Lin Chia-Pei, Hsu Wei-Chung, Wang Guan-Ling, Su Hui-Chen, Chung Han-Chi, Hung Sheng-Hui, Chen Mingchih, Chen Jeng-Wen, Wang Pa-Chun
Research and Development Department, Joint Commission of Taiwan, New Taipei City, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital and Children's Hospital, Taipei, Taiwan.
BMC Med Educ. 2025 Aug 1;25(1):1135. doi: 10.1186/s12909-025-07679-6.
Competency-Based Medical Education (CBME) emphasizes workplace-based assessments, yet factors influencing competency attainment remain underexplored. In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery introduced 11 Entrustable Professional Activities (EPAs), implemented nationwide via the EMYWAY platform in 2022. This study evaluates the nationwide adoption of EPA-based assessments in otolaryngology residency training and identifies factors associated with entrustment-supervision achievements.
A cross-sectional analysis reviewed EPA assessments from EMYWAY (August 2022-July 2023). Multivariate regression identified factors affecting attainment of expected entrustment-supervision levels by postgraduate year (R1: Level 2; R2-R3: Level 3; R4: Level 4; R5: Level 5).
A total of 9,345 EPA assessments were conducted across 274 residents in 34 training programs and evaluated by 362 faculty members. Overall, 68.2% (6,377/9,345) of assessments met expected entrustment-supervision levels. Factors negatively associated included training in urban hospitals (OR = 0.50, 95% CI 0.43-0.60), advanced case complexity (OR = 0.44, 95% CI 0.40-0.49), surgical procedures (OR = 0.40, 95% CI 0.34-0.46), and senior residency years (R4: OR = 0.29, 95% CI 0.24-0.35; R5: OR = 0.11, 95% CI 0.09-0.13). Conversely, emergency settings had higher achievement (OR = 4.83, 95% CI 3.70-6.31).
This study identifies specific challenges in urban hospitals, complex clinical scenarios, surgical contexts, and senior residency training that require targeted interventions. High achievement in emergency settings underscores the value of intensive clinical exposure. Refinements to the EPA framework are necessary to support senior residents' competency development. Future longitudinal research should assess long-term impacts on clinical proficiency and patient outcomes.
基于胜任力的医学教育（CBME）强调基于工作场所的评估，但影响胜任力获得的因素仍未得到充分探索。2020年，台湾耳鼻咽喉头颈外科学会引入了11项可托付专业活动（EPA），并于2022年通过EMYWAY平台在全国范围内实施。本研究评估了EPA评估在耳鼻喉科住院医师培训中的全国采用情况，并确定了与托付监督成就相关的因素。
一项横断面分析回顾了EMYWAY（2022年8月至2023年7月）的EPA评估。多变量回归确定了影响研究生年级达到预期托付监督水平的因素（R1：2级；R2-R3：3级；R4：4级；R5：5级）。
在34个培训项目中的274名住院医师中总共进行了9345次EPA评估，并由362名教员进行评估。总体而言，68.2%（6377/9345）的评估达到了预期的托付监督水平。负相关因素包括在城市医院培训（OR = 0.50，95% CI 0.43-0.60）、病例复杂性高（OR = 0.44，95% CI 0.40-0.49）、外科手术（OR = 0.40，95% CI 0.34-0.46）以及住院医师高年级（R4：OR = 0.29，95% CI 0.24-0.35；R5：OR = 0.11，95% CI 0.09-0.13）。相反，急诊环境中的成就更高（OR = 4.83，95% CI 3.70-6.31）。
本研究确定了城市医院、复杂临床场景、外科环境和高年级住院医师培训中的特定挑战，这些需要有针对性的干预措施。急诊环境中的高成就突出了强化临床接触的价值。有必要对EPA框架进行完善，以支持高年级住院医师的胜任力发展。未来的纵向研究应评估对临床能力和患者结局的长期影响。
