Finocchio L J, Bailiff P J, Grant R W, O'Neil E H
Pew Health Professions Commission, Center for the Health Professions, University of California, San Francisco 94109-5453, USA.
Acad Med. 1995 Nov;70(11):1023-8. doi: 10.1097/00001888-199511000-00021.
To examine physicians' attitudes toward 16 competencies deemed essential to the effective practice of medicine in the changing health care system.
In early 1991 a telephone survey was conducted of 300 physicians from random samples selected as representative of the physician population in the continental United States. The physicians were categorized as general practitioners, surgery specialists, and other specialists, and as belonging to the graduation cohorts of 1960-1969, 1970-1979, and 1980-1989. The physicians were asked to rate (1) the importance of formal undergraduate training in each of 16 competencies and (2) the adequacy of their own undergraduate training in the competencies (these ratings are reported only for the 87 physicians in the 1980-1989 cohort). The competencies were derived from the skills, attitudes, and behaviors defined by the Pew Health Professions Commission as necessary for the nation's health care practitioners to meet society's evolving health care needs.
Fifty percent or more of the physicians thought that 12 of the 16 competencies were "very important" to include in undergraduate training. Over 75% thought that it was "very important" to include the five competencies involving skills traditionally valued in medical practice: diagnosis and treatment, effective communication with patients, problem solving, lifelong learning, and counseling on medical ethics. More than 50% thought that undergraduate training was "very important" in some competencies that reflect the changing dynamics of medicine and care delivery over the past ten years: health promotion and preventive medicine, involvement of patient and family in care, management of large volumes of information, appropriate use of technology, working on a team with other professionals, and consideration of cost in clinical decision making. In rating their own training, over 50% felt well prepared (ratings of "excellent" or "good") in the five traditional competencies and, in addition, in their abilities to promote health, to manage large volumes of information, to work in teams, to understand and respond to diverse cultures, and to expand access to care. However, a majority felt that their training was only "fair" or "poor" regarding the involvement of patients and their families, evaluation of the appropriateness of costly technology, consideration of cost implications in their decision making, and understanding and supporting the community's role in health care. Forty percent or more felt poorly prepared to work in managed care settings or to accommodate increasing external scrutiny.
The physicians validated the traditional strengths of medical schools, but revealed curricular weaknesses in the teaching of competencies proposed as important for the emerging health care system, especially in the managed care environment.
研究医生对16项能力的态度，这些能力被认为是在不断变化的医疗体系中有效行医所必需的。
1991年初，对300名医生进行了电话调查，这些医生是从美国大陆随机抽取的，作为美国医生群体的代表样本。医生被分为全科医生、外科专家和其他专家，并按毕业年份分为1960 - 1969年、1970 - 1979年和1980 - 1989年三个队列。要求医生对（1）16项能力中每项能力本科正规培训的重要性，以及（2）他们自己在这些能力方面本科培训的充分性进行评分（这些评分仅针对1980 - 1989年队列中的87名医生）。这些能力源自皮尤健康职业委员会定义的技能、态度和行为，是美国医疗从业者满足社会不断变化的医疗需求所必需的。
50%或更多的医生认为16项能力中的12项对本科培训“非常重要”。超过75%的医生认为将涉及医学实践中传统重视技能的五项能力纳入本科培训“非常重要”：诊断与治疗、与患者有效沟通、解决问题、终身学习以及医学伦理咨询。超过50%的医生认为本科培训在一些反映过去十年医学和护理服务动态变化的能力方面“非常重要”：健康促进与预防医学、患者及家属参与护理、大量信息管理、技术的恰当使用、与其他专业人员团队协作以及临床决策中考虑成本。在对自身培训进行评分时，超过50%的医生认为自己在五项传统能力以及促进健康、管理大量信息、团队协作、理解和应对不同文化以及扩大医疗服务可及性等能力方面准备充分（评分为“优秀”或“良好”）。然而，大多数医生认为他们在患者及其家属参与、评估昂贵技术的适用性、决策中考虑成本影响以及理解和支持社区在医疗保健中的作用方面培训仅为 “一般” 或 “较差”。40%或更多的医生认为自己在管理式医疗环境中工作或应对日益增加的外部审查方面准备不足。
医生认可了医学院校的传统优势，但也揭示出在为新兴医疗体系（尤其是在管理式医疗环境中）所提议的重要能力教学方面课程存在薄弱环节。
