O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780 .
D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062 .
Acad Med. 2021 Jul 1;96(7S):S96-S104. doi: 10.1097/ACM.0000000000004106.
To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.
为了为未来十年确立可信赖专业活动 (EPAs) 的研究和开发议程，作者均在该研究领域活跃，回顾了近期的研究论文，寻求对未来研究的建议。他们汇集了他们的知识和经验，以确定三个潜在研究和开发层面：微观层面的学习和教学；中观层面的机构、项目和专业领域；以及宏观层面的区域、国家和国际动态。在这些层面内，作者对他们的研究和开发建议进行了分类。作者确定了 14 个离散主题，每个主题都包含多个可探索的问题或议题，从基础和概念性问题到实际问题都有涉及。迄今为止，许多研究都集中在 EPA 的开发和早期实施方面的各种问题上。未来的研究应侧重于 EPA 的大规模实施，以支持基于能力的医学教育 (CBME) 及其在三个层面上的后果。此外，作者呼吁从实施阶段开始进行严格的研究，重点关注概念问题。这些问题包括委托决策的性质及其与教育和学习者进步的关系，以及在培训阶段、学科和专业之间的界限内使用 EPA，包括持续的专业发展。评估 EPA 在各国价值的国际研究也是一个重要的考虑因素。未来的研究也应该对 EPA 使用的意外后果保持警惕。EPA 的概念是为了支持 CBME，努力改善教育和患者护理的结果，从而促成了这一议程的制定。
