信賴授權導向的討論應用於畢業後一般醫學內科訓練

Applying Entrustment-Based Discussion in Post-Graduate Year Training in Internal Medicine Rotations

信賴授權導向的討論（entrustment-based discussion, EBD），是以勝任能力為導向的醫學教育（competency-based medical education, CBME）中，評估可信賴專業活動（entrustable professional activities, EPAs）的寶貴工具。透過促進教師與學習者之間的結構化對話，EBD為做出信賴授權決定，提供了豐富的資訊來源。本研究顯示學員應答EBD 4個主要問題的狀況，會影響該次EBD所授予的信賴等級，妥善回答越多題項，可獲得更高的信賴等級，且有明確的對應型態可循。本研究發現EBD與現有的簡短臨床觀察（short practice observation, SPO），提供不同的評估資訊，且相較於SPO，EBD更有助於臨床能力委員會（clinical competency committee），進行總結性信賴授權決定。考量CBME為近年來醫學教育改革的趨勢，我們建議醫學教師在其訓練計畫中納入EBD，在EPAs框架內提供學員有效的評估和回饋。

Entrustment-based discussion (EBD) is a valuable tool for assessing entrustable professional activities (EPAs) within competency-based medical education (CBME). By facilitating structured conversations between educators and learners, EBD provides a rich source of information for making entrustment decisions. This study demonstrates that learners' responses to the four key EBD questions significantly influence the entrustment levels granted during the discussion. The more thoroughly learners answer these questions, the higher the entrustment level they are likely to receive, with clear response patterns identified. Our findings reveal that EBD provides different assessment information compared to short practice observations (SPOs). Furthermore, EBD is more beneficial than SPOs in supporting the clinical competency committee (CCC) in making summative entrustment decisions. Considering that CBME has become a key trend in medical education reform, we recommend that medical educators incorporate EBD into their training programs and enhance the assessment and feedback provided to learners within the EPAs framework.