建構台灣耳鼻喉頭頸外科能力導向住院醫師醫學教育訓練的整合式可信賴專業活動模式

Developing a Competency-Based Medical Education for Taiwan Otolaryngology-Head and Neck Surgery Resident Physician Training-An Integrated Entrustable Professional Activities Model

陳正文(Jeng-Wen Chen) ； 許巍鐘(Wei-Chung Hsu)

《台灣耳鼻喉頭頸外科雜誌》 57卷2期 (2022/06) Pp. 110-122

https://doi.org/10.6286/jtohns.202206_57(2).110

摘要

背景：學習里程碑（milestone）與可信賴專業活動（entrustable professional activity, EPA）是能力導向醫學教育（competency-based medical education, CBME）中的兩個主流評量工具；milestone描述個人所應具備的核心能力，EPAs則落實工作場域中的即時評量與回饋。本研究的目的在於設計規劃並建構台灣耳鼻喉頭頸外科住院醫師及專科醫師訓練本土化的整合式EPA學習評量架構。方法：在台灣耳鼻喉頭頸外科醫學會中成立CBME核心小組，運用修正式Glaser's最佳共識法決定EPA五階段定義、EPA任務主題的分類方式及數量。在完成整合式EPA學習評量草案後，經內部與外部專家審查EPA內容，再次修訂完成後定稿。結果：CBME核心小組包括10名委員，於2020年8月至2021年6月間經4次會議討論後完成整合式EPAs學習評量初稿，外審委員共包括8名非耳鼻喉科醫師與護理師背景之醫學教育專家，量性審查採用QUEPA（quality of entrustable professional activity）及EQual兩項工具，內審及外審的EPA內容審查結果以熱點圖協助呈現修訂焦點，QUEPA內、外審之平均分數分別為4.35 ± 0.64及4.65 ± 0.67（Likert scale 1-5），一致性檢定為0.79；EQual內、外審之平均分數分別為4.23 ± 0.65及4.64 ± 0.58 （Likert scale 1-5），一致性檢定為0.69，再次修訂後於2021年6月27日定稿完成。結論：本研究完成第一部台灣本土化整合EPA與milestone的「台灣耳鼻喉頭頸外科醫學會專科醫師訓練整合式學習評量」草案，作為耳鼻喉頭頸外科邁向CBME典範轉移的基礎藍圖。

關鍵字

competency-based medical education ； core competencies ； entrustable professional activity ； milestones ； Otolaryngology-Head and Neck Surgery ； resident physician（能力導向醫學教育 ； 核心能力 ； 可信賴專業活動 ； 學習里程碑 ； 耳鼻喉頭頸外科 ； 住院醫師）

並列摘要

BACKGROUND: Milestones and entrustable professional activities (EPAs) are two mainstream assessment tools in competency-based medical education (CBME). Milestones indicate a physician's attainment of core competencies, and EPAs operationalize workplace-based assessments and facilitate coaching and feedback. This study developed an integrated Taiwanese EPA-based learning and assessment framework for the training of Taiwanese resident otolaryngologists. METHODS: The CBME core group was assembled in the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery. We used the modified Glaser's state-of-the-art approach to consensus method to determine the definitions of the five-level EPAs, the categorization, and the number of task titles in the EPAs project. After we completed the draft, the core group members and external review group members subsequently reviewed the content of the EPAs. After the amendment, the core group members then discussed and finalized the EPA-based integrated assessment framework. RESULTS: The CBME core group comprised 10 members, and the external review group consisted of eight physicians and nursing or medical educators for quantitative and qualitative review. The Quality of Entrustable Professional Activities (QUEPA) and EQual assessment tools were used to evaluate the quality of the EPAs quantitatively. The average QUEPA scores in the internal and external reviewers were 4.23 ± 0.65 and 4.65 ± 0.67 (Likert scale 1-5), respectively, the overall intraclass correlations (ICC) of the QUEPA was 0.79. The average EQual scores in the internal and external reviewers were 4.23 ± 0.65 and 4.64 ± 0.58 (Likert scale 1-5), respectively, the overall ICC of the EQual was 0.69. In addition, heatmaps were employed to visualize the internal and external review results and assisted in identifying EPA aspects for further revision. From August 2020 to June 2021, the core group convened for four sessions to complete the finalized documents. CONCLUSIONS: Herein, we present a localized Taiwanese version of an integrated EPA-based assessment framework for resident otolaryngologists. The framework serves as the basis for the reorientation of otolaryngologist training to align with the CBME model.

並列關鍵字

competency-based medical education ； core competencies ； entrustable professional activity ； milestones ； Otolaryngology-Head and Neck Surgery ； resident physician