Stein D H, Salive M E
Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA.
Acad Med. 1996 Apr;71(4):375-80. doi: 10.1097/00001888-199604000-00016.
To evaluate training in general preventive medicine and public health, determining which experiences and institutional sponsors best prepare residents for practice and where improvements are most needed.
A 1991 survey of the 1,070 graduates of preventive medicine residencies from 1979 through 1989 asked the graduates to measure the adequacy of their training in preventive medicine topic areas by using a Likert-type scale of 1 (poor) to 4 (excellent). Adequacy was analyzed for variation against practice emphasis during training, training program sponsor, and other variables. The statistical methods included Student's t-test, analysis of variance and linear regression.
A total of 797 graduates (74.5%) responded. The overall mean ratings of adequacy of training were 3.1 (SD, 0.9) for epidemiology, 2.5 (SD, 1.0) for clinical preventive medicine, 2.4 (SD, 0.9) for environmental health, 2.3 (SD, 0.9) for health administration, 2.3 (SD, 0.9) for health education and behavioral sciences, and 2.2 (SD, 0.9) for occupational medicine. Training was rated highest for topics emphasized during practice experiences. Adequacy varied by type of institution sponsoring the residency. Women rated their training as being less adequate than did men in all areas except clinical preventive medicine. The graduates tended ultimately to practice in topic areas emphasized during training.
The graduates' ratings suggest that improvements are most needed in health administration, environment health, health education, and occupational medicine. Potential improvement strategies include highly focused practice experiences and increased emphasis on training in actual practice settings and community sites.
评估一般预防医学和公共卫生方面的培训，确定哪些经历和机构赞助者能让住院医师为实践做好最佳准备，以及最需要改进的地方。
1991年对1979年至1989年期间1070名预防医学住院医师毕业生进行了一项调查，要求毕业生使用从1（差）到4（优）的李克特量表来衡量他们在预防医学主题领域的培训充足程度。针对培训期间的实践重点、培训项目赞助者及其他变量，分析充足程度的差异。统计方法包括学生t检验、方差分析和线性回归。
共有797名毕业生（74.5%）做出回应。培训充足程度的总体平均评分在流行病学方面为3.1（标准差0.9），临床预防医学方面为2.5（标准差1.0），环境卫生方面为2.4（标准差0.9），卫生管理方面为2.3（标准差0.9），健康教育与行为科学方面为2.3（标准差0.9），职业医学方面为2.2（标准差0.9）。在实践经历中强调的主题培训评分最高。充足程度因赞助住院医师培训的机构类型而异。除临床预防医学外，女性在所有领域对其培训的评价都低于男性。毕业生最终倾向于在培训期间强调的主题领域执业。
毕业生的评分表明，卫生管理、环境卫生、健康教育和职业医学最需要改进。潜在的改进策略包括高度集中的实践经历，以及更多地强调在实际实践环境和社区场所的培训。
