E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434. B. Kinnear is assistant professor of medicine and pediatrics and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130.
Acad Med. 2019 Jul;94(7):937-939. doi: 10.1097/ACM.0000000000002753.
In this issue of Academic Medicine, Dewan and Norcini examine the significant variability of time-in-training between patient care "giants"-the physicians, nurse practitioners, and physician assistants who practice primary care-and they call for further studies to determine optimal training duration and eventual scope of practice. They ask, what is the minimum education and training required to practice primary care, or "how tall is the shortest giant?" In this Invited Commentary, the authors reframe the question from identifying the minimum length of training required, to identifying desired patient care outcomes. Primary care is not a uniform entity. It ranges from complex elderly chronically ill patients, to twentysomething millennials with acute problems, to pregnant women, to families, and everything in between. The authors argue that training should be fit for purpose and produce high-quality outcomes for patients. Competence should be defined by these outcomes. Drawing parallels with Major League Baseball, the authors note that time to competence development will be variable for different training programs depending on purpose, and also variable for people within those programs, even with shared purpose. While time is a tool for competence attainment, it should not be the metric by which readiness for practice is measured.
在本期《学术医学》中，德万和诺西尼考察了患者护理“巨人”（即从事初级保健的医生、护士从业者和医师助理）之间培训时间的显著差异，并呼吁进一步研究以确定最佳培训持续时间和最终实践范围。他们提出，从事初级保健工作需要最低限度的教育和培训，或者“最矮的巨人有多高？” 在这篇特邀评论中，作者将问题从确定所需的最短培训长度重新构建为确定预期的患者护理结果。初级保健不是一个统一的实体。它的范围从复杂的老年慢性病患者，到 20 多岁有急性问题的千禧一代，到孕妇，到家庭，以及两者之间的所有情况。作者认为，培训应该适合目的，并为患者带来高质量的结果。能力应该由这些结果来定义。作者通过与美国职棒大联盟进行类比指出，不同培训计划的能力发展所需时间将因目的而异，即使目的相同，计划内的人员也会有所不同。虽然时间是获得能力的一种手段，但它不应该成为衡量实践准备程度的标准。
