探寻本科医学教育中的托付之道：美国医学协会（AAMC）住院医师入职核心可托付专业活动托付概念小组的进展报告
Finding a Path to Entrustment in Undergraduate Medical Education: A Progress Report From the AAMC Core Entrustable Professional Activities for Entering Residency Entrustment Concept Group.
作者信息
Brown David R, Warren Jamie B, Hyderi Abbas, Drusin Ronald E, Moeller Jeremy, Rosenfeld Melvin, Orlander Philip R, Yingling Sandra, Call Stephanie, Terhune Kyla, Bull Janet, Englander Robert, Wagner Dianne P
机构信息
D.R. Brown is vice chair, chief of family and community medicine, and associate professor of humanities, health, and society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. J.B. Warren is assistant professor of pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon. A. Hyderi is associate dean for curriculum and associate professor of family medicine, University of Illinois College of Medicine, Chicago, Illinois. R.E. Drusin is vice dean for education and professor of medicine, Columbia University College of Physicians and Surgeons, New York, New York. J. Moeller is residency program director and assistant professor of neurology, Yale School of Medicine, New Haven, Connecticut. M. Rosenfeld is senior associate dean for medical education and associate professor of cell biology, New York University School of Medicine, New York, New York. P.R. Orlander is associate dean for curricular affairs, vice chair for education, and professor of internal medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. S. Yingling is associate dean for educational planning and quality improvement and assistant professor of medical education, University of Illinois College of Medicine, Chicago, Illinois. She was manager, Division of Education Quality, Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York, at the time this work began. S. Call is associate chair for education, residency program director, and professor of medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. K. Terhune is residency program director and associate professor of surgery, Vanderbilt University School of Medicine, Nashville, Tennessee. J. Bull is lead specialist in competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. R. Englander is associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota. D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
出版信息
Acad Med. 2017 Jun;92(6):774-779. doi: 10.1097/ACM.0000000000001544.
PROBLEM
To better prepare graduating medical students to transition to the professional responsibilities of residency, 10 medical schools are participating in an Association of American Medical Colleges pilot to evaluate the feasibility of explicitly teaching and assessing 13 Core Entrustable Professional Activities for Entering Residency. The authors focused on operationalizing the concept of entrustment as part of this process.
APPROACH
Starting in 2014, the Entrustment Concept Group, with representatives from each of the pilot schools, guided the development of the structures and processes necessary for formal entrustment decisions associated with students' increased responsibilities at the start of residency.
OUTCOMES
Guiding principles developed by the group recommend that formal, summative entrustment decisions in undergraduate medical education be made by a trained group, be based on longitudinal performance assessments from multiple assessors, and incorporate day-to-day entrustment judgments by workplace supervisors. Key to entrustment decisions is evidence that students know their limits (discernment), can be relied on to follow through (conscientiousness), and are forthcoming despite potential personal costs (truthfulness), in addition to having the requisite knowledge and skills. The group constructed a developmental framework for discernment, conscientiousness, and truthfulness to pilot a model for transparent entrustment decision making.
NEXT STEPS
The pilot schools are studying a number of questions regarding the pathways to and decisions about entrustment. This work seeks to inform meaningful culture change in undergraduate medical education through a shared understanding of the assessment of trust and a shared trust in that assessment.
问题
为了让即将毕业的医学生更好地向住院医师的专业职责过渡，10所医学院正在参与美国医学院协会的一项试点项目，以评估明确教授和评估13项进入住院医师阶段的核心可托付专业活动的可行性。作为这一过程的一部分，作者专注于将托付的概念付诸实践。
方法
从2014年开始，由各试点学校代表组成的托付概念小组指导制定与住院医师开始时学生责任增加相关的正式托付决策所需的结构和流程。
结果
该小组制定的指导原则建议，本科医学教育中的正式、总结性托付决策应由经过培训的小组做出，基于来自多名评估者的纵向表现评估，并纳入工作场所主管的日常托付判断。托付决策的关键在于有证据表明学生知道自己的局限（辨别力）、可以被信赖贯彻到底（尽责）、尽管可能有个人代价仍能坦诚（诚实），此外还要具备必要的知识和技能。该小组构建了一个关于辨别力、尽责和诚实的发展框架，以试点一个透明托付决策的模型。
下一步
试点学校正在研究一些关于托付的途径和决策的问题。这项工作旨在通过对信任评估的共同理解以及对该评估的共同信任，为本科医学教育中有意义的文化变革提供信息。
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