Woodworth Glenn E, Marty Adrian P, Tanaka Pedro P, Ambardekar Aditee P, Chen Fei, Duncan Michael J, Fromer Ilana R, Hallman Matthew R, Klesius Lisa L, Ladlie Beth L, Mitchell Sally Ann, Miller Juve Amy K, McGrath Brian J, Shepler John A, Sims Charles, Spofford Christina M, Van Cleve Wil, Maniker Robert B
From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.
Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
Anesth Analg. 2021 Jun 1;132(6):1579-1591. doi: 10.1213/ANE.0000000000005434.
Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States.
Experts in education and competency assessment were recruited to participate in a 6-step process using a modified Delphi method with iterative rounds to reach consensus on an entrustment scale, a list of EPAs and procedural skills, detailed definitions for each EPA, a mapping of the EPAs to the ACGME milestones, and a target level of entrustment for graduating US anesthesiology residents for each EPA and procedural skill. The defined EPAs and procedural skills were implemented using a website and mobile app. The assessment system was piloted at 7 anesthesiology residency programs. After 2 months, faculty were surveyed on their attitudes on usability and utility of the assessment system. The number of evaluations submitted per month was collected for 1 year.
Participants in EPA development included 18 education experts from 11 different programs. The Delphi rounds produced a final list of 20 EPAs, each differentiated as simple or complex, a defined entrustment scale, mapping of the EPAs to milestones, and graduation entrustment targets. A list of 159 procedural skills was similarly developed. Results of the faculty survey demonstrated favorable ratings on all questions regarding app usability as well as the utility of the app and EPA assessments. Over the 2-month pilot period, 1636 EPA and 1427 procedure assessments were submitted. All programs continued to use the app for the remainder of the academic year resulting in 12,641 submitted assessments.
A list of 20 anesthesiology EPAs and 159 procedural skills assessments were developed using a rigorous methodology to reach consensus among education experts. The assessments were pilot tested at 7 US anesthesiology residency programs demonstrating the feasibility of implementation using a mobile app and the ability to collect assessment data. Adoption at the pilot sites was variable; however, the use of the system was not mandatory for faculty or trainees at any site.
现代医学教育需要频繁进行能力评估。毕业后医学教育认证委员会（ACGME）提供了能力和里程碑的描述性框架，但未提供标准化工具来评估和跟踪学员随时间推移的能力。可托付专业活动（EPA）是一种基于工作场所的方法，用于在医疗现场评估能力里程碑的达成情况，可应用于美国的麻醉学培训。
招募教育和能力评估专家，采用改进的德尔菲法，经过6个步骤、多轮迭代，就托付量表、EPA和程序技能清单、每个EPA的详细定义、EPA与ACGME里程碑的映射，以及美国麻醉学住院医师毕业时每个EPA和程序技能的托付目标水平达成共识。使用网站和移动应用程序实施定义的EPA和程序技能。该评估系统在7个麻醉学住院医师培训项目中进行了试点。2个月后，对教员就其对评估系统可用性和实用性的态度进行了调查。收集了1年中每月提交的评估数量。
参与EPA制定的人员包括来自11个不同项目的18位教育专家。德尔菲轮次产生了一份最终的20项EPA清单，每项分为简单或复杂，确定了托付量表、EPA与里程碑的映射以及毕业托付目标。类似地制定了一份159项程序技能清单。教员调查结果显示，在所有关于应用程序可用性以及应用程序和EPA评估实用性的问题上，评分都很高。在2个月的试点期间，提交了1636项EPA评估和1427项程序评估。所有项目在学年剩余时间继续使用该应用程序，共提交了12641项评估。
采用严格方法制定了一份包含20项麻醉学EPA和159项程序技能评估的清单，以在教育专家中达成共识。这些评估在美国7个麻醉学住院医师培训项目中进行了试点测试，证明了使用移动应用程序实施的可行性以及收集评估数据的能力。试点地点的采用情况各不相同；然而，任何地点的教员或学员都没有被强制使用该系统。
