Entrustable Professional Activities in General Practice: Applications and Prospects

doi:10.12114/j.issn.1007-9572.2022.0235

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (19): 2307-2314.DOI: 10.12114/j.issn.1007-9572.2022.0235

Special Issue: 述评栏目最新文章合辑

• Editorial • Next Articles

Entrustable Professional Activities in General Practice: Applications and Prospects

1. Vanke School of Public Health, Tsinghua University, Beijing 100084, China
2. School of Medicine, Tsinghua University, Beijing 100084, China
3. Dengxiang Township Health Centre, Luohe 462324, China
4. Institute for Healthy China, Tsinghua University, Beijing 100084, China

Received:2022-04-13 Revised:2022-05-23 Published:2022-07-05 Online:2022-05-26
Contact: Yanhua CHEN, Jiming ZHU
About author:
DU Y R, CHEN Y H, WANG P C, et al. Entrustable professional activities in general practice: applications and prospects[J]. Chinese General Practice, 2022, 25 (19) : 2307-2314.

置信职业行为在全科医学领域的应用现状与展望

1．100084　北京市，清华大学万科公共卫生与健康学院
2．100084　北京市，清华大学医学院
3．462324　河南省漯河市邓襄镇卫生院
4．100084　北京市，清华大学健康中国研究院

通讯作者: 陈彦桦, 朱纪明
作者简介:
杜妍蓉，陈彦桦，王培成，等.置信职业行为在全科医学领域的应用现状与展望[J].中国全科医学，2022，25（19）：2307-2314.[www.chinagp.net] 作者贡献：杜妍蓉、陈彦桦、朱纪明负责文章的构思与设计，文献/资料收集与整理；杜妍蓉负责文章撰写与修订；陈彦桦、王培成、李晗歌、安朝阳参与文章修订和可行性分析；朱纪明负责文章的质量控制，并对文章整体负责。
基金资助:
国家卫生健康委员会科教司委托项目(20212001458); 清华大学卫健学院科研培育项目(100004001)

1. .pdf(622KB)

Abstract

Abstract:

The concept of entrustable professional activities (EPAs) was initiated by a medical professor in the Netherlands in 2005 with the aim of enhancing the implementation of competency-based medical education (CBME) in clinical practice. After more than ten years of development, great progress has been made in EPAs (mainly for training and assessment) in a variety of medical specialties in many countries, which has influenced general practice significantly. Some countries such as Canada, Australia and the U.S. have been developing their own EPAs in general practice, which can be applied to the supervision and assessment of trainees, and the entrustment decisions of supervisors. To our best knowledge, limited research in China has been focused on the EPAs, let alone their applications in general practice. We analysed the research developments, potential challenges and prospects of EPAs in general practice, hoping to provide evidence for future research in China.

Key words: Entrustable professional activities, Competency-based medical education, General practice

摘要：

为增强基于胜任力的医学教育（CBME）在临床实践环境中的可操作性，荷兰医学教育家于2005年提出置信职业行为（EPAs）概念。经过十多年的发展，EPAs在各国的多个医学专业培训与评估中取得长足进展，并逐渐在全科医学领域产生广泛影响。美国、加拿大、澳大利亚等国学者开发了全科EPAs清单，并将EPAs应用于对学员的监督和评估，以及对监督者的置信决策等方面。但我国对EPAs的研究尚处于起步阶段，在全科医学领域基本处于空白状态。本研究重点梳理了EPAs在全科医学领域的研究进展，分析了EPAs在全科医学领域应用的潜在问题及进一步的研究方向，以期为中国学者开展相关研究提供参考。

关键词: 置信职业行为, 基于胜任力的医学教育, 全科医学

Yanrong DU,Yanhua CHEN,Peicheng WANG, et al. Entrustable Professional Activities in General Practice: Applications and Prospects[J]. Chinese General Practice, 2022, 25(19): 2307-2314. DOI: 10.12114/j.issn.1007-9572.2022.0235.
杜妍蓉,陈彦桦,王培成等. 置信职业行为在全科医学领域的应用现状与展望[J]. 中国全科医学, 2022, 25(19): 2307-2314. DOI: 10.12114/j.issn.1007-9572.2022.0235.

Figures/Tables 1

References 44

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国家	EPAs名称	年份（年）	清单条目	实践应用
美国	全科医学76条EPAs清单	2013	进行成人体检、管理糖尿病患者、管理发热儿童、进行儿童体检、进行新生儿体检、管理腹痛患者等	选取其中60条EPAs构建住院医师认知技能文档，对住院医师认知技能的知识、理解及应用三个方面进行高频率观察
美国	FMAHealth 20条EPAs清单	2015	为所有年龄段的人提供全面、纵向的医疗服务；在多种环境下照顾患者和家属；针对健康及医疗问题提供首诊服务；提供预防保健，从而改善健康状况、干预疾病和伤害的风险因素，并在早期可治疗阶段发现疾病；提供加速康复和功能改善的医疗服务等	用于毕业后全科医学3年培训项目，基于EPAs进行住院医师自评与他评，实现长期、即时、客观的评估。可用于住院医师培训计划开发和课程的评估与设计
加拿大	全科住院医师35条EPAs清单	2015	包含9个领域，分别为：母婴医疗服务、儿童和青少年的医疗服务、成年人的医疗服务、老年人的医疗服务、临终关怀、行为医学、全球健康与弱势群体的医疗服务、外科与操作技能、职业素养。每个领域涵盖3~5项EPAs	纳入现有评估系统，作为住院医师胜任力发展的评估工具和学习工具，通过大量持续的EPAs评价表形成胜任力发展的可追踪轨迹图
澳大利亚	全科职业培训评估13条EPAs清单	2019	全面采集病史，并对所有患者进行检查；诊断常见病，并对鉴别诊断进行优先排序；在多种医疗服务环境中管理急症患者；管理常见慢性病患者和多病共存状态等	将EPAs应用于全科低/高年资学员的培训质量评估，以EPAs置信等级为刻度开展4次为期12个月的评估，同时进行学员的置信等级自评，展现了EPAs及其置信等级在培训评估中的优势
澳大利亚	全科学员80条求助EPAs清单	2020	包含了急诊、恶性肿瘤的早期识别、心理健康、儿科、女性健康、老年医疗服务和姑息治疗、普通内科、依赖/成瘾/疼痛管理、性健康、旅行医学10个领域内容。每个领域下分为若干临床问题	在培训初期提示全科学员应当向监督者求助的一系列工作场景，提示全科学员及时向监督者求助，以便更好地保障患者安全

国家	EPAs名称	年份（年）	清单条目	实践应用
美国	全科医学76条EPAs清单	2013	进行成人体检、管理糖尿病患者、管理发热儿童、进行儿童体检、进行新生儿体检、管理腹痛患者等	选取其中60条EPAs构建住院医师认知技能文档，对住院医师认知技能的知识、理解及应用三个方面进行高频率观察
美国	FMAHealth 20条EPAs清单	2015	为所有年龄段的人提供全面、纵向的医疗服务；在多种环境下照顾患者和家属；针对健康及医疗问题提供首诊服务；提供预防保健，从而改善健康状况、干预疾病和伤害的风险因素，并在早期可治疗阶段发现疾病；提供加速康复和功能改善的医疗服务等	用于毕业后全科医学3年培训项目，基于EPAs进行住院医师自评与他评，实现长期、即时、客观的评估。可用于住院医师培训计划开发和课程的评估与设计
加拿大	全科住院医师35条EPAs清单	2015	包含9个领域，分别为：母婴医疗服务、儿童和青少年的医疗服务、成年人的医疗服务、老年人的医疗服务、临终关怀、行为医学、全球健康与弱势群体的医疗服务、外科与操作技能、职业素养。每个领域涵盖3~5项EPAs	纳入现有评估系统，作为住院医师胜任力发展的评估工具和学习工具，通过大量持续的EPAs评价表形成胜任力发展的可追踪轨迹图
澳大利亚	全科职业培训评估13条EPAs清单	2019	全面采集病史，并对所有患者进行检查；诊断常见病，并对鉴别诊断进行优先排序；在多种医疗服务环境中管理急症患者；管理常见慢性病患者和多病共存状态等	将EPAs应用于全科低/高年资学员的培训质量评估，以EPAs置信等级为刻度开展4次为期12个月的评估，同时进行学员的置信等级自评，展现了EPAs及其置信等级在培训评估中的优势
澳大利亚	全科学员80条求助EPAs清单	2020	包含了急诊、恶性肿瘤的早期识别、心理健康、儿科、女性健康、老年医疗服务和姑息治疗、普通内科、依赖/成瘾/疼痛管理、性健康、旅行医学10个领域内容。每个领域下分为若干临床问题	在培训初期提示全科学员应当向监督者求助的一系列工作场景，提示全科学员及时向监督者求助，以便更好地保障患者安全

Entrustable Professional Activities in General Practice: Applications and Prospects

置信职业行为在全科医学领域的应用现状与展望

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