转换中的医学教育范式：从弗莱克斯尼尔革命到能力培养

Shifting the Paradigms of Medical Education: From the Flexner Revolution to Competence-Based Education

本文介绍了国外学者对医学教育两种范式的产生与转换过程所作的回顾，概要描述了基于胜任能力与产出评价的医学教育新范式的基本特征、发展历程和相应的课程设计步骤。医学教育从现行的基于结构和过程的范式向基于胜任能力与产出评价的范式转换，是21世纪的弗莱克斯尼尔革命，而缺乏有效的评价策略与方法则是胜任能力运动发轫到被逐步接受间隔近30年的重要原因。对胜任能力的界定与评价是决定范式转换的关键，并仍然是目前医学教育改革与发展所面临的主要挑战。

The review of the two paradigms of medical education and their arising and shifting by foreign scholars is introduced in the article. There is a general description of the competence-based and measurement of outcomes education paradigm in terms of major characteristics， developing process and the procedures of curriculum design. The paradigm shifting from the structure and process based education to the competence-based and measurement of outcomes education is the Flexner revolution in 21century， however， the lack of effective strategies and methods of evaluation lead to suspend the process in 30 years from start to the acceptance of the shifting. The definition of competence and evaluation are the critical factors of the shifting， but they are in current still to be a main challenge of the reform and development of medical education.