Santen Sally A, Hamstra Stanley J, Yamazaki Kenji, Gonzalo Jed, Lomis Kim, Allen Bradley, Lawson Luan, Holmboe Eric S, Triola Marc, George Paul, Gorman Paul N, Skochelak Susan
is Evaluation Consultant, American Medical Association, and Senior Associate Dean and Professor of Emergency Medicine, Virginia Commonwealth University School of Medicine.
At the time of writing, was Vice President, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education (ACGME), and is now Professor, Department of Surgery, University of Toronto, Adjunct Professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, and Research Consultant, ACGME.
J Grad Med Educ. 2021 Jun;13(3):404-410. doi: 10.4300/JGME-D-20-01268.1. Epub 2021 Jun 14.
The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation.
This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME).
ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models.
At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups.
Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.
美国医学协会医学教育加速变革（AMA - ACE）联盟提议医学院校采用一种新的包含卫生系统科学（HSS）以及基础与临床科学的三支柱模式。AMA - ACE的目标之一是支持卫生系统科学课程创新，以改善住院医师培训准备情况。
本研究通过与毕业后医学教育认证委员会（ACGME）合作，利用一个大型数据集将医学院毕业生与实习阶段的里程碑进行关联，从而评估卫生系统科学课程的有效性。
确定了与学校卫生系统科学课程相关的ACGME子能力，涉及内科、急诊医学、家庭医学、妇产科（OB/GYN）、儿科和外科。使用广义估计方程模型，比较了ACE学校毕业生与非ACE学校毕业生在6个月和12个月时的里程碑评分。
在6个月时，两组在所选ACGME能力方面的与卫生系统科学相关的里程碑表现水平相似。在1年时，与非ACE学校毕业生相比，妇产科的ACE毕业生在两项基于系统的实践（SBP）子能力上得分略高：SBP01（1.96对1.82，95%CI 0.03 - 0.24）和SBP02（1.87对1.79，95%CI 0.01 - 0.16）。在内科，ACE毕业生在三项与卫生系统科学相关的子能力上得分略高：SBP01（2.19对2.05，95%CI 0.04 - 0.26）、PBLI01（2.13对2.01；95%CI 0.01 - 0.24）和PBLI04（2.05对1.93；95%CI 0.03 - 0.21）。对于所考察的其他专业，两组之间没有显著差异。
与非ACE学校的毕业生相比，接受过卫生系统科学培训的学校的毕业生在大多数子能力方面的里程碑评分相似，在1年时，6个专业中只有5项子能力的里程碑评分存在非常小的差异。这些差异可能在教育上并无实际意义。
