制定血液科住院医师培训的可信赖专业活动框架

Entrustable professional activities (EPAs), essential for competent and safe clinical practice, serve as milestones to assess trainees' readiness for independent patient care. This study aimed to develop a context-specific EPA framework for hematology residency training in China.

We employed a modified Delphi method involving 35 experts from 8 academic hospitals to establish China's inaugural hematology-specific EPA framework. The development process comprised three key components: (1) a systematic literature review integrating international EPA models with China's the Standardized Training System for Residents (STSR) requirements; (2) structural validation through the EQual rubric (cut-off: 4.07); and (3) a two-round Delphi consultations evaluating importance, observability, evaluability, repeatability, feasibility and entrustment-supervision levels. Expert engagement metrics and inter-rater agreement evaluated consensus quality.

The preliminary 14-item framework was ultimately refined to 12 EPAs following the exclusion of "Public Health Emergency Response" (EPA 14; mean score=3.23) and "Imparting Bad News" (EPA 13; 57.1% experts advocated removing). Key revisions involved expanding the hematopoietic stem cell transplantation (HSCT) competency domain to include donor selection (EPA 7) and the provisional addition then subsequent removal of "Cellular Immunotherapy Complications Management" due to insufficient standardization of assessment criteria. The final EPAs achieved unanimous EQual compliance (≥4.07) and strong Delphi consensus (Kendall's W: Round 1 = 0.271, Round 2 = 0.529, p<0.001). Clinical entrustment-supervision levels were systematically stratified by training phase and expected competency at graduation.

This study has established China's first hematology-specific EPA framework by addressing gaps in global EPA models through integration of integrating local clinical demands (high patient volume, resource constraints) and multidisciplinary coordination. The framework provides a validated tool for competency-based assessment, with future steps focusing on digital implementation and nationwide validation.