從「醫療勝任能力」到「勝任醫療任務」：可信賴專業活動（EPAs）之實務應用

From Medical Competencies to Competent Medical Professionals: Application and Implementation of Entrustable Professional activities(EPAs)

以勝任能力為導向的醫學教育（competency-based medical education, CBME）是近年來醫學教育改革的趨勢，為使CBME 能夠落實在臨床工作職場的訓練與評估中，並弭平課堂教學與職場執業的落差，許多機構紛紛採用可信賴專業活動（entrustable professional activities, EPAs）的理論架構在臨床訓練中。本文從四個面向闡述從EPAs 的理論架構到實務應用的重要環節，包括：EPAs 之制定與共識、信賴等級與監督等級之關係、EPAs 與里程碑之關係、利用EPAs 進行臨床能力之評估。透過EPAs 的建置、執行、與評估，在兼顧病人安全與工作效率的前提下，循序漸進的增加受訓學員的參與及責任，讓核心的「醫療勝任能力」能夠轉化成執行臨床核心任務的勝任醫療人員。

Competency-based medical education (CBME) has been the current trend of medical educational reform. In order to implement CBME in clinical workplace training and assessment and close the gap between classroom learning and workplace practice, the concept and framework of entrustable professional activities (EPAs) have been widely applied for clinical training in many institutions. This article elaborated key elements while applying EPAs to clinical practice and training from four perspectives: identification and consensus of EPAs, relationship between supervision levels and entrustment decisions, relationship between EPAs and milestones, and assessment of clinical performance via EPAs. Through the identification, implementation and assessment of EPAs, core medical competencies could be transformed to competent medical professionals, executing clinical core professional activities or tasks through step-by-step increased participation and accountability of trainees, balancing clinical training, patient safety and working efficiency at the same time.