Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Hempstead, NY, USA.
Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, USA.
Perspect Med Educ. 2020 Aug;9(4):210-219. doi: 10.1007/s40037-020-00587-z.
Mobile apps that utilize the framework of entrustable professional activities (EPAs) to capture and deliver feedback are being implemented. If EPA apps are to be successfully incorporated into programmatic assessment, a better understanding of how they are experienced by the end-users will be necessary. The authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with an EPA app.
Structured interviews of faculty and residents were conducted with an interview guide based on the CFIR. Transcripts were independently coded by two study authors using directed content analysis. Differences were resolved via consensus. The study team then organized codes into themes relevant to the domains of the CFIR.
Eight faculty and 10 residents chose to participate in the study. Both faculty and residents found the app easy to use and effective in facilitating feedback immediately after the observed patient encounter. Faculty appreciated how the EPA app forced brief, distilled feedback. Both faculty and residents expressed positive attitudes and perceived the app as aligned with the department's philosophy. Barriers to engagement included faculty not understanding the EPA framework and scale, competing clinical demands, residents preferring more detailed feedback and both faculty and residents noting that the app's feedback should be complemented by a tool that generates more systematic, nuanced, and comprehensive feedback. Residents rarely if ever returned to the feedback after initial receipt.
This study identified key enablers and barriers to engagement with the EPA app. The findings provide guidance for future research and implementation efforts focused on the use of mobile platforms to capture direct observation feedback.
利用可委托专业活动 (EPA) 框架来获取和提供反馈的移动应用程序正在实施中。如果要将 EPA 应用程序成功纳入计划评估，就需要更好地了解最终用户的体验情况。作者使用实施研究综合框架 (CFIR) 进行了一项定性研究，以确定参与 EPA 应用程序的促进因素和障碍。
根据 CFIR，对教师和住院医师进行了结构化访谈，并使用访谈指南。两名研究作者使用定向内容分析对转录本进行独立编码。通过共识解决差异。研究团队随后将代码组织成与 CFIR 领域相关的主题。
8 名教师和 10 名住院医师选择参与研究。教师和住院医师都发现该应用程序易于使用，并能在观察到患者后立即提供反馈。教师们赞赏 EPA 应用程序如何强制提供简短、精炼的反馈。教师和住院医师都对该应用程序持积极态度，并认为该应用程序符合部门的理念。参与的障碍包括教师不了解 EPA 框架和规模、临床需求竞争、住院医师更喜欢更详细的反馈以及教师和住院医师都指出，该应用程序的反馈应该辅以生成更系统、更细微和更全面反馈的工具。住院医师很少在最初收到反馈后再次查看反馈。
本研究确定了参与 EPA 应用程序的主要促进因素和障碍。研究结果为未来侧重于使用移动平台获取直接观察反馈的研究和实施工作提供了指导。
