Pollett William G, Waxman Bruce P
Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada.
ANZ J Surg. 2012 Sep;82(9):581-7. doi: 10.1111/j.1445-2197.2012.06172.x. Epub 2012 Aug 21.
Canada and Australia share similar cultural origins and current multicultural societies and demographics but there are differences in climate and sporting pursuits. Surgeons and surgeon teachers similarly share many of the same challenges, but the health care and health-care education systems differ in significant ways. The objective of this review is to detail the different postgraduate surgical training programs with a focus on general surgery and how the programs of each country may benefit from appreciating the experiences of the other. The major differences relate to entry requirements, the role of universities in governance of training, mandatory skills courses in early training, the accreditation process, remuneration for surgical teachers and the impact of private practice. Many of the differences are culturally entrenched in their respective medical systems and unlikely to change substantially. Direct entry into specialty training without an internship per se is now firmly established in Canada just as delayed entry after internship is mandated by the Australian Medical Board. Both recognize the importance of establishing goals and objectives, modular curricular and the emerging role of online educational resources and how these may impact on assessments. The Royal Australasian College of Surgeons is unlikely to cede much responsibility to the universities but alternative academic models are emerging. Private health care in the two countries differs, but there are increasing opportunities for training in the private sector in Australia. In spite of the differences, both provide excellent health care and surgical training opportunities in an environment with significant fiscal, technological and societal challenges.
加拿大和澳大利亚有着相似的文化渊源，如今都是多元文化社会且人口结构相近，但在气候和体育追求方面存在差异。外科医生和外科教师同样面临许多共同的挑战，但两国的医疗保健和医疗保健教育系统在诸多重要方面存在不同。本综述的目的是详细介绍不同的研究生外科培训项目，重点是普通外科，以及每个国家的项目如何通过了解对方的经验而受益。主要差异涉及入学要求、大学在培训管理中的作用、早期培训中的必修技能课程、认证过程、外科教师的薪酬以及私人执业的影响。许多差异在各自的医疗系统中已根深蒂固，不太可能有实质性改变。在加拿大，不经实习直接进入专科培训已稳固确立，而澳大利亚医学委员会则规定实习后延迟进入。两国都认识到确立目标和目的、模块化课程以及在线教育资源的新兴作用及其对评估可能产生的影响的重要性。澳大利亚皇家外科学院不太可能将太多责任让渡给大学，但新的学术模式正在出现。两国的私人医疗保健情况不同，但澳大利亚私营部门的培训机会在增加。尽管存在差异，但两国在面临重大财政、技术和社会挑战的环境中都提供了优质的医疗保健和外科培训机会。
