King B F, Kindig R C, Noah W H, Tuteur P G
Internist. 1990 Jul-Aug;31(7):suppl 3-15.
The primary objective in medical training remains skill development in the delivery of medical care through the understanding of bedside data collection, natural history of disease, use of diagnostic tools and the influence of therapy--all applied to a specific patient. More recently, also considered important is training on the broader issues of health care delivery and public policy, especially since the environment of medicine is changing rapidly. With limited curricular time these issues must compete with the traditional and important clinical training. To evaluate how these subjects have been included in internal medicine training, the Resident Physicians Section (RPS) of the American Society of Internal Medicine (ASIM) sponsored a survey of United States internal medicine chief residents which was conducted by the Internal Medicine Center to Advance Research and Education (IMCARE). The objectives of the study were to 1) study the extent of training on health care delivery and public policy issues offered to residents by internal medicine residency programs; 2) assess training opportunities now available; and 3) determine areas of study not fulfilling perceived needs. The questionnaire contained 12 questions. Chief residents rated the 1) quality of their program in preparing residents on health care delivery, public policy issues and practice management; 2) level of instruction provided on 12 topics; and 3) degree of priority these same topics should have. Respondents were asked to identify 1) any other relevant areas their residency program covered particularly well; 2) the amount of time which should be devoted to these socioeconomic topics in each year of training; and 3) the most appealing formats for learning about these topics. Despite the rapidly growing influence of socioeconomic issues on medical practice, many chief residents perceive that important topics are not being addressed adequately. This study provides information on areas addressed well and topics that should receive greater attention. Recommendations are made for further studies and strategies to increase the emphasis on socioeconomic topics during medical education.
医学培训的主要目标仍然是通过理解床边数据收集、疾病自然史、诊断工具的使用以及治疗的影响——所有这些都应用于特定患者——来培养提供医疗服务的技能。最近，医疗服务提供和公共政策等更广泛问题的培训也被认为很重要，尤其是因为医学环境正在迅速变化。由于课程时间有限，这些问题必须与传统且重要的临床培训竞争。为了评估这些主题是如何纳入内科培训的，美国内科医师协会（ASIM）的住院医师分会（RPS）赞助了一项针对美国内科住院总医师的调查，该调查由推进研究与教育内科中心（IMCARE）进行。该研究的目的是：1）研究内科住院医师培训项目为住院医师提供的医疗服务提供和公共政策问题培训的程度；2）评估目前可用的培训机会；3）确定未满足感知需求的研究领域。问卷包含12个问题。住院总医师对以下方面进行了评分：1）他们的项目在为住院医师准备医疗服务提供、公共政策问题和实践管理方面的质量；2）在12个主题上提供的教学水平；3）这些相同主题应具有的优先程度。受访者被要求指出：1）他们的住院医师培训项目特别擅长涵盖的任何其他相关领域；2）在每年的培训中应分配给这些社会经济主题的时间量；3）了解这些主题最具吸引力的形式。尽管社会经济问题对医疗实践的影响迅速增长，但许多住院总医师认为重要主题没有得到充分解决。这项研究提供了关于处理得好的领域和应给予更多关注的主题的信息。针对进一步的研究以及在医学教育期间加强对社会经济主题重视的策略提出了建议。
