J Grad Med Educ. 2020 Aug;12(4):425-434. doi: 10.4300/JGME-D-19-00803.1.
In 2018, Canadian postgraduate emergency medicine (EM) programs began implementing a competency-based medical education (CBME) assessment program. Studies evaluating these programs have focused on broad outcomes using data from national bodies and lack data to support program-specific improvement.
We evaluated the implementation of a CBME assessment program within and across programs to identify successes and opportunities for improvement at the local and national levels.
Program-level data from the 2018 resident cohort were amalgamated and analyzed. The number of entrustable professional activity (EPA) assessments (overall and for each EPA) and the timing of resident promotion through program stages were compared between programs and to the guidelines provided by the national EM specialty committee. Total EPA observations from each program were correlated with the number of EM and pediatric EM rotations.
Data from 15 of 17 (88%) programs containing 9842 EPA observations from 68 of 77 (88%) EM residents in the 2018 cohort were analyzed. Average numbers of EPAs observed per resident in each program varied from 92.5 to 229.6, correlating with the number of blocks spent on EM and pediatric EM (r = 0.83, < .001). Relative to the specialty committee's guidelines, residents were promoted later than expected (eg, one-third of residents had a 2-month delay to promotion from the first to second stage) and with fewer EPA observations than suggested.
There was demonstrable variation in EPA-based assessment numbers and promotion timelines between programs and with national guidelines.
2018 年，加拿大的研究生急诊医学（EM）课程开始实施以能力为基础的医学教育（CBME）评估计划。评估这些计划的研究主要关注使用国家机构数据的广泛结果，缺乏支持特定计划改进的数据。
我们评估了 CBME 评估计划在各计划内部和之间的实施情况，以确定在地方和国家层面的成功和改进机会。
合并和分析了 2018 年住院医师队列的项目级数据。比较了各计划之间以及与国家 EM 专业委员会提供的指南相比，总体和每个 EPA 的可委托专业活动（EPA）评估数量以及住院医师通过项目阶段晋升的时间。从每个项目获得的总 EPA 观察值与 EM 和儿科 EM 轮转的数量相关。
分析了包含 2018 年队列中 68 名 EM 住院医师的 9842 个 EPA 观察值的 15 个（88%）计划中的数据，这些住院医师来自 17 个计划中的 77 个（88%）。每个计划中每位住院医师观察到的 EPA 数量平均从 92.5 到 229.6 不等，与 EM 和儿科 EM 花费的块数相关（r = 0.83， <.001）。与专业委员会的指南相比，住院医师的晋升时间比预期晚（例如，三分之一的住院医师从第一阶段到第二阶段的晋升延迟了 2 个月），并且 EPA 观察值比建议的少。
各计划之间以及与国家指南之间在基于 EPA 的评估数量和晋升时间方面存在明显差异。
