Garber Adam M, Feldman Moshe, Ryan Michael, Santen Sally A, Dow Alan, Goldberg Stephanie R
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102 USA.
Center of Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, VA USA.
Med Sci Educ. 2021 Feb 9;31(2):527-533. doi: 10.1007/s40670-021-01208-y. eCollection 2021 Apr.
The Core Entrustable Professional Activities for Entering Residency (Core EPAs) are clinical activities all interns should be able to perform on the first day of residency with indirect supervision. The acting (sub) internship (AI) rotation provides medical students the opportunity to be assessed on advanced Core EPAs.
All fourth-year AI students were taught Core EPA skills and performed these clinical skills under direct supervision. Formative feedback and direct observation data were provided via required workplace-based assessments (WBAs). Supervising physicians rated learner performance using the Ottawa Clinic Assessment Tool (OCAT). WBA and pre-post student self-assessment data were analyzed to assess student performance and gauge curriculum efficacy.
In the 2017-2018 academic year, 167 students completed two AI rotations at our institution. By their last WBA, 91.2% of students achieved a target OCAT supervisory scale rating for both patient handoffs and calling consults. Paired sample tests of the student pre-post surveys showed statistically significant improvement in self-efficacy on key clinical functions of the EPAs.
This study demonstrates that the AI rotation can be structured to include a Core EPA curriculum that can assess student performance utilizing WBAs of directly observed clinical skills.
Our clinical outcomes data demonstrates that the majority of fourth-year medical students are capable of performing advanced Core EPAs at a level acceptable for intern year by the conclusion of their AI rotations. WBA data collected can also aid in ad hoc and longitudinal summative Core EPA entrustment decisions.
The online version contains supplementary material available at 10.1007/s40670-021-01208-y.
进入住院医师培训阶段的核心可托付专业活动（Core EPAs）是所有实习生在住院医师培训第一天应能够在间接监督下执行的临床活动。代理（副）实习（AI）轮转使医学生有机会接受高级Core EPAs评估。
所有四年级AI学生均接受了Core EPA技能培训，并在直接监督下执行这些临床技能。通过所需的基于工作场所的评估（WBA）提供形成性反馈和直接观察数据。指导医师使用渥太华诊所评估工具（OCAT）对学习者的表现进行评分。对WBA和学生前后自我评估数据进行分析，以评估学生表现并衡量课程效果。
在2017 - 2018学年，167名学生在我们机构完成了两次AI轮转。在最后一次WBA时，91.2%的学生在患者交接和呼叫会诊这两项内容上达到了OCAT监督量表的目标评分。学生前后调查的配对样本检验显示，在EPA关键临床功能的自我效能方面有统计学上的显著提高。
本研究表明，AI轮转可以构建为包含Core EPA课程，该课程可利用直接观察临床技能的WBA来评估学生表现。
我们的临床结果数据表明，大多数四年级医学生在AI轮转结束时能够以实习年可接受的水平执行高级Core EPAs。收集的WBA数据也有助于临时和纵向的Core EPA总结性托付决策。
在线版本包含可在10.1007/s40670 - 021 - 0120� - y获取的补充材料。
