Larrabee Jerry G, Agrawal Dewesh, Trimm Franklin, Ottolini Mary
J Grad Med Educ. 2020 Feb;12(1):66-73. doi: 10.4300/JGME-D-19-00408.1.
In competency-based medical education, subcompetency milestones represent a theoretical stepwise description for a resident to move from the level of novice to expert. Despite their ubiquitous use in the assessment of residents, they were not designed for that purpose. Because entrustable professional activities (EPAs) require observable behaviors, they could serve as a potential link between clinical observation of residents and competency-based assessment.
We hypothesized that global faculty-of-resident entrustment ratings would correlate with concurrent subcompetency milestones-based assessments.
This prospective study evaluated the correlation between concurrent entrustment assessments and subcompetency milestones ratings. Pediatric residents were assessed in 4 core rotations (pediatric intensive care unit, neonatal intensive care unit, general inpatient, and continuity clinic) at 3 different residency training programs during the 2014-2015 academic year. Subcompetencies were mapped to rotation-specific EPAs, and shared assessments were utilized across the 3 programs.
We compared 29 143 pairs of entrustment levels and corresponding subcompetency levels from 630 completed assessments. Pearson correlation coefficients demonstrated statistical significance for all pairs ( < .001). Multivariate linear regression models produced -squared values that demonstrated strong correlation between mapped EPA levels and corresponding subcompetency milestones ratings (median = 0.81; interquartile range 0.73-0.83; < .001).
This study demonstrates a strong association between assessment of EPAs and subcompetency milestones assessment, providing a link between entrustment decisions and assessment of competence. Our data support creating resident assessment tools where multiple subcompetencies can be mapped and assessed by a smaller set of rotation-specific EPAs.
在基于胜任力的医学教育中，亚胜任力里程碑代表了住院医师从新手水平成长为专家水平的理论性逐步描述。尽管它们在住院医师评估中被广泛使用，但其并非为此目的而设计。由于可托付专业活动（EPA）需要可观察到的行为，它们可能成为住院医师临床观察与基于胜任力评估之间的潜在联系。
我们假设住院医师的整体托付评分与同时进行的基于亚胜任力里程碑的评估相关。
这项前瞻性研究评估了同时进行的托付评估与亚胜任力里程碑评分之间的相关性。在2014 - 2015学年期间，对来自3个不同住院医师培训项目的儿科住院医师进行了4个核心轮转（儿科重症监护病房、新生儿重症监护病房、普通住院部和连续性诊所）的评估。将亚胜任力映射到特定轮转的EPA，并在3个项目中采用共享评估。
我们比较了630项完整评估中的29143对托付水平和相应亚胜任力水平。Pearson相关系数显示所有配对均具有统计学意义（<0.001）。多元线性回归模型产生的R平方值表明，映射的EPA水平与相应的亚胜任力里程碑评分之间存在强相关性（中位数R平方 = 0.81；四分位间距0.73 - 0.83；<0.001）。
本研究表明EPA评估与亚胜任力里程碑评估之间存在紧密关联，为托付决策与能力评估之间提供了联系。我们的数据支持创建住院医师评估工具，通过较少的特定轮转EPA就能映射和评估多个亚胜任力。
