Vassallo Michael, Grey Joseph, Hemsley Anthony, Chris Liliana, Parker Stuart G
Department of Older Person Medicine, Royal Bournemouth Hospital, Bournemouth, Devon, UK.
Department of Geriatric Medicine, Cardiff and Vale UHB, University Hospital Wales, Cardiff, Devon, UK.
Educ Health (Abingdon). 2019 May-Aug;32(2):95-98. doi: 10.4103/efh.EfH_111_18.
Acquiring medical competencies alone does not necessarily lead to the delivery of quality clinical care. Many UK training programs are soon to be based on the curricula of entrustable professional capabilities (EPCs). These are tasks carried out in practice requiring proficiency in several competencies for quality practice. Assessments to evaluate EPCs for independent practice are needed. Comprehensive geriatric assessment (CGA) is an EPC in geriatric medicine. We describe the development of an assessment of CGA as an example of examining EPCs.
A CGA station was introduced in the Diploma in Geriatric Medicine clinical examination. Candidates rotate through four stations: three single competency-based stations (history, communication/ethics and physical examination) and an EPC-based station in CGA.
One hundred and seventy-eight (female: 96 [53.9%]) candidates took it. There was a weak but significantly positive correlation between the score at CGA and the total score in the other stations (r = 0.46; P < 0.001). Most candidates passing the station passed the examination. Correlation with other stations similarly showed weak significant correlations (Station 1: r = 0.38; P < 0.001, Station 3: r = 0.28; P < 0.001, and Station 4: r = 0.37; P < 0.001). There was 61.4% (kappa: 0.61; P = 0.000) agreement between examiners whether a candidate passed or failed. Agreement was higher for the other stations, i.e. Station 1 (kappa: 0.85; P < 0.001), Station 3 (kappa: 0.72; P < 0.001), and Station 4 (kappa: 0.85; P < 0.001).
Performance on the station correlated positively with overall performance, suggesting that it has discriminatory value in differentiating candidates with varying ability and the more able candidates pass the examination.
仅仅获得医学能力并不一定能带来高质量的临床护理。英国许多培训项目很快将以可托付专业能力（EPC）课程为基础。这些是在实践中执行的任务，需要具备多种能力才能实现高质量的实践。需要进行评估以评估独立实践的EPC。综合老年医学评估（CGA）是老年医学中的一项EPC。我们以CGA评估的开发为例，说明对EPC的考查。
在老年医学文凭临床考试中引入了一个CGA考站。考生轮转通过四个考站：三个基于单一能力的考站（病史、沟通/伦理学和体格检查）以及一个基于CGA的EPC考站。
178名考生（女性：96名[53.9%]）参加了考试。CGA考站的分数与其他考站的总分之间存在微弱但显著的正相关（r = 0.46；P < 0.001）。大多数通过该考站的考生通过了考试。与其他考站的相关性同样显示出微弱的显著相关性（考站1：r = 0.38；P < 0.001，考站3：r = 0.28；P < 0.001，考站4：r = 0.37；P < 0.001）。考官们对考生是否通过的判断一致性为61.4%（kappa值：0.61；P = 0.000）。其他考站的一致性更高，即考站1（kappa值：0.85；P < 0.001）、考站3（kappa值：0.72；P < 0.001）和考站4（kappa值：0.85；P < 0.001）。
该考站的表现与整体表现呈正相关，表明它在区分能力不同的考生方面具有鉴别价值，能力较强的考生通过了考试。
