11-以能力为基础的住院医师培训
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Introduction to Competency-Based Residency Education 以能力为基础的住院医师培训
Eric Schackow MD, PhD 医学博士，科学博士 Beijing, China 中国 北京 April 2012 2012 年4月 (adapted from Joyce, 2006)
Derstine, 2006
Goals of the Outcome Project 效果评估计划的目标
Practice-based Learning & Improvement 以实践为基础的学习和提高 Systems-based Practice Patient Care
Improving 以系统为基础的实践 Patient Care 病人照顾 改善病人 Medical 照顾 Knowledge Professionalism专业素养 医学知识 Interpersonal & Communication Skills 人际关系和交流技巧
阐述“效果评估计划”的基础含义，包含“核心能力”的概念
•Give practical examples of how the Core Competencies can be applied to individual resident performance
举实例看“核心能力”如何应用在住院医师临床技能上。
5. Analyze practice experience and perform practice-based improvement activities using a systematic methodology分析实 践经验，应用系统的方法论采取实践导向的改进措施。 Obtain and use information about their own population of patients and the larger population from which their patients are drawn从病人及病人所属的群体中获取并使用相关信息。 Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems寻找、评估、 理解与病人健康问题相关的科学研究。
Objectives目标
Upon completion of this lecture, Program Directors and faculty will be able to:
通过完成此次课程，项目主任和教师将会：
•State foundational concepts of the Outcome Project, including the concept of Core Competencies
住院医师在对病人健康问 题的处理及健康促进方面 要能提供关心的、恰当的 和有效的照顾服务。
Residents are expected to: 住院医师要：
Practice Based Learning and Improvement 基于实践的学习和提高
Residents must be able to 1. investigate and evaluate their patient care practices, 2. appraise and assimilate scientific evidence, and 3. improve their patient care practices.住院医师必须能够 发现并评估自己的临床工作 4. 状况，寻找并运用科学证据， 改善病人照顾水平。
•Professionalism专业素养 •Interpersonal and Communication Skills人际关系和交流 技巧
Medical Knowledge医学知识
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. 住院医师要展现出丰富的生物医学、临 床医学及相关学科知识（如：流行病学 和社会行为学），以及将这些知识应用 于病人照顾的能力。 Residents are expected to: 住院医师要：
Derstine, 2006
The Six Competencies 六项核心能力
•Medical Knowledge医学知识
•Patient Care病人照顾
•Practice Based Learning and Improvement以实践为基 础的学习和提高
•Systems Based Practice以系统为基础的实践
Goals of the Outcome Project 效果评估计划的目标
Practice-based Learning & Improvement 以实践为基础的学习和提高 Systemsbased Patient Practice Developing Care competence Developing 以系统为基础的 as competence a physician 病人照顾 实践 培养做医生的 as a 能力 Medical physician Knowledge Professionalism专业素养 医学知识 Interpersonal & Communication Skills人际关系和交流技 巧
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness应用科研设计与统计方 法的知识，评估临床科研及其他有关诊疗效果的信息
1. Demonstrate an investigatory and analytic thinking approach to clinical situations 表现出探究与 分析的思维模式来处理临床问题。 2. Know and apply the basic and clinically supportive sciences which are appropriate to their discipline 了解并应用与其专业相 关的各种基础学科和临床学科知 识。
Patient Care病人照顾
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
以能力为基础的住院医师培训
What is the Outcome Project? 效果评估计划是什么？
The Outcome Project is a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs. “效果评估计划”是美国毕业后医学教育认证委员会（ACGME）对住院医师培训 项目认证中培训成效更加关注的一项长期计划。 The ACGME identified six general competencies for residency education: ACGME鉴定的住院医师教育六大核心能力： • Medical Knowledge 医学知识 • Practice Based Learning and Improvement 以实践为基础的学习和提高 • Systems Based Practice 以系统为基础的实践 • Professionalism 专业素养 • Patient Care 病人照顾 • Interpersonal and Communication Skills 人际关系和交流技巧
What is Competency-based Education? 以能力为基础的教育是指什么？
Competency-based education focuses on learner performance (learning outcomes) in reaching specific objectives (goals and objectives of the curriculum).
以能力为基础的教育关注学员为达到特定的目标（教学 大纲的目标）而具备的临床技能（学习结果）。
Another way to look at this:
换种方式来看：
Learning 学习 Teaching 教授
Educational Outcomes
教育结果
ቤተ መጻሕፍቲ ባይዱ
Competency-based Residency Education
1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families 与病人及其 家属用尊重和关系的态度进行有效沟通。 2. Gather essential and accurate information about their patients 收集关于 病人必要和准确的信息 3. Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment 根据病人病情、偏好、科学新证据及临 床判断，作出知情同意的诊疗方案。 4. Develop and carry out patient management plans 制定并执行病人照顾 计划。 5. Counsel and educate patients and their families 给病人及其家属做咨询 和教育。 6. Use information technology to support patient care decisions and patient education 应用信息技术为病人照顾及宣教方案提供支持。 7. Perform competently all medical and invasive procedures considered essential for the area of practice 胜任所有行医范围内必要的医疗处理。 8. Provide health care services aimed at preventing health problems or maintaining health 提供以预防和健康维护为目标的健康照顾服务。 9. Work with health care professionals, including those from other disciplines, to provide patient-focused care ，与包括其他学科的义务工 作者合作，提供以病人为中心的健康照顾。
Eric Schackow MD, PhD 医学博士，科学博士 Beijing, China 中国 北京 April 2012 2012 年4月 (adapted from Joyce, 2006)
Derstine, 2006
Goals of the Outcome Project 效果评估计划的目标
Practice-based Learning & Improvement 以实践为基础的学习和提高 Systems-based Practice Patient Care
Improving 以系统为基础的实践 Patient Care 病人照顾 改善病人 Medical 照顾 Knowledge Professionalism专业素养 医学知识 Interpersonal & Communication Skills 人际关系和交流技巧
阐述“效果评估计划”的基础含义，包含“核心能力”的概念
•Give practical examples of how the Core Competencies can be applied to individual resident performance
举实例看“核心能力”如何应用在住院医师临床技能上。
5. Analyze practice experience and perform practice-based improvement activities using a systematic methodology分析实 践经验，应用系统的方法论采取实践导向的改进措施。 Obtain and use information about their own population of patients and the larger population from which their patients are drawn从病人及病人所属的群体中获取并使用相关信息。 Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems寻找、评估、 理解与病人健康问题相关的科学研究。
Objectives目标
Upon completion of this lecture, Program Directors and faculty will be able to:
通过完成此次课程，项目主任和教师将会：
•State foundational concepts of the Outcome Project, including the concept of Core Competencies
住院医师在对病人健康问 题的处理及健康促进方面 要能提供关心的、恰当的 和有效的照顾服务。
Residents are expected to: 住院医师要：
Practice Based Learning and Improvement 基于实践的学习和提高
Residents must be able to 1. investigate and evaluate their patient care practices, 2. appraise and assimilate scientific evidence, and 3. improve their patient care practices.住院医师必须能够 发现并评估自己的临床工作 4. 状况，寻找并运用科学证据， 改善病人照顾水平。
•Professionalism专业素养 •Interpersonal and Communication Skills人际关系和交流 技巧
Medical Knowledge医学知识
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. 住院医师要展现出丰富的生物医学、临 床医学及相关学科知识（如：流行病学 和社会行为学），以及将这些知识应用 于病人照顾的能力。 Residents are expected to: 住院医师要：
Derstine, 2006
The Six Competencies 六项核心能力
•Medical Knowledge医学知识
•Patient Care病人照顾
•Practice Based Learning and Improvement以实践为基 础的学习和提高
•Systems Based Practice以系统为基础的实践
Goals of the Outcome Project 效果评估计划的目标
Practice-based Learning & Improvement 以实践为基础的学习和提高 Systemsbased Patient Practice Developing Care competence Developing 以系统为基础的 as competence a physician 病人照顾 实践 培养做医生的 as a 能力 Medical physician Knowledge Professionalism专业素养 医学知识 Interpersonal & Communication Skills人际关系和交流技 巧
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness应用科研设计与统计方 法的知识，评估临床科研及其他有关诊疗效果的信息
1. Demonstrate an investigatory and analytic thinking approach to clinical situations 表现出探究与 分析的思维模式来处理临床问题。 2. Know and apply the basic and clinically supportive sciences which are appropriate to their discipline 了解并应用与其专业相 关的各种基础学科和临床学科知 识。
Patient Care病人照顾
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
以能力为基础的住院医师培训
What is the Outcome Project? 效果评估计划是什么？
The Outcome Project is a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs. “效果评估计划”是美国毕业后医学教育认证委员会（ACGME）对住院医师培训 项目认证中培训成效更加关注的一项长期计划。 The ACGME identified six general competencies for residency education: ACGME鉴定的住院医师教育六大核心能力： • Medical Knowledge 医学知识 • Practice Based Learning and Improvement 以实践为基础的学习和提高 • Systems Based Practice 以系统为基础的实践 • Professionalism 专业素养 • Patient Care 病人照顾 • Interpersonal and Communication Skills 人际关系和交流技巧
What is Competency-based Education? 以能力为基础的教育是指什么？
Competency-based education focuses on learner performance (learning outcomes) in reaching specific objectives (goals and objectives of the curriculum).
以能力为基础的教育关注学员为达到特定的目标（教学 大纲的目标）而具备的临床技能（学习结果）。
Another way to look at this:
换种方式来看：
Learning 学习 Teaching 教授
Educational Outcomes
教育结果
ቤተ መጻሕፍቲ ባይዱ
Competency-based Residency Education
1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families 与病人及其 家属用尊重和关系的态度进行有效沟通。 2. Gather essential and accurate information about their patients 收集关于 病人必要和准确的信息 3. Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment 根据病人病情、偏好、科学新证据及临 床判断，作出知情同意的诊疗方案。 4. Develop and carry out patient management plans 制定并执行病人照顾 计划。 5. Counsel and educate patients and their families 给病人及其家属做咨询 和教育。 6. Use information technology to support patient care decisions and patient education 应用信息技术为病人照顾及宣教方案提供支持。 7. Perform competently all medical and invasive procedures considered essential for the area of practice 胜任所有行医范围内必要的医疗处理。 8. Provide health care services aimed at preventing health problems or maintaining health 提供以预防和健康维护为目标的健康照顾服务。 9. Work with health care professionals, including those from other disciplines, to provide patient-focused care ，与包括其他学科的义务工 作者合作，提供以病人为中心的健康照顾。