ModMed Institute of Health Professions Education, Adelaide, SA.
Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, SA.
Med J Aust. 2019 May;210(8):354-359. doi: 10.5694/mja2.50130. Epub 2019 Apr 11.
To assess whether entrustment levels for junior trainees with respect to entrustable professional activities (EPAs) increase over time; whether entrustment levels for senior trainees are higher than for junior trainees; and whether self-assessment of entrustment levels by senior trainees more closely matches supervisor assessment than self-assessment by junior trainees.
DESIGN, SETTING, PARTICIPANTS: Observational study of 130 junior and 153 senior community-based general practice trainees in South Australia, 2017.
Differences in entrustment levels between junior and senior trainees; change in entrustment levels for junior trainees over 9 months; concordance of supervisor and trainee assessment of entrustment level over 9 months.
Senior trainees were 2.1 (95% CI, 1.66-2.58) to 3.7 times (95% CI, 2.60-5.28) as likely as junior trainees to be entrusted with performing clinical EPAs without supervision. The proportion of EPAs with which junior trainees were entrusted to perform unsupervised increased from 26% at 3 months to 35% at 6 months (rate ratio [RR], 1.37; 95% CI; 1.15-1.63), to 50% at 9 months (RR, 1.92; 95% CI, 1.64-2.26), and 69% at 12 months (RR, 2.68; 95% CI; 2.32-3.12). At 3 months, the mean differences in entrustment ratings between supervisors and trainees was 5.5 points (SD, 6.6 points) for junior trainees and 2.93 points (SD, 2.8 points) for senior trainees (P < 0.001).
EPAs are valid assessment tools in a workplace-based training environment.
评估初级受训者在可委托专业活动（EPAs）方面的委托水平是否随时间推移而提高；高级受训者的委托水平是否高于初级受训者；以及高级受训者的自我评估与主管评估相比，是否比初级受训者的自我评估更接近主管评估。
设计、地点和参与者：2017 年，对南澳大利亚的 130 名初级和 153 名高级社区全科医学培训生进行的观察性研究。
初级和高级培训生之间委托水平的差异；初级培训生在 9 个月内委托水平的变化；9 个月内主管和培训生对委托水平评估的一致性。
高级培训生进行无监督临床 EPA 的可能性是初级培训生的 2.1（95%置信区间，1.66-2.58）至 3.7 倍（95%置信区间，2.60-5.28）。初级培训生可委托进行无监督执行的 EPA 比例从 3 个月时的 26%增加到 6 个月时的 35%（比率比 [RR]，1.37；95%置信区间，1.15-1.63），到 9 个月时的 50%（RR，1.92；95%置信区间，1.64-2.26），到 12 个月时的 69%（RR，2.68；95%置信区间，2.32-3.12）。在 3 个月时，培训生与主管之间委托评分的平均差异为初级培训生 5.5 分（标准差，6.6 分），高级培训生 2.93 分（标准差，2.8 分）（P<0.001）。
EPAs 是工作场所培训环境中的有效评估工具。
