可信賴專業活動評量與回饋的執行困境與因應策略

Implementing Entrustable Professional Activity (EPA) Assessment and Strategies for Improvement

本研究目的是探討某區域教學醫院分院之急診部門的臨床教師，在以EPAs（Entrustable Professional Activities，EPAS）為導向的架構下，針對訓練計畫中的住院醫師進行評量與回饋時，所面臨的執行困境與因應之策略。本研究採半結構式訪談法進行資料的蒐集，訪談對象為區域教學醫院的三所分院之急診部門的9位臨床教師。臨床教師執行過程中，面臨的困境包含急診特性造成的教學時間有限或心力不足、住院醫師之學習經驗差異造成的回饋困難、尚未系統化的教學支援，致使評量及回饋造成時間和精神上的消耗、多元獎勵制度的實施仍待完善。另外，雖然受訪者認同EPAs資訊輔助系統在協助住院醫師的評量與回饋的諸項功能，但資訊輔助系統的介面友善程度應再優化，以及部分功能需再加強。藉由本研究分析與探討臨床教師的困境之後，建議藉由深化臨床教師對於CBME及EPA的認識、發展差異化且適性的教學與回饋策略、提供系統化師資培訓規劃與回饋引導、完善多元獎勵制度與教學支援系統，佐以資訊輔助平台功能優化的協助，讓教學、評量與回饋品質能具體提升，從而有效強化住院醫師的訓練效果。

This research aims to investigate the implementation dilemma encountered and response strategies adopted by clinical preceptors in the emergency department of regional teaching hospitals under the EPAs (Entrustable Professional Activities) -oriented framework in terms of the assessment of residents in training programs and provision of feedback. In this research, a semi-structured interview method was adopted to collect data. The interviewees were nine clinical preceptors in the emergency department from three regional teaching hospitals in northern, central, and southern Taiwan. Overall, the interviewees agreed that the EPAs-based e-portfolio system was helpful in the assessment of residents and the provision of feedback, but the friendliness of the system interface and some functions needed to be enhanced. In addition, there were other difficulties, including limited teaching time or inability to accomplish all the requirements due to the characteristics of the emergency department, difficulties in providing feedback due to different residents' learning experience, the time and mental consumption in the assessment and feedback caused by unsystematic teaching support, and the implementation of a diverse reward system that still needed to be improved. After the clinical preceptors' predicaments were analyzed and explored through this research, it is suggested that clinical preceptors' understanding of competency-based medical education (CBME) and EPAs should be increased, differentiated and appropriate teaching and feedback strategies need to be developed, systematic teacher training plans and feedback guidance ought to be provided, and the diverse reward system and teaching support system require improvement, as well as the functions of the e-portfolio system should be optimized, so as to specifically improve the quality of teaching, assessment, and feedback, thereby strengthening residents' training effectiveness.