1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Ann Am Thorac Soc. 2015 Apr;12(4):474-9. doi: 10.1513/AnnalsATS.201501-054OT.
Fellowship training in pulmonary and critical care has evolved substantially over the past decade. Training programs are increasingly focused on a rigorous, multifaceted assessment of an individual trainee's progress toward achieving specific curricular milestones, and their ability to independently manage a series of entrustable professional activities. This new system has provided programs with an enormous amount of detailed information related to the specific goals and outcomes of training. However, it has not addressed the unmet need for fellowship programs to systematically assess and teach advanced clinical reasoning and judgment. Training programs must address these cognitive processes in a proactive and supportive way, and are challenged to develop novel approaches that encourage continuous self-evaluation. Only by addressing these critical deficiencies will programs enable trainees to progress beyond a level of clinical competence to one of true expertise. These efforts will also encourage physicians at all levels of training to embrace their commitment to lifelong learning.
在过去的十年中，肺科和重症监护医学的住院医师培训发生了重大变化。培训计划越来越注重严格、多方面地评估个人学员在实现特定课程里程碑方面的进展，以及他们独立管理一系列可委托专业活动的能力。这个新系统为计划提供了大量与培训的具体目标和结果相关的详细信息。然而，它并没有解决住院医师培训计划系统地评估和教授高级临床推理和判断能力的未满足需求。培训计划必须以积极和支持的方式解决这些认知过程，并面临着开发鼓励持续自我评估的新方法的挑战。只有解决这些关键缺陷，计划才能使学员从临床能力提高到真正的专业水平。这些努力还将鼓励各级培训医生接受终身学习的承诺。
