Nguyen Vu T, Losee Joseph E
Pittsburgh, Pa.
From the Department of Plastic Surgery, University of Pittsburgh Medical Center.
Plast Reconstr Surg. 2016 Aug;138(2):527-531. doi: 10.1097/PRS.0000000000002407.
Graduate medical education is at the brink of a paradigm shift in educating the next generation of physicians. Over 100 years ago, the Flexner report helped usher in the Halstedian residency, based on timed exposure and knowledge assessment as the cornerstones of medical education. The addition of operative case logs and respective board examinations to the current model of surgical education has served to establish practice minimums; however, they do not provide any assessment of actual operative capability or clinical competence. Although these facets have been tempered over time, one could argue that they currently exist only as surrogates for the true goal of all graduate medical education: the development of competent, graduating physicians, capable of independent and ethical practice. There now exists a growing body of evidence that competency-based medical education is this century's Flexnerian revolution. By the objective, subjective, and global assessment of competence, it is thought that we can more effectively and efficiently educate our trainees, provide much needed accountability to our individual patients and to the public as a whole, and establish a lasting model of self-motivated, lifelong learning.
毕业后医学教育正处于教育下一代医生的范式转变边缘。100多年前，《弗莱克斯纳报告》推动了以定时接触和知识评估为医学教育基石的霍尔斯特德式住院医师培训模式的出现。在当前外科教育模式中增加手术病例记录和相应的委员会考试，有助于确立实践最低标准；然而，它们并未对实际手术能力或临床能力进行任何评估。尽管这些方面随着时间的推移有所缓和，但有人可能会说，它们目前仅作为所有毕业后医学教育真正目标的替代物存在：培养有能力、即将毕业的医生，使其能够独立且合乎道德地执业。现在有越来越多的证据表明，基于能力的医学教育是本世纪的弗莱克斯纳式革命。通过对能力进行客观、主观和全面评估，人们认为我们能够更有效、高效地培训学员，为我们的个体患者乃至整个公众提供迫切需要的问责制，并建立一个自我激励、终身学习的持久模式。
