Smith D R, Anderson R J, Boumbulian P J
Parkland Memorial Hospital, Dallas, Texas 75235.
Am J Med Sci. 1991 Nov;302(5):313-8. doi: 10.1097/00000441-199111000-00010.
Academic medicine is entering a period of introspection created by changing patterns of health and disease and changing patterns in reimbursement and health policy. To respond to existing health challenges, innovative strategies for health care delivery and education must be devised. The migration of medical education and health care delivery into centralized and frequently difficult-to-access campuses is being reviewed by payors, policy analysts, and purchasers of care. One proposed solution to this problem responds to the identified shortcomings in medical education and some of the failures of our health care delivery system. Community Oriented Primary Care (COPC) and the related discipline of Community Responsive Medicine define health-oriented strategies that blend traditional primary care and public health. The classroom in Community Responsive Medicine is the community. The curriculum is defined by the elements and skills necessary to improve the health status of the target community. The model allows the student and resident to appreciate and experience the entire spectrum of health and disease and to understand the sequence of events that may lead to illness. Tertiary care is a critical curriculum component, but in Community Responsive Medicine the curriculum is balanced between the ambulatory and tertiary care settings. Community Responsive Medicine defines a role for new leadership that can create responsive educational and health care delivery systems accountable to the communities they serve.
学术医学正进入一个反思期，这是由健康与疾病模式的变化以及报销和卫生政策模式的变化所引发的。为应对现有的健康挑战，必须设计出创新的医疗服务和教育策略。医疗教育和医疗服务向集中化且通常难以进入的校园迁移的情况，正受到支付方、政策分析师和医疗服务购买者的审视。针对这一问题提出的一个解决方案，回应了医学教育中已发现的缺陷以及我们医疗服务体系的一些不足。社区导向初级保健（COPC）以及相关的社区响应医学学科，定义了融合传统初级保健和公共卫生的以健康为导向的策略。社区响应医学中的课堂就是社区。课程由改善目标社区健康状况所需的要素和技能来界定。该模式让学生和住院医师能够认识和体验健康与疾病的全貌，并理解可能导致疾病的一系列事件。三级医疗是关键的课程组成部分，但在社区响应医学中，课程在门诊和三级医疗环境之间保持平衡。社区响应医学为新的领导层界定了一个角色，他们能够创建对所服务社区负责的响应式教育和医疗服务体系。
