從「醫療勝任能力」到「勝任醫療任務」：可信賴專業活動（EPAs）之實務應用

以勝任能力為導向的醫學教育(competency-based medical education, CBME)是近年來醫學教育改革的趨勢，為使CBME能夠落實在臨床工作職場的訓練與評估中，並弭平課堂教學與職場執業的落差，許多機構紛紛採用可信賴專業活動(entrustable professional activities, EPAs)的理論架構在臨床訓練中。本文從四個面向闡述從EPAs的理論架構到實務應用的重要環節，包括：EPAs之制定與共識、信賴等級與監督等級之關係、EPAs與里程碑之關係、利用EPAs進行臨床能力之評估。透過EPAs的建置、執行、與評估，在兼顧病人安全與工作效率的前提下，循序漸進的增加受訓學員的參與及責任，讓核心的「醫療勝任能力」能夠轉化成執行臨床核心任務的勝任醫療人員。

關鍵字

勝任能力導向醫學教育；核心能力；可信賴專業活動；信賴；監督

並列摘要

Competency-based medical education (CBME) has been the current trend of medical educational reform. In order to implement CBME in clinical workplace training and assessment and close the gap between classroom learning and workplace practice, the concept and framework of entrustable professional activities (EPAs) have been widely applied for clinical training in many institutions. This article elaborated key elements while applying EPAs to clinical practice and training from four perspectives: identification and consensus of EPAs, relationship between supervision levels and entrustment decisions, relationship between EPAs and milestones, and assessment of clinical performance via EPAs. Through the identification, implementation and assessment of EPAs, core medical competencies could be transformed to competent medical professionals, executing clinical core professional activities or tasks through step-by-step increased participation and accountability of trainees, balancing clinical training, patient safety and working efficiency at the same time.

並列關鍵字

competency-based medical education (CBME) ； core competency ； entrustable professional activities (EPAs),entrustment ； supervision

參考文獻

楊志偉：落實核心能力導向醫學教育（CBME）－簡介可信任的專業活動（EPAs）在醫學教育之應用。醫療品質雜誌 2016;10:32-38. [Yang CW: Translating competency-based medical education (CBME) into clinical practice: application of Entrustable Professional Activities (EPAs) in Medical Education. J Healthc Qual 2016;10:32-3.]

Frank JR, Mungroo R, Ahmad Y, et al: Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach 2010;32:631-7.

Swing S: ACGME launches outcomes assessment project. JAMA 1998;279:1492.

Frank JR: The CanMEDS 2005 physician competency framework. Ottawa, Ontario, Canada: Royal College of Physicians and Surgeons in Canada, 2005.

Glass JM: Competency based training is a framework for incompetence. BMJ 2014;348: g2909.

被引用紀錄

陳孟君、洪嫦巧、朱翠萍（2021）。「可信賴專業活動」於臨床護理教育之探討與實務應用。高雄護理雜誌，38(2)，31-39。https://doi.org/10.6692/KJN.202108_38(2).0003

陳淑賢、廖美南、高淑華、鄭麗華、邱存梅、陳淑津（2022）。護理領域可信賴專業活動之發展－從理論到應用。長庚護理，33(2)，47-55。https://doi.org/10.6386/CGN.202206_33(2).0005

林素雯、李銘櫻、江金英、林秋子（2020）。可信賴專業活動（EPAs）及建構兒科護理專業能力評估工具。長庚護理，31(4)，488-502。https://doi.org/10.6386/CGN.202012_31(4).0004

林雅涵、錢佳慧、范圭玲、吳美華（2022）。提升兒童加護病房新進護理師ECMO之照護能力。台灣醫學，26(1)，115-127。https://doi.org/10.6320/FJM.202201_26(1).0015

洪嫦巧、鄭靜瑜、朱翠萍（2022）。「可信賴專業活動」模式於護理教育之運用與建議。護理雜誌，69(3)，95-101。https://doi.org/10.6224/JN.202206_69(3).13

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從「醫療勝任能力」到「勝任醫療任務」：可信賴專業活動（EPAs）之實務應用

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