Moschinski-van Treel Lena, Bosse Hans Martin, Körner Lisa Marie, Steinweg Bernhard, Kerth Janna-Lina
Department of General Pediatrics, Pediatric Cardiology and Neonatology, Medical Faculty, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
Medical Faculty, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
J Med Educ Curric Dev. 2025 Sep 4;12:23821205251370214. doi: 10.1177/23821205251370214. eCollection 2025 Jan-Dec.
Medical education has been experiencing a transition from time- to competency-based. Since their introduction by Olle ten Cate in 2005, entrustable professional activities are a part of this process. We implemented a set of EPAs for the first 3 years of training at our hospital, encompassed by informational materials for trainees and supervisors.
Our objective was to assess barriers and facilitators for the implementation of entrustable professional activities in pediatric residency in a German tertiary hospital. Furthermore, our aim was to explore how they foster self-regulated learning and feedback, and to identify barriers and facilitators on the path to more confidence and safety.
We applied a qualitative approach with focus-group discussions (adhering to COREQ guidelines), 3 each with residents and supervisors. Focus groups were recorded, transcribed verbatim, and de-identified. Data analysis was conducted based on qualitative content analysis.
Three months after the implementation, no resident had fulfilled the required assessments. In the discussions, we identified barriers to and facilitators of the process. Both may be attributed to internal and external factors. The concept was supported by residents and supervisors, but time, priorities in the clinical routine, lack of initiative, and an inhibition on the part of the residents to approach the supervisors were the main reasons for the concept to fail. We identified a higher degree of structure, as well as commitment and accountability, as possible facilitators.
Entrustable professional activities are a promising means of promoting self-regulated learning and a positive feedback culture to increase confidence and safety in clinical practice. Our findings expose the factors that disrupt or promote this process. Our data provide guidance for implementation in a setting with little experience with this tool.
医学教育正在经历从基于时间到基于能力的转变。自2005年奥勒·滕·凯特引入可托付专业活动以来，它已成为这一过程的一部分。我们在我院实施了一套针对培训前三年的可托付专业活动，并为学员和带教老师提供了相关信息材料。
我们的目的是评估在德国一家三级医院的儿科住院医师培训中实施可托付专业活动的障碍和促进因素。此外，我们旨在探讨这些活动如何促进自我调节学习和反馈，并确定通往更高信心和安全性道路上的障碍和促进因素。
我们采用了定性研究方法，进行焦点小组讨论（遵循COREQ指南），分别与住院医师和带教老师各进行3次讨论。焦点小组讨论进行了录音，逐字转录，并进行了去识别处理。基于定性内容分析进行数据分析。
实施三个月后，没有住院医师完成所需评估。在讨论中，我们确定了该过程的障碍和促进因素。两者都可能归因于内部和外部因素。该概念得到了住院医师和带教老师的支持，但时间、临床日常工作的优先级、缺乏主动性以及住院医师不愿接近带教老师是该概念失败的主要原因。我们确定更高程度的结构化以及承诺和问责制可能是促进因素。
可托付专业活动是促进自我调节学习和积极反馈文化以提高临床实践中的信心和安全性的一种有前景的手段。我们的研究结果揭示了干扰或促进这一过程的因素。我们的数据为在对该工具缺乏经验的环境中实施提供了指导。
