Norero C
Escuela de Postgrado Facultad de Medicina, Universidad de Chile, Santiago de Chile.
Rev Med Chil. 1996 Apr;124(4):505-9.
Medical School graduates can enter a medicine subspecialty training program upon completion of a 3 year Internal Medicine residency. The Ministry of Health has contributed to postgraduate training by defining the type of physician the country needs, and by financial support of specially (Internal Medicine) training. Before 1995, when applicants began being charged a fee, finding for subspecialty training was provided exclusively by the universities. Currently, 450 training post are available for 550 graduates from all medical schools. Of these, 59 are in Internal Medicine and 58 in its subspecialties. A quantitative analysis of 40 years of training programs in Internal Medicine by the traditional medical schools shows that only the Catholic University of Chile Medical School privileges subspecially training whereas all other schools favor general Internal Medicine training. A high number of Internal Medicine trainees never take final examination. Nevertheless, training through practice, not necessarily in a university setting, accounts for 67% of Autonomous National Corporation for Certification of Medical Specialties. CONACEM accredited subspecialists. About 63% of those who finish an Internal Medicine training program decide to go into subspecialization. It is felt that subspecialization involves technical as well as non-professional aspects, such as a philosophical stance towards the search for truth through research and creativity. An integral education in a subspecialty can only be given by the university. Non-university centers, however, can contribute to subspecialization by allowing trainees to gain access to newer technology or to larger numbers of patients. A critical question is how many subspecialists should exist in relation to the number of generalists and according to the country's health requirements. In my personal view, the proportion of subspecialists is excessive. The decision to subspecialize should not be exclusively a personal choice, but should take into account the interests of all other participants in the process of subspecialization. Therefore, a definition must be reached as to the number and type of subspecialty training programs offered in the country. These programs should be made more flexible, to allow for a shortened specialty training, which in turn depends from the type of pregraduate training delivered. Some of the problems requiring an urgent solution in the specialization process are: 1) finding should be shared in some proportion by all those who will benefit from the subspecialist's action, including private hospitals and HMOS; 2) There should be a clear-cut central health policy, that will be respected by the decentralized State Health Services, with fulfillment of the teaching agreements, respect for the assigned clinical fields, and for the accredited teaching capacity; 3) Unauthorized or "parallel" training must be stopped and the role of scientific societies or of State Health Services must be clarified, 4) The institutional involvement of a number of academicians must be reinforced.
医学院毕业生在完成为期3年的内科住院医师培训后，可进入医学亚专业培训项目。卫生部通过明确国家所需医生类型以及对特定（内科）培训提供财政支持，为研究生培训做出了贡献。1995年之前，当申请人开始被收取费用时，亚专业培训的资金完全由大学提供。目前，所有医学院校的550名毕业生有450个培训岗位可供选择。其中，59个是内科岗位，58个是其亚专业岗位。对传统医学院40年内科培训项目的定量分析表明，只有智利天主教大学医学院重视亚专业培训，而其他所有学校都倾向于普通内科培训。大量内科实习生从未参加期末考试。然而，通过实践进行的培训（不一定是在大学环境中）占国家医学专业认证自主公司（CONACEM）认证亚专科医生的67%。完成内科培训项目的人中约63%决定进入亚专业领域。人们认为，亚专业涉及技术以及非专业方面，比如通过研究和创造力追求真理的哲学立场。大学才能提供亚专业的完整教育。然而，非大学中心可以通过让实习生接触更新技术或更多患者，为亚专业发展做出贡献。一个关键问题是，相对于全科医生数量以及根据国家卫生需求，应该有多少亚专科医生。在我个人看来，亚专科医生的比例过高。选择进入亚专业领域的决定不应仅仅是个人选择，而应考虑亚专业发展过程中所有其他参与者的利益。因此，必须确定该国提供的亚专业培训项目的数量和类型。这些项目应更加灵活，以允许缩短专业培训时间，而这又取决于本科前培训的类型。在专业化过程中一些需要紧急解决的问题包括：1）资金应由所有将从亚专科医生的工作中受益的人按一定比例分担，包括私立医院和健康维护组织（HMOS）；2）应该有明确的中央卫生政策，分散的国家卫生服务机构应予以遵守，履行教学协议，尊重指定的临床领域以及认可的教学能力；3）必须停止未经授权或“平行”的培训，并明确科学协会或国家卫生服务机构的作用；4）必须加强一些院士的机构参与度。
