Goldman L
University of California, School of Medicine, San Francisco 94143-0120, USA.
Ann Intern Med. 1999 Feb 16;130(4 Pt 2):364-7. doi: 10.7326/0003-4819-130-4-199902161-00007.
Hospitalism as a career option is likely to reinforce the emphasis of traditional medical residency programs on inpatient care; may become an alternative area of emphasis in many subspecialty fellowship programs; and may even generate its own specific types of advanced training and certification. In the academic setting, subspecialists and their trainees are concerned that hospitalists may request fewer consultations, which could adversely affect subspecialists and the education of both fellows and residents. However, the focus and expertise of hospitalists is likely to improve inpatient education for students and residents and is appealing because it has the potential to improve the quality of inpatient care. Perhaps the major effect of the hospitalist movement on academic centers will be the creation of a cadre of physicians committed to critical pathways; clinical guidelines; quality assurance; risk management; clinical re-engineering; and the use of the inpatient service as a laboratory for developing, evaluating, and implementing initiatives to improve patient care. Although any fundamental change in the organization of clinical services brings with it the risk that essential components of the current system will be jeopardized, the hospitalist movement may have great benefits if it can develop safeguards to ensure seamless patient care and the appropriate use of subspecialty expertise.
将医院医学作为一种职业选择可能会强化传统住院医师培训项目对住院治疗的重视；在许多亚专科 fellowship 项目中可能会成为另一个重点领域；甚至可能产生其自身特定类型的高级培训和认证。在学术环境中，亚专科医生及其受训人员担心医院医生可能会减少会诊请求，这可能会对亚专科医生以及 fellowship 学员和住院医师的教育产生不利影响。然而，医院医生的专注点和专业知识很可能会改善对医学生和住院医师的住院教育，并且具有吸引力，因为它有可能提高住院治疗的质量。医院医学运动对学术中心的主要影响可能是造就一批致力于关键路径、临床指南、质量保证、风险管理、临床流程再造以及将住院服务用作开发、评估和实施改善患者护理举措的实验室的医生骨干队伍。尽管临床服务组织的任何根本性变革都伴随着当前系统的基本组成部分可能受到损害的风险，但如果医院医学运动能够制定保障措施以确保患者护理的无缝衔接以及亚专科专业知识的恰当使用，那么它可能会带来巨大益处。
