Beresin E V
Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA.
J Am Acad Child Adolesc Psychiatry. 1997 Oct;36(10):1339-48. doi: 10.1097/00004583-199710000-00015.
To examine major current influences on child and adolescent psychiatry (CAP) residency training, highlighting the most common problems. Potential solutions and unresolved dilemmas are presented.
Data were gathered from empirical studies, review articles, national census data, and discussions over the past decade at national meetings on recruitment of residents and faculty; clinical, didactic, and research training; the impact of managed care and changes in graduate medical education funding; and the professional development of CAP residents.
Overall there are significant problems recruiting U.S. medical students and attracting faculty into CAP training programs. Economic forces, including decreased reimbursements from managed care and the federal government, are threatening the survival and vitality of training programs. Managed care is harmful for sound residency training and identity formation of the child and adolescent psychiatrist.
The integrity of CAP residency training in the future will depend on increased efforts of teaching hospitals and programs to develop fiscally viable systems of care integrated with residency training; seek new sources of training subsidies; modify traditional models of clinical and didactic curricula; and foster greater collaboration between training programs locally and nationally.
探讨当前对儿童及青少年精神病学（CAP）住院医师培训的主要影响因素，重点关注最常见的问题，并提出潜在的解决方案和未解决的困境。
数据收集自实证研究、综述文章、全国人口普查数据，以及过去十年在全国住院医师和教员招聘会议上的讨论；临床、教学和研究培训；管理式医疗的影响以及毕业后医学教育资金的变化；以及CAP住院医师的职业发展。
总体而言，在美国医学生的招募以及吸引教员参与CAP培训项目方面存在重大问题。经济因素，包括管理式医疗和联邦政府报销的减少，正威胁着培训项目的生存和活力。管理式医疗对健全的住院医师培训以及儿童和青少年精神科医生的身份形成有害。
未来CAP住院医师培训的完整性将取决于教学医院和培训项目加大力度，开发与住院医师培训相结合的财政上可行的护理系统；寻找新的培训补贴来源；修改传统的临床和教学课程模式；并促进地方和全国培训项目之间的更大合作。
