目的 对八年制临床医学专业学生临床实习阶段进行基于置信职业行为(entrustable professional activities,EPAs)的评价,以发现临床实习教学中的不足。方法 采用问卷调查方法。选取在北京大学第一医院进行临床实习的2017级八年制临床医学专业50名学生进行EPAs的自我评价(自评)和带教教师评价(他评),采用Wilcoxon符号秩检验对自评和他评的结果进行比较,并将每个指标评价为3级及以上的比例和无法评价的比例进行统计。结果 大多数指标的自评和他评结果一致,如EPA1(接诊患者)、EPA5(医疗文书书写)、EPA6(病例汇报)的自评和他评结果均为3(3,4);少数指标存在差异,如EPA10(知情同意)的自评和他评结果分别为3(3,4)和3(2,3),其差异具有统计学意义(P＜0.05)。部分指标自评和他评为3级及以上的比例均较高,如EPA1(接诊患者)、EPA5(医疗文书书写)、EPA6(病例汇报)的比例分别为100.0%和88.2%、94.0%和91.8%、90.0%和91.8%。部分指标自评和他评为3级及以上的比例较低,如EPA8(危急重症识别与处理)、EPA9(患者转运与交接)的比例分别为30.0%和43.6%、50.0%和51.8%。结论 八年制临床医学专业学生EPAs自评和他评结果基本一致,基本达到临床实习教学要求,部分EPAs指标评价结果与住院医师入职基本要求相比仍有不足,建议进一步完善临床实习教学,以促进与毕业后教育的平稳过渡。
Objective Evaluation based on entrustable professional activities(EPAs)was implemented for eight-year program undergraduates of clinical medicine during the period of internship in order to find the deficiencies in clinical training. Methods Fifty students of grade 2017 who were trained as internship in Peking University First Hospital were enrolled in the research. A questionnaire survey was carried out for self-assessment and trainer's EPAs-based evaluation. Wilcoxon test was applied for comparing the self-assessment and trainer's evaluation.The proportion of each EPAs item reached level 3 or above and the proportion that could not be evaluated were calculated. Results Results of most items of self-assessment were consistent with trainer's evaluation, such as EPA1 (gathering history and performing physical examination during patient encounter), EPA5 (prepare and complete medical documents), and EPA6 (provide oral presentation of a case or a clinical encounter), which were all 3(3,4). Significant difference was found between self-assessment and trainer's evaluation in several items such as EPA10 (obtaining informed consent for clinical tests and/or procedures) which was 3 (3,4) and 3 (2,3) respectively (P < 0.05),. The proportion of items such as EPA1、EPA5、EPA6 which were clearly required by clinical practice training rated as level 3 or above was high in both self-assessment and trainer's evaluation, which were 100.0% and 88.2%, 94.0% and 91.8%, 90.0% and 91.8% respectively. The proportion of items such as EPA8 ( identification of clinical emergency and critical illness and providing initial management)、EPA9 ( transit and hand over the patient) rated as level 3 or above was low in both self-assessment and trainer's evaluation which were 30.0% and 43.6%, 50.0% and 51.8% respectively. Conclusions The eight-year program students of clinical medicine basically meet the requirements of clinical practice training, and evaluation results of EPAs items showed the distance to the entrance standards of residents' training. It is suggested to improve clinical practice training to support the promote the transition from school education to post-graduate medical education.
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