El-Haddad Carlos, Damodaran Arvin, McNeil H Patrick, Hu Wendy
C. El-Haddad is a rheumatologist, Department of Medicine, Campbelltown Hospital, Campbelltown, Australia, and research master's student in medical education, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia. A. Damodaran is a rheumatologist and director, Clinical Teaching Unit, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia. H.P. McNeil is professor of medicine and executive dean, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia. W. Hu is professor of medical education, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
Acad Med. 2017 Jun;92(6):800-808. doi: 10.1097/ACM.0000000000001616.
The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA.
The authors chose "management of acute low back pain (LBP)" as a common, important clinical task on which to base the patient-centered EPA. In 2015, 14 patients who presented to a teaching hospital with acute LBP participated in semistructured interviews exploring their illness experience and expectations of doctors. Clinicians representing multiple disciplines participated in a focus group. The authors used the Framework Method to analyze data, identifying and developing themes, similarities, and differences between patient and clinician input. They used the findings to develop the EPA. Through an iterative procedure of data review and tracking data sources, they determined how patient and clinician input informed each EPA descriptor.
Drawing from their firsthand experience of LBP, patients described unique expectations of trainees which directly informed EPA descriptors. For example, the authors primarily used patients' detailed descriptions of desirable and observable trainee behaviors to inform the required attitudes descriptor.
Patients can provide unique contributions, complementary to those of clinicians, to EPAs. Consultations with patients led to the development of a patient-centered EPA, which aligned best clinical practice with patient expectations. Educators seeking to apply patient-centered care to EPA development could adopt a similar approach.
医学教育界正迅速接受将可托付专业活动（EPA）作为评估住院医师的一种方式。建议在制定EPA时让利益相关者参与，但尚无研究调查患者意见的作用。在这项定性研究中，作者调查了患者意见在设计以患者为中心的EPA方面可能带来的影响。
作者选择“急性腰痛（LBP）的管理”作为一项常见且重要的临床任务，以此为基础制定以患者为中心的EPA。2015年，14名因急性LBP到一家教学医院就诊的患者参与了半结构化访谈，探讨他们的患病经历和对医生的期望。代表多个学科的临床医生参加了一个焦点小组。作者使用框架法分析数据，确定并梳理患者和临床医生意见之间的主题、异同点。他们利用研究结果来制定EPA。通过反复的数据审查和追踪数据源的过程，他们确定了患者和临床医生的意见如何为每个EPA描述符提供信息。
基于他们对LBP的亲身经历，患者描述了对实习生的独特期望，这些期望直接为EPA描述符提供了信息。例如，作者主要利用患者对理想的和可观察到的实习生行为的详细描述，来确定所需态度描述符的内容。
患者可以为EPA做出独特贡献，补充临床医生的贡献。与患者的协商促成了以患者为中心的EPA的制定，使最佳临床实践与患者期望保持一致。寻求将以患者为中心的护理应用于EPA制定的教育工作者可以采用类似方法。
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