C. Whitehead is director and scientist, Wilson Centre, BMO Financial Group Chair in Health Professions Research, University Health Network, vice president of education, Women's College Hospital, and associate professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. E. Paradis holds the Canada Research Chair in Collaborative Healthcare Practice and is assistant professor, Leslie Dan Faculty of Pharmacy, Department of Anesthesia and Department of Sociology, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2019 Jul;94(7):940-942. doi: 10.1097/ACM.0000000000002749.
In this issue, Dewan and Norcini invite readers to reconsider the basic minimum standards for independent primary care practice. Their willingness to push boundaries, question turf wars, and suggest innovative ways forward is laudable. Although their piece is timely and provocative, it does not fully consider the interplay between individual and system factors that influence people to pursue different kinds of degrees and practice in this context. In this Invited Commentary, the authors discuss imperatives that are underacknowledged by Dewan and Norcini: the importance of diversity in health system planning; status, power, and privilege; the extension of their argument beyond primary care; the conflation of time in training with competence; and important issues of distribution of health care resources. Ultimately, the authors argue that there may be strength in diversity, one that should not be obscured by attempts to normalize training time.
本期特刊中，Dewan 和 Norcini 邀请读者重新思考独立初级保健实践的基本最低标准。他们愿意突破界限、质疑地盘之争并提出创新的前进方式，这值得称赞。尽管他们的文章很及时且具有煽动性，但并没有充分考虑影响人们在这种背景下追求不同学位和实践的个体因素和系统因素之间的相互作用。在这篇特邀评论中，作者讨论了 Dewan 和 Norcini 未充分考虑的一些必要因素：卫生系统规划多样性的重要性；地位、权力和特权；将他们的论点扩展到初级保健之外；培训时间与能力的混淆；以及医疗资源分配的重要问题。最终，作者认为多样性可能具有优势，不应试图通过标准化培训时间来掩盖这一点。
