Papadakis M A, Kagawa M K
Department of Medicine, University of California, San Francisco.
Am J Med. 1995 Jan;98(1):7-12. doi: 10.1016/S0002-9343(99)80075-8.
To assess the case mix or experiential curriculum of a university-based categorical medicine residency program and compare the residents' continuity clinic case mix with the outpatients seen by practicing internists.
Descriptive study during the 1991-1992 academic year of 24,218 inpatients and outpatients from the University of California, San Francisco, Department of Medicine's three core hospitals: the University of California, San Francisco Hospital; the Department of Veterans Affairs Medical Center; and the San Francisco General Hospital. The diagnoses and ages of patients who made office visits to practicing internists from the National Ambulatory Medical Care Survey (NAMCS) were compared with corresponding data from the categorical medicine residents' continuity clinic patients.
Seventy percent of the general medicine inpatients at the three core hospitals had one of the 25 most common principal diagnoses for inpatients. Eighty-seven percent of the patients seen by the residents in their continuity clinic had one of the 20 most common diagnoses seen by practicing internists in the NAMCS. The age distribution was similar in both groups.
A systematic assessment of clinical training at one university-based hospital program shows that common internal medicine problems represent the case mix of the great majority of patients, both inpatients and outpatients, seen by categorical medicine residents. Residents' continuity clinic patients are similar to patients seen by practicing internists. The program's challenge is to ensure that residents have adequate time with general medicine experiences, both in the inpatient setting and in the ambulatory and longitudinal care settings, while balancing and integrating these activities.
评估一所大学附属的分类医学住院医师培训项目的病例组合或经验课程，并将住院医师连续性诊所的病例组合与执业内科医生诊治的门诊患者进行比较。
在1991 - 1992学年对来自加利福尼亚大学旧金山分校医学部的三家核心医院（加利福尼亚大学旧金山分校医院、退伍军人事务部医疗中心和旧金山总医院）的24218名住院患者和门诊患者进行描述性研究。将来自国家门诊医疗护理调查（NAMCS）中执业内科医生门诊患者的诊断和年龄与分类医学住院医师连续性诊所患者的相应数据进行比较。
三家核心医院70%的普通内科住院患者的主要诊断属于25种最常见的住院患者主要诊断之一。住院医师在连续性诊所诊治的患者中，87%的患者的诊断属于执业内科医生在NAMCS中诊治的20种最常见诊断之一。两组的年龄分布相似。
对一所大学附属医院项目临床培训的系统评估表明，常见的内科问题代表了分类医学住院医师诊治的绝大多数住院患者和门诊患者的病例组合。住院医师连续性诊所的患者与执业内科医生诊治的患者相似。该项目面临的挑战是确保住院医师在住院环境、门诊和长期护理环境中都有足够的时间积累普通内科经验，同时平衡和整合这些活动。
