Jonas W B
Office of Alternative Medicine, National Institute of Health, Bethesda, Md., USA.
J Am Board Fam Pract. 1997 Mar-Apr;10(2):104-10.
The central role of primary care physicians in health care management, as well as their influence on patients at the highest risk for life-style related disease, makes adequate training in office and hospital health promotion activities essential.
A questionnaire adapted from one used nationally was sent to all the military training programs in internal medicine, family practice, pediatrics, and obstetrics-gynecology. The questionnaire addressed areas of content, emphasis, facilities, setting, personnel, techniques, and methods used in teaching, as well as priorities placed on health promotion in general and in specific areas.
A response was obtained from all training programs (n = 59). Overall, 85 percent had set aside specific time to teach health promotion topics, and 81 percent had set aside time to teach preventive screening. Health promotion topics were incorporated by 85 percent of the programs, and preventive service topics were included in the core curriculum in 86 percent. In 63 percent of the programs residents were taught about assessment of patient motivation, but behavioral modification, relapse prevention, and self-efficacy skills were taught in less than one half of the programs (47, 37, and 34 percent, respectively). For the most part, programs stressed the traditional teaching techniques, such as discussion and lectures (93 percent and 92 percent, respectively), and rarely applied the more effective (and labor-intensive) methods of case precepting (58 percent), viewing videotaped cases (24 percent), and role-playing (5 percent). Only 41 percent of the programs had patient education materials readily available, but many (65 percent) had modified patient problem lists to include preventive or health promotion topics. Physician or patient reminders were used by only a few programs (35 percent and 17 percent, respectively), and in only 48 percent were the residents trained to use any health-screening or health risk appraisal questionnaire. Programs overwhelmingly relied on their physician staff and residents to do health promotion teaching and made little use of ancillary health care personnel who might be better trained in patient education methods.
Primary care residency programs emphasize teaching health promotion and preventive services but generally have not yet developed the teaching systems to provide residents with skills training in preventive and health promotion services. Programs could enhance the clinical prevention skills of physicians completing residencies by having the physicians focus on the skills needed to teach patients self-efficacy, behavior modification, and health maintenance, by using physician and patient reminders, and by taking advantage of health care personnel trained in health education.
初级保健医生在医疗保健管理中发挥着核心作用，并且他们对患生活方式相关疾病风险最高的患者具有影响力，这使得针对门诊和医院健康促进活动进行充分培训至关重要。
一份改编自全国使用的问卷被发送给所有内科、家庭医学、儿科学以及妇产科的军事培训项目。该问卷涉及教学内容、重点、设施、环境、人员、技术和方法等领域，以及总体和特定领域中对健康促进的重视程度。
所有培训项目（n = 59）均做出了回应。总体而言，85%的项目留出了特定时间来教授健康促进主题，81%的项目留出了时间来教授预防性筛查。85%的项目纳入了健康促进主题，86%的项目将预防服务主题纳入了核心课程。63%的项目对住院医师进行了患者动机评估的教学，但行为改变、复发预防和自我效能技能的教学在不到一半的项目中开展（分别为47%、37%和34%）。在很大程度上，项目强调传统教学技术，如讨论和讲座（分别为93%和92%），很少应用更有效的（且耗费人力的）病例带教（58%）、观看录像病例（24%）和角色扮演（5%）方法。只有41%的项目随时提供患者教育材料，但许多项目（65%）修改了患者问题清单以纳入预防或健康促进主题。只有少数项目使用医生或患者提醒（分别为35%和17%），并且只有48%的项目对住院医师进行了使用任何健康筛查或健康风险评估问卷的培训。项目绝大多数依赖其医生员工和住院医师来进行健康促进教学，很少利用可能在患者教育方法方面受过更好培训的辅助医疗人员。
初级保健住院医师培训项目强调健康促进和预防服务的教学，但总体上尚未开发出教学系统，为住院医师提供预防和健康促进服务方面的技能培训。通过让医生专注于教授患者自我效能感、行为改变和健康维护所需的技能，使用医生和患者提醒，并利用在健康教育方面受过培训的医疗人员，项目可以提高完成住院医师培训的医生的临床预防技能。
