J.H. Strasser is senior research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC.
M.M. Jewers is cofounder and vice president, Open Avenues Foundation, and chief operating officer, Project Alianza, Boston, Massachusetts.
Acad Med. 2022 Jan 1;97(1):129-135. doi: 10.1097/ACM.0000000000004419.
The Teaching Health Center (THC) Graduate Medical Education program enables primary care physicians to train in community-based, underserved settings by shifting the payment structure and training environment for graduate medical education. To understand how THCs have successfully trained primary care physicians who practice in community-based settings, the authors conducted a mixed-methods exploratory study to examine THC residency graduates' experiences of mentorship and career planning during their residencies, perceptions of preparation for postresidency practice, and how these experiences were related to postresidency practice environments.
Surveys were conducted for all 804 graduating THC residents nationally, 2014-2017 (533 respondents, 66% response rate). Three quantitative outcomes were measured: graduates' perceptions of preparation for practice after residency (Likert scale), satisfaction with mentorship and career planning (Likert scale), and characteristics of postresidency practice environment (open-ended). A qualitative analysis of open-text survey answers, using thematic content analysis, was also conducted.
Most THC graduates (68%) were satisfied with their mentorship and career planning experience and generally felt prepared for postresidency practice in multiple settings (78%-93%). Of the 533 THC graduates who provided information about their practice environment, 445 (84%) were practicing in primary care; nationally, 64% of physicians who completed primary care residencies practiced in primary care. Of the 445 THC graduates practicing in primary care, 12% practiced in rural areas, compared with 7% of all physicians. Just over half of THC graduates (51%) practiced in medically underserved areas, compared with 39% of all physicians.
This study offers early evidence that the THC model produces and retains primary care physicians who are well prepared to practice in underserved areas. Given these promising findings, there appears to be a substantial benefit to growing the THC program. However, the program continues to face uncertainty around ongoing, stable funding.
教学医疗中心（THC）研究生医学教育计划通过改变研究生医学教育的支付结构和培训环境，使初级保健医生能够在以社区为基础的服务不足的环境中接受培训。为了了解 THC 如何成功培训在社区环境中执业的初级保健医生，作者进行了一项混合方法探索性研究，以检查 THC 居住毕业生在居住期间的指导和职业规划经验、对毕业后实践准备的看法，以及这些经验如何与毕业后实践环境相关。
对全国范围内所有 804 名即将毕业的 THC 居民进行了调查，时间为 2014-2017 年（533 名受访者，66%的回复率）。测量了三个定量结果：毕业生对毕业后实践准备的看法（李克特量表）、对指导和职业规划的满意度（李克特量表）以及毕业后实践环境的特征（开放式）。还对开放式调查答案进行了定性分析，使用主题内容分析。
大多数 THC 毕业生（68%）对他们的指导和职业规划经验感到满意，并且普遍对在多种环境中进行毕业后实践感到满意（78%-93%）。在提供有关其实践环境信息的 533 名 THC 毕业生中，445 名（84%）在初级保健领域执业；全国范围内，完成初级保健住院医师培训的医生中有 64%在初级保健领域执业。在 445 名在初级保健领域执业的 THC 毕业生中，有 12%在农村地区执业，而所有医生中只有 7%在农村地区执业。超过一半的 THC 毕业生（51%）在医疗服务不足的地区执业，而所有医生中只有 39%在医疗服务不足的地区执业。
这项研究提供了早期证据，表明 THC 模式培养并留住了准备在服务不足地区执业的初级保健医生。鉴于这些有希望的发现，扩大 THC 计划似乎有很大的好处。然而，该计划仍面临持续稳定资金的不确定性。
