Viewpoint: Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice?
Viewpoint: Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice?
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观点： 基于能力的研究生培训： 我们能否弥合理论与临床实践之间的差距？
DOI：
10.1097/acm.0b013e31805559c7
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发表时间：
2007-06-01
影响因子：
7.4
通讯作者：
Scheele, Fedde
中科院分区：
文献类型：
--
作者：
ten Cate, Olle;Scheele, Fedde
引入能力为基础的研究生医学培训，最近在加拿大，美国，英国，荷兰和其他国家的国家管理机构的刺激，是一个重大的进步，但在同一时间，它唤起了课程实施的关键问题。一个令人关注的问题是将一般能力转化为临床教学实践。作者观察到围绕术语能力的混乱，这可能会产生不利影响时，教学和评估计划的设计。本文旨在澄清能力术语。为了将能力框架背后的想法与患者护理的工作环境联系起来，作者建议分析专业实践的关键活动，并将这些活动与预定的能力联系起来，使用可持续的专业活动（EPA）和授予的责任声明（STARs）可能会弥合基于能力的教育理论与临床实践之间的潜在差距。经济伙伴关系协定反映了共同构成这一职业的那些活动。执行大多数这些经济伙伴关系协定需要具备若干能力。作者建议不要花太多的精力来评估能力，因为它们是在能力框架中抽象定义的，而是专注于观察具体的关键临床活动，并从几个观察到的活动中推断出多种能力的存在。然后，居民可以被授予EPA的责任。这可以有助于向基于能力的培训迈进，在这种培训中，培训的时间长短可以灵活，培训的结果比培训的时间长短更为重要。
The introduction of competency-based postgraduate medical training, as recently stimulated by national governing bodies in Canada, the United States, the United Kingdom, The Netherlands, and other countries, is a major advancement, but at the same time it evokes critical issues of curricular implementation. A source of concern is the translation of general competencies into the practice of clinical teaching. The authors observe confusion around the term competency, which may have adverse effects when a teaching and assessment program is to be designed. This article aims to clarify the competency terminology. To connect the ideas behind a competency framework with the work environment of patient care, the authors propose to analyze the critical activities of professional practice and relate these to predetermined competencies.The use of entrustable professional activities (EPAs) and statements of awarded responsibility (STARs) may bridge a potential gap between the theory of competency-based education and clinical practice. EPAs reflect those activities that together constitute the profession. Carrying out most of these EPAs requires the possession of several competencies. The authors propose not to go to great lengths to assess competencies as such, in the way they are abstractly defined in competency frameworks but, instead, to focus on the observation of concrete critical clinical activities and to infer the presence of multiple competencies from several observed activities. Residents may then be awarded responsibility for EPAs. This can serve to move toward competency-based training, in which a flexible length of training is possible and the outcome of training becomes more important than its length.