Mental Health and Addictions Service, Waikato District Health Board, Hamilton, New Zealand.
School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Acad Psychiatry. 2023 Apr;47(2):134-142. doi: 10.1007/s40596-022-01712-2. Epub 2022 Oct 12.
OBJECTIVE: Entrustable professional activities (EPAs) are used as clinical activities in postgraduate psychiatry training in Australasia. This study aimed to explore psychiatry trainees' perceptions of the impact of EPAs on their motivation and learning. METHODS: A constructivist grounded theory approach was used to conceptualize the impact of EPAs on trainees' motivation and learning. A purposive sample of trainees was recruited from across New Zealand. Semi-structured individual interviews were used for data collection and continued until theoretical saturation was reached. RESULTS: The impact of EPAs on learning was mediated by the trainee's appraisals of subjective control, value, and the costs of engaging with EPAs. When appraisals were positive, EPAs encouraged a focus on particular learning needs and structured learning with the supervisor. However, when appraisals were negative, EPAs encouraged a superficial approach to learning. Trainee appraisals and their subsequent impact on motivation and learning were most affected by EPA granularity, alignment of EPAs with clinical practice, and the supervisor's conscientiousness in their approach to EPAs. CONCLUSIONS: To stimulate learning, EPAs must be valued by both trainees and supervisors as constituting a coherent work-based curriculum that encompasses the key fellowship competencies. If EPAs are to be effective as clinical tasks for learning, ongoing faculty development must be the leading priority.
目的:委托专业活动(EPAs)在澳大拉西亚的研究生精神病学培训中被用作临床活动。本研究旨在探讨精神病学受训者对 EPA 对其动机和学习的影响的看法。
方法:采用建构主义扎根理论方法来概念化 EPA 对受训者动机和学习的影响。从新西兰各地招募了具有代表性的受训者样本。使用半结构化的个人访谈进行数据收集,直到达到理论饱和。
结果:EPA 对学习的影响是通过受训者对主观控制、价值和参与 EPA 的成本的评估来调节的。当评估为积极时,EPA 鼓励关注特定的学习需求,并与主管一起进行结构化学习。然而,当评估为消极时,EPA 鼓励对学习采取肤浅的方法。受训者的评估及其对动机和学习的后续影响受 EPA 粒度、EPA 与临床实践的一致性以及主管在 EPA 方法上的认真程度的影响最大。
结论:为了激发学习,EPA 必须得到受训者和主管的重视,因为它们构成了一个连贯的基于工作的课程,涵盖了研究员的主要能力。如果 EPA 要作为学习的临床任务有效,必须将教师发展作为首要任务。
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