Departments of Technology Development and Pediatric, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clinical Research and Development Center of Shanghai Municipal Hospitals, Shanghai Shenkang Hospital Development Center, Shanghai, China.
Front Public Health. 2022 Jul 7;10:896097. doi: 10.3389/fpubh.2022.896097. eCollection 2022.
The purpose of this study is to explore the practicality and feasibility of EPA (level 4 theory) for establishing medical training and service model in China.
We opted for a mixed qualitative and quantitative research method, considering both explanatory and exploratory sequential designs. The qualitative research comprehended focus groups and interviews conducted with two panels of experts. The quantitative research was conducted to collect data about the applicability of international entrustable professional activities (EPAs) pediatrics standards in the Chinese context by organizing a seminar with a sample of 60 pediatricians. A questionnaire was designed with EPAs and distributed within professional networks. Structural equation modeling and statistical analysis were used to process the data.
In this study, Medical Service-Groups Model (MSGM) with four levels was successfully established to measure the correlation between specialized and general EPAs. As expected, results showed that specialized EPAs were built on top of general EPAs. There may be a mediating mechanism that general EPAs contribute to the lower level of specialization EPAs. In addition, levels 1 and 2 were primarily needed to lay the groundwork for levels 3 and 4, and these higher levels of EPAs were still the most informative for specialized Gastroenterology EPAs.
The diagnosis and treatment level of primary general practitioners, as the basis of the pediatric medical service chain, affected the clinical disposal ability of specialists. The establishment of MSGM provided a theoretical basis for the linkage training of general practitioners and specialist physicians. In future studies, scholars must explore China's EPAs based on unique national conditions.
本研究旨在探讨 EPA（四级理论）在中国建立医学培训和服务模式的实用性和可行性。
我们采用混合定性和定量研究方法，同时考虑解释性和探索性顺序设计。定性研究包括两个专家组的焦点小组和访谈。定量研究通过组织一个有 60 名儿科医生样本的研讨会，收集关于国际可委托专业活动（EPA）儿科标准在中国语境下适用性的数据。设计了一份包含 EPA 的问卷，并在专业网络中分发。采用结构方程建模和统计分析处理数据。
本研究成功建立了四级医疗服务组模型（MSGM），以衡量专科和一般 EPA 之间的相关性。结果表明，专科 EPA 建立在一般 EPA 之上。可能存在一种中介机制，即一般 EPA 有助于降低专科 EPA 的水平。此外，第 1 级和第 2 级主要用于为第 3 级和第 4 级奠定基础，而这些更高层次的 EPA 对于专科胃肠病学 EPA 仍然是最具信息量的。
基层全科医生的诊疗水平作为儿科医疗服务链的基础，影响了专科医生的临床处置能力。MSGM 的建立为全科医生和专科医生的联合培训提供了理论基础。在未来的研究中，学者们必须基于独特的国情探索中国的 EPA。
