现代医学强调以胜任力为导向的教育,但胜任力难于评价。2005年,Olle ten Cate教授首先提出置信职业行为,将临床工作拆分成若干要件,提取其中的“关键”行为,描述预期学习者不同阶段所能够达到的水平或能力。监督者通过观察,对整个过程给予评价,确认学习者在何种程度监督下能够完成该任务或承担其责任。因此,置信职业行为能够协助胜任力转化到临床实践,综合体现学习者的临床胜任力。
Modern medicine emphasizes competency-based education, but competency is difficult to evaluate. In 2005, Olle ten Cate firstly proposed the confidence of entrustable professional activities (EPA). EPA separates the clinical work into several important elements, extracts the “key” behaviors, and describes the level or ability that the expected learners can achieve at different stages. The supervisors evaluate the whole process through observation, and confirm the degree of supervision in which the learners can complete the task or take the responsibility. Therefore, EPA can assist the competencies to be transformed into clinical practice and embody the clinical competencies of learners comprehensively.
[1]Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: A systematic review [J].Acad Med,2009,84(3):301-309.DOI:10.1097/ACM.0b013e3181971f08.
[2]Ginsburg S, Mcilroy J, Oulanova O, et al. Toward authentic clinical evaluation: Pitfalls in the pursuit of competency[J].Acad Med,2010,85(5):780-786.DOI:10.1097/ACM.0b013e3181d73fb6.
[3]El-Haddad C, Damodaran A, Mcneil HP, et al. The ABCs of entrustable professional activities: An overview of ‘entrustable professional activities' in medical education[J].Intern Med J,2016,46(9):1006-1010.DOI:10.1111/imj.12914.
[4]齐心,刘占兵,李海潮,等.第一年外科住院医师客观结构化临床考试的实施及评价[J].中华医学教育探索杂志,2017,16(1):12-16.DOI:10.3760/cma.j.issn.2095-1485.2017.01.003.
[5]Epstein RM. Assessment in medical education-replies[J].N Engl J Med,2007,356 (4):387-396.DOI:10.1056/NEJMra054784.
[6]Rethans JJ, Norcini JJ, Barónmaldonado M, et al. The relationship between competence and performance: Implications for assessing practice performance [J].Med Educ,2002,36(10):901-909.DOI:10.1046/j.1365-2923.2002.01316.x.
[7]ten Cate O. Entrustability of professional activities and competency-based training[J].Med Edu,2005,39(12):1176-1177.DOI:10.1111/j.1365-2929.2005.02 341.x.
[8]van der Vleuten CPM, Schuwirth LW. Assessing professional competence: From methods to programmes[J].Med Educ,2005,39(3):309-317.DOI:10.1111/j.1365-2929.2005.02094.x.
[9]Ten Cate O. Nuts and bolts of entrustable professional activities[J].J Grad Med Educ,2013,5(1):157-158.DOI:10.4300/JGME-D-12-00380.1.
[10]Ten CO. Trust, competence, and the supervisor's role in postgraduate training [J].BMJ,2006,333(7571):748-751.DOI:10.1136/bmj.38938.407569.94.
[11]ten Cate O, Young JQ. The patient handover as an entrustable professional activity: Adding meaning in teaching and practice[J].BMJ Qual Saf,2012,21 (Suppl 1):19-12.DOI:10.1136/bmjqs-2012-001213.
[12]ten Cate O, Scheele F. Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice?[J].Academic Medicine,2007,82 (6):542-547. DOI:10.1097/ACM.0b013e31805559c7.
[13]Kennedy TJ, Regehr G, Baker GR, et al. Point-of-care assessment of medical trainee competence for independent clinical work[J].Acad Med,2008,83(10 Suppl):S89-S92.DOI:10.1097/ACM.0b013e318183c8b7.
[14]Choo KJ, Arora VM, Barach P, et al. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis[J].J Hosp Med,2014,9(3):169-175.DOI:10.1002/jhm.2150.
[15]ten Cate O. AM last page: What entrustable professional activities add to a competency-based curriculum[J].Acad Med,2014,89(4):691.DOI:10.1097/ACM.0000000000000161.
[16]Aylward M, Nixon J, Gladding S. An entrustable professional activity (EPA) for handoffs as a model for EPA assessment development[J].Acad Med,2014,89(10):1335-1340.DOI:10.1097/ACM.0000000000000317.
[17]Dhaliwal U, Gupta P, Singh T. Entrustable professional activities: Teaching and assessing clinical competence[J].Indian Pediatrics,2015,52(7):591-597. DOI:10.1007/s13312-015-0681-3.
[18]Association of American Medical Colleges. Core entrustable professional activities for entering residency: Curriculum developers' guide [S/OL].[2018-07-05].https://store.aamc.org/downloadable/download/sample/sample_id/63/.
[19]Holmes AV, Peltier CB, Hanson JL, et al. Writing medical student and resident performance evaluations: Beyond “performed as expected”[J].Pediatrics,2014, 133(5):766-768.DOI:10.1542/peds.2014-0418.
[20]Solet DJ, Norvell JM, Rutan GH, et al. Lost in translation: Challenges and opportunities in physician-to-physician communication during patient handoffs [J].Acad Med,2005,80(12):1094-1099.DOI:10.1097/00001888-200512000-00005.
[21]Englander R, Carraccio C. From theory to practice: Making entrustable professional activities come to life in the context of milestones[J].Acad Med,2014,89(10):1321-1323.DOI:10.1097/ACM.0000000000000324.
[22]Shaughnessy AF, Sparks J, Cohen-Osher M, et al. Entrustable professional activities in family medicine[J].J Grad Med Educ,2013,5(1):112-118.DOI:10. 4300/JGME-D-12-00034.1.
[23]van Loon KA, Driessen EW, Teunissen PW, et al. Experiences with EPAs, potential benefits and pitfalls[J].Med Teach,2014,36(8):698-702.DOI:10.3109/0142159x.2014.909588.
