Kozak R J, Kazzi A A, Langdorf M I, Martinez C T
University of California at Irvine, USA.
Acad Emerg Med. 1997 Jul;4(7):736-41. doi: 10.1111/j.1553-2712.1997.tb03770.x.
To assess the potential actions of medical school deans, graduate medical education (GME) committee chairs, and hospital chief executive officers (CEOs) regarding future funding reductions for residency training. Specifically, institutions with emergency medicine (EM) residencies were surveyed to see whether EM training was disproportionally at risk for reductions.
An anonymous 2-page survey was used. Ninety-eight EM residency programs were identified using the American Medical Association Graduate Medical Education Directory 1994-95. Seventy deans, 102 GME chairs, and 97 hospital CEOs were identified. The survey posed a hypothetical 25% forced reduction in residency positions and asked the decision makers for their responses. Options included: 1) proportional reductions of training positions from all residencies, 2) proportional reductions in either primary care or specialty residency positions, or 3) reduction or elimination of specific training programs. The survey asked for a first and second choice of residencies to be reduced or eliminated from an alphabetical list of 17. The survey elicited explanations for each program reduction.
200 (74%) of 269 surveys were returned. Eighty-four responders selected specific residencies to be reduced or eliminated. EM was selected 8 times, making EM the seventh most vulnerable residency to be targeted for reductions. The decision makers who selected proportional reductions chose to reduce across all residencies 32 times, among only the specialty residencies 129 times, and among only the primary care residencies 3 times.
In the setting of anticipated residency cuts, favored proportional reductions in specialty residencies would likely affect EM training. However, most GME decision makers with an existing EM residency program do not consider the EM residency a top choice to be reduced or eliminated.
评估医学院院长、毕业后医学教育（GME）委员会主席及医院首席执行官（CEO）针对未来住院医师培训经费削减可能采取的行动。具体而言，对设有急诊医学（EM）住院医师培训项目的机构进行调查，以了解EM培训是否面临不成比例的削减风险。
采用一份两页的匿名调查问卷。利用1994 - 1995年美国医学协会毕业后医学教育名录确定了98个EM住院医师培训项目。确定了70位院长、102位GME委员会主席和97位医院CEO。该调查提出了住院医师岗位强制削减25%的假设情况，并询问决策者的应对措施。选项包括：1）所有住院医师培训岗位按比例削减；2）初级保健或专科住院医师培训岗位按比例削减；3）减少或取消特定培训项目。调查要求从17个按字母顺序排列的住院医师培训项目列表中选出第一和第二选择进行削减或取消。调查还征集了每个项目削减的理由。
269份调查问卷中有200份（74%）被返还。84名受访者选择了特定的住院医师培训项目进行削减或取消。EM被选中8次，使EM成为第七个最易被削减的住院医师培训项目。选择按比例削减的决策者中，选择在所有住院医师培训项目中削减的有32次，仅在专科住院医师培训项目中削减的有129次，仅在初级保健住院医师培训项目中削减的有3次。
在预计住院医师培训岗位削减的情况下，倾向于按比例削减专科住院医师培训岗位可能会影响EM培训。然而，大多数设有现有EM住院医师培训项目的GME决策者并不认为EM住院医师培训项目是最优先考虑削减或取消的对象。
