基于胜任力的医学教育已取得长足进展并产生广泛影响,但在临床实践方面的教学与评价仍然存在一定局限性。为了增强基于胜任力的医学教育在临床实践环境中的可操作性,将其切实应用于实际的临床实践教学和评价中,置信专业活动应运而生。本文介绍了置信专业活动定义与应用基础、阐述了置信专业活动与胜任力和医学教育里程碑之间的关系,并举例说明了置信专业活动的设置与评价,展望了未来的研究趋势。置信专业活动的引入可以为我国的医学教育发展提供新的思路与参考。
Significant progress has been made in competency-based medical education (CBME), but it still shows limitation in practical applications. In order to apply competency-based medical education into training and evaluation of clinical practice, entrustable professional activities (EPAs) came into being. This article introduces the definition and application basis of EPAs, explains the relationship between EPAs and competencies and milestones, illustrates the setting and evaluation of EPAs, and finally indicates future research trends. Therefore, the introduction of EPAs may provide a reference and new approach for the reformation of medical education in China.
[1] Frank JR, Mungroo R, Ahmad Y, et al. Toward a definition of competency-based education in medicine: a systematic review of published definitions[J]. Med Teach, 2010,32(8):631-637. DOI: 10.3109/0142159X.2010.500898.
[2] Shorey S, Lau TC, Lau ST, et al. Entrustable professional activities in health care education: a scoping review[J]. Med Educ, 2019,53(8):766-777. DOI: 10.1111/medu.13879.
[3] Ten Cate O. Entrustability of professional activities and competency-based training[J]. Med Educ, 2005,39(12):1176-1177. DOI: 10.1111/j.1365-2929.2005.02341.x.
[4] Meyer EG, Chen HC, Uijtdehaage S, et al. Scoping review of entrustable professional activities in undergraduate medical education[J]. Acad Med, 2019,94(7):1040-1049. DOI: 10.1097/ACM.0000000000002735.
[5] Ten Cate O, Chen HC, Hoff RG, et al. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE Guide No. 99[J]. Med Teach, 2015,37(11):983-1002. DOI: 10.3109/0142159X.2015.1060308.
[6] 金哲, 齐心, 李海潮, 等. 置信职业行为在临床医学教育中的应用[J].中华医学教育杂志,2019,39(4):314-320. DOI: 10.3760/cma.j.issn.1673-677X.2019.04.018.
[7] 齐心. 置信职业行为与住院医师胜任力关系探讨[J].中华医学教育杂志,2020,40(4):306-310. DOI: 10.3760/cma.j.cn115259-20191008-00827.
[8] 李磊, 汤勇, 王志宏, 等. 置信专业活动:胜任力导向医学教育国际进展[J].医学与哲学,2020,41(12):65-68. DOI: 10.12014/j.issn.1002-0772.2020.12.15.
[9] 楊志偉, 周致丞, 蕭政廷. 從 [醫療勝任能力] 到 [勝任醫療任務] :可信賴專業活動(EPAs)之實務應用[J].台灣醫學,2018, 22(1): 46-54.
[10] Association of American Medical Colleges. The Core Entrustable Professional Activities (EPAs) for Entering Residency[EB/OL].[2020-05-17].https://www.aamc.org/what-we-do/mission-areas/medical-education/cbme/core-epas.
[11] Yardley S, Teunissen PW, Dornan T. Experiential learning: transforming theory into practice[J]. Med Teach, 2012,34(2):161-164. DOI: 10.3109/0142159X.2012.643264.
[12] Korthagen FAJ. Situated learning theory and the pedagogy of teacher education: towards an integrative view of teacher behavior and teacher learning[J]. Teaching and Teacher Education, 2010, 26(1):98-106.DOI:10.1016/j.tate.2009.05.001.
[13] Lomis K, Amiel JM, Ryan MS, et al. Implementing an entrustable professional activities framework in undergraduate medical education: early lessons from the AAMC core entrustable professional activities for entering residency pilot[J]. Acad Med, 2017,92(6):765-770. DOI: 10.1097/ACM.0000000000001543.
[14] 宋文文, 李鸿鹤, 丁宁, 等. 以胜任力为导向的医学教育里程碑标准的研究进展[J].中华医学教育杂志,2019,39(12):897-900. DOI: 10.3760/cma.j.issn.1673-677X.2019.12.001.
[15] Accreditation Council for Graduate Medical Education. Milestones [EB/OL].[2020-05-20].http://www.acgme.org/acgmeweb/tabid/430/ProgramandInstitutionalAccreditation/NextAcceditationSystem/ Milestones.aspx.
[16] 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.
[17] Kulik C-LC, Kulik JA, Bangert-Drowns RL. Effectiveness of mastery learning programs: a meta-analysis[J]. Rev Educ Res 1990,60(2):265-299.
