Hafferty F W, Goldberg H I
Health Serv Res. 1986 Apr;21(1):107-25.
This study examined the impact of a community-based, totally decentralized training program on the likelihood that graduates would establish their first practice within predefined and limited geographic regions. We found that when students in a physician assistant/nurse practitioner program received their preclinical and terminal training (preceptorship) in a region geographically proximate to their home residence, the likelihood that they would establish their first practice in that region was greatly increased. Similar results were found for students who took their preclinical training away from their home region but returned there for terminal training. Three additional training pathways were identified as being associated with markedly lower rates of regionally based graduate retention. Discriminant analysis was used to compare the relative impact of training and personal variables on retention. The educational process itself was found to be the single most important predictor of graduate retention. When structural variables were controlled, personal variables such as marital status, age, or sex had no predictive capabilities. With appropriate attention to the structural components of training--particularly terminal training (preceptorship)--experiences, PAs and NPs can be targeted to specific and relatively focused areas of medical need. These data suggest that several decentralized training strategies exist for physician assistants and nurse practitioners that would contribute to meeting health care delivery needs in chronically underserved areas.
本研究考察了一项基于社区的完全分散式培训项目对毕业生在预先设定的有限地理区域内开展首次执业的可能性的影响。我们发现，当医师助理/执业护士项目的学生在与其家乡地理位置相近的地区接受临床前培训和终末期培训（带教实习）时，他们在该地区开展首次执业的可能性会大幅增加。对于那些在远离家乡的地区接受临床前培训但返回原地接受终末期培训的学生，也发现了类似的结果。另外三种培训途径被确定与基于地区的毕业生留用率显著较低有关。采用判别分析来比较培训和个人变量对留用率的相对影响。结果发现，教育过程本身是毕业生留用率最重要的单一预测因素。当控制了结构变量后，婚姻状况、年龄或性别等个人变量没有预测能力。通过适当关注培训的结构组成部分——尤其是终末期培训（带教实习）经历，医师助理和执业护士可以被引导至特定且相对集中的医疗需求领域。这些数据表明，存在几种针对医师助理和执业护士的分散式培训策略，有助于满足长期服务不足地区的医疗服务需求。
