Kurtz K J
West J Med. 1982 Jan;136(1):76-82.
The recent establishment of primary care residencies at the University of Nevada School of Medicine has raised important questions about local priorities in the training of physicians to provide primary care for adults. Because the amount of money available for health care training is decreasing, these questions also have national importance. Primary care internal medicine, not synonymous with general internal medicine, offers distinct advantages to patients over family practice adult care and primary care offered by internist subspecialists. The University of Nevada has a singular opportunity to organize a strong primary care internal medicine residency, but national problems of internal medicine emphasis exist. Nationwide changes in internal medicine residency programs (ongoing) and American Board of Internal Medicine nationalization of the fledgling primary care internal medicine fellowship movement are suggested. Specifically proposed is an extra year for primary care training with a single examination after four years, producing general internists with a primary care "minor." Alternately, and ideally, there would be a full two-year primary care fellowship with a separate internal medicine primary care subspecialty board examination. Either of the above options would provide necessary training and academic credibility for primary care internists, and would redirect internal medicine certification and training.
内华达大学医学院近期设立的基层医疗住院医师项目引发了一些重要问题，这些问题关乎当地在培养为成年人提供基层医疗服务的医生方面的优先事项。由于可用于医疗培训的资金正在减少，这些问题也具有全国性意义。基层医疗内科与普通内科不同义，相较于家庭医疗成人护理以及内科亚专科医生提供的基层医疗服务，它为患者带来了独特优势。内华达大学有一个独特的机会来组织一个强大的基层医疗内科住院医师项目，但内科领域存在全国性的重点问题。文中建议对内科住院医师项目进行全国范围内的变革（正在进行中），以及美国内科医学委员会对新兴的基层医疗内科专科培训项目进行全国统一管理。具体提议是增加一年的基层医疗培训时间，四年后进行一次统一考试，培养出具有基层医疗“辅修专业”的普通内科医生。或者，理想的情况是设立一个为期两年的完整基层医疗专科培训项目，并进行单独的内科基层医疗亚专科委员会考试。上述任何一种选择都将为基层医疗内科医生提供必要的培训和学术认可，并重新调整内科认证和培训方向。
