Long D M
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-7709, USA.
Acad Med. 2000 Dec;75(12):1178-83. doi: 10.1097/00001888-200012000-00009.
The goal of all graduate medical education is to ensure that the graduating physician is competent to practice in his or her chosen field of medicine. The evaluation of a resident's competency to practice, however, has never been clearly defined, nor has the fixed period of time given for residency training in each specialty been shown to be the right amount of time for each individual resident to achieve competency. To better ensure that new physicians have the competencies they need, the author proposes the replacement of the current approach to residents' education, which specifies a fixed number of years in training, with competency-based training, in which each resident remains in training until he or she has been shown to have the required knowledge and skills and can apply them independently. Such programs, in addition to tailoring the training time to each individual, would make it possible to devise and test schemes to evaluate competency more surely than is now possible. The author reviews the basis of traditional residency training and the problems with the current training approach, both its fixed amount of time for training and the uncertainty of the methods of evaluation used. He then explains competency-based residency education, notes that it is possible, indeed probable, that some trainees will become competent considerably sooner than they would in the current required years of training, quotes a study in which this was the case, and explains the implications. He describes the encouraging experience of his neurosurgery department, which has used competency-based training for its residents since 1994. He then discusses issues of demonstrating competency in procedural and nonprocedural fields, as well as the evaluation of competency in traditional and competency-based training, emphasizing that the latter approach offers hope for better ways of assessing competency.
所有毕业后医学教育的目标都是确保即将毕业的医生有能力在其选择的医学领域执业。然而，对住院医师执业能力的评估从未得到明确界定，而且每个专科规定的住院医师培训固定时长也并未被证明对每个住院医师来说都是达到胜任能力所需的恰当时间。为了更好地确保新医生具备他们所需的能力，作者提议用基于能力的培训取代目前针对住院医师的教育方式，目前的方式规定了固定的培训年限，而基于能力的培训是让每个住院医师持续接受培训，直到证明其具备所需的知识和技能并能独立运用这些知识和技能。这样的项目除了能根据个人情况调整培训时间外，还能设计并测试比目前更可靠的能力评估方案。作者回顾了传统住院医师培训的基础以及当前培训方式存在的问题，包括培训时间固定以及所用评估方法的不确定性。然后，他解释了基于能力的住院医师教育，指出有些受训者确实有可能比按照目前规定的培训年限更早达到胜任能力，引用了一项表明情况确实如此的研究，并说明了其中的影响。他描述了自己所在神经外科自1994年以来对住院医师采用基于能力培训的令人鼓舞的经验。接着，他讨论了在程序性和非程序性领域证明能力的问题，以及传统培训和基于能力培训中的能力评估问题，强调后一种方法为更好地评估能力提供了希望。
