Witzburg R A, Noble J
Department of Medicine, Boston City Hospital, Boston University School of Medicine, Massachusetts 02118.
J Gen Intern Med. 1988 Jan-Feb;3(1):48-53. doi: 10.1007/BF02595756.
A primary care (PC) pathway was initiated within the medical residency program at Boston City Hospital (BCH) in 1974. The authors studied the PC and traditional (TD) track graduates of the program to compare career development, goals, and practice patterns. The 185 graduates of the nine resident cohorts from 1974 through 1983 were surveyed; the overall response rate was 74%. Primary care careers have been chosen by 81% of PC graduates, compared with 38% of TD graduates (p less than 0.001); career satisfaction is equally high in the two groups. Among the PC graduates, 68% are practicing in high-need areas, compared with only 37% of TD graduates (p less than 0.001). PC graduates are more likely to make house calls, provide extended office hours, round in nursing homes or chronic care facilities, and co-practice with nurse practitioners or physician's assistants, and they are more active in women's health care, care of the terminally ill, and treating patients with sexual dysfunction (all p less than 0.05). PC graduates utilize various community agencies more frequently and supplement patient education with outside resources more intensively (p less than 0.001). The career choices and practice locations of PC graduates reflect the training goals of the PC curriculum and differ from the career choices and practices of the TD graduates from the same program.
1974年，波士顿市医院（BCH）的住院医师培训项目启动了初级保健（PC）路径。作者对该项目的初级保健和传统（TD）方向的毕业生进行了研究，以比较他们的职业发展、目标和执业模式。对1974年至1983年九个住院医师队列的185名毕业生进行了调查；总体回复率为74%。81%的初级保健方向毕业生选择了初级保健职业，而传统方向毕业生的这一比例为38%（p<0.001）；两组的职业满意度同样高。在初级保健方向毕业生中，68%在高需求地区执业，而传统方向毕业生的这一比例仅为37%（p<0.001）。初级保健方向毕业生更有可能上门问诊、延长门诊时间、在养老院或慢性病护理机构查房，并与执业护士或医师助理合作执业，他们在女性健康护理、临终关怀以及治疗性功能障碍患者方面也更积极（所有p<0.05）。初级保健方向毕业生更频繁地利用各种社区机构，并更密集地利用外部资源补充患者教育（p<0.001）。初级保健方向毕业生的职业选择和执业地点反映了初级保健课程的培训目标，与同一项目传统方向毕业生的职业选择和执业情况不同。
