a Department of Emergency, Medicine Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
b Department of Medical Education , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
Teach Learn Med. 2019 Apr-May;31(2):186-194. doi: 10.1080/10401334.2018.1526689. Epub 2018 Dec 31.
Thirteen measurable Entrustable Professional Activities (EPAs) have been proposed by the Association of American Medical Colleges as a means to operationalize medical school graduates' patient care qualifications. Mastery learning is an effective method for boosting clinical skills, but its applicability to the EPAs remains to be studied. The authors designed this study to evaluate a mastery learning intervention to teach and assess components of 3 of the 13 EPAs in a 4th-year capstone course.
The course featured mastery learning principles and addressed three EPA-based skills: (a) obtain informed consent, (b) develop a differential diagnosis and write admission orders, and (c) write discharge prescriptions. All students underwent a baseline skills assessment, received feedback, engaged in deliberate practice with actionable feedback, and completed a similar skills-based posttest assessment. Students continued with practice and testing until the minimum passing standards (MPSs) were reached for each posttest.
All medical students at a single medical school (Northwestern University, Feinberg School of Medicine) who matriculated in 2012 and graduated with the class of 2016 participated in a required transition to residency course immediately prior to graduation.
There were 134 students eligible to participate, and 130 (97.0%) completed all curricular requirements and assessments. All 130 medical students who completed the course met or exceeded the MPS for each of the three EPA-based clinical skills. Reliability coefficients for outcome data were uniformly high. Measures for each of the three clinical skills showed statistically significant improvement.
The capstone course was an effective approach to teach and assess components of three EPA-based clinical skills to mastery learning standards in a 4th-year capstone course. We learned that this approach for implementation is feasible and results in significant improvement in components of EPA skill performance. Next steps will include developing assessments incorporating the mastery model into components of additional EPAs, identifying the best location within the curriculum to insert this content, and expanding the number of assessments as part of a larger assessment system.
美国医学学院协会提出了 13 项可委托的专业活动（EPAs），作为将医学院毕业生的患者护理资格付诸实践的一种手段。掌握学习是提高临床技能的有效方法，但它在 EPAs 中的适用性仍有待研究。作者设计了这项研究，以评估掌握学习干预措施，在第四年的顶点课程中教授和评估 13 项 EPA 中的 3 项的组成部分。
该课程采用掌握学习原则，解决了三个基于 EPA 的技能：（a）获得知情同意，（b）制定鉴别诊断并开出入院医嘱，以及（c）开出出院处方。所有学生都接受了基线技能评估，收到了反馈，进行了有针对性的实践，并进行了类似的基于技能的后测评估。学生继续练习和测试，直到达到每个后测的最低通过标准（MPS）。
在 2012 年入学并于 2016 年毕业的一所医学院（西北大学，芬伯格医学院）的所有医学生都参加了在毕业前立即进行的强制性住院医师过渡课程。
共有 134 名学生符合参与条件，其中 130 名（97.0%）完成了所有课程要求和评估。完成课程的 130 名医学生均达到或超过了基于三个 EPA 的临床技能的 MPS。结果数据的可靠性系数均很高。三个临床技能中的每一个的衡量标准都显示出统计学上的显著改善。
顶点课程是一种有效的方法，可按照掌握学习标准在第四年的顶点课程中教授和评估基于三个 EPA 的临床技能的组成部分。我们了解到，这种实施方法是可行的，并导致 EPA 技能表现成分的显著提高。下一步将包括开发评估，将掌握模型纳入其他 EPA 的组成部分，确定课程中插入此内容的最佳位置，并扩大评估数量作为更大评估系统的一部分。
