米勒
能力(人力资源)
心理学
医学教育
工作(物理)
医疗保健
棱锥(几何)
护理部
医学
社会心理学
政治学
工程类
物理
光学
法学
生物
机械工程
生态学
作者
Olle ten Cate,Carol Carraccio,Arvin Damodaran,Wade Gofton,Stanley J. Hamstra,Danielle Hart,Denyse Richardson,Shelley Ross,Karen Schultz,Eric J. Warm,Alison J. Whelan,Daniel J. Schumacher
出处
期刊:Academic Medicine
[Ovid Technologies (Wolters Kluwer)]
日期:2020-10-13
卷期号:96 (2): 199-204
被引量:86
标识
DOI:10.1097/acm.0000000000003800
摘要
The iconic Miller’s pyramid, proposed in 1989, characterizes 4 levels of assessment in medical education (“knows,” “knows how,” “shows how,” “does”). The frame work has created a worldwide awareness of the need to have different assessment approaches for different expected outcomes of education and training. At the time, Miller stressed the innovative use of simulation techniques, geared at the third level (“shows how”); however, the “does” level, assessment in the workplace, remained a largely uncharted area. In the 30 years since Miller’s conference address and seminal paper, much attention has been devoted to procedures and instrument development for workplace-based assessment. With the rise of competency-based medical education (CBME), the need for approaches to determine the competence of learners in the clinical workplace has intensified. The proposal to use entrustable professional activities as a framework of assessment and the related entrustment decision making for clinical responsibilities at designated levels of supervision of learners (e.g., direct, indirect, and no supervision) has become a recent critical innovation of CBME at the “does” level. Analysis of the entrustment concept reveals that trust in a learner to work without assistance or supervision encompasses more than the observation of “doing” in practice (the “does” level). It implies the readiness of educators to accept the inherent risks involved in health care tasks and the judgment that the learner has enough experience to act appropriately when facing unexpected challenges. Earning this qualification requires qualities beyond observed proficiency, which led the authors to propose adding the level “trusted” to the apex of Miller’s pyramid.
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