Norris T E, Coombs J B, Carline J
University of Washington School of Medicine, Division of Regional Affairs and Rural Health, Seattle 98195, USA.
J Am Board Fam Pract. 1996 Mar-Apr;9(2):86-93.
A shortage of family physicians persists in rural and medically underserved areas of the United States. We explore the hypothesis that a definable set of educational needs should be addressed for rural family physicians, both during their formal education and as part of continuing education while in practice.
An educational needs assessment questionnaire was sent to 1096 family physicians who had finished residency and entered rural practice within the last 3 years. Six hundred twenty-seven (57.2 percent) of the questionnaires were returned. The demographic characteristics of the respondent physicians and their assessment of the appropriateness and adequacy of their educational process in preparing them for rural practice were analyzed by looking at individual items and groups of items or subject areas.
We were able to define successfully a group of items that were important components of rural practice but were not adequately addressed in training programs. Theses groups included counseling, pediatrics, obstetrics and gynecology, geriatrics, surgery and trauma, medical specialties, surgical specialties, community medicine and management, and a mixed factor that included rehabilitation, behavioral sciences, learning disabilities (in children), chronic childhood problems, and human growth.
It is possible to define a group of educational areas not covered adequately by standard family practice curriculum that should be included in preparation for rural practice. If these areas were included in the education of rurally oriented family practice medical students and residents, these physicians would be more adequately prepared to meet the demands of rural practice. If preparation for rural practice is improved, rural communities might be more successful in recruiting and retaining well-trained family physicians.
美国农村及医疗服务欠缺地区持续面临家庭医生短缺的问题。我们探讨这样一个假设,即针对农村家庭医生,在其接受正规教育期间以及从业后的继续教育中,应满足一系列明确的教育需求。
向1096名在过去3年内完成住院医师培训并进入农村地区执业的家庭医生发放了一份教育需求评估问卷。共收回627份问卷(回收率为57.2%)。通过查看单个项目、项目组或学科领域,分析了答卷医生的人口统计学特征,以及他们对自身教育过程在为农村执业做准备方面的适当性和充分性的评估。
我们成功确定了一组项目,这些项目是农村医疗实践的重要组成部分,但在培训项目中未得到充分涉及。这些项目组包括咨询、儿科学、妇产科、老年医学、外科与创伤、医学专科、外科专科、社区医学与管理,以及一个综合因素,其中包括康复、行为科学、(儿童)学习障碍、儿童慢性问题和人类成长。
有可能确定一组标准家庭医学课程未充分涵盖的教育领域,这些领域应纳入农村医疗实践的准备工作中。如果这些领域纳入面向农村的家庭医学医学生和住院医师的教育内容,这些医生将能更好地为满足农村医疗实践的需求做好准备。如果农村医疗实践的准备工作得到改善,农村社区在招聘和留住训练有素的家庭医生方面可能会更成功。