Newton Warren, Arndt Jane E
Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7595, USA.
Acad Med. 2008 Nov;83(11):1030-8. doi: 10.1097/ACM.0b013e3181892933.
The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
当前对初级保健兴趣的复兴可以从回顾联邦对学术性家庭医学的投资历史中受益。作者回顾了《第七章，第747节初级保健医学和牙科学培训》（第七章）拨款计划30年的经验，探讨了三个问题：（1）家庭医学可获得哪些第七章拨款计划，其目标是什么？（2）第七章如何改变了该学科？以及（3）第七章家庭医学计划对该学科之外产生了什么影响？第七章拨款计划从对家庭医学新学科的广泛支持演变为更专注于特定的国家劳动力目标，如改善对服务不足和弱势群体的护理以及增加卫生专业的多样性。拨款计划在几乎所有医学院校建立家庭医学以及支持该领域的教育基础方面发挥了重要作用。第七章拨款有助于增强该学科的社会资本。在家庭医学之外，第七章促进了创新性门诊教育的发展、针对服务不足和弱势群体的机构举措以及初级保健研究能力。不利影响包括家庭医学学术单位相对忽视临床和研究任务，以及在机构层面上，在没有核心机构支持的情况下开展医学教育举措，随着拨款资金减少，这使向社区的教育创新和推广面临风险。对学术性家庭医学的再投资可为家庭医学带来巨大益处，并有助于重新定位学术健康中心。本文是《学术医学》关于第七章卫生专业培训计划主题特刊的一部分。
