De Lorenzo Robert A
Department of Clinical Investigations, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Mil Med. 2008 Jul;173(7):635-40. doi: 10.7205/milmed.173.7.635.
Military graduate medical education (GME) comprises a substantial fraction of U.S. physician training capacity. The wars in Iraq and Afghanistan have placed substantial stress on military medicine, and lay and professional press accounts have raised awareness of the effects on military GME. To date, however, objective data on military GME quality remains sparse.
Determine the accreditation status of U.S. military GME programs. Additionally, military GME program data will be compared to national (U.S.) accreditation lengths.
Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) data.
All military-sponsored core programs in specialties with at least three residencies were included. Military-affiliated but civilian-sponsored programs were excluded.
The current and past cycle data were used for the study. For each specialty, the current mean accreditation length and the net change in cycle was calculated. National mean accreditation lengths by specialty for 2005 to 2006 were obtained from the ACGME. Comparison between the overall mean national and military accreditation lengths was performed with a z test. All other comparisons employed descriptive statistics.
Ninety-nine military programs in 15 specialties were included in the analysis. During the study period, 1 program was newly accredited, and 6 programs had accreditation withdrawn or were closed. The mean accreditation length of the military programs was 4.0 years. The overall national mean for the same specialties is 3.5 years (p < 0.01). In previous cycles, 68% of programs had accreditation of 4 years or longer, compared to 70% in the current cycle, while 13% had accreditation of 2 years or less in the previous cycle compared to 14% in the current cycle. Ten (68%) of the military specialties had mean accreditation lengths greater than the national average, while 5 (33%) were below it. Ten (68%) specialties had stable or improving cycle lengths when compared to previous cycles.
Military GME accreditation cycle lengths are, overall, longer than national averages. Trends show many military programs are experiencing either stable or slightly lengthening accreditation compared to previous cycles. A few specialties show a declining trend. There has been a modest 5% decline in the number of military core residency programs since 2000.
军事毕业后医学教育（GME）在美国医生培训能力中占很大比例。伊拉克和阿富汗战争给军事医学带来了巨大压力，大众媒体和专业媒体的报道提高了人们对军事GME所受影响的认识。然而，迄今为止，关于军事GME质量的客观数据仍然很少。
确定美国军事GME项目的认证状态。此外，将军事GME项目数据与全国（美国）认证时长进行比较。
对毕业后医学教育认证委员会（ACGME）的数据进行回顾性审查。
纳入所有由军方赞助、专业至少有三个住院医师培训项目的核心项目。排除与军方有关联但由民间赞助的项目。
使用当前和过去周期的数据进行研究。计算每个专业的当前平均认证时长和周期净变化。2005年至2006年各专业的全国平均认证时长数据来自ACGME。使用z检验对全国总体平均认证时长和军事认证时长进行比较。所有其他比较采用描述性统计。
分析纳入了15个专业的99个军事项目。在研究期间，1个项目新获得认证，6个项目的认证被撤销或项目关闭。军事项目的平均认证时长为4.0年。相同专业的全国总体平均时长为3.5年（p<0.01）。在前几个周期中，68%的项目认证时长为4年或更长，当前周期为70%；前一周期13%的项目认证时长为2年或更短，当前周期为14%。10个（68%）军事专业的平均认证时长高于全国平均水平，5个（33%）低于全国平均水平。与前几个周期相比，10个（68%）专业的认证周期时长稳定或延长。
总体而言，军事GME认证周期长于全国平均水平。趋势表明，与前几个周期相比，许多军事项目的认证处于稳定或略有延长状态。少数专业呈下降趋势。自2000年以来，军事核心住院医师培训项目数量略有下降，降幅为5%。
