A. Smirnova is a PhD researcher, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California. S. Chahine is assistant professor and scientist, Centre for Educational Research and Innovation (CERI), Western University, London, Ontario, Canada. A.L. Kalet is professor of medicine and surgery, director of research on medical education outcomes (ROMEO), Unit of the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, and director of research, Program on Medical Education and Technology, NYU School of Medicine, New York, New York. R. Tamblyn is professor, Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, medical scientist, McGill University Health Center Research Institute, scientific director, Clinical and Health Informatics Research Group, McGill University, and scientific director, Canadian Institutes of Health Research-Institute of Health Services and Policy Research, Montreal, Quebec, Canada. K.M.J.M.H. Lombarts is professor and lead investigator, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. D.J. Schumacher is associate professor, Division of Emergency Medicine, and pediatric emergency physician, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio.
Acad Med. 2019 May;94(5):671-677. doi: 10.1097/ACM.0000000000002620.
Assessment and evaluation of trainees' clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes. This article provides a way forward by identifying and articulating how clinical performance measures can be used to enhance GME by linking educational objectives with relevant clinical outcomes. The authors explore four key challenges: defining as well as measuring clinical performance measures, using electronic health record and clinical registry data to capture clinical performance, and bridging silos of medical education and health care quality improvement. The authors also propose solutions to showcase the value of clinical performance measures and conclude with a research and implementation agenda. Developing a common taxonomy of uniform specialty-specific clinical performance measures, linking these measures to large-scale GME databases, and applying both quantitative and qualitative methods to create a rich understanding of how GME affects quality of care and patient outcomes is important, the authors argue. The focus of this article is primarily GME, yet similar challenges and solutions will be applicable to other areas of medical and health professions education as well.
评估和评价学员的临床绩效措施对于确保安全、高质量的患者护理至关重要。这些措施还有助于培养反思性、表现出色的临床医生，并使研究生医学教育（GME）对公众负责。尽管临床绩效措施具有巨大的潜力，但在这种方式下定义、提取和衡量临床绩效的挑战阻碍了它们在教育和质量改进方面的应用。本文通过确定和阐明如何将教育目标与相关临床结果联系起来，为临床绩效措施如何用于增强 GME 提供了一种方法。作者探讨了四个关键挑战：定义和衡量临床绩效措施、使用电子健康记录和临床注册表数据来捕捉临床绩效，以及弥合医学教育和医疗保健质量改进之间的隔阂。作者还提出了解决方案，以展示临床绩效措施的价值，并以研究和实施议程结束。作者认为，制定统一的专科特定临床绩效措施的通用分类法、将这些措施与大规模 GME 数据库联系起来，以及应用定量和定性方法来深入了解 GME 如何影响护理质量和患者结果非常重要。本文的重点主要是 GME，但类似的挑战和解决方案也将适用于医学和卫生专业教育的其他领域。
