Hamilton C B, Smith C A, Butters J M
University of Tennessee-Knoxville 37996, USA.
J Rural Health. 1997 Fall;13(4):320-8. doi: 10.1111/j.1748-0361.1997.tb00974.x.
Several initiatives have been introduced over the years to address the maldistribution of health care professionals and to improve access to care for underserved rural populations. One of these is the sponsorship of community-based, service-oriented teams comprised of students from various health disciplines. This study investigated extramural training as a complement to traditional hospital-based experiences. The specific objective of the study was to determine the extent to which the nation's medical schools combine training with a rural community-based experience in the form of an interdisciplinary student health team program. In the fall of 1994, a 32-item questionnaire was mailed to the chief academic or clinical affairs administrators of the nation's 126 allopathic medical schools. A total of 104 (82.5%) medical schools responded to the survey. Eighty-six of the respondents (82.7%) reported some type of rural training or public service activity; 22 (21.2%) acknowledged the sponsorship of an interdisciplinary student health team program. Small rural communities, those with populations of 5,000 or fewer, were the focus of 76 percent of the reporting programs. Nearly two-thirds of the reporting programs were located in the South, the region with the nation's lowest physician-to-population ratio. The nursing and medical professions were most frequently represented, although a wide range of disciplines were identified as participating on the student health teams. Activities of the teams included both ambulatory care and community outreach services. The majority of the programs used team-building exercises to enhance team effectiveness. Extramural training programs offer students a realistic examination of the social, cultural, economic, and political forces that influence both individual and community health. Rural community-based programs, such as interdisciplinary student health teams, should be valued because they can strengthen the link between the sponsoring institution's educational mission and its public service obligation.
多年来，人们采取了多项举措来解决医疗保健专业人员分布不均的问题，并改善农村弱势群体获得医疗服务的机会。其中一项举措是资助由来自不同健康学科的学生组成的社区服务型团队。本研究调查了校外培训作为传统医院实习的补充情况。该研究的具体目标是确定美国医学院校在多大程度上以跨学科学生健康团队项目的形式，将培训与农村社区实习相结合。1994年秋季，一份包含32个问题的问卷被邮寄给了美国126所全科医学院校的首席学术或临床事务管理人员。共有104所（82.5%）医学院校回复了调查。86名受访者（82.7%）报告了某种类型的农村培训或公共服务活动；22所（21.2%）承认资助了跨学科学生健康团队项目。人口在5000人及以下的小农村社区是76%的报告项目的重点。近三分之二的报告项目位于南方，该地区的医生与人口比例是美国最低的。护理和医学专业的学生参与最为频繁，不过也有广泛的其他学科被确定为参与了学生健康团队。团队的活动包括门诊护理和社区外展服务。大多数项目采用团队建设活动来提高团队效率。校外培训项目让学生切实审视影响个人和社区健康的社会、文化、经济和政治力量。基于农村社区的项目，如跨学科学生健康团队，应该受到重视，因为它们可以加强主办机构的教育使命与其公共服务义务之间的联系。
