Whitcomb Michael E
Association of American Medical Colleges, Washington, DC 20037, USA.
J Am Board Fam Med. 2007 Jul-Aug;20(4):356-64; discussion 329-31. doi: 10.3122/jabfm.2007.04.070100.
Family medicine stands at a critical point in its history. To achieve a place of enhanced prominence within American medicine, the discipline must acknowledge the fundamental changes that have occurred in the country's health care system in recent decades and discard its historical attachment to the fundamental beliefs that led to the establishment of the specialty almost 40 years ago. If the discipline is to serve the most critical needs of the American public, family medicine residency programs must be redesigned to train family physicians who will be experts in the ambulatory care of patients with chronic disease. To accomplish this, family medicine residency programs should provide residents in training with a more concentrated experience in the care of such patients. The enhanced focus of training on education for chronic illness care can be accomplished within a 2-year training period by eliminating training requirements that are no longer relevant to the practice of family medicine in most communities.
家庭医学正处于其历史的关键节点。为了在美国医学领域获得更高的地位，该学科必须认识到近几十年来美国医疗保健系统发生的根本性变化，并摒弃其对近40年前导致该专业设立的基本信念的历史执着。如果该学科要满足美国公众最迫切的需求，家庭医学住院医师培训项目必须重新设计，以培养能够成为慢性病患者门诊护理专家的家庭医生。要做到这一点，家庭医学住院医师培训项目应为住院医师提供更集中的此类患者护理经验。通过取消在大多数社区中与家庭医学实践不再相关的培训要求，在两年的培训期内可以加强对慢性病护理教育的培训重点。
