勝任能力為導向的醫學教育（CBME）與藥學教育未來展望

The Competence-Based Medical Education and Future Perspectives of Pharmacy Education

吳庭青(Ting-Ching Wu) ； 高啟蘭(Chi-Lan Kao) ； 黃婉翠(Wan-Tsui Huang)

《臺灣臨床藥學雜誌》 29卷4期 (2021/10) Pp. 206-219

https://doi.org/10.6168/FJCP.202110_29(4).0003

摘要

勝任能力（competency）是在醫療專業人員身上可被觀察到的能力，包含知識、技能和態度等面向。使用勝任能力的組織架構，以成果導向來進行教學計畫的設計、執行與評估即是勝任能力為導向的醫學教育（competence-based medical education, CBME）。CBME的概念包含四個原則，分別是聚焦於學習成果、強調能力、不強調時間導向的訓練，與以學員為中心。在落實CBME於臨床教育方面分為兩部分，其一為勝任能力的評核，方法有里程碑（milestones）與可信任專業活動（entrustable professional activities, EPAs）；其二為透過成立臨床能力委員會（clinical competency committee），建立一套完整的系統性教學評量、回饋與課程改善機制，確保完訓者擁有獨立完成臨床任務的能力。關於藥學教育的現況，美國臨床藥學會（American College of Clinical Pharmacy）、美國藥學院協會（American Association of Colleges of Pharmacy, AACP）與美國衛生系統藥師協會（American Society of Health-System Pharmacists）皆有對藥學生或畢業後新進（postgraduate year, PGY）藥師之教學計畫訂定核心能力與可觀察到的標準，AACP更進一步於2017年提出適用於藥學畢業生的核心EPAs。財團法人醫院評鑑暨醫療品質策進會也於2018年提出西醫師PGYEPAs試辦計畫。在這股以勝任能力為導向的風潮下，藥師也應審視既有的課程、評量與勝任能力之間的關係，確保完訓藥師皆能提供高品質且安全的醫療照護，符合病人與民眾的期許。

關鍵字

CBME ； 里程碑 ； EPAs ； CCC

並列摘要

The performance of health professionals in executing clinical duties can be gauged as clinical competency in various dimensions such as knowledge, skills, and attitudes. Medical education programs to improve clinical competence, or competence-based medical education (CBME), adopt goals-directed philosophy in the design, execution, and assessment steps with an organized scheme of standards of performance. CBME relies on four principles, namely, focusing on outcomes, emphasizing clinical competency to acquire, de-emphasizing time allocation, and promoting greater learner centeredness. There are two parts to practice CBME. The first part is the assessment of competency with tools like milestones and entrustable professional activities (EPAs). The second part is to establish a complete mechanism of teaching evaluation, course feedback, and improvement by a clinical competency committee, to ensure that trainees have the ability to complete clinical tasks independently. With regard to the current state of pharmacy education, the American College of Clinical Pharmacy, the American Association of Colleges of Pharmacy (AACP), and the American society of health-system pharmacists have defined core competencies and standards of observable performance for pharmacy students in the pre- and postgraduate years (PGY). The AACP went a step further by introducing core EPAs for pharmacy graduates in 2017. The joint commission of Taiwan also proposed a pilot project including EPAs for medical graduates in PGY in 2018. With this trend towards competence-based learning, pharmacists should also re-evaluate the relationship between existing curricula and their potential to achieve competency, so as to ensure that pharmacists in training, after completion of clinical programs, are able to provide high quality and safe health care that meets the expectation of patients and the public.

並列關鍵字

Competence-Based Medical Education (CBME) ； Milestones ； Entrustable Professional Activities (EPAs) ； Clinical Competency Committee (CCC)