分者间信度不同，从中度到近乎完美的一致性。五个病例情景评估工具中的三个包含可衡量学生表现的内部一致性项目。此外，这些病例情景的单项得分与整体委托决策高度相关。
高保真模拟在评估医学生对紧急患者护理的委托能力方面显示出了良好的潜力。该试点项目的初步证据表明，大多数病例和相关检查表项目具有内容有效性。评估还显示出中等强度的教师评分者间信度。
