Exploring Integration in Action: Competencies as Building Blocks of Expertise
Exploring Integration in Action: Competencies as Building Blocks of Expertise
复制标题
探索行动中的整合：能力作为专业知识的基石
DOI：
10.1097/acm.0000000000001772
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发表时间：
2017
影响因子：
7.4
通讯作者：
Nicole N. Woods
中科院分区：
文献类型：
--
作者：
M. Mylopoulos;Debaroti Borschel;T. O’Brien;Sofia Martimianakis;Nicole N. Woods
目的能力框架，如CanMEDS角色和ACGME核心能力可能会导致医生可以孤立地学习和实践个人能力的隐含假设。与此相反，适应性专业知识的模型表明，能力的整合反映了专家医生的能力。因此，旨在教授离散角色或能力的教育规划可能会忽视对患者护理至关重要的专家医生能力。为了发展专门知识，学习机会必须反映专家能力。为了更好地理解能力为基础的医学教育和专家发展之间的关系，作者试图探讨如何制定综合能力在病人护理研究生医学实习生。方法使用认知民族志的方法，在2014-2015年，作者进行了观察，并完善和阐述这些观察，特别是非正式采访13名研究生实习生参与者。数据收集导致92小时的观察，26例患者的情况下，肖像，和共220页的现场记录进行分析。通过分析，作者确定和检查的时刻，研究生学员似乎是同时制定多种能力。结果作者确定了两个关键的专家能力的时刻，综合能力：发现复杂性和以病人为中心。他们描述了这些整合形式的两种机制：重视患者对其疾病的叙述，以及整合理解。结论理解综合能力作为专家能力的组成部分，沿着认识到支持整合的机制的重要性，提供了一个机会，利用现有的能力为基础的框架来理解和教授适应性的专业知识。
Purpose Competency frameworks such as the CanMEDS roles and the ACGME core competencies may lead to the implicit assumption that physicians can learn and practice individual competencies in isolation. In contrast, models of adaptive expertise suggest that the integration of competencies reflects the capabilities of an expert physician. Thus, educational programming aimed at teaching discrete roles or competencies might overlook expert physician capabilities that are central to patient care. To develop expertise, learning opportunities must reflect expert capabilities. To better understand the relationship between competency-based medical education and expert development, the authors sought to explore how integrated competencies are enacted during patient care by postgraduate medical trainees. Method Using a cognitive ethnographic approach, in 2014–2015 the authors conducted observations and—to refine and elaborate these observations—ad hoc informal interviews with 13 postgraduate trainee participants. Data collection resulted in 92 hours of observation, 26 patient case portraits, and a total of 220 pages of field notes for analysis. Through analysis, the authors identified and examined moments when postgraduate trainees appeared to be simultaneously enacting multiple competencies. Results The authors identified two key expert capabilities in moments of integrated competence: finding complexity and being patient-centered. They described two mechanisms for these forms of integration: valuing the patient’s narrative of their illness, and integrated understanding. Conclusions Understanding integrated competencies as the building blocks of expert capabilities, along with recognizing the importance of mechanisms that support integration, offers an opportunity to use existing competency-based frameworks to understand and teach adaptive expertise.