導入可信賴專業活動(EPAs)於醫事檢驗師PGY學員臨床抽血技能訓練之實務分享

Clinical Blood Drawing Skills Training for Medical Technologist PGY Trainees through Implementation of Entrustable Professional Activities (EPAs)

以勝任能力為導向的醫學教育（Competency-based medical education, CBME）目前已成為國內教學醫院各部門互相學習的目標，而可信賴專業活動（Entrustable professional activities, EPAs）是目前最常用來落實CBME的重要策略。本研究以檢驗醫學部二年期新進（Post-graduate year, PGY）醫事檢驗師為對象，以EPAs為架構進行臨床抽血技能訓練之推廣專案。依EPAs步驟流程設計以「臨床門診採血作業」為任務，建置即時評估表（Ad hoc）與多元評估來認定信賴等級（1-5 level，共7個等級），並以等級4A「可獨立執行任務」為合格標準。執行結果分析，表單內容效度指數（Content validity index, CVI值）為100%；以三段試評影片進行表單信度驗證，教師評分共識（Cronbach’sα值）分別為0.84，0.84，0.99；學員成績結訓皆達4A。抽血技能訓練EPAs推廣專案執行前後，教師活動滿意度調查關於「學員的學習成效」由7.78提升至8.83 （p值=0.20）；「教師間評核一致性」由7.89提升至8.67 （p值=0.28）；「EPA評估工具容易操作度」由7.22提升至7.67 （p值=0.54）；「評估工具滿意度」由7.56提升至8.50 （p值=0.21）。學員活動滿意度調查認為「對抽血更具信心且收穫更多」為9.8。由滿意度結果得知教師與學員皆認同EPAs推廣專案；臨床能力委員會（Clinical Competency Committee，CCC）除了給予最終的信賴等級外，也可針對EPAs推廣專案作適度的調整。

Competency-based medical education (CBME) has gained popularity as a method of teaching and assessing clinical skills. Entrustable professional activities (EPAs) have been utilized to implement CBME, and this study focuses on the promotion of clinical blood drawing skills training using EPAs in a teaching hospital. Specifically, the study targets two-year post-graduate year (PGY) medical technologists in the Department of Laboratory Medicine. The mission of ’’clinical outpatient blood collection procedure’’ is assigned according to step-by-step process design of the EPAs, and real-time evaluation forms and multi-assessments are used to verify the entrustment scale. The eligibility criteria for the PGY medical technologists to achieve is level 4A, which signifies the ability to perform tasks independently.
The results of the study are promising. The content validity index (CVI value) of the evaluation form was 100%, indicating high quality and relevance of the assessment tool. The reliability of the form was also verified through testing evaluation videos, and consensus teacher evaluations showed high agreement (Cronbach’sαvalues of 0.84, 0.84, and 0.99). At the end of the training, all PGY students achieved the grade of 4A, demonstrating successful attainment of the targeted clinical skills.
Teacher and student satisfaction with the training program was assessed through surveys. Teachers reported increased satisfaction with ’’students’ learning effectiveness,’’ ’’inter-teacher evaluation consistency,’’ and ’’ease of operation of EPAs assessment tools’’ after the implementation of the blood drawing skills training EPAs project. Similarly, trainees rated the program highly with 9.8 on the satisfaction assessment, indicating gains in confidence with blood drawing.
The positive feedback from both teachers and students suggests that the EPAs project was successful. The Clinical Competency Committee (CCC) can use the project’s entrustment scale as a framework for evaluating and revising the blood drawing skills training program. This study contributes to the growing body of research supporting the use of CBME and EPAs in medical education, and highlights the potential for improving the quality of clinical skills training through targeted and effective assessments.
In summary, this study provides evidence for the effectiveness of an EPAs-based approach to clinical blood drawing skills training, with high levels of satisfaction reported by both teachers and students