Ten Cate Olle, Jarrett Jennie B
Center for Research and Development of Health Professions Education, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL 60612, USA.
Pharmacy (Basel). 2023 Jun 18;11(3):107. doi: 10.3390/pharmacy11030107.
Entrustable Professional Activities (EPAs) and entrustment decision making are rapidly becoming mainstream in competency-based education in the health professions. EPAs are the units of professional practice to entrust graduates with once they have developed the required competencies. They were conceived to enable a gradual increase in professional autonomy during training, by allowing trainees to practice activities in which they have demonstrated they have mastered well, with decreasing supervision. However, practicing health care unsupervised generally requires licensure. The question for pharmacy education, as well as for undergraduate medical education, is can students be given any autonomy in practice, even when they have fully mastered an EPA yet remain unlicensed? While entrustment decisions for licensed practitioners have autonomy consequences, some educators in undergraduate programs speak of 'entrustment determinations', to avoid decisions about students that affect patient care, in other words saying, we would trust you, rather than we will trust you. However, graduating learners without the experience of responsibility and reasonable autonomy creates a gap with full practice responsibilities, which may jeopardize patient safety after training. What can programs do to retain the power of using EPAs while at the same time guarding patient safety?
可托付专业活动（EPAs）和托付决策正在迅速成为卫生专业基于能力的教育的主流。EPAs是一旦毕业生具备所需能力就可托付给他们的专业实践单元。其目的是通过允许受训者在已证明熟练掌握的活动中进行实践，并减少监督，从而在培训期间逐步增加专业自主性。然而，通常情况下，无监督地从事医疗保健工作需要获得执业许可。药学教育以及本科医学教育面临的问题是，即使学生已完全掌握了一项EPA但仍未获得执业许可，能否给予他们一定的实践自主权？虽然对有执照从业者的托付决策会产生自主性方面的影响，但一些本科项目的教育工作者提及“托付判定”，以避免做出影响患者护理的关于学生的决策，换句话说就是，我们“会信任你”，而不是“我们将信任你”。然而，没有责任和合理自主权体验的毕业学员与完全的实践责任之间存在差距，这可能会在培训后危及患者安全。各项目能做些什么来在保留使用EPAs的权力的同时保障患者安全呢？
