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

Xi Jing; Li Min; Zhong Hui; Pan Yanyan; Zhou Jinyi

doi:10.3760/cma.j.cn116021-20230411-01439

您当前的位置：

首页 >

文章列表页 >

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

Research on entrustable professional activities | 更新时间：2023-11-01

- Entrustable professional activities in undergraduate medical education in foreign medical colleges and universities: research advances and implications
- Chinese Journal of Medical Education Research Vol. 22, Issue 10, Pages: 1451-1457(2023)
- 作者机构：
  
  1.苏州大学苏州医学院临床技能中心，苏州　215000
  2.苏州大学附属第一医院临床教学办公室，苏州　215000
  3.苏州大学苏州医学院教育教学办公室，苏州　215000
- 作者简介：
  
  Zhou Jinyi, Email: zhoujinyi_suda@163.com
- 基金信息：
  
  General Research Project of Hospital Management Innovation in Jiangsu Province in 2021(JSYGY-3-2021-171);Research Project of Higher Education Reform of Soochow University in 2021 (Sudajiao 〔2021〕 No. 108)(苏大教〔2021〕108号);Medical Education Research Project of Medical Education Branch of Chinese Medical Association and Medical Education Professional Committee of China Association of Higher Education in 2020(20B0021)
- DOI：10.3760/cma.j.cn116021-20230411-01439
  CLC： R4
- Published：20 October 2023，
  
  Received：11 April 2023，
扫描看全文
奚婧, 李珉, 钟慧, 等. 国外医学院校教育阶段置信职业行为研究进展与启示[J]. 中华医学教育探索杂志, 2023, 22(10): 1451-1457.

Xi Jing, Li Min, Zhong Hui, et al. Entrustable professional activities in undergraduate medical education in foreign medical colleges and universities: research advances and implications. [J]. Chinese Journal of Medical Education Research 22(10):1451-1457(2023)
奚婧, 李珉, 钟慧, 等. 国外医学院校教育阶段置信职业行为研究进展与启示[J]. 中华医学教育探索杂志, 2023, 22(10): 1451-1457. DOI： 10.3760/cma.j.cn116021-20230411-01439.

Xi Jing, Li Min, Zhong Hui, et al. Entrustable professional activities in undergraduate medical education in foreign medical colleges and universities: research advances and implications. [J]. Chinese Journal of Medical Education Research 22(10):1451-1457(2023) DOI： 10.3760/cma.j.cn116021-20230411-01439.

摘要

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。

Abstract

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.

关键词

置信职业行为医学院校教育胜任力导向医学教育米勒金字塔德雷福斯模型

Keywords

Entrustable professional activityUndergraduate medical educationCompetency-based medical educationMiller's pyramidDreyfus and Dreyfus's model of skills acquisition

references

Ryan MS, Iobst W, Holmboe ES, et al. Competency-based medical education across the continuum: how well aligned are medical school EPAs to residency milestones? [J]. Med Teach, 2022, 44(5): 510-518. DOI: 10.1080/0142159x.2021.2004303http://dx.doi.org/10.1080/0142159x.2021.2004303.

Carraccio C, Englander R, Van Melle E, et al. Advancing competency-based medical education: a charter for clinician-educators [J]. Acad Med, 2016, 91(5): 645-649. DOI: 10.1097/acm.0000000000001048http://dx.doi.org/10.1097/acm.0000000000001048.

孙宝志，李建国，王启明. 中国临床医生岗位胜任力模型构建与应用[M]. 北京：人民卫生出版社， 2015.

陈心航，吴红斌，江哲涵，等. 国际置信职业行为研究在医学教育中的发展与启示[J]. 中华医学教育杂志， 2020， 40（12）： 945-950. DOI: 10.3760/cma.j.cn115259-20201012-01447http://dx.doi.org/10.3760/cma.j.cn115259-20201012-01447.

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.xhttp://dx.doi.org/10.1111/j.1365-2929.2005.02341.x.

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-12-00380.1http://dx.doi.org/10.4300/jgme-d-12-00380.1.

杜妍蓉，陈彦桦，王培成，等. 置信职业行为在全科医学领域的应用现状与展望[J]. 中国全科医学， 2022， 25（19）： 2307-2314. DOI: 10.12114/j.issn.1007-9572.2022.0235http://dx.doi.org/10.12114/j.issn.1007-9572.2022.0235.

吕涛，刘俊，刘瑛，等. 基于置信职业行为的妇产科住院医师规范化培训与考核模式的构建[J]. 中华医学教育杂志， 2022， 42（6）： 550-553. DOI: 10.3760/cma.j.cn115259-20220310-00294http://dx.doi.org/10.3760/cma.j.cn115259-20220310-00294.

齐心，金哲，韩晓宁，等. 住院医师置信职业行为指标的构建研究[J]. 中华医学教育杂志， 2021， 41（2）： 104-108. DOI: 10.3760/cma.j.cn115259-20201117-01599http://dx.doi.org/10.3760/cma.j.cn115259-20201117-01599.

冯莉莉，陈旭岩，张向阳，等. 急诊住院医师置信职业行为指标构建及应用初探[J]. 中国毕业后医学教育， 2021， 5（3）： 197-201. DOI: 10.3969/j.issn.2096-4293. 2021.03.002http://dx.doi.org/10.3969/j.issn.2096-4293.2021.03.002.

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.2019.04.018http://dx.doi.org/10.3760/cma.j.issn.1673-677X.2019.04.018.

刘喆，刘林，周文静，等. 住院医师置信职业行为量表在住培评价中的应用探索[J]. 中华医学教育杂志， 2023， 43（2）： 156-160. DOI: 10.3760/cma.j.cn115259-20220826-01082http://dx.doi.org/10.3760/cma.j.cn115259-20220826-01082.

von Streng Paats T, Masud T, Huwendiek S, et al. Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review [J]. Age Ageing, 2022, 51(5): afac100. DOI: 10.1093/ageing/afac100http://dx.doi.org/10.1093/ageing/afac100.

Pinilla S, Lenouvel E, Cantisani A, et al. Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review [J]. BMC Med Educ, 2021, 21(1): 1-10. DOI: 10.1186/s12909-021-02608-9http://dx.doi.org/10.1186/s12909-021-02608-9.

Linsenmeyer M, Wimsatt L, Speicher M, et al. Status of entrustable professional activities (EPA) implementation at colleges of osteopathic medicine in the United States and future considerations [J]. J Am Osteopath Assoc, 2020, 120(11): 749-760. DOI: 10.7556/jaoa.2020.129http://dx.doi.org/10.7556/jaoa.2020.129.

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.0000000000002735http://dx.doi.org/10.1097/acm.0000000000002735.

Salisbury SK, Rush BR, Ilkiw JE, et al. Collaborative development of core entrustable professional activities for veterinary education [J]. J Vet Med Educ, 2020, 47(5): 607-618. DOI: 10.3138/jvme.2019-0090http://dx.doi.org/10.3138/jvme.2019-0090.

Zainuldin R, Tan HY. Development of entrustable professional activities for a physiotherapy undergraduate programme in Singapore [J]. Physiotherapy, 2021, 112: 64-71. DOI: 10.1016/j.physio.2021.03.017http://dx.doi.org/10.1016/j.physio.2021.03.017.

Arunachalam S, Pau A, Nadarajah VD, et al. Entrustable professional activities in undergraduate dental education: a practical model for development and validation [J]. Eur J Dent Educ, 2023, 27(2): 332-342. DOI: 10.1111/eje.12809http://dx.doi.org/10.1111/eje.12809.

Fazio SB, Ledford CH, Aronowitz PB, et al. Competency-based medical education in the internal medicine clerkship: a report from the alliance for academic internal medicine undergraduate medical education task force [J]. Acad Med, 2018, 93(3): 421-427. DOI: 10.1097/acm.0000000000001896http://dx.doi.org/10.1097/acm.0000000000001896.

Hauer KE, Boscardin C, Fulton TB, et al. Using a curricular vision to define entrustable professional activities for medical student assessment [J]. J Gen Intern Med, 2015, 30(9): 1344-1348. DOI: 10.1007/s11606-015-3264-zhttp://dx.doi.org/10.1007/s11606-015-3264-z.

Elnicki DM, Aiyer MK, Cannarozzi ML, et al. An entrustable professional activity (EPA)-based framework to prepare fourth-year medical students for internal medicine careers [J]. J Gen Intern Med, 2017, 32(11): 1255-1260. DOI: 10.1007/s11606-017-4089-8http://dx.doi.org/10.1007/s11606-017-4089-8.

Nayyar B, Yasmeen R, Khan RA. Using language of entrustable professional activities to define learning objectives of radiology clerkship: a modified Delphi study [J]. Med Teach, 2019, 41(12): 1419-1426. DOI: 10.1080/0142159x.2019.1645951http://dx.doi.org/10.1080/0142159x.2019.1645951.

Croft H, Gilligan C, Rasiah R, et al. Development and inclusion of an entrustable professional activity (EPA) scale in a simulation-based medicine dispensing assessment [J]. Curr Pharm Teach Learn, 2020, 12(2): 203-212. DOI: 10.1016/j.cptl.2019.11.015http://dx.doi.org/10.1016/j.cptl.2019.11.015.

Curran VR, Deacon D, Schulz H, et al. Evaluation of the characteristics of a workplace assessment form to assess entrustable professional activities (EPAs) in an undergraduate surgery core clerkship [J]. J Surg Educ, 2018, 75(5): 1211-1222. DOI: 10.1016/j.jsurg.2018.02.013http://dx.doi.org/10.1016/j.jsurg.2018.02.013.

Holmstrom AL, Chia MC, O'Brien CL, et al. Entrustable professional activity-based summative performance assessment in the surgery clerkship [J]. J Surg Educ, 2021, 78(4): 1144-1150. DOI: 10.1016/j.jsurg.2020.12.001http://dx.doi.org/10.1016/j.jsurg.2020.12.001.

Pinilla S, Cantisani A, Klöppel S, et al. Introducing a psychiatry clerkship curriculum based on entrustable professional activities: an explorative pilot study [J]. Acad Psychiatry, 2021, 45(3): 354-359. DOI: 10.1007/s40596-021-01417-yhttp://dx.doi.org/10.1007/s40596-021-01417-y.

Klapheke M, Abrams MP, Cubero M, et al. Aligning medical student workplace-based assessments with entrustable professional activities and the RIME model in a psychiatry clerkship [J]. Acad Psychiatry, 2022, 46(3): 283-288. DOI: 10.1007/s40596-022-01614-3http://dx.doi.org/10.1007/s40596-022-01614-3.

Thompson LR, Leung CG, Green B, et al. Development of an assessment for entrustable professional activity (EPA) 10: emergent patient management [J]. West J Emerg Med, 2017, 18(1): 35-42. DOI: 10.5811/westjem.2016.10.31479http://dx.doi.org/10.5811/westjem.2016.10.31479.

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.0000000000001543http://dx.doi.org/10.1097/ACM.0000000000001543.

Logiudice AB, Sibbald M, Monteiro S, et al. Intrinsic or Invisible? An audit of CanMEDS roles in entrustable professional activities [J]. Acad Med, 2022, 97(8): 1213-1218. DOI: 10.1097/ACM.0000000000004731http://dx.doi.org/10.1097/ACM.0000000000004731.

Michaud PA, Jucker-Kupper P, The Profiles Working Group. The "Profiles" document: a modern revision of the objectives of undergraduate medical studies in Switzerland [J]. Swiss Med Wkly, 2016, 146: w14270. DOI: 10.4414/smw.2016.14270http://dx.doi.org/10.4414/smw.2016.14270.

Chen HC, Van den Broek WE, Ten Cate O. The case for use of entrustable professional activities in undergraduate medical education [J]. Acad Med, 2015, 90(4): 431-436. DOI: 10.1097/acm.0000000000000586http://dx.doi.org/10.1097/acm.0000000000000586.

Miller GE. The assessment of clinical skills/competence/performance [J]. Acad Med, 1990, 65(9 Suppl): S63-S67. DOI: 10.1097/00001888-199009000-00045http://dx.doi.org/10.1097/00001888-199009000-00045.

王筝扬，黄一琳，万姗姗，等. 德雷福斯模型在临床能力评估与教学中应用的启示[J]. 中华医学教育杂志， 2021， 41（11）： 1038-1041. DOI: 10.3760/cma.j.cn115259-20210619-00776http://dx.doi.org/10.3760/cma.j.cn115259-20210619-00776.

Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice [J]. Med Teach, 2010, 32(8): 638-645. DOI: 10.3109/0142159x.2010.501190http://dx.doi.org/10.3109/0142159x.2010.501190.

郑嘉堂，孔玉侠，董爱梅. CanMEDS-FM框架介绍及其应用实例分析[J]. 中国全科医学， 2017， 20（8）： 918-921. DOI: 10.3969/j.issn.1007-9572.2017.08.006http://dx.doi.org/10.3969/j.issn.1007-9572.2017.08.006.

LaMantia J. The ACGME core competencies: getting ahead of the curve [J]. Acad Emerg Med, 2002, 9(11): 1216-1217. DOI: 10.1111/j.1553-2712.2002.tb01578.xhttp://dx.doi.org/10.1111/j.1553-2712.2002.tb01578.x.

Grayev A, Catanzano TM, Sarkany D, et al. ACGME diagnostic radiology milestones 2.0: the time is now [J]. Acad Radiol, 2022, 29 Suppl 5: S18-S26. DOI: 10.1016/j.acra.2020.11.020http://dx.doi.org/10.1016/j.acra.2020.11.020.

Ten Cate O. AM last page: what entrustable professional activities add to a competency-based curriculum [J]. Acad Med, 2014, 89(4):691. DOI: 10.1097/acm.0000000000000161http://dx.doi.org/10.1097/acm.0000000000000161.

李珊，齐建光，齐心，等. 基于置信职业行为的儿科住院医师形成性评价体系的构建探索[J]. 中国毕业后医学教育， 2021， 5（3）： 193-196， 201. DOI: 10.3969/j.issn.2096-4293.2021.03.001http://dx.doi.org/10.3969/j.issn.2096-4293.2021.03.001.

Jarrett JB, Antoun J, Hasnain M. Entrustable professional activity utilization: a CERA study of family medicine residency program directors [J]. Fam Med, 2019, 51(6): 471-476. DOI: 10.22454/fammed.2019.876961http://dx.doi.org/10.22454/fammed.2019.876961.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Establishment of entrustable professional activities for entering residency

Research advances in the application of entrustable professional activities in competency-oriented medical education in colleges and universities

Related Author

Tan Meimei

Xu Qieshi

Gan Jirui

Li Ying

Wang Feng

Wang Qingqing

Wu Youjia

Ji Qiuhong

Related Institution

Department of Education, China-Japan Friendship Hospital

Institute for Hospital Management of Tsinghua University

Department of Laboratory Medicine, Affiliated Hospital of Nantong University

Department of General Surgery, Affiliated Hospital of Nantong University

Department of Pediatrics, Affiliated Hospital of Nantong University

⁰