J Am Osteopath Assoc. 2020 Nov 1;120(11):749-760. doi: 10.7556/jaoa.2020.129.
Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entrustable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country.
To review the status of EPA implementation at COMs nationally.
An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from "moderate implementation with reporting" to "full implementation with reporting." Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings.
Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above "somewhat knowledgeable" toward "expert" regarding knowledge of EPAs, but 23 (64%) also indicated "no confidence" or "somewhat confident" regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the "foundational implementation" (10; 28%), "slight implementation" (11; 31%), and "moderate implementation" (11, 31%) categories, with a few schools indicating "no implementation" (2; 5%) or "progressive implementation" (2; 5%).
The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.
以能力为基础的医学教育、住院医师培训的发展里程碑以及单一的研究生医学教育（GME）认证系统在过去十年中出现，这就需要新的方法来充分准备毕业生以满足能力方面的新标准，包括 13 项核心可委托专业活动（EPA）进入住院医师实习。美国骨科学院（AACOM）可委托专业活动（EPA）指导委员会已经实施了一个信息收集过程，为全国各地的骨科医学院（COMs）提供支持各种 EPA 相关实施工作的建议。
审查全国 COMs 实施 EPA 的情况。
采用解释性混合方法设计来指导 41 个问题的调查和访谈反馈的信息收集和综合；该设计的总体前提是使用定性数据来建立在初始定量发现的基础上。该调查通过链接以电子方式发送到 AACOM 机构数据库中 47 所学校的每个主要、分校和卫星校园的联络人。调查管理后，根据包含 18 个问题的脚本对具有 EPA 实施水平从“有报告的适度实施”到“有报告的完全实施”的 16 个机构进行了后续的结构化访谈。访谈后，对访谈记录进行了分析，并将结果与原始调查结果进行了汇总比较。
在所调查的 47 所学校中，有 42 所（89.4%）做出了回应。为了保持数据编码和分析的一致性，在审查中保留了具有独立提交调查答复的 36 所（76.6%）骨科医学院。这些回应者中的大多数（36 中的 23 名；64%）表示，他们的机构在 EPA 知识方面处于“相当了解”到“专家”的水平，但 23 名（64%）也表示在 EPA 实施方面“没有信心”或“有些信心”。访谈后的结果表明，大多数学校在“基础实施”（10；28%）、“略有实施”（11；31%）和“适度实施”（11；31%）类别中分布均匀，少数学校表示“没有实施”（2；5%）或“渐进实施”（2；5%）。
本审查结果表明，大多数骨科医学院正处于 EPA 实施的早期阶段，根据所涉及的具体 EPA，各计划年度的重点有所不同。许多学校似乎都在参与课程改革工作，这将支持他们机构内 EPA 使用的推进。大多数机构都认为教师发展是一个持续的关键需求。
