Google Research, US.
Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, US.
Perspect Med Educ. 2023 Mar 13;12(1):68-75. doi: 10.5334/pme.10. eCollection 2023.
Two decades after competency-based medical education appeared in the lexicon of medical educators, the community continues to struggle with realizing its full potential. The implementation of the time variable, fixed outcome component has languished based on complexity compounded by resistance to change. Learners continue to transition from medical school to residency, and then practice, primarily based on time rather than having achieved the ability to meet the needs of the patient populations they will serve. Only those few who demonstrate glaring deficiencies do not graduate. The authors urge the medical education community to move from the current fixed time path of medical education toward the implementation of a true continuum of time variable, fixed outcome education, training, and practice. The latter is defined by purposeful learning, coaching, feedback, and repetition on the path to achieving and maintaining expertise. The opportunities afforded by such a time-variable, fixed outcome approach include: 1) development of a career long growth mindset, 2) ability to address evolving population health needs and careers within the context of one's practice, and 3) continual improvement of care quality and outcomes for patients on the journey towards expertise for providers.
在以能力为基础的医学教育出现在医学教育者的词汇表中二十年后，该领域仍在努力充分发挥其潜力。基于对变革的抵制而变得复杂的时间变量、固定结果因素的实施进展缓慢。学习者继续从医学院过渡到住院医师培训，然后再进入实践，主要是基于时间，而不是基于他们已经具备满足所服务患者群体需求的能力。只有那些表现出明显缺陷的人才无法毕业。作者敦促医学教育界从当前的固定时间医学教育路径转向实施真正的时间变量、固定结果教育、培训和实践的连续体。后者是通过有目的的学习、指导、反馈和在实现和保持专业知识的道路上的重复来定义的。这种时间变量、固定结果方法提供的机会包括：1）发展终身成长型思维模式，2）能够根据自己的实践情况解决不断变化的人群健康需求和职业问题，3）在向专业人员提供护理的过程中不断提高患者的护理质量和结果。
