胜任力导向的医学教育(competency-based medical education,CBME)是医学教育改革的发展趋势,但是在实施层面仍然存在问题。本文以急诊医学为例、以置信职业行为(entrustable professional activities,EPA)为基础,构建了胜任力导向的急诊住院医师培训课程。该培训课程以信任决定为核心,参考美国医学教育专家David E Kern提出的课程开发六步法,从评估课程可行性和目标学员需求出发,筛选急诊专业核心EPA,确定教学目的及具体教学目标,基于知识、技能和态度选择合适的教学策略和评估方法,通过学习档案电子化、定期反馈和授权认证等确保课程实施并从课程和学员两方面评估教学效果等。本文详细阐述了该课程的准备和实施过程,以弥合住院医师抽象的胜任力能力评估与真实的临床工作之间的裂隙,提供了基于EPA的急诊住院医师规范化培训课程设计的具体模板。
Competency-based medical education (CBME) is becoming a goal of modern medical education reform and a global trend, but there are some problems fund during its implementation. This article aims to provide a practical model, based on the concept of entrustable professional activities (EPAs) to translate personal competency assessment to clinical practice derived from curriculum development for emergency resident training. Using Kern's six-step approach to curriculum development, needs assessments of targeted learners were conducted, and all EPAs of emergency training were selected and described in order to identify curriculum goals and specific learning objectives. Educational strategy and assessment tools were linked to the specific task-oriented knowledge, skills and attitudes. Implementation of this curriculum requires trainee portfolios and progress interviews, statements of awarded responsibility. Evaluates whether the curriculum is successful and how it can be improved from the participants and the program. This model provides a new and promising method to fill the gap between the CBME and clinical tasks. The curriculum also provides a process template for using EPAs to drive curriculum development and innovation, which may be transferred to other domain of clinical training.
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