Mazzone Michael, Krasovich Susanne, Fay David, Ginn Patrick, Lopresti Leigh, Nelson Karen, Ambuel Bruce
Waukesha Family Medicine Residency Program, Department of Family and Community Medicine, Medical College of Wisconsin, Waukesha, WI 53188, USA. michael.
Fam Med. 2011 Jul-Aug;43(7):514-21.
There have been dramatic changes in the specialty of family medicine and the American health care system in the more than 40 years since the formation of the specialty. As a result, there is urgent need for experimentation and innovation in residency training to better prepare family physicians.
Waukesha Family Medicine Residency used a strategic planning process to identify four guiding concepts for a new model of residency education: intentional diversification; options for advanced training in a fourth year of residency; longitudinal, competency-based training; and strong fundamental background in family medicine skills. These concepts guided radical restructuring of the curriculum.
The new Majors and Masteries curriculum begins with 19 months of training in core family medicine skills. Residents then elect to pursue a Major or Mastery in an area of interest. Majors are completed within 3 years, while Masteries are completed in 4 years and include advanced training (MPH, MBA, advanced obstetrics). Since implementation, residents have selected a broad range of Majors, three residents have elected advanced training in three different mastery areas, and resident recruitment has not been disrupted.
The Majors and Masteries curriculum and the process used to implement it may benefit other residencies considering radical curriculum change.
自家庭医学专业形成以来的40多年间，家庭医学专业和美国医疗保健系统发生了巨大变化。因此，迫切需要在住院医师培训中进行试验和创新，以使家庭医生得到更好的培养。
沃基肖家庭医学住院医师培训项目采用战略规划流程，为新的住院医师教育模式确定了四个指导理念：有针对性的多样化；住院医师第四年的高级培训选项；基于能力的纵向培训；以及扎实的家庭医学技能基础。这些理念指导了课程的彻底重组。
新的“主修与精通”课程从19个月的核心家庭医学技能培训开始。住院医师随后选择在感兴趣的领域攻读“主修”或“精通”方向。“主修”方向在3年内完成，而“精通”方向在4年内完成，包括高级培训（公共卫生硕士、工商管理硕士、高级产科学）。自实施以来，住院医师选择了广泛的“主修”方向，三名住院医师选择了三个不同“精通”领域的高级培训，并且住院医师招募工作没有受到干扰。
“主修与精通”课程及其实施过程可能会使其他考虑彻底改变课程的住院医师培训项目受益。
