Application of clinical thinking training system based on entrustable professional activities in emergency teaching

Abstract

Abstract Background Standardized training for resident physicians (STRP) is essential for improving their clinical skills. The standardized training for resident physicians in emergency medicine differs from other disciplines, focusing more on knowledge related to medical emergencies and emergency care skills requiring urgency and real-time response. There are specific differences in knowledge content, teaching methods, curriculum design, and career development compared to other specialties. As a national-level teaching base for emergency medicine, our hospital continuously explores and innovates in teaching models, discovering a model more suitable for emergency medicine. Objective This study summarizes practical experience in teaching and assessment integration (TAA), evaluates teaching training effectiveness with the Clinical Thinking Training System (CTTS), and examines integrating this system with innovative teaching and assessment models' impact on resident physicians' clinical abilities. Methods In our study, we selected residents who rotated in our department from July-December 2023 and randomly divided them into a reform group (n = 106) and a control group (n = 104). The reform group received training using the Clinical Thinking Training System (CTTS) while the control group received standard training consistent with the existing STRP framework. We integrate innovative teaching and assessment (TAA) models and the Entrustable Professional Activities (EPAs) scale to assess students' abilities, stratifying by grade level, background, and major to evaluate students' departmental rotation examination (DRE) and EPAs scores. Result The DRE scores and Mini-CEX scores were significantly higher in the reformed group compared to the control group. The final assessments showed the reform group scored significantly higher in first-case documentation and overall clinical thinking decision-making. Specifically, the reform group had significantly higher scores in first-case documentation for second-year, third-year, undergraduate, and graduate students, and non-emergency specialty students. The clinical thinking decision-making scores of the reform group were significantly higher across different years, specialties, and educational backgrounds. All the EPAs results indicated the CTTS improved treatment decision-making abilities among students with different years of training, educational backgrounds, and specialties. Moreover, the ability for continuous patient management improved to some extent among students in different years and with different educational backgrounds. Conclusion The integration of innovative teaching and assessment models with the CTTS is more conducive to improving the examination performance and confidence in professional behavior of resident physicians.

Keywords

• Clinical thinking training system
• Integration of teaching and assessment
• Entrustable professional activities
• Teaching reform
• Mini-CEX score
• Standardized training for resident physicians