置信职业行为在儿科住院医师培训中的实践研究

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

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。

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.