Kang Angela J, Gielissen Katherine, Windish Donna
Clinical Instructor, Yale Waterbury Internal Medicine Residency Program, Yale University School of Medicine.
Clinical Instructor, Department of General Internal Medicine, Yale University School of Medicine.
MedEdPORTAL. 2019 Nov 22;15:10854. doi: 10.15766/mep_2374-8265.10854.
The Accreditation Council for Graduate Medical Education's milestones require internal medicine residents to have competency in calling consults. Based on a literature review, we developed an Entrustable Professional Activity (EPA) to delineate the knowledge, skills, and attitudes required for a consultation request and, building on the EPA, implemented an assessment instrument to provide feedback to interns calling consultation requests and assess the quality of their consult questions and the level of supervision required in performing this milestone.
Assessments were done on internal medicine inpatient teaching services. Consultation requests were performed by interns and observed by residents using the assessment instrument. Feedback was provided to the interns. Interns then completed a self-reflection instrument based on the feedback.
Twenty-six paired observations were collected over three 1-month rotations. There was a moderate positive correlation ( = .43) comparing resident and intern responses to how they felt about the intern's ability to make a consultation request. There was a strong positive correlation ( = .65) comparing resident opinion of how strong the intern's ability in calling a consult to how well the consult question used the PICO (patient, intervention, comparators, outcomes of interest) framework. Twenty-five out of 28 interns (89%) said they would make a change during their next consultation request due to feedback from their resident.
Our EPA-based assessment instrument provided an opportunity to give interns feedback and to assess the quality of the consultation requests they made.
毕业后医学教育认证委员会的里程碑要求内科住院医师具备提出会诊请求的能力。基于文献综述，我们制定了一项可托付专业活动（EPA），以界定提出会诊请求所需的知识、技能和态度，并在此基础上实施了一项评估工具，为提出会诊请求的实习生提供反馈，评估他们会诊问题的质量以及完成该里程碑所需的监督水平。
在内科住院教学服务中进行评估。实习生提出会诊请求，住院医师使用评估工具进行观察。向实习生提供反馈。实习生随后根据反馈完成一份自我反思工具。
在三个为期1个月的轮转期间收集了26对观察数据。住院医师和实习生对实习生提出会诊请求能力的感受之间存在中度正相关（r = 0.43）。住院医师对实习生提出会诊请求能力的评价与会诊问题对PICO（患者、干预措施、对照、感兴趣的结果）框架的运用程度之间存在强正相关（r = 0.65）。28名实习生中有25名（89%）表示，由于住院医师的反馈，他们会在下次提出会诊请求时做出改变。
我们基于EPA的评估工具为向实习生提供反馈以及评估他们提出的会诊请求的质量提供了机会。
