中华医学教育杂志

中华医学教育杂志 ›› 2022, Vol. 42 ›› Issue (3): 263-267.DOI: 10.3760/cma.j.cn115259-20210704-00839

• 住院医师规范化培训 • 上一篇    下一篇

置信职业行为在儿科住院医师培训中的实践研究

李珊1, 周文静2, 齐心3, 江哲涵4, 齐建光1   

  1. 1北京大学第一医院儿科,北京 100034;
    2北京大学公共卫生学院2020级医学教育管理专业硕士研究生,北京 100191;
    3北京大学第一医院整形烧伤科,北京 100034;
    4北京大学医学教育研究所 全国医学教育发展中心,北京 100191
  • 收稿日期:2021-07-04 出版日期:2022-03-01 发布日期:2022-02-23
  • 通讯作者: 齐建光, Email: qjg2006@126.com
  • 基金资助:
    北京大学医学部教育教学研究课题(2020YB13,2020YB31);北京大学医学部专科医师规范化培训研究重点课题(2019ZP04);北京大学“教学新思路2.0”项目(2021YB015)

A pilot study to implement entrustable professional activities in pediatric residency program in China

Li Shan1, Zhou Wenjing2, Qi Xin3, Jiang Zhehan4, Qi Jianguang1   

  1. 1Pediatric Department, Peking University First Hospital, Beijing 100034, China;
    2Master Degree Candidate of Medical Education Management, School of Public Health, Enrolled in 2020, Peking University, Beijing 100191, China;
    3Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing 100034, China;
    4Institute of Medical Education & National Center for Health Professions Education Department, Peking University, Beijing 100191, China
  • Received:2021-07-04 Online:2022-03-01 Published:2022-02-23
  • Contact: Qi Jianguang, Email: qjg2006@126.com
  • Supported by:
    The Educational Teaching Research Project in Peking University Health Science Center(2020YB13,2020YB31); The Medical Specialist Standardized Training Research Project in Peking University Health Science Center(2019ZP04); Innovative Teaching Program 2.0 in Peking University(2021YB15)

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摘要： 目的 研究儿科住院医师培训中住院医师置信职业行为(entrustable professional activities, EPAs)指标的应用效果,发现临床培训中的问题。方法 采用问卷调查方法,调查对象为2020年7月至12月在北京大学第一医院儿科进行培训的55名住院医师及其15名上级主治医师,对55名住院医师的日常表现进行EPAs评价。针对不同年资住院医师的教师评价和住院医师自我评价结果,分别进行了不同年资间的Kruskal-Wallis检验,不同年资组间进行两两独立样本秩和检验(Mann-Whitney U检验)。结果 随着年资的增加,EPAs的教师评价和住院医师的自我评价结果呈现逐年增高的趋势,第五年住院医师的教师评价和自我评价级别最高,教师评价中EPA 11置信决策级别为(7.3±0.7)级,自我评价中EPA 10置信决策级别为(7.5±0.5)级。不同年级之间各EPAs教师评价指标进行了Kruskal-Wallis检验,其差异均具有统计学意义(P<0.05)。教师评价的组间比较提示,第一、第二年资住院医师间评分除EPA10(知情同意)以外,差异有统计学意义(Bonferroni的P值矫正法,P<0.0125),其余年级间差异无统计学意义。所有年级在EPA4(治疗决策)、EPA8(危急重症识别与处置)、EPA15(公共卫生事件应对)评分均相对较低。结论 不同年资儿科住院医师之间EPAs评价有一定的区分度;同时提示需要对儿科住院医师加强某些临床项目的培训。

关键词: 儿科, 置信职业行为, 住院医师, 毕业后教育, 实践

Abstract: Objective Entrustable professional activities (EPAs) applied for residency training consisting of 15 EPAs was developed by Peking University First Hospital (PKUFH) in 2020. A pilot study was implemented with PKUFH Pediatric Residency Program aiming for its efficacy and to orient clinical training. Methods Totally 55 residents who joined PKUFH Pediatric Residency Program from July 2020 to December 2020 were enrolled with some clinical trainers. The self-assessment and trainer's assessment was conducted. An 8-scale supervision scale was used and Kruskal Wallis test was applied for comparing the self-assessment and trainer's assessment. Mann-Whitney U test was conducted to compare the assessment results from different residents. Results The scores of both trainer-assessment and self-assessment by the trainees score increase year by year in each EPAs. Post-graduate year 5 (PGY5)residents showed highest supervision level, with the highest trainer-assessment in EPA 11(7.3±0.7) and highest self-assessment in EPA10(7.5±0.5). A good discrimination between each group in all EPAs items (Kruskal-Wallis test, P<0.05) was found. A significant difference (Bonferroni P correction, P<0.0125) was found between second year and first year residents except EPA10 (Obtain informed consent for tests and or procedure). No significant difference was found between in groups. All residents showed a low assessment score in EPA4 (making a medical decision), EPA8 (recognize a patient requiring urgent or emergent care and initiate evaluation and management) and EPA15 (public health events management). Conclusions EPAs are feasible in the assessment of pediatric residents. Specialized training on medical decision making, critical care and public health events should be strengthened in order to fill the gap found in this research.

Key words: Pediatrics, Entrustable professional activities, Residents, Post-graduate education, Implement

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