Faculty of Health Sciences, Serv. Medicina I, HFF, UBI Portugal, Portugal.
Eur J Intern Med. 2010 Oct;21(5):374-6. doi: 10.1016/j.ejim.2010.04.014. Epub 2010 Jul 13.
Around the world, there is an increasing need for more efficiency in healthcare alongside cost containment. Internal medicine physicians are in a pivotal position in this regard. In many countries, they act as bridges between ambulatory/continuity of care systems and hospital-based intensive care and sophisticated therapies. Within the medical field, they often bridge gaps between many specialities increasingly required to provide modern medical care. These skills of managing complex environments, being sensitive to health economics and using large amounts of information, are not normally taught or developed in programmes of internal medicine. While some skills are natural and acquired through practice, other skills would benefit from insights from the fields of management. On the other hand, it seems critical to have internists playing a leading role in the future care of aging populations, and they are the most likely to understand the needs of these multi-pathology cases. On a practical level, internists face the daily challenges of engaging and leading as many people as possible to provide the best care; this requires very good leadership, negotiation, team-working and change-management skills, all of which can be vastly enhanced with specific education initiatives that are targeted and customised to physicians' needs. Management education for internists should be "spiral", starting from medical school and expanding to incorporate issues as the physician matures into new activities and responsibilities. In practical terms, current internists and residents of internal medicine can be brought into contact with such education by a combination of workshops as well as residential and online courses.
在全球范围内，医疗保健需要提高效率，同时控制成本。内科医生在这方面处于关键地位。在许多国家，他们充当了门诊/连续护理系统与医院重症监护和复杂治疗之间的桥梁。在医学领域，他们经常弥合许多专科之间的差距，这些专科越来越需要提供现代医疗护理。管理复杂环境、对卫生经济学敏感以及使用大量信息的这些技能通常不在内科医学课程中教授或发展。虽然有些技能是天生的，并且通过实践获得，但其他技能将受益于管理领域的见解。另一方面，似乎需要内科医生在未来老龄化人口的护理中发挥主导作用，而且他们最有可能了解这些多病理病例的需求。在实践层面上，内科医生每天都面临着让尽可能多的人参与并提供最佳护理的挑战；这需要非常出色的领导能力、谈判能力、团队合作能力和变革管理能力，所有这些都可以通过针对医生需求的具体教育计划得到极大的提高。内科医生的管理教育应该是“螺旋式”的，从医学院开始，随着医生成长为新的活动和责任，不断扩大范围，纳入相关问题。实际上，可以通过将研讨会以及住宿和在线课程相结合，使当前的内科医生和内科住院医师接触到这种教育。
