耳鼻喉科住院醫師「學習里程碑」之多中心評量

Multicenter Assessment of Milestone Project for Otolaryngologic Resident Physicians

謝易達(Yi-Ta Hsieh) ； 辛宗翰(Chung-Han Hsin) ； 黃澤人(Tzer-Zen Hwang) ； 陳一嘉(Yi-Jia Chen) ； 廖伯武(Po-Wu Liao) ； 鄒繼群(Chi-Chun Chou) ； 劉嘉銘(Chia-Ming Liu) ； 林凱南(Kai-Nan Lin) ； 陳正文(Jeng-Wen Chen)

《台灣耳鼻喉頭頸外科雜誌》 54卷4期 (2019/12) Pp. 177-184

https://doi.org/10.6286/jtohns.201912_54(4).177

摘要

背景與目的：本院於2017年導入中文版耳鼻喉頭頸外科住院醫師「學習里程碑」評量系統，至2019年7月止已完成5次間隔半年之階段性評量。本研究之目的在進一步應用此評量系統進行多中心評量，呈現不同層級訓練醫院住院醫師在訓練過程中，六大核心能力之量化學習進程，評估其可行性。方法：中文版耳鼻喉頭頸外科「學習里程碑」評量系統包含21項次核心能力，368個里程碑。北、中、南區共3家耳鼻喉頭頸外科專科訓練醫院參與研究，於2019年2月由本研究主持人分別至中區及南區訓練醫院說明評量方式後，進行住院醫師自評，總醫師及主治醫師複評，之後收集所有評量資料進行統計分析。結果：北、中、南三區合併呈現的住院醫師21項次核心能力之主治醫師複評平均分數，隨訓練年資增加而提升，呈現統計學上顯著差異（Kruskal-Wallis test p ＜ 0.0001），北、中、南三區分別呈現之主治醫師複評平均分數亦呈現隨訓練年資而增加的趨勢（nested ANOVA p = 0.0148）。進一步依六大核心能力分層分析則顯示「病患照護」及「醫學知識」兩項核心能力之平均分數較能呈現隨訓練年資增加而上升的趨勢，而「制度下的臨床工作」、「從工作中學習及成長」、「專業素養」及「人際關係與溝通技巧」等核心能力進步的趨勢則較為平緩。結論：經過適當的教育訓練，初步結果顯示中文版耳鼻喉頭頸外科「學習里程碑」評量系統可應用於多中心評量，呈現住院醫師六大核心能力之進程，未來可結合線上自動化評量流程，進一步推廣至更多訓練中心，呈現本專科以勝任能力為導向的醫學教育訓練模式。

關鍵字

milestone ； otolaryngology ； core competency ； the Accreditation Council for Graduate Medical Education ； subcompetency（里程碑 ； 耳鼻喉科 ； 核心能力 ； 美國畢業後醫學教育評鑑委員會 ； 次核心能力）

並列摘要

BACKGROUND: In 2017, we implemented the Chinese version of the Otolaryngology Milestone Project as a framework of assessment for otolaryngologic resident physicians. By July 2019, we had completed five semiannual staged assessments. This study aims to investigate the feasibility of the evaluating system for multicenter assessment, and to determine quantitative changes in learning progress regarding the six core competencies for assessing resident physicians during their training in different training centers. METHOD: The Chinese version of the Otolaryngology Milestone Project addresses 21 subcompetencies, and there are 368 milestones in total. Three otolaryngologic resident training centers in the northern, central, and southern districts of Taiwan participated in the study. In February 2019, the principal investigator of the research presented the assessment process of the Milestone Project in the central and southern training centers. Subsequently, we conducted independent self-assessments by the resident doctors, which the chief resident and attending physicians independently reevaluated. All the assessment data were collected for statistical analysis. RESULTS: The combined average scores of attained milestones of the 21 subcompetencies in the northern, central, and southern training centers, which were reevaluated by the attendings, demonstrated significant increase ( p ＜ 0.0001) with training seniority of the resident physicians. Average scores from each training center also showed improvement according to the training years (nested ANOVA, p = 0.0148). Subgroup analysis, according to the six core competencies revealed that the score results for ＂patient care＂ and ＂medical knowledge＂ were more likely to indicate heightened attainment of milestone levels as the program progressed. However, the curves of the score results for ＂system-based practice＂, ＂problem-based learning and improvement＂, ＂professionalism＂ and ＂interpersonal and communication skills＂ were more horizontal, showing that the milestones might indicate better performance than expected, even in residents with low training seniority. CONCLUSIONS: Through appropriate education and training, our preliminary results showed that the Chinese version of the Otolaryngology Milestone Project was feasible for multicenter assessment for otolaryngologic resident physicians. All resident physicians demonstrated increased attainment of milestone levels with training seniority. The future application of the Milestone Project will be an online automated workflow for Milestones assessments and a universal comparison of the attainment of core competencies among different institutions. A step forward toward the competency-based medical education of the otolaryngologic specialty will then be achieved.

並列關鍵字

milestone ； otolaryngology ； core competency ； the Accreditation Council for Graduate Medical Education ； subcompetency