Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0685, USA.
Acad Med. 2010 Feb;85(2):266-72. doi: 10.1097/ACM.0b013e3181c859fb.
One hundred years after Flexner wrote his report for the Carnegie Foundation, calls are heard for another "Flexnerian revolution," a reform movement that would overhaul an approach to medical education that is criticized for its expense and inefficiency, its failure to respond to the health needs of our communities, and the high cost and inefficiency of the health care system it supports. To address these concerns, a group of Vanderbilt educators, national experts, administrators, residents, and students attended a retreat in November 2008. The goal of this meeting was to craft a new vision of physician learning based on the continuous development and assessment of competencies needed for effective and compassionate care under challenging circumstances. The vision that emerged from this gathering was that of a health care workforce comprised of physicians and other professionals, all capable of assessing practice outcomes, identifying learning needs, and engaging in continuous learning to achieve the best care for their patients. Several principles form the foundation for this vision. Learning should be competency based and embedded in the workplace. It should be linked to patient needs and undertaken by individual providers, by teams, and by institutions. Health professionals should be trained in this new model from the start of the educational experience, leading to true interprofessional education, with shared facilities and the same basic coursework. Multiple entry and exit points would provide flexibility and would allow health professionals to redirect their careers as their goals evolved. This article provides a detailed account of the model developed at the retreat and the obstacles that might be encountered in attempting to implement it.
在 Flexner 为卡内基基金会撰写报告一百周年后，人们呼吁进行另一场“Flexner 式革命”，这是一场改革运动，旨在彻底改革医学教育方法，该方法因费用高昂、效率低下、未能满足社区的健康需求以及其所支持的医疗保健系统成本高昂和效率低下而受到批评。为了解决这些问题，一群范德比尔特教育工作者、国家专家、管理人员、住院医师和学生于 2008 年 11 月参加了一次务虚会。这次会议的目的是根据在具有挑战性的环境下进行有效和富有同情心的护理所需的能力的不断发展和评估，制定新的医师学习愿景。这次会议形成的愿景是，医疗保健工作队伍由医师和其他专业人员组成，他们都能够评估实践结果、确定学习需求并参与持续学习，以为患者提供最佳护理。有几个原则构成了这一愿景的基础。学习应该基于能力，并嵌入工作场所。它应该与患者的需求相关联，并由个人提供者、团队和机构来开展。卫生专业人员应该从教育经验开始就接受这种新模式的培训，从而实现真正的跨专业教育，共享设施和相同的基础课程。多个进入和退出点将提供灵活性，并允许卫生专业人员随着目标的发展重新调整他们的职业。本文详细介绍了务虚会上制定的模式以及在尝试实施过程中可能遇到的障碍。
