畢業後一般醫學訓練住院醫師對於施行可信賴專業活動之觀點探討: 質性研究

Abstract

核心能力導向醫學教育（Competency-based Medical Education，CBME）是近年來醫學教育改革趨勢，主要根據社會及醫療需求定義住院醫師所需之核心能力，再依核心能力去進行課程設計，強調課程結束後之成果，而非過程面的課程內容或評量。目前許多醫學教育學者及機構提出落實CBME的具體做法，其中較知名的方法就是可信賴之專業活動(Entrustable Professional Activities，EPAs）及里程碑計畫（Milestones Project）。國泰綜合醫院於2019年開始規劃將全院之教學課程設計導入可信賴的專業活動概念，並首先於一般醫學內科示範病房全面執行。 本研究之目的是以住院醫師的觀點出發，探討導入可信賴專業活動的訓練模式後住院醫師的學習經驗變化。本研究為質性研究，使用針對住院醫師的深度訪談做為資料收集的方式，透過逐字稿分析了解住院醫師對於可信賴專業活動的觀點。我們發現可信賴專業活動透過聚焦專業任務，加深核心能力與臨床工作的串聯，有助於住院醫師創造核心能力相關的學習目標。可信賴專業活動，不只做為一個評估工具，更可以協助教師指導核心能力教學與聚焦臨床回饋。

Competency-based Medical Education (CBME) is the trend of medical education in recent years. It mainly designs courses according to the core competencies of the trainees, and emphasizes the outcomes after training, other than focusing on the process such as course content or assessment. Many scholars and institutions in the field of medical education have proposed the methods implement CBME. The most famous tools are Entrustable Professional Activities (EPAs) and Milestones Project. Cathay General Hospital started out medical education program under the setting of Entrustable professional activities (EPAs) since 2019. First we started the pilot program in the general internal medicine training center. Our study aimed to collect the qualitative data from postgraduate residents' about their learning experience after entrustable professional activities implementation. We used depth interviews to the residents for data collection. Through transcripts analysis, we understood the postgraduate residents' perceptions about entrustable professional activities. We found that entrustable professional activities can enhance the connection of core competencies and clinical works by focusing on professional tasks. It could also assist the residents to create learning target relating to core competencies. Entrustable professional activities are not only assessment tools, they can guide clinical teaching and create focused feedback.