McPhee S J, Mitchell T F, Schroeder S A, Perez-Stable E J, Bindman A B
JAMA. 1987 Sep 18;258(11):1491-5.
We surveyed all 49 graduates of the University of California, San Francisco, residency program in primary care internal medicine to determine whether they chose careers as general internists and whether training in ambulatory care at the expense of hospital-based medicine is adequate preparation for general internal medicine practice. Graduates rated adequacy of training and relevance to their current clinical practice of 87 content and skill areas on five-point Likert scales. Of the 44 respondents, 39 (89%) chose careers as general internists and five (11%) as subspecialty internists. Training in nine of 11 internal medicine disciplines (eg, cardiology) was rated as highly adequate, and the areas as highly relevant. For ten of 15 non-internal medicine areas (eg, ear, nose, and throat), mean relevance scores significantly exceeded adequacy scores, suggesting training underemphasis. Mean relevance scores also significantly exceeded adequacy scores for seven of 11 basic knowledge/skill areas (eg, patient interviewing) and 13 of 14 areas related to clinical practice (eg, quality assurance). We conclude that the vast majority of graduates of the University of California, San Francisco, primary care residency program became general internists and that, rather than feeling deficient in training in hospital-based medicine, graduates reported unmet needs for ambulatory-care experiences and skills related to general internal medicine practice.
我们对加州大学旧金山分校初级保健内科住院医师项目的所有49名毕业生进行了调查，以确定他们是否选择成为普通内科医生，以及以牺牲医院医学为代价的门诊护理培训是否足以胜任普通内科实践。毕业生们用五点李克特量表对87个内容和技能领域的培训充分性及其与当前临床实践的相关性进行了评分。在44名受访者中，39人（89%）选择成为普通内科医生，5人（11%）选择成为专科内科医生。11个内科专业领域中的9个（如心脏病学）的培训被评为高度充分，这些领域与临床实践高度相关。在15个非内科领域中的10个（如耳鼻喉科），平均相关性得分显著超过充分性得分，表明培训受到忽视。11个基本知识/技能领域中的7个（如患者访谈）以及14个与临床实践相关领域中的13个（如质量保证）的平均相关性得分也显著超过充分性得分。我们得出结论，加州大学旧金山分校初级保健住院医师项目的绝大多数毕业生成为了普通内科医生，而且毕业生们并未觉得医院医学培训不足，而是表示在门诊护理经验以及与普通内科实践相关的技能方面存在未满足的需求。
