Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland.
Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
Med Educ. 2019 Mar;53(3):234-249. doi: 10.1111/medu.13792. Epub 2019 Jan 4.
This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice.
Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).
In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6-41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency-based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6-32).
This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.
本综述旨在综合一些关于研究生医师使用可委托专业活动（EPAs）的现有工作，评估工作质量，并为未来的研究和实践提供方向。
2018 年 9 月，在五个电子数据库（Medline、Scopus、Web of Science、PsycINFO 和 CINAHL）中进行了系统搜索。还搜索了参考文献列表、Google Scholar 和 Google。使用多种设计质量评估工具（QATSDD）评估方法学质量。
共纳入 49 项研究，分为 EPA 开发（n = 37；占总纳入研究的 76%）、EPA 的实施和/或评估（n = 10；20%）或两者（n = 2；4%）。描述了许多专业的 EPA，包括内科（n = 14；36%）、儿科（n = 8；21%）和精神病学（n = 4；10%）。在开发研究中，92%的研究使用了不止一种方法来生成 EPA。使用最多的两种方法是在工作组中开发初始 EPA（n = 27；69%）和通过审议进行修订（n = 21；54%）。开发论文的质量各不相同（平均 QATSDD 得分为 20，范围为 6-41）。实施和评估研究使用的方法包括观察学员表现（n = 6；50%）和让学员参加基于能力的课程，其中包括 EPA（n = 4；33%）。这些实施研究的方法学质量差异很大（平均 QATSDD 得分为 19.5，范围为 6-32）。
本综述强调需要：（i）考虑 EPA 开发的最佳实践指南；（ii）关注 EPA 开发和 EPA 研究的方法学质量，以及（iii）进一步研究在课程中实施 EPA。
