Orlander J D, Callahan C M
Department of Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts.
J Gen Intern Med. 1991 Sep-Oct;6(5):460-5. doi: 10.1007/BF02598172.
To determine whether current fellowships in general internal medicine (FGIM) meet the perceived needs and objectives of physicians entering careers in academic internal medicine.
A modified Delphi method yielded the 18 curricular elements included in the mailed survey. Participants outlined both actual and ideal fellowship experiences by rating the degree of emphasis of each curricular element on a Likert scale. Respondents then prioritized elements by rank-ordering them on perceived importance. Current job descriptions and opinions on related issues in FGIM were collected.
Potential fellows, current fellows, and recent graduates were surveyed. Individuals were identified through the Society of General Internal Medicine associates' mailing list and solicitation of program directors. Nonfellow associates served as the proxy group for potential fellows.
579 surveys were mailed; 348 (60%) responses were received, of which 288 (50%) were suitable for analysis. Of all respondents, 38% were current fellows and 40% were recent graduates. When asked to prioritize educational needs during fellowship training, respondents ranked research methodology, ambulatory medicine, critical review of the literature, epidemiology, biostatistics, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curriculum as the top ten. Only minor deviations in rank order were found between graduates and nongraduates. Mean Likert scale scores for degree of emphasis of each curricular element in graduates' actual fellowships were compared with mean scores for graduates' ideal fellowship descriptions. High-priority elements that were perceived as adequately emphasized included research methodology, critical analysis of the literature, epidemiology, and biostatistics. High-priority elements that were perceived as inadequately emphasized included ambulatory medicine, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curricula.
FGIM largely meet the expectations of their fellows for preparation for research responsibilities. However, several curricular elements concerned with preparation for future clinical and teaching responsibilities are perceived by graduates as underemphasized. These areas deserve increased emphasis during fellowship training to better prepare fellows for their future roles in academic general internal medicine.
确定当前普通内科住院医师培训项目（FGIM）是否满足进入学术性内科职业的医生所感知到的需求和目标。
采用改良的德尔菲法得出邮寄调查问卷中包含的18个课程要素。参与者通过在李克特量表上对每个课程要素的强调程度进行评分，概述了实际和理想的住院医师培训经历。然后，受访者根据感知到的重要性对要素进行排序。收集了FGIM当前的工作描述和对相关问题的意见。
对潜在住院医师、现任住院医师和近期毕业生进行了调查。通过普通内科协会会员的邮件列表和向项目主任征集来确定个人。非住院医师会员作为潜在住院医师的代理组。
共邮寄了579份调查问卷；收到348份回复（60%），其中288份（50%）适合分析。在所有受访者中，38%是现任住院医师，40%是近期毕业生。当被要求对住院医师培训期间的教育需求进行排序时，受访者将研究方法、门诊医学、文献批判性综述、流行病学、生物统计学、教学技能、医学咨询、科研基金申请撰写、预防医学和教育课程设计列为前十。毕业生和非毕业生之间在排序上只有微小差异。将毕业生实际住院医师培训中每个课程要素强调程度的平均李克特量表得分与毕业生理想住院医师培训描述的平均得分进行了比较。被认为得到充分强调的高优先级要素包括研究方法、文献批判性分析、流行病学和生物统计学。被认为强调不足的高优先级要素包括门诊医学、教学技能、医学咨询、科研基金申请撰写、预防医学和教育课程设计。
FGIM在很大程度上满足了其住院医师对承担研究职责准备工作的期望。然而，毕业生认为一些与未来临床和教学职责准备相关的课程要素未得到充分强调。这些领域在住院医师培训期间应得到更多重视，以便更好地使住院医师为其在学术性普通内科的未来角色做好准备。
