is a PGY-4 Resident, General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
is an Innovation Scientist, Health Professions Education Scientist, Director, Research & Evaluation, Postgraduate Medical Education, Adjunct Assistant Professor, Department of Medicine, Edmonton, Alberta, Canada, and Vice-Chair, Canadian Association for Medical Education Foundation, Ottawa, Ontario, Canada; and.
J Grad Med Educ. 2024 Apr;16(2):166-174. doi: 10.4300/JGME-D-23-00470.1. Epub 2024 Apr 15.
Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.
先前的研究表明，住院医师对基于能力的医学教育（CBME），尤其是可委托的专业活动（EPAs）持混合反应。然而，鉴于在这种模式下强调学习评估，了解促使住院医师获得 EPAs 的动机对于 CBME 的长久性可能至关重要。本研究探讨了 3 个领域的住院医师观点：获得 EPAs 的动机、EPAs 的感知重要性以及对 CBME 课程的总体想法。这是一项顺序探索性混合方法研究，包括两个数据收集阶段。第 1 阶段是对 2019 年 11 月至 2020 年 7 月在加拿大一家机构接受 CBME 的住院医师进行半结构式访谈。分析包括主题和显式内容分析。第 2 阶段是电子封闭式调查，以捕捉住院医师申请 EPA 的主要动机和 EPA 对学习的重要性。调查数据进行描述性分析。在 120 名符合条件的住院医师中，25 名（21%）和 107 名（89%）分别参加了访谈和调查。获得 EPA 的主要动机是项目要求。对学习 EPA 的重要性存在差异。增加住院医师工作量、为了最大限度地提高 EPA 得分而玩游戏以及导师缺乏共同所有权被认为是课程的批评。调查结果证实了访谈结果。尽管许多住院医师认识到 EPAs 的价值，但大多数人并非出于内在动机在当前的 CBME 框架下寻求评估。
