Wartman S A, O'Sullivan P S, Cyr M G
Division of General Internal Medicine, Brown University, Providence, RI.
J Gen Intern Med. 1990 Jan-Feb;5(1 Suppl):S59-69. doi: 10.1007/BF02600439.
Residency programs consist of a range of activities involving service to patients and education of residents. The observation that a conflict exists between the service and education components of residency is widespread and has been used to explain many of the problems afflicting such programs today. The authors believe that the service/education conflict is a significant barrier to change in residency programs. A model is presented for residency education that reorganizes the service and education components. First, they present a broad overview of the conflict. Then they provide a brief historical perspective and comment on some of the current recommendations for residency programs. Next, they discuss how principles of adult learning relate to residency and propose a new model of residency that adheres more closely to these principles. Finally, the proposed model is presented in some detail and its implications are discussed. Only if the service and education components of residency are carefully delineated can residency programs adapt to the changing and growing needs of postgraduate medical education.
住院医师培训项目包括一系列涉及为患者服务和培训住院医师的活动。住院医师培训中服务与教育部分之间存在冲突这一现象普遍存在，并且已被用于解释当今困扰此类项目的许多问题。作者认为，服务/教育冲突是住院医师培训项目变革的重大障碍。本文提出了一个用于住院医师培训的模型，该模型对服务和教育部分进行了重新组织。首先，他们对冲突进行了广泛概述。然后提供了一个简要的历史视角，并对当前一些针对住院医师培训项目的建议进行了评论。接下来，他们讨论了成人学习原则与住院医师培训的关系，并提出了一个更紧密遵循这些原则的住院医师培训新模式。最后，详细介绍了所提出的模型并讨论了其影响。只有仔细界定住院医师培训的服务和教育部分，住院医师培训项目才能适应毕业后医学教育不断变化和增长的需求。
