Ten Cate Olle
Th.J.(Olle) ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
Acad Med. 2017 Jun;92(6):736-738. doi: 10.1097/ACM.0000000000001623.
With the increased interest in the use of entrustable professional activities (EPAs) in undergraduate medical education (UME) and graduate medical education (GME) come questions about the implications for assessment. Entrustment assessment combines the evaluation of learners' knowledge, skills, and behaviors with the evaluation of their readiness to be entrusted to perform critical patient care responsibilities. Patient safety, then, should be an explicit component of educational assessments. The validity of these assessments in the clinical workplace becomes the validity of the entrustment decisions.Modern definitions of the validity of educational assessments stress the importance of the purpose of the test and the consequences of the learner's score. Thus, if the learner is a trainee in a clinical workplace and entrusting her or him to perform an EPA is the focus of the assessment, the validity argument for that assessment should include a patient safety component.While the decision to allow a learner to practice unsupervised is typically geared toward GME, similar decisions are made in UME regarding learners' readiness to perform EPAs with indirect supervision (i.e., without a supervisor present in the room). Three articles in this issue address implementing EPAs in UME.The author of this Commentary discusses the possibility of implementing true entrustment decisions in UME. He argues that bringing the patient into the educational assessment equation is marrying educational and health care responsibilities. Building trust in learners from early on, gradually throughout the continuum of medical education, may reframe our vision on assessment in the workplace.
随着本科医学教育（UME）和毕业后医学教育（GME）中对可托付专业活动（EPA）使用的兴趣增加，出现了关于评估影响的问题。托付评估将对学习者知识、技能和行为的评估与对他们准备好被托付履行关键患者护理职责的评估结合起来。因此，患者安全应该是教育评估的一个明确组成部分。这些评估在临床工作场所的有效性就变成了托付决策的有效性。教育评估有效性的现代定义强调测试目的和学习者分数后果的重要性。因此，如果学习者是临床工作场所的实习生，并且托付其执行EPA是评估的重点，那么该评估的有效性论证应该包括患者安全组成部分。虽然允许学习者在无监督的情况下进行实践的决定通常针对毕业后医学教育，但在本科医学教育中也会就学习者在间接监督下（即房间内没有监督人员）执行EPA的准备情况做出类似决定。本期的三篇文章讨论了在本科医学教育中实施EPA的问题。本评论的作者讨论了在本科医学教育中做出真正托付决策的可能性。他认为将患者纳入教育评估等式就是将教育责任和医疗责任结合起来。从早期开始，在医学教育的整个连续过程中逐步建立对学习者的信任，可能会重塑我们对工作场所评估的看法。
