E. Krupat is associate professor, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. At the time of writing, the author was also director, Center for Evaluation, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2018 Mar;93(3):371-376. doi: 10.1097/ACM.0000000000001865.
The Core Entrustable Professional Activities for Entering Residency (Core EPAs) have taken a strong hold on undergraduate medical education (UME). This Perspective questions their value added and considers the utility of the Core EPAs along two separate dimensions: (1) the ways they change the content and focus of the goals of UME; and (2) the extent to which entrustable professional activity (EPA)-based assessment conforms to basic principles of measurement theory as practiced in the social sciences. Concerning content and focus, the author asks whether the 13 Core EPAs frame UME too narrowly, putting competencies into the background and overlooking certain aspirational, but important and measurable, objectives of UME. The author also discusses the unevenness of EPAs in terms of their breadth and their developmental status as core activities. Regarding measurement and assessment, the author raises concerns that the EPA metric introduces layers of inference that may cause distortions and hinder accuracy and rater agreement. In addition, the use of weak anchors and multidimensional scales is also of concern. The author concludes with a proposal for reframing the Core EPAs and Accreditation Council for Graduate Medical Education competencies into broadly defined sets of behaviors, referred to as "Tasks of Medicine," and calls for the development of a systematic and longitudinal research agenda. The author asserts that "slowing down when you should" applies to medical education as well as patient care, and calls for a reevaluation of the Core EPAs before further commitment to them.
核心住院医师可委托专业活动（Core EPAs）在本科医学教育（UME）中占据了重要地位。本文质疑了它们的附加值，并从两个不同维度考虑了 Core EPAs 的效用：（1）它们改变 UME 目标的内容和重点的方式；（2）基于可委托专业活动（EPA）的评估在多大程度上符合社会科学中实践的基本测量理论原则。关于内容和重点，作者询问了 13 项核心 EPA 是否将 UME 框架设置得过于狭隘，将能力置于背景之中，忽略了 UME 的某些有抱负但重要且可衡量的目标。作者还讨论了 EPA 在广度上的不平衡以及它们作为核心活动的发展状况。关于测量和评估，作者提出了一些担忧，即 EPA 指标引入了可能导致扭曲和阻碍准确性和评级者一致性的多层次推理。此外，弱锚和多维量表的使用也令人担忧。作者最后提出了一个建议，即将 Core EPAs 和研究生医学教育认证委员会的能力重新定义为广泛定义的行为集，称为“医学任务”，并呼吁制定一个系统和纵向的研究议程。作者断言，“该慢的时候要慢”不仅适用于患者护理，也适用于医学教育，并呼吁在进一步承诺之前，对 Core EPAs 进行重新评估。
