A.G. Pereira is associate professor and assistant dean for curriculum, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. M. Woods is assistant professor and assistant dean for educational development, University of Texas Medical Branch, Galveston, Texas. A.P.J. Olson is assistant professor and clerkship director, Subinternship in Critical Care, Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota. S. van den Hoogenhof is director of operations, Assessment and Evaluation, Office of Medical Education, University of Minnesota Medical School, Minneapolis, Minnesota. B.L. Duffy is assistant professor and residency program director, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. R. Englander is professor and associate dean for undergraduate medical education, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Acad Med. 2018 Apr;93(4):560-564. doi: 10.1097/ACM.0000000000001939.
In the United States, the medical education community has begun a shift from the Flexnerian time-based model to a competency-based medical education model. The graduate medical education (GME) community is substantially farther along in this transition than is the undergraduate medical education (UME) community.GME has largely adopted the use of competencies and their attendant milestones and increasingly is employing the framework of entrustable professional activities (EPAs) to assess trainee competence. The UME community faces several challenges to successfully navigating a similar transition. First is the reliance on norm-based reference standards in the UME-GME transition, comparing students' performance versus their peers' with grades, United States Medical Licensing Examination Step 1 and Step 2 score interpretation, and the structured Medical School Performance Evaluation, or dean's letter. Second is the reliance on proxy assessments rather than direct observation of learners. Third is the emphasis on summative rather than formative assessments.Educators have overcome a major barrier to change by establishing UME outcomes assessment criteria with the advent and general acceptance of the physician competency reference set and the Core EPAs for Entering Residency in UME. Now is the time for the hard work of developing assessments steeped in direct observation that can be accepted by learners and faculty across the educational continuum and can be shown to predict clinical performance in a much more meaningful way than the current measures of grades and examinations. The acceptance of such assessments will facilitate the UME transition toward competency-based medical education.
在美国，医学教育界已经开始从 Flexnerian 基于时间的模式向基于能力的医学教育模式转变。相比之下，研究生医学教育（GME）社区在这一转变中已经取得了实质性的进展，而本科医学教育（UME）社区则落后了许多。GME 已经在很大程度上采用了能力及其相关的里程碑，并越来越多地使用可委托的专业活动（EPAs）框架来评估学员的能力。UME 社区在成功进行类似转型方面面临着几个挑战。首先，在 UME-GME 过渡中依赖基于规范的参考标准，将学生的表现与他们的同龄人进行比较，通过成绩、美国医师执照考试（USMLE）第 1 步和第 2 步的分数解释，以及结构化医学院表现评估（Medical School Performance Evaluation，MSPE）或院长的信函。其次，依赖代理评估而不是直接观察学习者。第三，强调总结性评估而不是形成性评估。教育工作者通过建立 UME 成果评估标准，克服了变革的主要障碍，这些标准随着医师能力参考集的出现和普遍接受，以及 UME 中进入住院医师实习期的核心 EPAs 而建立。现在是时候进行艰苦的工作了，开发出基于直接观察的评估方法，这些评估方法可以被教育领域的学习者和教师接受，并可以证明比当前的成绩和考试更有意义地预测临床表现。这些评估方法的接受将促进 UME 向基于能力的医学教育的转变。
