Evans J R
Allelix Biopharmaceuticals, Inc., Mississauga, Ontario, Canada L4V.
Acad Med. 1992 Nov;67(11):719-23. doi: 10.1097/00001888-199211000-00002.
The author examines the growing discontinuity between medical education and the general health needs of society. He explains and illustrates this failure of the academic medical center in several ways: by a parable; by reporting the results of his informal survey of faculty and residents; by presenting the findings of an international conference on medical education; and by giving a detailed description of the design and impact of the "Health of the Public" program, launched by the Pew Charitable Trusts and the Rockefeller Foundation in 1986. He maintains that there is an imbalance in the training of physicians and other health professionals because academic medical centers are dominated by supply-side thinking--which is driven by new knowledge and technology and the resulting need to find patients to fit the interests and technical capabilities of specialists and the equipment and services of hospitals--and have under-emphasized demand-side thinking, which concerns the patient and the health expectations, needs, and trends in the community. The author maintains that academic medical centers can continue to achieve the recognition they seek, but can do so by making the changes needed to better balance the driving forces of supply and demand. Only by doing this will they fulfill their fundamental mission of fostering the health of the public.
作者审视了医学教育与社会总体健康需求之间日益增大的脱节。他通过几种方式解释并说明了学术医疗中心的这一失败之处：用一则寓言；通过报告他对教员和住院医师的非正式调查结果；通过展示一次医学教育国际会议的研究结果；以及通过详细描述由皮尤慈善信托基金和洛克菲勒基金会于1986年发起的“公众健康”项目的设计和影响。他坚持认为，医师和其他卫生专业人员的培训存在失衡，因为学术医疗中心受供给侧思维主导——这种思维由新知识和技术以及由此产生的为专家的兴趣和技术能力以及医院的设备和服务寻找适配患者的需求所驱动——而对需求侧思维重视不足，需求侧思维关注患者以及社区中的健康期望、需求和趋势。作者认为，学术医疗中心可以继续获得它们所追求的认可，但要通过做出必要的改变来更好地平衡供需驱动力才能做到。只有这样做，它们才能履行其促进公众健康的基本使命。
