Proger S
N Engl J Med. 1975 Jun 19;292(25):1318-24. doi: 10.1056/NEJM197506192922504.
To meet the need and resolve long standing conflicts in the delivery of primary care in an age of specialization, I propose an experiment with a different type of primary medical education based on the separation of careers into community-oriented primary and continuing care of ambulatory patients and hospital-based intensive care of acutely ill bed patients. High-school graduates selected for interest, aptitude, and personality would follow a six-year pathway through college and medical school. A singular feature of the proposal would be the replacement of bedside training with an undergraduate traineeship of two to 2 1/2 years in the hospital ambulatory specialty clinics, emergency clinic, and a primary-care model practice unit, followed by a one-year externship in this primary-care center. The graduate would be oriented toward group and team practice and would work in a system integrating primary, secondary, and tertiary care.
为满足在专业化时代提供初级医疗服务的需求并解决长期存在的冲突，我提议进行一项关于不同类型初级医学教育的实验，该教育基于将职业分为面向社区的初级和门诊患者的持续护理以及基于医院的急性病卧床患者的重症护理。根据兴趣、能力和个性选拔的高中毕业生将经过六年的大学和医学院学习路径。该提议的一个独特之处在于，将在医院门诊专科诊所、急诊诊所和初级保健模式实践单位进行为期两年至两年半的本科实习，取代床边培训，随后在这个初级保健中心进行为期一年的见习。毕业生将以团队协作的方式开展工作，并在一个整合了初级、二级和三级护理的系统中工作。
