- 期刊
耳鼻喉科住院醫師訓練中導入「學習里程碑」評量計畫
Implementation of the Milestone Project in Otolaryngologic Residency Training
摘要
背景：以核心能力(core competency)為導向的醫學教育訓練(competency-based medical education, CBME)已成主流，如何於耳鼻喉科住院醫師訓練過程中落實六大核心能力教學，達成學習目標，則需要一套有系統的評量方法，用來記錄、評估受訓學員的學習進程。方法：本研究取得美國畢業後醫學教育評鑑委員會(the Accreditation Council for Graduate Medical Education, ACGME)正式授權，翻譯耳鼻喉科「學習里程碑」(milestone)為繁體中文版，經ACGME逆向翻譯審核通過，科內10名主治醫師篩選後，訂出耳鼻喉科「學習里程碑」評量系統(the Otolaryngology Milestone Project)，並於2017年7月針對本院4位住院醫師進行第一次評量，評量後收集並比較住院醫師自評、總醫師及主治醫師複評的結果，提出報告。結果：耳鼻喉科「學習里程碑」評量系統含21項「次核心能力」(subcompetency)，每項分5階，每階有1-6個里程碑，共368個里程碑。住院醫師自評、總醫師及主治醫師複評所需時間介於15-30分鐘，整體平均分數隨著訓練年資呈現更高的里程碑階層，雖然各級住院醫師的自評分數都低於總醫師及主治醫師複評的平均分數，但仍呈現相當的一致性。結論：耳鼻喉科「學習里程碑」評量系統涵蓋知識、技能、態度與行為特質等層面，有助於分析並了解住院醫師在六大核心能力的學習進程，住院醫師的整體分數(階)隨著訓練年資逐步提升，且在自評及總醫師、主治醫師的複評分數中呈現一致性，藉由本研究的初步成果，可作為專科學會制訂「學習里程碑」評量系統之參考。
並列摘要
BACKGROUND: Competency-based medical education has emerged as a mainstream method for educating and assessing the next generation of physicians. A framework for assessing the development of otolaryngologic resident physicians over six core competency domains is essential. METHODS: We obtained a formal license agreement from the Accreditation Council for Graduate Medical Education (ACGME) to translate the Otolaryngology Milestones into the traditional Chinese version. The traditional Chinese version of the Otolaryngology Milestones had previously been translated into English and approved by the ACGME. A working group of ten staff otolaryngologists was responsible for the screening and the development of the milestone project most applicable to otolaryngology. We piloted the milestone assessment with four residents in July 2017. The residents performed independent self-evaluations, and the chief residents and the staff physicians graded them independently. We compared score differences based on postgraduate year level and raters (self, chief resident, and staff). RESULTS: The Otolaryngology Milestone Project comprises 21 subcompetencies. Each subcompetency has five levels and each level contains one to six milestones. In total, 368 milestones are included. Completing Otolaryngology Milestone evaluations requires an average of 15-30 minutes per resident. Overall, the milestone data revealed greater attainment of milestones as the program progressed. The residents underestimated their level of proficiency. Agreement between each resident's self-assessment and chief resident and staff grading was moderate. CONCLUSIONS: The Otolaryngology Milestones represent the knowledge, skills, attitudes, and attributes that correspond to each milestone component and level. The milestones are intended to describe and document resident's progress in developing competencies based on observable measures. Our preliminary data revealed greater achievement of milestone levels as the program progressed and moderate interrater agreement.