Mink Richard B, Schwartz Alan, Herman Bruce E, Turner David A, Curran Megan L, Myers Angela, Hsu Deborah C, Kesselheim Jennifer C, Carraccio Carol L
R.B. Mink is professor of pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, and chief, Division of Pediatric Critical Care Medicine, and director, Pediatric Critical Care Medicine Fellowship, Harbor-UCLA Medical Center, Torrance, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois. B.E. Herman is professor of pediatrics, vice chair for education, and residency program director, University of Utah School of Medicine, Salt Lake City, Utah. D.A. Turner is associate professor of pediatrics, Duke University School of Medicine, and associate director of graduate medical education, Duke University Medical Center, Durham, North Carolina. M.L. Curran is assistant professor of pediatrics and director, Pediatric Rheumatology Fellowship Program, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois. A. Myers is associate professor and director, Infectious Diseases Fellowship Program, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. D.C. Hsu is associate professor of pediatrics, associate program director, Pediatric Residency Program, and clinical and education chief, Pediatric Emergency Medicine Section, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas. J.C. Kesselheim is assistant professor of pediatrics, Harvard Medical School, and associate fellowship program director for education, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts. C.L. Carraccio is vice president, Competency-Based Assessment, American Board of Pediatrics, Chapel Hill, North Carolina.
Acad Med. 2018 Feb;93(2):283-291. doi: 10.1097/ACM.0000000000001820.
Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN).
SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015.
Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson's iota = 0.73).
The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.
可委托专业活动（EPA）代表了医生在临床实践中进行的常规且必要的活动。尽管已经提出了一些监督水平量表，但尚未得到验证。在本研究中，研究人员创建了儿科亚专业常见EPA的监督水平量表，然后在儿科亚专业研究网络（SPIN）进行的一项研究中检验了其有效性。
SPIN指导委员会成员采用改良的德尔菲法为七个常见EPA中的六个制定了独特的量表。研究人员在一项多亚专业研究中寻找有效性证据，在该研究中，儿科住院医师培训项目主任和临床能力委员会在2014年秋季和2015年春季使用这些量表对住院医师进行评估。
创建了六个EPA的单独量表，每个量表有五个递进的委托水平。在秋季和春季，每年对来自200多个项目的每个培训年级的300多名住院医师进行了评估。在这两个时期以及每个EPA中，委托水平都有递进增加，二年级住院医师的评分高于一年级住院医师（P < .001），三年级住院医师的评分高于二年级住院医师（P < .001）。对于每个EPA，春季评分高于秋季（P < .001）。评分者间信度较高（詹森和奥尔森的iota = 0.73）。
为这六个常见的儿科亚专业EPA制定的监督量表在基于EPA的儿科住院医师评估中显示出强有力的有效性证据。它们也可能为其他专业量表的开发提供参考。
