Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA.
Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
Teach Learn Med. 2020 Jan-Mar;32(1):34-44. doi: 10.1080/10401334.2019.1618307. Epub 2019 Jun 8.
Many U.S. medical schools have responded to the adoption of competency-based medical education (CBME) frameworks by renewing their final-year curricula and including internship preparatory courses. The purpose of this scoping review was to map the published literature regarding the final year to discern how medical schools have responded to this paradigm change. A structured 5-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal, and 8 medical education journals were conducted to identify relevant articles published from 2006 to 2016. Four authors screened articles for inclusion using standardized eligibility criteria; interrater agreement was discussed and calculated. Authors extracted data elements, and a consensus-based approach was used to categorize, sort, and structure information gathered. Among 6,485 articles retrieved, 817 articles were included in the study. From 2007-2011 to 2012-2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. The majority of articles did not reference a CBME framework (572/817; 70%), the frequency of mentions increased 268% from 2007-2011 to 2012-2016. Nearly three fourths of preparatory course-related papers reference a CBME framework (37/50; 74%). Our findings may reflect a movement in U.S. medical schools toward using shared assessment metrics to support 4th-year medical students' preparation for their postgraduate medical education. Despite an increased reference to CBME, there is relatively little use of competency-based assessment frameworks to evaluate learning outcomes. This review also found a substantial increase in the frequency of articles referencing senior-year preparatory courses in U.S. medical schools. Articles tended to describe institution-specific research or experiences. Opportunities likely exist for multi-institutional and organizational collaboration in determining the structure of the final year of medical school.
许多美国医学院校通过更新他们的最后一年课程并包括实习预备课程来应对基于能力的医学教育（CBM）框架的采用。本范围综述的目的是绘制已发表的关于最后一年的文献，以了解医学院校如何应对这种范式转变。采用结构化的 5 步方法进行了这项范围综述。对 PubMed、ERIC、Scopus、MedEdPortal 和 8 种医学教育期刊进行了电子检索，以确定从 2006 年到 2016 年发表的相关文章。四位作者使用标准化的合格标准筛选文章以确定其是否符合入选条件；讨论并计算了组内一致性。作者提取数据元素，并使用基于共识的方法对收集到的信息进行分类、排序和结构。在检索到的 6485 篇文章中，有 817 篇文章纳入研究。从 2007-2011 年到 2012-2016 年，涉及医学院最后一年的文章增加了 93%，而描述实习预备课程的文章增加了 218%。大多数文章没有参考 CBM 框架（572/817；70%），从 2007-2011 年到 2012-2016 年，提及的频率增加了 268%。近四分之三与预备课程相关的论文都参考了 CBM 框架（37/50；74%）。我们的研究结果可能反映了美国医学院校正在朝着使用共同的评估指标的方向发展，以支持第四年医学生为他们的研究生医学教育做好准备。尽管对 CBM 的提及有所增加，但很少使用基于能力的评估框架来评估学习成果。本综述还发现，美国医学院校参考高年级预备课程的文章频率大幅增加。文章倾向于描述机构特定的研究或经验。在确定医学院最后一年的结构方面，可能存在多机构和组织合作的机会。
