国外医学院校教育阶段置信职业行为研究进展与启示

Entrustable professional activities in undergraduate medical education in foreign medical colleges and universities: research advances and implications

目的综述国外医学院校教育(undergraduate medical education, UME)阶段置信职业行为(entrustable professional activities, EPAs)的框架构建流程与内容、理论依据及评价方法。方法通过计算机检索PubMed、Web of Science、Embase及Scopus数据库自建库至2022年5月国外发表的UME阶段EPAs相关文献, 进行系统综述。结果研究共纳入文献17篇, 发现UME阶段EPAs框架构建主要流程为:参考现有EPAs框架并广泛开展多轮咨询与修定。EPAs内容包括核心基本EPAs、核心特定专业EPAs, 以及个人选择性EPAs。EPAs框架制定的理论依据主要参考米勒金字塔能力评估(Miller’s pyramid of assessment)模型及德雷福斯专业技能获得模型(Dreyfus and Dreyfus’s model of skills acquisition)。主流EPAs胜任力框架有加拿大CanMEDS、美国ACGME六大核心胜任力及其相应的里程碑(milestones), 突出UME阶段评价的EPAs置信等级为9级分层, 置信决定评价方法则主要包括观察、交流及审查结果等。结论国外UME阶段EPAs相关研究已较为成熟, 国内相关研究较为缺乏。我国医学教育研究者可借鉴国外EPAs开发经验, 结合国情, 积极构建涵盖UME阶段的医学教育一体化EPAs框架和置信等级评价标准, 推动胜任力导向评价与反馈, 加快构建服务生命全周期、健康全过程的医学人才培养体系。

Objective To review the process,contents,theoretical basis,and evaluation methods for constructing the framework of entrustable professional activities(EPAs)in the stage of undergraduate medical education(UME)in foreign medical colleges and universities.Methods PubMed,Web of Science,Embase,and Scopus databases were searched to obtain the articles on EPAs in the stage of UME published up to May 2022,and then a systematic review was performed.Results A total of 17 articles were included,and the analysis showed that the framework of EPAs in the UME stage was mainly constructed by referring to the existing framework of EPAs and conducting multiple rounds of consultation and revision.The contents of EPAs include core basic EPAs,core specific professional EPAs,and individual selective EPAs.The theoretical basis for developing the EPAs framework mainly include the Miller's Pyramid of Assessment model and Dreyfus and Dreyfus's Model of Skills Acquisition.The mainstream frameworks of EPAs competency include Canadian CanMEDS,six core competencies of American ACGME and their corresponding milestones.The confidence level of EPAs evaluated at the UME stage is highlighted as 9 levels of stratification,and the evaluation methods for confidence decision mainly include observation,communication,and review of results.Conclusion Foreign EPAs-related research in the UME stage has become more mature,but there is a lack of related studies in China.Chinese medical education researchers can learn from the experience in the development of EPAs in foreign countries and combine it with China's actual situation to construct an integrated EPAs framework for medical education covering the UME stage and the evaluation criteria for confidence level,so as to promote competency-oriented evaluation and feedback and accelerate the construction of a medical talent training system that serves the whole life cycle and the whole health process.