Kolars J C
University of Michigan Medical School, Ann Arbor, USA.
Acad Med. 2000 Apr;75(4):337-45. doi: 10.1097/00001888-200004000-00009.
Based on his work in Shanghai, China, the author believes that U.S. academic health centers (AHCs) should take a leadership role in global health initiatives. While acknowledging that most AHCs already have focused projects involving research or education with foreign institutions, he proposes a greater coordination of these projects into programs that, in some areas, could also be linked to clinical delivery systems where care may be provided. These AHC "platforms" overseas would be structured as a partnership between an AHC in the United States and one in the foreign country where the platform is located, to promote their missions of education, research, and service. For example, U.S. AHCs benefit, and are often dependent upon, international trainees who seek further clinical or research training in the United States. However, the identification of suitable candidates and career guidance, so the students' career choices could benefit their home countries, are often lacking. Thus, the United States is often viewed as facilitating a "brain drain" of future leaders in academic medicine from developing areas of the world. The author proposes a way to lessen this problem by shifting more on-site training to settings in the students' home countries, which could occur if AHCs were willing to develop overseas platforms. U.S. students would also benefit from access to medical training in foreign lands for both the cultural perspectives they offer and the unique diseases and medical situations encountered. He also suggests that shared platforms would lead to greater research opportunities for institutions in the United States and abroad. He argues for increased efforts at coordinating these activities with the rising demand for Western clinical services by multinational companies and U.S. expatriate communities overseas. The potential pitfalls of such initiatives as well as the need for permanent relationships are discussed. In conclusion, he believes that AHCs have an opportunity to establish global health initiatives through education, research, and patient care that will both enhance their own institutions and benefit the international community.
基于其在中国上海的工作经历，作者认为美国学术医疗中心（AHCs）应在全球健康倡议中发挥领导作用。虽然承认大多数AHCs已经有涉及与外国机构开展研究或教育的重点项目，但他提议将这些项目进行更好的协调，纳入一些在某些领域还可与可能提供医疗服务的临床服务系统相联系的项目。这些海外的AHC“平台”将构建成美国的一个AHC与该平台所在外国的一个AHC之间的伙伴关系，以促进其教育、研究和服务使命。例如，美国的AHCs受益于，且常常依赖于那些在美国寻求进一步临床或研究培训的国际学员。然而，往往缺乏对合适候选人的识别和职业指导，以便学生的职业选择能使其祖国受益。因此，美国常常被视为促使世界发展中地区学术医学未来领导人的“人才外流”。作者提出了一种通过将更多现场培训转移到学生祖国的环境中来减轻这一问题的方法，如果AHCs愿意开发海外平台，这种情况就可能发生。美国学生也将受益于在国外获得医学培训，因为这能提供文化视角以及所遇到的独特疾病和医疗情况。他还建议共享平台将为美国和国外的机构带来更多研究机会。他主张加大力度，将这些活动与跨国公司和海外美国侨民社区对西方临床服务不断增长的需求进行协调。文中讨论了此类倡议的潜在陷阱以及建立长期关系的必要性。总之，他认为AHCs有机会通过教育、研究和患者护理来开展全球健康倡议，这将既能提升其自身机构，又能造福国际社会。
