基于胜任力的美国麻醉住院医师培训里程碑2.0解读

The Anesthesiology Milestones 2.0 an competency-based assessment for residency training in the United States:an interpretation

经过近30年的医学教育变革,住院医师培训的评价从基于时间转变为基于胜任力的人才培养模式,然而高效且可重复评估工具的开发面临挑战,因此全球的医学教育工作者正在积极开发与专业相关性强、普适性高,且可测量的住院医师培养和评价体系。美国毕业后医学教育认证委员会(ACGME)持续致力于提高毕业后医学教育全生命周期的人才培养质量,以确保国家住院医师项目能够培养出达到胜任力、可信任且富有同情心的医师。里程碑是ACGME基于胜任力的医学人才培养模式的进一步发展,即从新手到专家的5级阶段和二级胜任力,致力于形成专业人才培养可应用的里程碑。里程碑1.0经过5年的麻醉医师人才培养过程的积累仍待改进,亦为里程碑2.0提供重要的研究基础和独特视角。里程碑1.0在麻醉住院医师人才培养和评价等方面均面临挑战,例如,二级胜任力与当前和未来麻醉临床实践的不匹配,住院医师培训质量的评估与评价,以及教师自身发展工具的开发等。2021年美国ACGME经过多轮的专家咨询,召集各利益相关方构建麻醉住院医师培训里程碑2.0。本文对美国麻醉住院医师里程碑2.0进行解读,着重强调修订的合理性和实用性,以期为中国麻醉住院医师人才培养模式提供参考。目前,中国尚缺乏系统、合作、连续的麻醉教育研究,亟待基于胜任力和里程碑的麻醉住院医师人才培养框架,以期缩小与发达国家麻醉人才培养的差距。

From a time-based to a competency-based medical education,the evolution of residency training began nearly 30 years ago,the development of valid and reproducible assessment tools faces challenges.Medical educators across specialties remain motivated to develop a relevant,generalizable,and measurable system.The Accreditation Council for Graduate Medical Education(ACGME)in the United States commits to the responsibility by assuring that the process and outcome of graduate medical education(GME)in the national residency programs produce competent,safe,and compassionate doctors.The Milestones Project is the ACGME′s evolution to a competency-based system,which allows each specialty to develop its own subcompetencies and 5-level progression of Milestones,along a continuum of novice to expert.Milestones 1.0 provided important foundational information and insights for the education community,that has had nearly 5 years of experience for residency training in Anesthesiology,needs to be improved.Milestones 1.0 highlighted challenges with assessment and evaluation of residents,some mismatch between subcompetencies and current and future clinical practices in Anesthesiology,and the need for faculty development tools.The ACGME assembled representatives from stakeholder groups using an iterative process within the Anesthesiology community to develop the second generation of Milestones in 2021.This article describes Milestones 2.0 for residency training in Anesthesiology in the United States,emphasizing the rationality and practicability,to provide evidence for residency training in Anesthesiology in China.There is a lack of systematic,cooperative and continuous research on medical education in Anesthesiology in China,and a lack of competency-based and milestone-based residency training in Anesthesiology.It is urgent to narrow the gap between developed countries and China to improve medical education and training in Anesthesiology.