Tian Hong, Xu Lan, Xi Jing, Yin Jie, Dai Haiping, Wang Ying, Chen Jia, Li Chunrui, Zhu Yu, Wang Huafeng, Zhou Mo, Long Yuan, Song Xuewen, Yang Li, Qi Jiajun, Zhou Jinyi, Xue Shengli
National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Training and Education Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Adv Med Educ Pract. 2025 Sep 10;16:1651-1663. doi: 10.2147/AMEP.S541605. eCollection 2025.
Entrustable professional activities (EPAs), essential for competent and safe clinical practice, serve as milestones to assess trainees' readiness for independent patient care. This study aimed to develop a context-specific EPA framework for hematology residency training in China.
We employed a modified Delphi method involving 35 experts from 8 academic hospitals to establish China's inaugural hematology-specific EPA framework. The development process comprised three key components: (1) a systematic literature review integrating international EPA models with China's the Standardized Training System for Residents (STSR) requirements; (2) structural validation through the EQual rubric (cut-off: 4.07); and (3) a two-round Delphi consultations evaluating importance, observability, evaluability, repeatability, feasibility and entrustment-supervision levels. Expert engagement metrics and inter-rater agreement evaluated consensus quality.
The preliminary 14-item framework was ultimately refined to 12 EPAs following the exclusion of "Public Health Emergency Response" (EPA 14; mean score=3.23) and "Imparting Bad News" (EPA 13; 57.1% experts advocated removing). Key revisions involved expanding the hematopoietic stem cell transplantation (HSCT) competency domain to include donor selection (EPA 7) and the provisional addition then subsequent removal of "Cellular Immunotherapy Complications Management" due to insufficient standardization of assessment criteria. The final EPAs achieved unanimous EQual compliance (≥4.07) and strong Delphi consensus (Kendall's W: Round 1 = 0.271, Round 2 = 0.529, p<0.001). Clinical entrustment-supervision levels were systematically stratified by training phase and expected competency at graduation.
This study has established China's first hematology-specific EPA framework by addressing gaps in global EPA models through integration of integrating local clinical demands (high patient volume, resource constraints) and multidisciplinary coordination. The framework provides a validated tool for competency-based assessment, with future steps focusing on digital implementation and nationwide validation.
可托付专业活动（EPA）对于胜任且安全的临床实践至关重要，是评估实习生独立护理患者准备情况的里程碑。本研究旨在为中国血液学住院医师培训制定一个针对具体情境的EPA框架。
我们采用改良德尔菲法，邀请了来自8家学术医院的35位专家，建立了中国首个血液学特定EPA框架。开发过程包括三个关键部分：（1）系统的文献综述，将国际EPA模型与中国住院医师规范化培训体系（STSR）要求相结合；（2）通过EQual评分标准进行结构验证（临界值：4.07）；（3）两轮德尔菲咨询，评估重要性、可观察性、可评估性、可重复性、可行性和托付-监督水平。专家参与指标和评分者间一致性评估了共识质量。
最初的14项框架最终精简为12项EPA，排除了“公共卫生应急响应”（EPA 14；平均得分=3.23）和“传达坏消息”（EPA 13；57.1%的专家主张删除）。关键修订包括扩大造血干细胞移植（HSCT）能力领域，纳入供体选择（EPA 7），以及由于评估标准标准化不足，临时增加然后又删除了“细胞免疫治疗并发症管理”。最终的EPA达到了一致的EQual合规（≥4.07）和强烈的德尔菲共识（肯德尔W系数：第一轮=0.271，第二轮=0.529，p<0.001）。临床托付-监督水平根据培训阶段和毕业时的预期能力进行了系统分层。
本研究通过整合当地临床需求（高患者数量、资源限制）和多学科协调，弥补了全球EPA模型的不足，建立了中国首个血液学特定EPA框架。该框架为基于能力的评估提供了一个经过验证的工具，未来步骤将集中在数字化实施和全国范围内的验证。
