發展癌症臨床照護之可信賴專業活動（EPAs）歷程

背景：近年來醫學教育倡導以核心能力為導向（Competence-basedmedical education）為改革的趨勢，其中｢可信賴專業活動｣（Entrustable Professional Activities, EPAs）是教學與評量兩者兼具的教學方式，一項EPA任務可涵蓋三到四種核心能力的訓練，系統性地教學並評量學員勝任的信賴等級。癌症照護在全球是健康照護關注的重要議題，新進護理師應具備癌症病人之全人照護任務的能力，因此選定為發展EPAs的主題。組成EPAs發展小組，閱讀相關文獻並與專家討論癌症照護新進護理師應具備的任務內容，以名義團體法確認發展小組內的共識，以問卷調查法建立專家共識，EPAs品質以EQual（Queen's EPA Quality Rubric, EQual）檢核，再做評分者間一致性檢測。以名義團體法共篩選出「化學藥物靜脈點滴治療病人照護」、「癌症病人情緒困擾之照護」、「癌症末期病人安寧共同照護」等三項任務做為發展EPAs的主題。以問卷調查法由腫瘤護理專家提供內容修改建議，以符合臨床教學實務；由醫事教育專家進行三項EPAs品質EQual評分，平均分數分別為：4.53、4.39、4.19，皆大於合格分數4.07分，內部一致性Cronbach's α達0.89。藉由分享癌症臨床照護可信賴專業活動的發展過程，期能提供同業參考與交流。EPAs仍有發展與應用上的限制，包括各科別的任務內容結構較難有標準化，教學者教學評估的負荷增加等，建議辦理跨專科合作與分享，EPA任務內容做充分的共識討論交換意見，整併重複的評核項目。

關鍵字

可信賴專業活動；癌症照護；新進護理師訓練計畫

並列摘要

Background: The purpose of entrustable professional activities (EPAs) advocated by medical education is to strengthen professional core competencies, structurally confirm the abilities of learners, and assess the trust levels of competence. Because cancer currently ranks first among the causes of death in Taiwan and constitutes a key challenge to health care in countries worldwide, an urgent need for new nurses to be trained in holistic cancer care competencies is present. A team was formed to develop EPAs and to review and examine existing cancer care-related knowledge, skills, and assessment tools to formulate task content, discuss and integrate nominal group methods, conduct importance assessments, and establish expert consensus through questionnaire surveys. The quality of the EPAs was assessed using EQual (Queen's EPA Quality Rubric), and interrater consistency was assessed. Three EPA themes were developed: (1) "Care of intravenous chemical therapy", (2) "Care of cancer patients with emotional distress" and (3) "Palliative care for cancer patients". Oncology nursing experts provided suggestions for modification of the questionnaire content to maximize its association with clinical teaching practice. The average EQual scores of the three EPAs were 4.53, 4.39, and 4.19 for each of the aforementioned themes, respectively. These scores were all higher than the required threshold of 4.07, and Cronbach's α score for internal consistency was 0.89. By sharing the process of developing credible professional activities related to holistic cancer care, we hope to provide a reference and facilitate effective peer exchange. Notably, this study involved several limitations regarding the development and application of EPAs; how these limitations could be eliminated should be carefully considered in future work.

並列關鍵字

entrustable professional activity ； cancer care ； postgraduate training

參考文獻

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