Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois.
Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago Illinois.
J Surg Educ. 2021 Jul-Aug;78(4):1144-1150. doi: 10.1016/j.jsurg.2020.12.001. Epub 2020 Dec 29.
The objectives of this study were to 1) assess the performance Entrustable Professional Activities (EPAs) when integrated into the summative assessment of third-year medical students on the surgery clerkship and 2) to compare EPAs to traditional clinical performance assessment tools.
EPA assessments were collected prospectively from a minimum of 4 evaluators at the completion of each surgical clerkship rotation from November 2019 to June 2019. Overall EPA-based clinical performance scores were calculated as the sum of the mean EPA score from each evaluator. A rating of overall clinical performance called the clinical performance appraisal (CPA) was also collected. EPA ratings were compared to the CPA score, National Board of Medical Examiners exam score, objective structured clinical exam scores, and final clerkship grade.
Northwestern Memorial Hospital, a tertiary care teaching institution in Chicago, IL.
Overall, 446 evaluations (111 students) were included in the analysis. The aggregate EPA scores ranged from 11.6-24.0 (mean 19.9 ± 2.0), and the CPA scores ranged from 4.4-9.0 (mean 7.6 ± 0.7). The variance among learners in EPA scores was significantly higher than CPA scores (p < 0.001). The aggregate EPA scores correlated well with CPA scores (Spearman's rho 0.803) but had lesser, positive correlations with the objective structured clinical exam (rho 0.153) and National Board of Medical Examiners (rho 0.265) scores. When all EPA scores were included in ordinal logistic regression, only EPA 6, oral presentation of patients, was independently associated with students' final grades (OR: 10.05, 95%CI 1.41-71.80; p = 0.02).
Integration of EPAs for use in clinical performance assessment of medical students is feasible within a surgery clerkship. Compared to a global clinical performance assessment, EPA-based assessment provided better discrimination of clinical performance among learners. Use of EPAs may better identify advanced learners and those that need additional time.
本研究旨在：1）评估在外科实习中整合可委托专业活动（EPAs）对三年级医学生总结性评估的表现，以及 2）将 EPAs 与传统临床绩效评估工具进行比较。
2019 年 11 月至 2019 年 6 月，从每个外科轮转结束时，至少有 4 名评估员前瞻性地收集 EPA 评估。整体基于 EPA 的临床绩效评分计算为每位评估员的平均 EPA 评分之和。还收集了一项名为临床绩效评估（CPA）的整体临床绩效评级。将 EPA 评级与 CPA 评分、美国国家医学院考试成绩、客观结构化临床考试成绩和最终实习成绩进行比较。
西北纪念医院，位于伊利诺伊州芝加哥的一家三级护理教学机构。
总体而言，纳入分析的有 446 次评估（111 名学生）。总体 EPA 评分范围为 11.6-24.0（平均 19.9 ± 2.0），CPA 评分范围为 4.4-9.0（平均 7.6 ± 0.7）。学习者之间 EPA 评分的差异明显高于 CPA 评分（p < 0.001）。总体 EPA 评分与 CPA 评分相关性良好（Spearman 秩相关系数 0.803），但与客观结构化临床考试（rho 0.153）和美国国家医学院考试（rho 0.265）的相关性较低。当所有 EPA 评分均纳入有序逻辑回归时，只有 EPA6（患者口头报告）与学生的最终成绩独立相关（OR：10.05，95%CI 1.41-71.80；p = 0.02）。
在外科实习中整合 EPAs 用于医学生临床绩效评估是可行的。与整体临床绩效评估相比，基于 EPA 的评估在学习者之间提供了更好的临床绩效区分度。使用 EPAs 可能更好地识别出高级学习者和那些需要额外时间的学习者。
