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[日本研究生精神病学教育中的一些困难解决方案]

[Some resolutions in difficulties of postgraduate psychiatric education in Japan].

作者信息

Kojima Takuya, Hosaka Takashi

机构信息

Dept. of Psychiatry, Nihon Univ. School of Medicine.

出版信息

Seishin Shinkeigaku Zasshi. 2003;105(2):221-6.

Abstract
  1. Board Certification System of Psychiatry There was a heated debate about "Postgraduate Psychiatric Education and Board Certification of Psychiatry" in the annual meeting for the Japanese Society of Psychiatry and Neurology held in Nagasaki in 1968 and in Kanazawa in 1969. The oppositions of young psychiatrists were as follows; 1) Issues of low cost of medical expense as government politics, social protect politics from psychiatric patients, and improper management of patients in mental hospitals should be dealt before making Board Certification System of Psychiatry. 2) Management of the Society of Psychiatry and Neurology dissatisfies many psychiatrists. Board Certification Systems started in many medical societies from 1969 to 1987. Main nine departments except psychiatry started the system. In 1987, the Japan Association of Chairmen of Department of Psychiatry of Medical Colleges (JACDPM) proposed a program for a postgraduate course. The Japanese Society of Psychiatry and Neurology (JSPN) formed the Committee on Psychiatric Education in 1987 and Working Group on Accreditation Program (WGAP) in 1991 under the Committee of Psychiatric Education. After intensive discussions on the Board certification, the WGAP reported a summary of their discussions in 1994. The essence of the WGAP recommended model for the Board of Association was as follows: Minimal Requirements Outline Training Period--three years psychiatric training after two years primary care experience by rotation through other departments. Field of Training--WGAP recommended that post-graduate training should be given at different kinds of institutes such as the department of psychiatry in medical schools, mental hospitals, out-patient mental clinics, community experiences in rehabilitation, day care, social clubs and health centers. Assessment--both oral examination and case reports are requested for evaluation and board certification. Re-evaluation every five years is required. However, there have been the following opinions and the Board Certification System has not been realized. 1) Making improvement in mental hospital is more important than starting Post-graduate Training and Organization for Board Certification of Psychiatry System (PTOBCP). 2) Starting PTOBCP makes professors in department of psychiatry in medical colleges give great power to suppress the right of personal management. 3) Financial support for postgraduate trainee and trainer is insufficient. Medical and psychiatric situations have changed from 2001 to 2002. 1) A neutral organization instead of academic societies will make Board Certification System in each department in the future. 2) Postgraduate educational rotation system (two years) will start in 2004. 3) Advertisement of being certificated by the Board has been possible. In recent situation, necessity for making of PTOBCP is increasing and many members of JSPN long to make it. In the 98th annual meeting, 2002 it was decided to make PTOBCP. 2. Post-graduate mandatory education system including psychiatry Recently, it was legally decided that post-graduate education for two years should be mandatory for every medical doctor who has passed a national board from 2004. Furthermore, psychiatric training should be mandatory for every rotating resident. The period of psychiatric training is one, two or three months, which depends upon each teaching hospital. It is epoch-making that every resident should receive psychiatric training, however, in other words, it means that psychiatric education in Japan will be re-evaluated through such a new training system.
摘要
  1. 精神病学委员会认证制度

1968年在长崎以及1969年在金泽召开的日本精神神经学会年会上,针对“研究生精神病学教育与精神病学委员会认证”展开了激烈辩论。年轻精神科医生的反对意见如下:1)在建立精神病学委员会认证制度之前,应先解决政府政策导致的医疗费用低廉、针对精神病患者的社会保护政策以及精神病院患者管理不当等问题。2)精神神经学会的管理让许多精神科医生不满。1969年至1987年期间,许多医学学会开始实行委员会认证制度。除精神病学外的主要九个科室启动了该制度。1987年,日本医学院校精神病学系主任协会(JACDPM)提出了一个研究生课程计划。日本精神神经学会(JSPN)于1987年成立了精神病学教育委员会,并于1991年在精神病学教育委员会下设认证项目工作组(WGAP)。在对委员会认证进行深入讨论后,WGAP于1994年报告了其讨论总结。WGAP为协会委员会推荐的模式要点如下:最低要求 培训期限——在经过两年通过轮转其他科室获得的初级医疗经验后,进行三年的精神病学培训。培训领域——WGAP建议研究生培训应在多种机构进行,如医学院校的精神病学系、精神病院、门诊精神科诊所、康复社区体验、日间护理、社会俱乐部和健康中心。评估——要求进行口试和病例报告以进行评估和委员会认证。每五年需要重新评估。然而,存在以下意见,委员会认证制度尚未实现。1)改善精神病院比启动研究生培训和精神病学委员会认证组织(PTOBCP)更为重要。2)启动PTOBCP会让医学院校精神病学系的教授获得过大权力来压制个人管理权利。3)对研究生学员和培训师的资金支持不足。2001年至2002年期间,医学和精神病学情况发生了变化。1)未来将由一个中立组织而非学术团体来制定各科室的委员会认证制度。2)研究生教育轮转制度(两年)将于2004年启动。3)已可以进行委员会认证的宣传。在当前情况下,建立PTOBCP的必要性日益增加,许多JSPN成员渴望建立该制度。在2002年第98届年会上,决定建立PTOBCP。

  1. 包括精神病学在内的研究生强制教育制度

最近,法律规定自2004年起,每位通过国家委员会考试的医生都必须接受为期两年的研究生教育。此外,每位轮转住院医师都必须接受精神病学培训。精神病学培训的时长为一、二或三个月不等,这取决于各教学医院。每位住院医师都应接受精神病学培训,这具有划时代意义,然而,换句话说,这意味着日本的精神病学教育将通过这样一种新的培训体系进行重新评估。

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