Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, H3A 0G4, Canada.
Surg Endosc. 2023 Apr;37(4):3191-3200. doi: 10.1007/s00464-022-09502-5. Epub 2022 Aug 16.
The Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding feasibility and perceived value.
The FC coordinated the development of EPAs in collaboration with the sponsoring societies for Advanced GI/MIS, Bariatrics, Foregut, Endoscopy and Hepatopancreaticobiliary (HPB) fellowships encompassing the preoperative, intraoperative, and postoperative phases of care for key competencies. Fifteen accredited fellowship programs participated in this project. The assessments were collected through a unique platform on the FC website. Programs were asked to convene a Clinical Competency Committee (CCC) on a quarterly basis. The pilot group met monthly to support and improve the process. An exit survey evaluated the perceived value of EPAs.
The 15 participating programs included 18 fellows and 106 faculty. A total of 655 assessments were initiated with 429 (65%) completed. The average (SD) number of EPAs completed for each fellow was 24(18); range 0-72. Intraoperative EPAs were preferentially completed (71%). The average(SD) time for both the fellow and faculty to complete an EPA was 27(78) hours. Engagement increased from 39% of fellows completing at least one EPA in September to 72% in December and declining to 50% in May. Entrustment level increased from 6% of EPAs evaluated as "Practice Ready" in September to 75% in June. The exit survey was returned by 63% of faculty and 72% of fellows. Overall, 46% of fellows and 74% of program directors recommended full-scale implementation of the EPA framework.
A competency-based assessment framework was developed by the FC and piloted in several programs. Participation was variable and required ongoing strategies to address barriers. The pilot project has prepared the FC to introduce CBME across all FC training programs.
研究员理事会（FC）正在向基于能力的医学教育（CBME）模式过渡，包括引入可委托的专业活动（EPAs）来培训和评估研究员。本研究描述了 FC 在为期十个月的试点项目中采用的实施过程，并介绍了关于可行性和感知价值的数据。
FC 与高级胃肠/微创、减重、前肠、内镜和肝胆胰（HPB）研究员的赞助协会合作，协调了 EPAs 的开发，涵盖了关键能力的术前、术中和术后护理阶段。十五个认可的研究员计划参与了该项目。评估是通过 FC 网站上的一个独特平台收集的。项目被要求每季度召开一次临床能力委员会（CCC）会议。试点组每月开会以支持和改进该过程。一项退出调查评估了 EPA 的感知价值。
参与的 15 个项目包括 18 名研究员和 106 名教师。共启动了 655 次评估，其中 429 次（65%）完成。每位研究员完成的平均（SD）EPA 数量为 24（18）；范围 0-72。优先完成了术中 EPA（71%）。研究员和教师完成 EPA 的平均（SD）时间分别为 27（78）小时。参与度从 9 月至少有一名研究员完成一项 EPA 的 39%增加到 12 月的 72%，然后下降到 5 月的 50%。在 9 月评估为“准备执业”的 EPA 中，可委托级别从 6%增加到 6 月的 75%。共有 63%的教师和 72%的研究员返回了退出调查。总体而言，46%的研究员和 74%的项目主任建议全面实施 EPA 框架。
FC 开发了基于能力的评估框架，并在几个项目中进行了试点。参与度各不相同，需要采取持续策略来解决障碍。试点项目为 FC 在所有 FC 培训计划中引入 CBME 做好了准备。
