Murphree P D, Brandon W
Department of Family Medicine, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA.
Ochsner J. 2000 Oct;2(4):228-32.
The impact of managed care in the 1990s and the need for more broadly trained primary care physicians led the American Board of Internal Medicine and the American Board of Family Practice to explore ways to collaboratively train primary care physicians. One proposed solution was a combined residency incorporating the training curriculums of both boards in an integrated fashion. In 1995, the Alton Ochsner Medical Foundation Combined Family Practice and Internal Medicine Residency Program was one of the first to be approved by the two boards. The first residents began training in July 1996. Due to overlap in curriculums, completion for both boards is possible in 48 months as opposed to the 72 months a consecutive approach would require. The first graduates completed the program in July 2000.The combined residents rotate on both the Family Practice inpatient service and the General Internal Medicine wards and participate in continuity care clinics and precepting in both core programs. Facilities for the program involve only existing clinics and administrative personnel. Residents serve as primary care physicians for a mixed ethnic, middle-class patient population atOchsner's New Orleans East satellite clinic, provide longitudinal obstetric and pediatric care at an inner city clinic, and complete a rural primary care rotation. Inservice examination scores have been consistently high with several combined residents scoring at the top United States level on both examinations. The program has matched with our highest ranked students over each year of the program despite a marked decline in US graduates entering primary care fields. Graduates of the combined program are ideal staff for either medical schools or residency programs of either core program.While this residency is in its early stages, both boards have mandated an indepth evaluation to determine the quality and outcomes of training. The results of a recent survey of current Ochsner residents assessing their perceptions of the combined program were encouraging. We plan to track our graduates and compare them with recent graduates of the two core programs in order to document long-term impact.
20世纪90年代管理式医疗的影响以及对接受更广泛培训的初级保健医生的需求，促使美国内科医学委员会和美国家庭医疗委员会探索合作培训初级保健医生的方法。一个提议的解决方案是设立一个联合住院医师项目，以综合的方式将两个委员会的培训课程结合起来。1995年，奥尔顿·奥克斯纳医学基金会联合家庭医疗与内科住院医师项目成为首批获得两个委员会批准的项目之一。首批住院医师于1996年7月开始培训。由于课程重叠，相对于连续培训方式所需的72个月，完成两个委员会要求的培训仅需48个月。首批毕业生于2000年7月完成该项目。联合住院医师在家庭医疗住院服务和普通内科病房轮转，并参与两个核心项目的连续性护理诊所和带教工作。该项目的设施仅涉及现有的诊所和行政人员。住院医师在奥克斯纳新奥尔良东部卫星诊所为不同种族的中产阶级患者群体担任初级保健医生，在内城区诊所提供纵向产科和儿科护理，并完成农村初级保健轮转。在职考试成绩一直很高，有几位联合住院医师在两项考试中都取得了美国顶级水平的成绩。尽管进入初级保健领域的美国毕业生数量显著下降，但该项目在每年都吸引了我们排名最高的学生。联合项目的毕业生是医学院或两个核心项目中任何一个住院医师项目的理想员工。虽然这个住院医师项目尚处于早期阶段，但两个委员会都已要求进行深入评估，以确定培训的质量和成果。最近一项对奥克斯纳现任住院医师评估他们对联合项目看法的调查结果令人鼓舞。我们计划跟踪我们的毕业生，并将他们与两个核心项目的近期毕业生进行比较，以记录长期影响。
