Dunn M R, Miller R S
Division of Graduate Medical Education, American Medical Association, Chicago, IL 60610, USA.
JAMA. 1996 Sep 4;276(9):710-3.
Each year the American Medical Association (AMA) surveys all programs in graduate medical education (GME) accredited by the Accreditation Council for Graduate Medical Education. Because of the importance of GME in the national workforce policy debate, this year's survey report has been expanded to provide more detailed GME data. The authors describe the historical basis of the current GME workforce dilemma and the multiple forces that now tend to neutralize efforts to adapt to a changing marketplace. For example, as resident physicians find it increasingly difficult to locate suitable employment, one would expect a reduction in hospital-based programs and in the number of their resident physician appointments. Yet, while US medical graduates (USMGs) did not pursue certain programs in this year's National Resident Matching Program, AMA data show that during the past 2 years the reduced number of residents in hospital-based programs was almost exactly offset by the increased number in new and expanded programs. Also, more USMGs are leaving residency training to enter practice after 3 years of basic training in primary care (internal medicine, pediatrics, and family practice). At the same time, an increasing number of international medical graduates are remaining in subspecialty programs. Other examples are cited to show the ebb and flow of GME activities that behave like "shifting sands."
美国医学协会（AMA）每年都会对经毕业后医学教育认证委员会（ACGME）认证的所有毕业后医学教育（GME）项目进行调查。鉴于毕业后医学教育在全国劳动力政策辩论中的重要性，今年的调查报告有所扩充，以提供更详细的毕业后医学教育数据。作者描述了当前毕业后医学教育劳动力困境的历史背景以及目前倾向于抵消适应不断变化的市场所做努力的多种因素。例如，随着住院医师越来越难找到合适的工作，人们会预计基于医院的项目及其住院医师任命数量会减少。然而，虽然美国医学毕业生（USMGs）在今年的全国住院医师匹配项目中没有选择某些项目，但AMA数据显示，在过去两年中，基于医院的项目中住院医师数量的减少几乎完全被新的和扩大的项目中住院医师数量的增加所抵消。此外，越来越多的美国医学毕业生在接受3年初级保健（内科、儿科和家庭医学）基础培训后，离开住院医师培训去从事临床工作。与此同时，越来越多的国际医学毕业生留在专科项目中。文中还列举了其他例子来说明毕业后医学教育活动的起伏，这些活动就像“流沙”一样变幻无常。
