Landefeld C Seth, Callahan Christopher M, Woolard Nancy
University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA.
Ann Intern Med. 2003 Oct 7;139(7):609-14. doi: 10.7326/0003-4819-139-7-200310070-00034.
Internists--"doctors for adults"--provide most of the medical care given to older Americans, especially those with serious chronic disease. Nonetheless, the United States lacks an adequate physician workforce with mastery in caring for older persons and with expertise in building knowledge about how best to provide this care. This supplement aims to strengthen the physician workforce by fostering incremental and sustained improvements in the training of internal medicine residents in the care of older adults and in the development of geriatrics-oriented general internal medicine faculty. It identifies 3 major barriers to these improvements: lack of adequately trained teachers and mentors, the belief that explicit training in geriatrics has little to offer the generalist, and inadequate funding. Three strategies offer particular promise in overcoming these barriers: engaging directors of internal medicine residency programs, funding centers to promote collaboration between teaching and research programs in general internal medicine and geriatrics, and providing substantial incremental funding on the national level to pay for the time required to care for frail older patients and to teach and do research about this care. The barriers and strategies identified in this supplement may also inform efforts to enhance the skills of practicing physicians and improve training and faculty development in family medicine and other disciplines.
内科医生——“成人医生”——为美国老年人提供了大部分医疗服务，尤其是那些患有严重慢性病的老年人。尽管如此，美国缺乏足够数量的、精通照顾老年人以及掌握如何以最佳方式提供此类护理相关知识的医生队伍。本增刊旨在通过逐步且持续地改进内科住院医师在照顾老年人方面的培训以及培养以老年医学为导向的普通内科教员，来加强医生队伍建设。它指出了实现这些改进的3个主要障碍：缺乏训练有素的教师和导师、认为老年医学的明确培训对全科医生帮助不大以及资金不足。有3项策略在克服这些障碍方面特别有前景：让内科住院医师培训项目主任参与进来、资助促进普通内科和老年医学教学与研究项目之间合作的中心，以及在国家层面提供大量额外资金，以支付照顾体弱老年患者所需的时间以及开展关于此类护理的教学和研究所需的时间。本增刊中确定的障碍和策略也可能为提高执业医生技能以及改善家庭医学和其他学科的培训与教员发展的努力提供参考。
